There is a perception held by others in the health sciences that surgeons are not adequately assessing surgical procedures. In an Editorial in the Lancet in 1996, entitled, 鈥淪urgical Research or Comic Opera: Questions, but Few Answers,鈥� Richard Horton criticized surgeons for their high reliance on case studies and stated that, if surgeons wished to retain their academic reputation, they must find imaginative ways to collaborate with epidemiologists to improve the design of the case series and to plan randomized trials.¹ Furthermore, he quoted a medical statistician, Major Greenwell, who stated in 1923: 鈥淚 should like to shame surgeons out of comic opera performances which they suppose are statistics of operations.鈥�¹ In a similar condemnation, David H. Spodick complained of 鈥渢he repeated reporting of biased data from uncontrolled or poorly controlled trials, giving an illusion of success due to sheer quantity but that a thousand zeros look impressive on paper, but they still amount to zero.鈥�¹