Yes. I shall argue that surgical sympathectomy, as routinely practiced throughout the United States of America, amounts to felony assault, battery, fraud and racketeering under applicable law.

Let us begin with the definition of fraud. Fraud is “intentional deception resulting in harm to another person”. There are four elements which must be present in order to constitute a fraud -

1. Deception – Did the perpetrator intentionally deceive the victim with lies or omissions?
2. Reliance – Was the deception believable, and did the victim rely upon that deception?
3. Benefit – Did the perpetrator gain or benefit in some way as a result of the deception?
4. Harm – Was the victim damaged in some way as a result of the deception?

a. Deception

ETS surgeons and recruiters, via their websites, censored discussion forums, promotional videos, newsletters, CD-ROMS, television appearances,  published studies, consent forms and confidential patient consultations, present and promote surgical sympathectomy as a safe, effective procedure to treat the embarrassing problem of excessive sweating, a benign condition. In reality, the facts will show that ETS surgeons are causing a horrible disease, disabling a large percentage of their patients both physically and mentally, and are covering up this horrible truth with propaganda; propaganda which includes fraudulent medical studies, false advertising, mail fraud, bogus medical claims, intentional concealment of vital information, and silencing past patients with malicious lawsuits.

False depiction of human physiology

Routinely the surgeons describe the function of the thoracic sympathetic nerve ganglia (and therefore the effect of ETS) in very deceptive ways. They employ phrases such as “snip the nerve which controls hand sweating” when actually the snipped nerves control sweating on the entire top of the body, and also carry signals to the heart, the lungs, the blood vessels, the thyroid gland and more. Surgeons will say that the purpose of sympathectomy is to "reduce sweating", when actually it can permanently destroy all sweating on the top 1/3 of the body forever. This is called anhidrosis, a disabling, dangerous and disturbing medical condition.

False claim of a cure

Many ETS surgeons promise a cure for hyperhidrosis, a demonstrably false claim. ETS is proven to cause excessive sweating in the lower body, a side effect surgeons euphemistically refer to as “compensatory sweating”. “Compensatory sweating” is a medically incorrect, deceptive term. The correct term is "compensatory hyperhidrosis" or "reflex hyperhidrosis", because the lower body sweating is excessive. Excessive sweating is hyperhidrosis. It is obvious why the surgeon would not use the right term, for how can ETS cure hyperhidrois by causing hyperhidrosis? There is only one published study which actually measured sweating before and after ETS, and the study showed that ETS increases the total amount of sweating. Even ignoring all the other severe disabilities caused by ETS, the central claim, i.e. that ETS is a treatment for hyperhidrosis, fails on its own merit.

False claim of relevant knowledge

Surgeons pretend to know the cause of hyperhidrosis, and pretend to be able to treat it at its source, both absurd claims.

Surgeons state or imply that the source of hyperhirosis is in the sympathetic nervous system, In fact, medical science does not know the cause of hyperhidrosis. It has been theorized that hyperhidrosis stems from an over-active sympathetic nervous system, but we don't really know that. The SNS is controlled by the thalamic region of the brain, especially the hypothalamus, and hyperhidrosis could just as easily result from some defect up there. Even if it is true that an "overactive" sympathetic nervous system is responsible for excessive sweating, ETS surgery does not "turn down" sympathetic function. It kills sympathetic function in one body area, and makes it hyperactive in another.

Many ETS surgeons state or imply that they have isolated the nerve responisble for the (hand/face/armpit/foot) sweating. This is a blatant lie for two reasons:

1. There is no such thing as a "sweat gland nerve", the nerves that connect to sweat glands are all bundled up with nerves to the heart, the lungs, the blood vessels, the arrector pili muscles, the thyroid gland, and other important things.

2. There is no way to limit denervation from ETS surgery to "just the hands" or "just the armpits" or "just the feet" or "just the face". Rather, denervation tends to take place over much larger regions of the body, and the most common pattern of skin denervation includes the entire top 1/3 of the body, from the nipple line upwards, including the head, face, scalp, arms, hands, shoulders, upper back, armpits and chest.

"Cherry Picking" Testimonials

Almost all ETS surgeon websites feature happy testimonials from patients. However, there are multitudinous negative testimonials by disabled patients, going back many years and continuing unabated to the present. There have been several suicides by patients who could not tolerate the nerve damage. This is a clear omission of vital information. ETS surgery is proven in the published literature to disable a certain large percentage of patients, and the words "disabled" and "disabling" appear in the medical literature in reference to ETS surgery. Informed consent must therefore include the word "disabled", and routinely it does not.

