5 ms·

and like many orthopedic surgeries have turned out to be not better than noninvasive alternatives ( my personal pet peeve is the knee: http://www.nejm.org/doi/f

by erkkie 13y ago

and like many orthopedic surgeries have turned out to be not better than noninvasive alternatives ( my personal pet peeve is the knee: http://www.nejm.org/doi/full/10.1056/NEJMoa1301408 http://www.nejm.org/doi/full/10.1056/NEJMoa1301408 , http://www.nejm.org/doi/full/10.1056/NEJMoa0708333 http://www.nejm.org/doi/full/10.1056/NEJMoa0708333 ). In general surgical procedures are much more based on anecdotes and personal experiences (of the surgeons) than long term evidence of efficiency (for various reasons).

tensor 13y ago
I remember hearing an interesting talk discussing this. I forgot the author, but I'll try to relate a bit of the content. Doing proper experimental testing for surgeries often has significant ethical problems. For instance, to do it correctly you need to do "fake" surgery on some patients. This is to account for the placebo effect. However, doing this exposes the patient to health risks, which is arguably not ethical. Then there is the tricky problem of the case where a technique does work, and not performing it causes a patient to die. Yes, they died in the name of science, but it still goes against the goals and ethics of many doctors. On the other hand, performing ineffective surgery also exposes patients to significant risk, and may even cause death. So it's a really difficult topic. Myself, I'd still like to see the experiments done, even if the cost if not saving some lives we could have at times.
mturmon 13y ago
Yes, thanks for digging that up. My wife had a knee operation for chondromalacia that turned out to be a mistake, but it was earnestly recommended at the time.
- erkkie 13y ago
  Hope she's doing well, I cannot recommend daily PT enough, that and diet (emphasis on anti-inflammatory nature) can produce amazing results. I've also had success with LLLT (http://en.wikipedia.org/wiki/Low_level_laser_therapy http://en.wikipedia.org/wiki/Low_level_laser_therapy) but it may well be a placebo effect, the science of it is still kinda inconclusive. At least best to our knowledge so far it's non-harmful.

by erkkie 13y ago

tensor 13y ago

I remember hearing an interesting talk discussing this. I forgot the author, but I'll try to relate a bit of the content. Doing proper experimental testing for surgeries often has significant ethical problems. For instance, to do it correctly you need to do "fake" surgery on some patients. This is to account for the placebo effect. However, doing this exposes the patient to health risks, which is arguably not ethical. Then there is the tricky problem of the case where a technique does work, and not performing it causes a patient to die. Yes, they died in the name of science, but it still goes against the goals and ethics of many doctors. On the other hand, performing ineffective surgery also exposes patients to significant risk, and may even cause death. So it's a really difficult topic. Myself, I'd still like to see the experiments done, even if the cost if not saving some lives we could have at times.

mturmon 13y ago

Yes, thanks for digging that up. My wife had a knee operation for chondromalacia that turned out to be a mistake, but it was earnestly recommended at the time.

erkkie 13y ago
Hope she's doing well, I cannot recommend daily PT enough, that and diet (emphasis on anti-inflammatory nature) can produce amazing results. I've also had success with LLLT (http://en.wikipedia.org/wiki/Low_level_laser_therapy http://en.wikipedia.org/wiki/Low_level_laser_therapy) but it may well be a placebo effect, the science of it is still kinda inconclusive. At least best to our knowledge so far it's non-harmful.