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Does anyone have any examples of surgeries that are done today in modern medicine that are basically placebo? I'm surprised the article didn't give a single exa

Does anyone have any examples of surgeries that are done today in modern medicine that are basically placebo? I'm surprised the article didn't give a single example.

hnuser123456 6y ago
Routine wisdom teeth removal, male genital mutilation, dentists giving fillings far before they are required, causing toothaches and sensitivity... But these all turn out to be easy money for someone, for some odd reason.
- bsanr 6y ago
  I imagine that this gray area is where a lot of "unnecessary surgery" comes from. The vast majority of people have no medical need for circumcision (but some do). A lot of people don't need their wisdom teeth removed (but many probably should). You might need a filling eventually (just not now). Where do you draw the line, in a world where setting up studies to find conclusive evidence for binary medical decision-making ("Should this ever be done in the presence of x, or should it never be done?") is hard enough? I had two surgeries in 2019; in both cases the consulting doctor told me that it was 50/50 if I actually needed them or if they'd actually fix the issues that might have been associated with them. One was a pretty smashing success, the other (ironically more expensive) one was a 4-figure wash that had the surgeon dodging my inquiries as to what went wrong. Unfortunately, it turns out that medical decision-making entails taking a holistic view of the situation and giving advice that the doctor then has to take responsibility for. Good luck achieving that on a systemic level within the ever-dysfunctional structure of American healthcare.
- jessaustin 6y ago
  I've assisted on numerous third molar extractions, on patients up to sixty years old. None of those people were glad they had neglected to get the work done in their twenties. If you're not sure about a recommended dental filling, just go to a different dentist for a second opinion. By the time a cavity causes you pain you'll need a root canal and possibly a crown.
  - hnuser123456 6y ago
    I got all mine out at ~18 for no discernable reason. Earlier in the year, got a filling despite visible substantial enamel. Was fine before, but I could barely handle drinks colder than body temperature for about 6 months. I think it could've waited.
  - worker767424 6y ago
    > If you're not sure about a recommended dental filling, just go to a different dentist for a second opinion. This happened to me, probably twice. The first time I got rushed through the fillings and had them the same appointment as a cleaning because they were minor (they were). I still felt abused by it. A few years later, the same dentist found something else. I got a second opinion this time. It was basically that an aggressive dentist might reasonably want to fill it, but the second opinion was "don't bother." Five years and on a new dentist and it hasn't been so much as mentioned by the new dentist. Unless something is obviously wrong or you have a known history of cavities, I'd always get a second opinion.
  - klenwell 6y ago
    In my early twenties, I was scheduled to get my wisdom teeth removed. It was going to cost me the equivalent of about a couple week's wages at the time. If I did it without general anesthetic it would be significantly cheaper. The oral surgeon to whom I was referred said I could do it either way, it was my choice. He did mention that, on a scale of 1-10, he would estimate the difficulty of removing my teeth at a 9. In x-rays, a couple looked like they were coming in upside-down. After calculating the number of hours of work the anesthetic would cost me, I decided to bite the bullet of go with a local anesthetic. (My dad was also tough-guying me to skip the general anesthetic.) So I called the surgeon's office to make an appointment. When I mentioned that I would be opting opt of general anesthetic, the receptionist paused and asked me to hold. When she came back, she said that the doctor specified that general anesthetic would be necessary. I mentioned the conversation I had already had with him. She again asked me to hold. When she returned, she said it was no longer an option. I put off the appointment. Miffed, I decided to take a closer look at the practice. This was pre-internet so I went to my local public library. I tracked down a British NHS study that suggested extraction was over-prescribed in the US in part due to the private insurance system. (I guess you can insert your tired joke about British teeth here.) One NHS study coupled with my incipient suspicion of the American medical system was enough for me. Plus all the money I was going to save. I decided to forego the surgery. Almost 30 years on and I can say I have no regrets. (Yet?) My third molars are still buried in my gums. A few years ago, the bottom right one partially broke through the gum. It was irritating at times but never really painful. I take care to floss and brush it with my other teeth. It seems to have come to rest. If I remember correctly, the study stated that after age 30 or 40, most people's wisdom teeth will have settled. One internet commenter's tale backed by one study for which I no longer have the reference.
- pstch 6y ago
