I had thought about this and had amended this to "in most cases" before you posted. If the standard of care is removing the appendix, and you have a strong rea

I had thought about this and had amended this to "in most cases" before you posted. If the standard of care is removing the appendix, and you have a strong reason to believe that something less may be superior, you may be able to conduct a randomized trial. But any other combination of facts is going to be hard for an IRB to swallow.