Although interesting, the title way overstates the claims of the article. The article is focusing on surgery to reduce pain. Pain can't be measured externally, it's subjective.<p>Most surgery is not like that, it involves some objective condition. Such as before you had an appendix, now you don't. Before your bone was broken in the wrong shape, now it's the right shape.
> 7/ For sure, there are many studies that study variations of surgical methods. That is, they try to find out whether an incision from the left is better or from the right.<p>> But very few studies try to find out whether the incision does anything at all for the patient. Shocking, but that’s the truth.<p>Assuming that those studies do not always conclude "neither is better than the other", this implies one or both of these:<p>1. At least one of the two options is better than the placebo.<p>2. At least one of the two options is worse than the placebo.<p>In other words, finding differences in effectiveness of different intervention approaches <i>must</i> mean that either <i>some</i> of these interventions are better than placebo, or that <i>all</i> (except maybe the best one) are measurably worse than performing no surgery at all.<p>> "the severity of your symptoms does not change the effectiveness of the operation"<p>I hate the word "effectiveness" because it can mean anything. Effectiveness at what? Measured how? Surely the severity of my symptoms ("my toe hurts" vs "half my leg has been shot off") plays a role in determining whether amputation is an "effective" remedy? Or you could argue that it is equally effective at "removing" the symptom in both cases. But then killing the patient would be peak effectiveness - no more pain at all, guaranteed! It's just pointless to discuss such a thesis - if you talk about "effectiveness", your statements very quickly become unfalsifiable.
> 5/ As Dr Ian Harris said, the unsaid attitude could be stated like: “you have to operate on patients quickly before they get better“.<p>Wow, really puts a new perspective on the usually massive wait times here in Norway.
> 11/ But because it’s costly and risky to perform surgeries, the urgent question is: what surgical procedures are today’s equivalent of bloodletting? And those that we know are bloodletting, how do we get rid of them as a society?<p>Instead of thinking of these surgeries as ineffective and looking to restrict their use, we can think of the placebo as effective in many cases, and try to lower their cost.<p>In America, high healthcare costs are partly driven by the fact that Americans are over medicated and doctors are incentivized to intervene. If "alternative" (placebo) medicines were more available, I wonder if we would have lower costs and similar healthcare outcomes.
> For such surgeries, randomized control trials have found that if you make an incision in the knee but don’t do anything, it’s as effective as actually conducting the surgery of the knee.<p>This is pretty crazy. I would suggest it shows that the vast majority of people having knee surgery didn't need it in the first place, or haven't tried alternatives.<p>If your knee is genuinely shot to bits and needs replacing with a artificial part, I can't see any scenario where placebo surgery would relieve pain anywhere close to an actual arthroplasty.
Are they though? They are no better than placebo. But are they better than doing nothing? And if they are, what are the alternatives? “Placebo effect” won’t work if you just tell the patient “we are giving you placebo”.<p>So the industry still needs to exist, research and marketing still needs to be done and surgeries still need to be performed if “placebo” is more effective than doing nothing at all.
I have a torn meniscus. The surgeon looked at it and said: " you can have surgery if you want but it won't make much difference, if you can live with it now". 5 years later, no problems, and no more knee locking. Touch wood...
Seems obvious to me that the strong "placebo" effect would be largely because it makes the person rest properly. Especially with knees and backpain etc. I didn't watch the video, he doesn't talk about that?
>What if the pain isn’t going away at all? Should you then get surgery?<p>>Golden advice by Dr Ian -> “the severity of your symptoms does not change the effectiveness of the operation“<p>I like how straight up & honest this Dr is.
A "placebo surgery", if it involves incisions to the point of being indistinguishable to the patient, isn't really a placebo since it will still require healing and recovery.