  This is exactly what I thought 3 years ago when a dentist told me that it was very important for me to get rid of my wisdom teeth, because loss of enamel meant that they were very likely to decay quickly even with proper hygiene. Other dentists told me that it was not necessary, and could be done later if the teeth ended up decaying too much. Now the teeth are completely decayed, I've started to feel severe pain, and since I've developed severe thrombopenia (<20 G/L), I can't get them extracted easily (couldn't find any dentist willing to take that risk), so since six months, I have to take anti inflammatory drugs for the pain and antiobiotics to limit the infections, as well as the folic acid and corticosteroids needed for ITP, and I have no idea when will this end. It's very difficult to differentiate important advice from "easy money" advices, especially when this advice stems for a principle of precaution. Most peoples don't develop severe ITP, but if they do, getting wisdom teeth removed before they can cause problems can be very important.
  - giardini 6y ago
    This is a long shot but some claim that vitamin K-2 can regenerate teeth to some degree. It might get your teeth in good enough condition to remove. I had started taking K-2 (Jarrow MK-7 menaquinone-7 FWIW) for other reasons but when my semiannual dental checkup came due, both the technician and dentist kept marveling about how pristine and healthy my teeth were. They credited it to my brushing and flossing habits, which had not changed. I took the praise but was puzzled until I remembered that the K-2 might be helping my teeth.
- ThePadawan 6y ago
  > Routine wisdom teeth removal That one is new to me. My dentist took X-rays at that point in puberty where it would become obvious if the wisdom teeth were obviously and majorly deviating (thus requiring removal). The X-ray came back somewhere between "inconclusive" and "too early to tell", so I still have my wisdom teeth.
jpm_sd 6y ago
https://www.nytimes.com/2016/08/04/upshot/the-right-to-know-that-an-operation-is-next-to-useless.html https://www.nytimes.com/2016/08/04/upshot/the-right-to-know-... https://www.mdalert.com/article/surgery-for-torn-meniscus-in-the-knee-is-often-unnecessary-ineffective-misdirected https://www.mdalert.com/article/surgery-for-torn-meniscus-in... https://www.health.harvard.edu/blog/knee-arthroscopy-should-this-common-knee-surgery-be-performed-less-often-2020042019507 https://www.health.harvard.edu/blog/knee-arthroscopy-should-...
jpmattia 6y ago
The first thing that occurred to me when I read the title: Tonsillectomies used to be very common when I was growing up, and eventually that stopped. See eg: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5883156/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5883156/
- pcthrowaway 6y ago
  Circumcision is another big one which used to be widely purported to have some positive health effects.
  - ReactiveJelly 6y ago
    I'm against circumcision because foreskin can be used to make a vagina, if your baby boy turns 18 and decides to be a woman instead. It's part of my "Weird hills to die on Grand Tour" https://en.wikipedia.org/wiki/Sex_reassignment_surgery_(male-to-female)#Genital_surgery https://en.wikipedia.org/wiki/Sex_reassignment_surgery_(male...
    - deleted 6y ago
      [deleted]
    - markdown 6y ago
      Not because genital mutilation of children is just barbaric?
  - patja 6y ago
    The US CDC (Center for Disease Control) currently recommends male circumcision for positive health effects.
    - notRobot 6y ago
      Yes, but almost all of the studies referenced in the guidelines took place in Africa, where proper genital hygiene and sex-ed is not taught. If you teach your kids to properly clean under the foreskin, circumcision largely loses its advantages.
podiki 6y ago
Knee surgery [0] is the one I've heard about before. Placebo (and nocebo) are really interesting effects, but also conflated with regression to the mean. There's a nice discussion of this in the very entertaining Math of Life and Death by Kit Yates [1], a fun book for people not normally interested in math especially (but I also found it informative and a good read). [0] https://www.scientificamerican.com/article/study-suggests-common-kne/ https://www.scientificamerican.com/article/study-suggests-co... [1] https://kityates.com/ https://kityates.com/
- NoodleIncident 6y ago
  My dad just had a similar surgery in the shoulder; I'm not sure whether to send him this! There's no sense making the placebo effect less effective, or even reducing the efficacy of a useful surgery with the nocebo effect. In his case, there was a golf-ball-sized "something" that they had to cut up into pieces to remove. So hopefully that's a real improvement, along with the debridement that they went in there to do.
  - podiki 6y ago
    If he's feeling better and doing well, why mess with a good thing! There's definitely a range of issues people have, and probably an over prescribing of treatment generally, which can make some of these broader studies harder to interpret (as pointed out in the article). If I had something that big basically anywhere it's not supposed to be, I think I'd be happier with it gone. In any event, hope your dad keeps feeling better!
    - crawfordcomeaux 6y ago
      The reason for sharing recovery could be largely placebo driven is because it empowers the patient by revealing a previously unknown skill they can develop. Studies are showing that "open placebos," which is when the patient knows it's a placebo, can work even better than when the patient doesn't know. Choosing one's own beliefs with deep intention and choosing to pick them up or put them down quickly are skills for improving both learning and healing. Withholding opportunities to develop these skills from people denies their need for autonomy and efficacy in their healing. I would ask him if he wants to know of anything simple that can boost his recovery. I would also propose he prepare to mourn many losses immediately after, since there's possibly a lot of opportunity for regret when someone learns so much of the things they've done in their lives may have been unnecessary and within their power to heal from. Some people can get stuck in grieving/regret and this slows the healing process down, so I consider it important to learn to grieve efficiently for quick healing.
