A significant admission from an ETS surgeon, President of the ISSS:

"General represents the ESB (whether as ETS as ETSC or ELS) a substantial interference in regulatory processes of the body represent the decision for this operation requires that previously conservative treatments were made. An ESB is therefore at the end of a treatment history, and never at the beginning."
http://www.dhhz.de/index....;subPage=&section=32

it is an automatic translation (google) from german, so you have to look at what the 'gist' of what he is saying: ETS, ESB = "a substantial interference in regulatory processes of the body"