Overall Strategy

Abstract

The first requirement in tackling this broad subject is a satisfactory definition of strategy. Since the subject concerns the war against gallstone disease, and since this book is an international undertaking, we thought it appropriate to consult the writings of a famous military strategist, Von Clausewitz. He states that ‘die Strategie ist der Gebrauch des Gefechts zum Zweck des Krieges’. This is translated as ‘strategy is the use of battles for the object of the war’. Thus, strategy consists of relating methods to a clearly defined object. We would define the object of the war against gallstone disease as being ‘to ensure that as many gallstone patients as possible are maintained free of gallstones in the long term’. In order to achieve this object, we have at present three non-surgical methods that we can use - a physical approach (fragmentation therapy or extracorporeal shock wave lithotripsy), a chemical approach (the use of chemical solvents, in particular methyl tert-butyl ether) and a physico-chemical approach (bile acid therapy using chenodeoxycholic acid (CDCA) and/or ursodeoxycholic acid UDCA)).