rsync 6y ago
"Does anyone have any examples of surgeries that are done today in modern medicine that are basically placebo?" Spinal fusions for injuries not sustained in car accidents or horse throws or ... other literally back-breaking trauma. People with plain old uninteresting everyone-gets-it back pain get spinal fusions - a major, invasive surgery. There is a complicated nexus of obesity, refusal to do PT exercises, and huge economic incentives for surgeons that lead to these procedures. This critical review even mentions a Cochrane review[1]: "... and often does not even result in the spine being fused. That last one is not a big deal, because the results of the surgery are not well correlated with whether or not the spine fuses."[2] [1] https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001352.pub3/abstract https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD... [1] http://doctorskeptic.blogspot.com/2012/08/is-lumbar-spine-fusion-just-placebo.html http://doctorskeptic.blogspot.com/2012/08/is-lumbar-spine-fu...
- klenwell 6y ago
  Here's a New Yorker article that I bookmarked years ago that also questions the efficacy of back surgery for chronic pain: https://www.newyorker.com/magazine/2002/04/08/a-knife-in-the-back https://www.newyorker.com/magazine/2002/04/08/a-knife-in-the... From the opening: Last year, approximately a hundred and fifty thousand lower-lumbar spinal fusions were performed in the United States. The operation, which involves removing lumbar disks and mechanically bracing the vertebrae, is of tremendous benefit to patients with fractured spines or spinal cancers; more frequently, however, it is performed to alleviate chronic lower-back pain. But how effective is it? That’s a question that many of the doctors who perform the fusions, and the insurers who pay for them, appear reluctant to ask.
- Afton 6y ago
  In addition to the nexus you point to, it's worth mentioning that for a lot of back pain, we have no idea what causes it, or why it goes away (if it does). I suspect a lot of it is pressure from individuals wanting their doctor to do something to help them with their debilitating and mysterious problem. Source: I talked my dad out of a spinal fusion. I'm still not sure it was the right choice.
gnopgnip 6y ago
Not really a placebo, but broken collarbones are an example of this. The most common injuries can be healed with just a sling and rest. With surgery it makes sense with compound fractures or bones that are overlapping significantly or not where they need to be as it might not heal at all with a sling. Compared to just healing with a sling, surgery has increased risks from complications, the metal plate that can cause discomfort and a noticeable scar. With surgery the healing time is usually faster too
patja 6y ago
I don't know if it is a placebo, but many births by cesarean section are medically unnecessary, and can cause harm.
jartelt 6y ago
There are questions about the efficacy of some meniscus surgeries performed for knee pain. Outcomes are rehab are often similar to outcomes after surgery + rehab. https://pubmed.ncbi.nlm.nih.gov/28522452/ https://pubmed.ncbi.nlm.nih.gov/28522452/
ehnto 6y ago
The pathology for clavicle fractures is still changing today, with evidence suggesting that there is no need to operate on types of fractures they would previously operate on. I shattered my clavicle on my bike, many pieces, bits were floating in the middle of nowhere, it was pointing in all the wrong directions. It would have typically been suggested for surgery, but my hospital is a research hospital and so my case was cause for heated debate and I was eventually recommended not to get the surgery. During the process I met with many doctors for checkins and most of them were extremely surprised it wasn't operated on, but by the end of the healing process the surgeons said that if they had gotten that result from surgery they would be elated. So it all worked out and I've healed just fine without surgery, plates or follow up operations. There is a difference in time though, I was in a sling for nearly 8 weeks, whereas my friend who had surgery and plates put in was using his arm again in much less time.
appleflaxen 6y ago
spine/back/disk surgery is a huge one.
hartleybrody 6y ago
The article links to a YouTube video of a lecture by the author[0]. One of the top comments contains a list of timestamps in the video where he discusses specific surgeries: 7:55 Angina example 10:05 Parkinson’s disease example 13:10 Multiple sclerosis example 14:52 emphysema example 18:47 knee pain 20:40 spine surgery 21:52 Injection therapy for pain 24:59 Explain perceived effectiveness 26:29 correlation vs causation 29:33 Improvement not due surgery 30:33 Natural history 34:01 regression to the mean 35:43 concomitant treatment 39:16 perceived improvement: patient vs clinician 41:50 therapeutic envelope 42:38 Intervention: the placebo pill 44:02 Building the ideal placebo 47:02 “Why do we still operated?” 52:00 Determining effectiveness 52:55 Reducing error in estimating the truth 54:55 Why we need blinded randomized trials 55:12 Ethics and Placebo 59:50 One possible solution 1:00:20 Current status of placebo RCT in orthopedics 1:00:44 Summary, questions, and comments [0]: https://www.youtube.com/watch?v=IzueFu1cq5U https://www.youtube.com/watch?v=IzueFu1cq5U

