Dr Kim puts a zigzag in what remains of Alex Malo’s small intestine

This story in today’s New York Times is fascinating:

Alex Malo was born with several feet of his small intestine hanging outside his body. The loop of intestine had slipped out through an abnormal opening in his abdomen while he was still developing in the womb. The tight opening pinched the intestine, cutting off its blood supply and killing the tissue. The day Alex was born, doctors operated to remove the dead stretch of intestine.

Which, to cut a long story and Alex Malo’s small intestine short, caused big problems. If your intestine is too short, you can’t eat.

But Dr Kim had already been thinking about this. Here’s his idea:

Surgeons make a row of slits along the dilated stretch of intestine, alternating from one side to the other and stapling shut the edges of each side of the “V” that results. They use a small surgical stapler, which both cuts and staples. What results is a zigzag tube that is much longer and skinnier than the original distended bowel. The surgeons named the operation the STEP procedure, for serial transverse enteroplasty.

This had to be tested on animals first, and “a million forms” had to be signed saying yes, it could kill Alex but please do it anyway. They did. It worked. Read the whole thing.

There are many lessons to be learned from this story. I suggest four:

One: the New York Times still has its uses.

Two: testing on animals has its uses.

Three: people with names like “Kim” are making a huge contribution to life in America.

Four: you need the right institutional setting to do clever things.

Dr. Kim said he had not discussed the new operation with the surgeon who told him a decade ago that it would never work.

“You have to have the right environment,” he said, “where people are open to new ideas and really try to push the envelope with innovative surgery, for this kind of crazy idea to eventually make it to the bedside to treat children with disease.”

Entrepreneurship is just as much a medical thing as a more conventionally “business” thing, or, to put it another way, running medicine rather like a business, as the USA is famous for doing, can also do a lot of good.

I don’t know the details of how well or badly Britain’s National Health Service works in circumstances like these, but I doubt it would have been such a good environment for Dr Kim, or for Alex Malo.