T.F. Higgins, D.S. Horwitz, and K.L.S. Schabel reply:
We appreciate Dr. Riley's feedback on our study. Her point is well taken—our paper focused mostly on the economic impact, but the environmental impact must be assessed as well.
The trend toward single-use devices may be largely driven by financial and industry concerns, but in many cases there is little reason not to salvage much of what is used in the operating room. As surgeons and citizens, we are obliged to consider our environmental impact and assess the true resource cost of what we consume.
As with many environmental concerns, establishing economic incentives may be the best way to ensure improved environmental stewardship. Hopefully programs such as the one examined in this study may be a step toward demonstrating the viability of such economic incentives.
These letters originally appeared, in slightly different form, on . They are still available on the web site in conjunction with the article to which they refer.