Does anyone have any examples of surgeries that are done today in modern medicine that are basically placebo? I'm surprised the article didn't give a single example.

hnuser123456 6y ago

Routine wisdom teeth removal, male genital mutilation, dentists giving fillings far before they are required, causing toothaches and sensitivity... But these all turn out to be easy money for someone, for some odd reason.

bsanr 6y ago
I imagine that this gray area is where a lot of "unnecessary surgery" comes from. The vast majority of people have no medical need for circumcision (but some do). A lot of people don't need their wisdom teeth removed (but many probably should). You might need a filling eventually (just not now). Where do you draw the line, in a world where setting up studies to find conclusive evidence for binary medical decision-making ("Should this ever be done in the presence of x, or should it never be done?") is hard enough? I had two surgeries in 2019; in both cases the consulting doctor told me that it was 50/50 if I actually needed them or if they'd actually fix the issues that might have been associated with them. One was a pretty smashing success, the other (ironically more expensive) one was a 4-figure wash that had the surgeon dodging my inquiries as to what went wrong. Unfortunately, it turns out that medical decision-making entails taking a holistic view of the situation and giving advice that the doctor then has to take responsibility for. Good luck achieving that on a systemic level within the ever-dysfunctional structure of American healthcare.
jessaustin 6y ago
I've assisted on numerous third molar extractions, on patients up to sixty years old. None of those people were glad they had neglected to get the work done in their twenties. If you're not sure about a recommended dental filling, just go to a different dentist for a second opinion. By the time a cavity causes you pain you'll need a root canal and possibly a crown.
- hnuser123456 6y ago
  I got all mine out at ~18 for no discernable reason. Earlier in the year, got a filling despite visible substantial enamel. Was fine before, but I could barely handle drinks colder than body temperature for about 6 months. I think it could've waited.
- worker767424 6y ago
  > If you're not sure about a recommended dental filling, just go to a different dentist for a second opinion. This happened to me, probably twice. The first time I got rushed through the fillings and had them the same appointment as a cleaning because they were minor (they were). I still felt abused by it. A few years later, the same dentist found something else. I got a second opinion this time. It was basically that an aggressive dentist might reasonably want to fill it, but the second opinion was "don't bother." Five years and on a new dentist and it hasn't been so much as mentioned by the new dentist. Unless something is obviously wrong or you have a known history of cavities, I'd always get a second opinion.
- klenwell 6y ago
  In my early twenties, I was scheduled to get my wisdom teeth removed. It was going to cost me the equivalent of about a couple week's wages at the time. If I did it without general anesthetic it would be significantly cheaper. The oral surgeon to whom I was referred said I could do it either way, it was my choice. He did mention that, on a scale of 1-10, he would estimate the difficulty of removing my teeth at a 9. In x-rays, a couple looked like they were coming in upside-down. After calculating the number of hours of work the anesthetic would cost me, I decided to bite the bullet of go with a local anesthetic. (My dad was also tough-guying me to skip the general anesthetic.) So I called the surgeon's office to make an appointment. When I mentioned that I would be opting opt of general anesthetic, the receptionist