The positive testimonials from patients are typically collected within a few short weeks or months after surgery, while the negative consequences of surgery often do not manifest themselves for many months or even years. This is because of mutation that takes place at the cellular level, in all cells that have been denervated. This mutation is called "Denervation Supersensitivity". Denervation Supersensitivity was discovered by Walter Cannon, and it is known as "Cannon's Law or Denevation Supersensitivity". The ongoing gradually changing nature of ETS disability is also owing to the attempted regrowth of damaged nerves, which can, among other things, cause Frey's syndrome when salivary nerves freakishly fuse with sympathetic nerves.

False advertising

In light of the above, it is clear that ETS surgeon websites constitute false advertising. Some ETS surgeons disavow responsibility for or knowlege of the content of their own advertising websites, websites dedicated entirely to the purpose of marketing the sympathetomy practice of that one particular surgeon. Denying knowledge of, or resposibilty for, one's own advertising website is, on its face, very suspicious behaviour.

False ignorance of disabilities caused by sympathetic denervation

ETS is proven to cause a long list of physical disabilities, including a slow and weak heart beat, diminished lung capacity, diminished baroreflex, paralyzed blood vessels and chronic pain. In turn, these dysfunctional body parts can lead to poor thermoregulation and diminshed exercise capacity, among other things. Many ETS surgeons do not mention these problems at all. A few ETS surgeons do mention lowered heart rate, but then claim that it is a benefit, equating it with the lowered heart rate achieved by physical conditioning, a ridiculous assertion.

Thoracic sympathectomy has also been shown to cause permanent psychiatric changes, including a significant decrease in alertness and fear. The world leader in using ETS to treat psychiatric patients is also the president of the largest and most prestigious international organization devoted exclusively to ETS surgeons, and has presented his findings repeatedly at its annual conferences, conferences which are routinely attended by many prominent ETS surgeons. The psychiatric effects of the surgery have been documented in many large published studies. It is dubious for a surgeon to claim ignorance of the psychiatric effects of ETS. Needless to say, patients complaining of excessive sweating are not told that sympathectomy can leave them with a modified personality.

Fraudulent publications

Many ETS surgeons have authored and published scientific papers which indicate that the procedure is safe and effective. The vast majority of these are studies in which the authors took no scientific measurements of any kind. Obviously when functions such as heart rate, contraction strength, lung volume, blood vessel constriction, exercise capacity, thermoregulation, endocrine function, and psychiatric condition are not measured, then no changes will be reported. And even though the purpose of the surgery is to treat hyperhidrosis, amazingly, these studies do not even attempt to measure sweating! The average ETS paper amounts to propaganda, not science.

Motive

ETS surgeons are intentionally deceiving their patients with both lies and omissions. They do so for one simple, yet powerful reason: They have to. If they told the whole truth, nobody (or almost nobody) would consent to surgery. It's about the money, and it's about continuing the experiment.

b. Reliance

The deceptive statements of the surgeons are very believable. After all, they appear to be supported by many published studies which characterize sympathectomy as safe and effective. How would the patient know that these studies are backed by no scientific measurements of any kind?

We all rely on the expertise of our doctors. Few prospective ETS patients have knowledge about the function of the sympathetic nervous system. If a thoracic surgeon describes the sympathetic ganglia as a “nerve that controls sweating to the hand”, who is the patient to disagree?

It is the supreme act of reliance to allow oneself to be drugged unconscious, cut open and permanently modified.

c. Benefit

ETS surgeons charge anywhere from $12,000 to $40,000 or more for a job that can be completed in a half hour. The benefit to the surgeon is obvious.

d. Harm

ETS surgery can cause permanent physical and mental disability. Anhidrosis is painful and disturbing. Compensatory hyperhidrosis can be severe enough to soak clothing. This alone can be disabling, and the word “disabling” appears in the medical literature in reference to it. ETS patients can have severe thermoregulation problems and diminished exercise capacity.

All of this can require the disabled ETS patient to make major changes in lifestyle and/or career, especially if it involves warm weather, or sensitive use of the hands, or physical exertion, or strong emotion. Of course this can lead to loss of income and medical expenses, in addition to the pain and suffering.

