tag:blogger.com,1999:blog-6193043695356712843.post6730745244474222871..comments2023-09-02T23:55:45.583+10:00Comments on Doctor Skeptic: Placebo trials of surgeryDr Skeptichttp://www.blogger.com/profile/09376469049519802493noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-6193043695356712843.post-73810846034011758142015-05-27T14:58:24.186+10:002015-05-27T14:58:24.186+10:00Thanks for the suggestion. FAI is a good one and I...Thanks for the suggestion. FAI is a good one and I am currently doing some observational data linkage work on this, but there are no good comparative trials out there that I am aware of. I will keep a look out. In the meantime, surgeons will continue to increase their uptake of this unproven procedure before anybody gets any funny ideas about testing it.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-44175461971553637312015-05-27T09:23:58.964+10:002015-05-27T09:23:58.964+10:00How about surgeries for femoral acetabular impinge...How about surgeries for femoral acetabular impingement? <br /><br />-LOVE your blog and have been a reader for years since I found your spinal surgery as placebo blog post way back when. Please keep up the great work!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-88943479873155965302015-05-23T01:27:52.734+10:002015-05-23T01:27:52.734+10:00Thanks Hans. Unfortunately I couldn't work out...Thanks Hans. Unfortunately I couldn't work out what your organisation is all about because the website is in German. Is there an English language version of the site?Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-57648862057135204272015-05-23T01:23:49.265+10:002015-05-23T01:23:49.265+10:00Great question.
First to cover your suggestions. ...Great question.<br /><br />First to cover your suggestions. Tonsillectomy, yes. THR and TKR yes, but difficult, as the rebalancing of alignment (mainly in Total Knee Replacement) is hard to control for. In some of the less severe patients (mild radiographic changes) this can be done and it wouldn't surprise me if knee replacement didn't come out much better than sham.<br />"Most shoulder procedures" - yes. They are doing a sham surgery trial for shoulder decompression in the UK now. I am involved in designing an RCT for reverse shoulder replacement versus non-op treatment for bad shoudler fractures.<br /><br />Now, what other ones?<br />Spine fusion for non-specific pain.<br />Hernia repair.<br />Cholecystectomy.<br />Excision of high grade brain tumours.<br />Bariatric surgery (lap banding).<br />Coronary stenting<br />Most revascularisation procedures.<br />Hysterectomy for dodgy indications.<br />Floating kidney (yes, people are still doing this).<br />Some fracture surgery.<br />Achilles' tendon repairs.<br />Spinal cord stimulators (almost certainly placebos).<br />Almost any procedure you can think of for non-specific pain.<br /><br />And that's without even thinking about it too hard. Pick a specialty - they've all got their share of dodgy procedures.Dr Skeptichttps://www.blogger.com/profile/09376469049519802493noreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-67903729846870462702015-05-20T16:15:42.170+10:002015-05-20T16:15:42.170+10:00Which surgical procedures (currently in use) would...Which surgical procedures (currently in use) would you most like to see placebo tested? <br />Which do you suspect would not outperform sham, but would likely never get tested due to "ethics".<br /><br />Personally I'd like to see:<br />- Tonsillectomy<br />- THR<br />- TKR<br />- TSR (most shoulder procedures actually, especially "rotator cuff repair")<br />- etc<br /><br />I'd be interested to know your gut feeling on a few surgeries currently inoculated from critisism by confirmation bias and the institution of medicine.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-6193043695356712843.post-78599353685632049912015-05-20T04:45:14.911+10:002015-05-20T04:45:14.911+10:00Dear collegue,
I read since the beginning your blo...Dear collegue,<br />I read since the beginning your blogs with high interest and agree with your conclusiones. In this study form Oxford , new Finnish study on meniscus surgery is missing. It would even strengthen the conclusions. A new meniscus study is underway by Stefan Lohmander from Lund in Sweden with the hyposthesis, that partial meniscectomy even leads to a higher and earlier onset of arthritis than non-operative treatment with physiotherapy etc.<br />A very interesting study was published by Lohmander in 2013, showing that non-operative treated patients with ACL injury had after 5 years not more or even less arthritic changes than the operative reconstructed group Frobell RB, Roos HP, Roos EM, Roemer FW, Ranstam J, Lohmander LS: Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ 2013; 346: f232).<br />A few years ago we have established an Internet platform for second medical opinion (www.medexo.com). After having consulted around 1000 patients with orthopaedic problems, we could avoid more than 70% of the proposed surgeries. After 2 1/2 years these patients were still satisfied with their non-operative treatment. Interesting is that the non-operative treated group was 18 days earlier back to work than the operative treated group.<br />I would be happy to exchange experiences with you in the future. Prof. Dr. Hans PaesslerAnonymoushttps://www.blogger.com/profile/03995563854225167201noreply@blogger.com