paused and asked me to hold. When she came back, she said that the doctor specified that general anesthetic would be necessary. I mentioned the conversation I had already had with him. She again asked me to hold. When she returned, she said it was no longer an option. I put off the appointment. Miffed, I decided to take a closer look at the practice. This was pre-internet so I went to my local public library. I tracked down a British NHS study that suggested extraction was over-prescribed in the US in part due to the private insurance system. (I guess you can insert your tired joke about British teeth here.) One NHS study coupled with my incipient suspicion of the American medical system was enough for me. Plus all the money I was going to save. I decided to forego the surgery. Almost 30 years on and I can say I have no regrets. (Yet?) My third molars are still buried in my gums. A few years ago, the bottom right one partially broke through the gum. It was irritating at times but never really painful. I take care to floss and brush it with my other teeth. It seems to have come to rest. If I remember correctly, the study stated that after age 30 or 40, most people's wisdom teeth will have settled. One internet commenter's tale backed by one study for which I no longer have the reference.
pstch 6y ago
This is exactly what I thought 3 years ago when a dentist told me that it was very important for me to get rid of my wisdom teeth, because loss of enamel meant that they were very likely to decay quickly even with proper hygiene. Other dentists told me that it was not necessary, and could be done later if the teeth ended up decaying too much. Now the teeth are completely decayed, I've started to feel severe pain, and since I've developed severe thrombopenia (<20 G/L), I can't get them extracted easily (couldn't find any dentist willing to take that risk), so since six months, I have to take anti inflammatory drugs for the pain and antiobiotics to limit the infections, as well as the folic acid and corticosteroids needed for ITP, and I have no idea when will this end. It's very difficult to differentiate important advice from "easy money" advices, especially when this advice stems for a principle of precaution. Most peoples don't develop severe ITP, but if they do, getting wisdom teeth removed before they can cause problems can be very important.
- giardini 6y ago
  This is a long shot but some claim that vitamin K-2 can regenerate teeth to some degree. It might get your teeth in good enough condition to remove. I had started taking K-2 (Jarrow MK-7 menaquinone-7 FWIW) for other reasons but when my semiannual dental checkup came due, both the technician and dentist kept marveling about how pristine and healthy my teeth were. They credited it to my brushing and flossing habits, which had not changed. I took the praise but was puzzled until I remembered that the K-2 might be helping my teeth.
ThePadawan 6y ago
> Routine wisdom teeth removal That one is new to me. My dentist took X-rays at that point in puberty where it would become obvious if the wisdom teeth were obviously and majorly deviating (thus requiring removal). The X-ray came back somewhere between "inconclusive" and "too early to tell", so I still have my wisdom teeth.

jpm_sd 6y ago

https://www.nytimes.com/2016/08/04/upshot/the-right-to-know-that-an-operation-is-next-to-useless.html https://www.nytimes.com/2016/08/04/upshot/the-right-to-know-... https://www.mdalert.com/article/surgery-for-torn-meniscus-in-the-knee-is-often-unnecessary-ineffective-misdirected https://www.mdalert.com/article/surgery-for-torn-meniscus-in... https://www.health.harvard.edu/blog/knee-arthroscopy-should-this-common-knee-surgery-be-performed-less-often-2020042019507 https://www.health.harvard.edu/blog/knee-arthroscopy-should-...

