The Australian public must have confidence that innovative surgical interventions are safe, effective, and justifiable economically. Surgical innovation involves risks. Informed consent is challenging when the risk to benefit ratio is unknown, and especially so when the objectivity of the surgeon-innovators, colleagues, universities, and hospitals is compromised by conflict of interest. The primary areas of conflict for those involved in surgical innovation are economic, but prestige, career advancement, optimism bias, and reputation for being at the cutting edge are all at play [1]. By its nature, innovation in surgery usually precedes a full evaluation of key health outcomes. Two examples of surgical innovation from the 1990s are contrasted.Society's narratives regarding the management of cancer and obesity are strikingly different. Cancer is discussed positively reflecting hope and optimism. There is positive engagement from the health sector, and advocacy groups and forums provide patient support and advice. Cancer therapy is discussed alongside health outcomes and survival. In * John B Dixon