Postoperative metastasis risk: more than immunosuppression.

assistance of the anesthesiologist(s) involved, most adverse events were self-reported by that practitioner. Also, the involved anesthesiologist(s) were generally present for the discussion and error analysis. Finally, the suggestion by Gauge that this peer review mechanism would be corrupted, if it were applied to patient compensation, is an interesting speculation. Perhaps, Gauge would be more comfortable with a no-fault system of medical liability. The stability with which all adverse outcomes occur suggests that this may also be a viable alternative. Hogan and Lavaruso wish to preserve and modify the present malpractice tort system. Their argument that the tort system should be preserved because it is our “best weapon in the battle for autonomy against managed care” must raise a smile on the faces of those who see similar value in both. As for their remaining arguments, the principles of scientific medicine are part of every medical school curriculum in the United States, and a stronger focus is being made on evidencebased medicine as we struggle to be cost effective. Increasing public exposure to courtroom proceedings, however, demonstrates that the legal system does not suffer from the same imposed cost constraints, nor does it adhere to the same scientific rigors. The lack of a response to the growing body of evidence that the tort system falls short of its goals is a good example. The suggestions for a Specialty Board of Legal Medicine and a Medical Malpractice Bar appear to offer a niche for a new breed of practitioner, but the legal profession should test these remedies with the same scientific principles and cost consciousness that the medical profession applies consistently.