jpmattia 6y ago

The first thing that occurred to me when I read the title: Tonsillectomies used to be very common when I was growing up, and eventually that stopped. See eg: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5883156/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5883156/

pcthrowaway 6y ago
Circumcision is another big one which used to be widely purported to have some positive health effects.
- ReactiveJelly 6y ago
  I'm against circumcision because foreskin can be used to make a vagina, if your baby boy turns 18 and decides to be a woman instead. It's part of my "Weird hills to die on Grand Tour" https://en.wikipedia.org/wiki/Sex_reassignment_surgery_(male-to-female)#Genital_surgery https://en.wikipedia.org/wiki/Sex_reassignment_surgery_(male...
  - deleted 6y ago
    [deleted]
  - markdown 6y ago
    Not because genital mutilation of children is just barbaric?
- patja 6y ago
  The US CDC (Center for Disease Control) currently recommends male circumcision for positive health effects.
  - notRobot 6y ago
    Yes, but almost all of the studies referenced in the guidelines took place in Africa, where proper genital hygiene and sex-ed is not taught. If you teach your kids to properly clean under the foreskin, circumcision largely loses its advantages.

podiki 6y ago

Knee surgery [0] is the one I've heard about before. Placebo (and nocebo) are really interesting effects, but also conflated with regression to the mean. There's a nice discussion of this in the very entertaining Math of Life and Death by Kit Yates [1], a fun book for people not normally interested in math especially (but I also found it informative and a good read). [0] https://www.scientificamerican.com/article/study-suggests-common-kne/ https://www.scientificamerican.com/article/study-suggests-co... [1] https://kityates.com/ https://kityates.com/

NoodleIncident 6y ago
My dad just had a similar surgery in the shoulder; I'm not sure whether to send him this! There's no sense making the placebo effect less effective, or even reducing the efficacy of a useful surgery with the nocebo effect. In his case, there was a golf-ball-sized "something" that they had to cut up into pieces to remove. So hopefully that's a real improvement, along with the debridement that they went in there to do.
- podiki 6y ago
  If he's feeling better and doing well, why mess with a good thing! There's definitely a range of issues people have, and probably an over prescribing of treatment generally, which can make some of these broader studies harder to interpret (as pointed out in the article). If I had something that big basically anywhere it's not supposed to be, I think I'd be happier with it gone. In any event, hope your dad keeps feeling better!
  - crawfordcomeaux 6y ago
    The reason for sharing recovery could be largely placebo driven is because it empowers the patient by revealing a previously unknown skill they can develop. Studies are showing that "open placebos," which is when the patient knows it's a placebo, can work even better than when the patient doesn't know. Choosing one's own beliefs with deep intention and choosing to pick them up or put them down quickly are skills for improving both learning and healing. Withholding opportunities to develop these skills from people denies their need for autonomy and efficacy in their healing. I would ask him if he wants to know of anything simple that can boost his recovery. I would also propose he prepare to mourn many losses immediately after, since there's possibly a lot of opportunity for regret when someone learns so much of the things they've done in their lives may have been unnecessary and within their power to heal from. Some people can get stuck in grieving/regret and this slows the healing process down, so I consider it important to learn to grieve efficiently for quick healing.

rsync 6y ago

"Does anyone have any examples of surgeries that are done today in modern medicine that are basically placebo?" Spinal fusions for injuries not sustained in car accidents or horse throws or ... other literally back-breaking trauma. People with plain old uninteresting everyone-gets-it back pain get spinal fusions - a major, invasive surgery. There is a complicated nexus of obesity, refusal to do PT exercises, and huge economic incentives for surgeons that lead to these procedures. This critical review even mentions a Cochrane review[1]: "... and often does not even result in the spine being fused. That last one is not a big deal, because the results of the surgery are not well correlated with whether or not the spine fuses."[2] [1] https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001352.pub3/abstract https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD... [1] http://doctorskeptic.blogspot.com/2012/08/is-lumbar-spine-fusion-just-placebo.html http://doctorskeptic.blogspot.com/2012/08/is-lumbar-spine-fu...

