A eight-year-old procedure for removing uterine fibroid tumours from women has highlighted a turf war between two medical specialities. The normal treatment for the tumours is a hysterectomy done by gynaecologists. But doctors in France discovered in the mid- 90s that it was possible remove the tumours with a much less invasive operation under local anaesthetic. The procedure, called uterine artery embolisation (UAE), seems to be as safe as a hysterectomy, although it is done by doctors who call themselves interventional radiologists.

However, says the Wall Street Journal, gynaecologists are keeping the news of the easier alternative to themselves, perhaps because they will lose the US$2,000 fee for a hysterectomy. About 200,000 hysterectomies are done each year in the US, so more than US$400 million is at stake. "When you're sitting in a gynaecologist's office, and they know that their livelihood is depending on the services that they provide, they are less likely to refer you to another specialist," comments Dr Ruth Shaber, a gynaecologist with Kaiser Permanente. Many women are learning about the possibility of UAE from the internet rather than from their doctor.

Most American states have informed consent laws which require doctors to inform patients about all "reasonable alternatives" to surgery. The American College of Obstetrics & Gynaecology declined to comment to the WSJ about whether UAE constitutes a "reasonable alternative". However bioethicist Arthur Caplan, of the University of Pennsylvania, says that resolving the conflict is a "no-brainer". "When a legitimate medical specialty is offering an alternative that's been around for eight years, you need to tell your patients about it," he says.