ETS victims are searching for treatment for their ills. Many have undergone nerve graft surgeries or clamp removals to attempt to reverse the procedure. These are costly, and sadly have proven mostly ineffective. Still, it is cost that would not have to be paid, but for the deception of the surgeons. 

Various promising new treatments have been proposed, including new nerve grafts, nerve stimulating implants, and cloning. There are many ETS victims willing to try these kinds of experimental procedures, and the cost of these treatments must also be counted in the damages.

The harm to ETS patients is permanent and profound. It encompasses physical, mental, and financial damages.

2. Civil vs. Criminal Fraud

A fraud claim can be pursued civilly, criminally, or both. What is the difference between civil and criminal fraud?

First, in a civil fraud the plaintiff is the victim suing for money, whereas in a criminal matter the plaintiff is the government suing to put the perpetrator in jail. Second, the burden of proof is higher in a criminal proceeding, requiring proof beyond a reasonable doubt, whereas a civil fraud requires the prood to be "clear and convincing". That's generally thought to be a lower standard than "beyond a reasonable doubt" but still a higher standard than the "preponerance of the evidence" required other civil actions. Beyond that, there are no clear cut distinctions between the two. Both civil and criminal prosecutions may arise from the same set of circumstances.

It is assumed that the government (either a district or U.S. attorney) will not proceed with a criminal prosecution unless they believe there is fraud provable beyond a reasonable doubt. There are some further questions which can be examined to help determine the depth and breadth of fraudulent wrongdoing, and which may help to elevate the evidence beyond the reasonable doubt threshold, and into the criminal arena:

1. Ongoing pattern - Was the fraud an isolated event, or does it represent a continuing pattern of behavior? 
2. Conspiracy - Was the perpetrator acting alone, or involving others in a coordinated conspiracy?
3. Other crimes - Is fraud the end of it, or are there other felony charges which also apply to the same circumstances?

a. Ongoing Pattern

The ETS surgeons often brag about how many hundreds or thousands of times they have done the procedure. I think it is very safe to say that whatever they are doing, they are doing it repeatedly.

b. Conspiracy

ETS surgeons typically employ a staff of recruiters trained to entice prospective patients, using the same deceptive techniques outlined above. In some cases these recruiters may be innocently reciting propaganda given them by the surgeon, oblivious to the true nature of sympathectomy. However, many if not most of the recruiters are nurses who have been taught physiology and are aware of the many functions of the sympathetic nervous system. Furthermore,  over time, these same nurses handle complaints from dissatisfied patients, and see the disabilities firsthand.

As mentioned, many ETS surgeons publish their findings in medical journals. The vast majority of these studies involve no scientific measurements of any kind, relying exclusively on carefully fabricated, wholly subjective patient questionnaires. By only offering questions about certain narrow issues, such as “compensatory sweating”, the studies are able to avoid mention of entire categories of disability. Even with regard to compensatory hyperhidrosis, there is no consensus on how to define the “mild”, “moderate” , and “severe” forms. One surgeon characterizes sweating for no reason while sitting still in an air-conditioned room as “mild”. Obviously if one is free to define and re-define terms as one wishes, one can claim any sort of results whatsoever.

Worse, some ETS studies do not even involve a patient questionnaire, and are the exclusive product of the surgeon’s “clinical impressions”. This is a clear license for the surgeon to just say whatever he wants, for how can anyone question someone else’s impressions?

The scientists and doctors who review these studies for publication know better. The job of a peer review committee is to analyze the data submitted by the author to see if it really means what the author says it means. But what does the peer review committee analyze when there is no data? The answer is that many of these ETS studies are not peer reviewed at all. Rather, they are accepted and published in exchange for a fee, a practice known as “pay-to-play”.

c. Other Crimes

In addition to fraud, below I conclude that felony assault and battery also apply to sympathectomy as typically practiced in the U.S.

The definition of assault is "The unlawful use of violence with intent to injure another person". There are three elements which must be present to constitute assault –

1. Unlawful Conduct – Were the actions of the perpetrator unlawful, as opposed to just careless?
2. Violence – Were the actions of the alleged perpetrator violent?
3. Intent – Was there an intent to injure the victim, or was the injury accidental?

a. Unlawful Conduct

We have shown that the techniques used to obtain consent to ETS surgery are fraudulent, and therefore unlawful. The patient is lured onto the operating table under false pretenses by the very people who are present in the operating room, the very people who stand to benefit from the fraud. Everything that is done to the patient while lying unconscious is done unlawfully.

b. Violence

It is hard to imagine something much more violent than stabbing with sharp tools and penetrating the ribcage.

c. Intent to Injure

Sympathectomy is, by definition, the intentional destruction of the thoracic sympathetic nerves. The destruction of this tissue is proven to cause disabling injury in the form of a permanent autonomic nervous system disorder, so say the National Institutes of Health. ETS surgery compromises function of the heart, the lungs, and the blood vessels. It causes anhidrosis on a large part of the body including the head, a very dangerous and disabling condition. From a physiological point of view, sympathectomy is nothing more, and nothing less than nerve damage. Intentional nerve damage.

