In Surgery, the ultimate placebo Professor Ian Harris, an orthopaedic surgeon clinician and academic provides us with a view that is not often considered – that some surgery may be ineffective, or as effective as placebo. Much has been written recently about the interesting topic of placebos, and much has been written about ineffectiveness and over treatment in modern medicine; Professor Harris ties it together and applies it to surgery.
The opening gives us historical perspective, then the first few chapters are mainly devoted to the placebo effect and how it works (or doesn’t, because placebos, by definition, don’t have an effect – this is explained). He makes the case for surgery having a strong ‘placebo effect’ because of the invasive nature, cost, technology and the attitude of the practitioners.
In the middle chapters, there are examples of placebo surgical procedures past and present. Some well-known and some not. Professor Harris is well known for some of these views, and there is a risk that his wish to show surgery as a placebo has biased his presentation of the evidence. Certainly, he only presents the less effective procedures, but his message is not that all surgery is placebo and he acknowledges this. His overall message is that the effectiveness of surgery (even in those procedures that are effective) is probably overestimated and that the harms are similarly underestimated. Sort of: if all of these previously well established procedures ended up being ineffective, what about the procedures we are doing now?
He provides some reasons why current practice continues, apparently often uncoupled from evidence, or without evidence, but this is coming largely from experience and conjecture and there is little data provided that might have provided more insight into the relative contribution of many of the factors mentioned. More like ‘food for thought’ but for a book (not a research paper), that’s OK. There are plenty of references provided at the end for anyone who wishes to pursue the evidence further.
The last few chapters ask us why we should care and what can we do about it. Like many books and articles pointing out the lack of effectiveness of modern medicine, solutions are generic (more information, better science, more scepticism) and more thought could have been put into concrete solutions that may be implemented.
Overall, the book provides an interesting read especially for those not familiar with this topic, mainly through the use of examples, and the explanations provided. While it might change a few minds, it is not likely to influence the larger problems (to which he refers) to any great extent. The aim of the book however, is to make people think differently about surgery and I think it will achieve that. For regular readers of the blog, many sections will be familiar, but I personally prefer having the whole message packaged in a tangible (and not too thick) book.
My verdict? I would buy this book if I hadn’t written it and been given a copy for free.
Dr Skeptic is a surgeon with an interest in evidence based medicine: the science behind medicine. He is interested in finding the true risks and benefits of interventions, and how this often differs from the perceived risks and benefits, as seen by the public, the media, and the doctors themselves. The book – Surgery The Ultimate Placebo is available on Amazon.
I am a surgeon with an interest in evidence based medicine: the science behind medicine. I am interested in finding the true risks and benefits of interventions, and how this often differs from the perceived risks and benefits, as seen by the public, the media, and the doctors themselves.