klenwell 6y ago
Here's a New Yorker article that I bookmarked years ago that also questions the efficacy of back surgery for chronic pain: https://www.newyorker.com/magazine/2002/04/08/a-knife-in-the-back https://www.newyorker.com/magazine/2002/04/08/a-knife-in-the... From the opening: Last year, approximately a hundred and fifty thousand lower-lumbar spinal fusions were performed in the United States. The operation, which involves removing lumbar disks and mechanically bracing the vertebrae, is of tremendous benefit to patients with fractured spines or spinal cancers; more frequently, however, it is performed to alleviate chronic lower-back pain. But how effective is it? That’s a question that many of the doctors who perform the fusions, and the insurers who pay for them, appear reluctant to ask.
Afton 6y ago
In addition to the nexus you point to, it's worth mentioning that for a lot of back pain, we have no idea what causes it, or why it goes away (if it does). I suspect a lot of it is pressure from individuals wanting their doctor to do something to help them with their debilitating and mysterious problem. Source: I talked my dad out of a spinal fusion. I'm still not sure it was the right choice.

gnopgnip 6y ago

Not really a placebo, but broken collarbones are an example of this. The most common injuries can be healed with just a sling and rest. With surgery it makes sense with compound fractures or bones that are overlapping significantly or not where they need to be as it might not heal at all with a sling. Compared to just healing with a sling, surgery has increased risks from complications, the metal plate that can cause discomfort and a noticeable scar. With surgery the healing time is usually faster too

patja 6y ago

I don't know if it is a placebo, but many births by cesarean section are medically unnecessary, and can cause harm.

jartelt 6y ago

There are questions about the efficacy of some meniscus surgeries performed for knee pain. Outcomes are rehab are often similar to outcomes after surgery + rehab. https://pubmed.ncbi.nlm.nih.gov/28522452/ https://pubmed.ncbi.nlm.nih.gov/28522452/

ehnto 6y ago

The pathology for clavicle fractures is still changing today, with evidence suggesting that there is no need to operate on types of fractures they would previously operate on. I shattered my clavicle on my bike, many pieces, bits were floating in the middle of nowhere, it was pointing in all the wrong directions. It would have typically been suggested for surgery, but my hospital is a research hospital and so my case was cause for heated debate and I was eventually recommended not to get the surgery. During the process I met with many doctors for checkins and most of them were extremely surprised it wasn't operated on, but by the end of the healing process the surgeons said that if they had gotten that result from surgery they would be elated. So it all worked out and I've healed just fine without surgery, plates or follow up operations. There is a difference in time though, I was in a sling for nearly 8 weeks, whereas my friend who had surgery and plates put in was using his arm again in much less time.

appleflaxen 6y ago

spine/back/disk surgery is a huge one.

hartleybrody 6y ago

The article links to a YouTube video of a lecture by the author[0]. One of the top comments contains a list of timestamps in the video where he discusses specific surgeries: 7:55 Angina example 10:05 Parkinson’s disease example 13:10 Multiple sclerosis example 14:52 emphysema example 18:47 knee pain 20:40 spine surgery 21:52 Injection therapy for pain 24:59 Explain perceived effectiveness 26:29 correlation vs causation 29:33 Improvement not due surgery 30:33 Natural history 34:01 regression to the mean 35:43 concomitant treatment 39:16 perceived improvement: patient vs clinician 41:50 therapeutic envelope 42:38 Intervention: the placebo pill 44:02 Building the ideal placebo 47:02 “Why do we still operated?” 52:00 Determining effectiveness 52:55 Reducing error in estimating the truth 54:55 Why we need blinded randomized trials 55:12 Ethics and Placebo 59:50 One possible solution 1:00:20 Current status of placebo RCT in orthopedics 1:00:44 Summary, questions, and comments [0]: https://www.youtube.com/watch?v=IzueFu1cq5U https://www.youtube.com/watch?v=IzueFu1cq5U