Battery is defined as “an assault in which the assailant makes physical contact with the victim”.

Physical Contact

Obviously, in the case of ETS surgery, if we have assault assault then we also have battery.

RICO stands for “The Racketeer Influenced and Corrupt Organizations Act”, a United States law which provides for extended penalties for criminal acts performed as part of an ongoing criminal organization.

The RICO act was originally passed to prosecute organized crime operations, like the Mafia, but since the 1980's has been widely used to prosecute corrupt corporations. These are the main elements which must be present to pursue a RICO case. An excellent reference on RICO can be found here.

a. Crime within a crime - is there an underlying Federal crime, or a state crime which is specifically mentioned in the RICO act?

b. Operation and management - Do the perpetrators actually take part in the day to day decisions and activities that are criminal in nature?

c. Pattern - Does the criminal activity represent an ongoing, continuing pattern of conduct?

d. Enterprise - Are the perpetrators part of a collective entity, such as a corporation or society?

a. Crime within a crime

Assault, battery and fraud are serious state felonies, but they are not listed in the RICO act. However, most ETS surgeons have distributed fraudulent materials through the U.S. mail. Mail fraud is the most common federal crime used to qualify an organization for RICO prosecution.

b. Operation and management

The ETS surgeons train their recruiters, provide information for the websites, authorize the distribution of promotional materials through the mail, appear on the television shows, publish the fraudulent studies, give the deceitful consultations, and most importantly of all, intentionally and with advance planning destroy perfectly healthy nerve tissue in innocent human beings.

c. Pattern

Whatever the ETS surgeons are doing, they are doing it repeatedly.

d. Enterprise

Most ETS surgeons are medical corporations which employ themselves and their various staff, and so meet the enterprise criteria.

ETS surgeons have gone so far as to form national and international organizations for the purpose of promoting and expanding their practice. These organizations appear to take strong measures to obfuscate the truth about the disturbing and disabling nature of sympathetic surgery, a truth which is well known and well documented within the medical community, and therefore within the organizations themselves.

 6. Conclusions

Thoracic sympathectomy, as typically practiced in the United States, is fraud. Very few if any patients will consent to ETS knowing all the risks. So surgeons routinely lie and withhold crucial information from their patients in order to obtain consent. The patients rely upon that deception and are physically, emotionally and financially damaged as a result, while the surgeons derive great financial benefit.

Thoracic sympathectomy, as typically practiced in the United States, is assault and battery, because the surgeon is unlawfully using violence to intentionally damage nerves, and because the surgeon comes in physical contact with the victim without informed consent.

Thoracic sympathectomy, as typically practiced in the United States, is racketeering because there is underlying federal crime, a continuing pattern, there are corporations and other official organizations, and because the surgeons take part in the day to day operations.

ETS surgeons, with their current standard of practice, are a menace to society. It is therefore concluded that the public interest would well served for appropriate law enforcement officials to indict and prosecute all U.S. based ETS surgeons who are defrauding and disabling their patients. Those ETS surgeons who are fully informing patients about the proven risks of thoracic sympathectomy, if such exist, should be left alone, and well-informed patients should be free to undergo sympathectomy if they so desire.

by Songboy1234

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LEGAL DISCLAIMER

I, Alexander Baker, aka Songboy1234, am the author of "Is Sympathectomy a Crime?". I am not a lawyer. I have researched and believe to be correct the legal principles employed in the article. I am not a doctor. I have researched the function of the autonomic nervous system and believe the medical knowledge to be correct. Also, I have firsthand knowledge of ETS like no ETS surgeon ever will. The article does not constitute legal advice or medical advice, and I am not responsible for anyone else's medical or legal problems. I have enough of my own, thank you. As always, if any errors are brought to my attention, it is my policy to correct them immediately.

-songboy1234