NY Times article on “useless” surgery

August 4, 2016

The New York Times posted a really interesting article this week (click here if you want to read it), about the effectiveness (or otherwise), of common surgical procedures. We kind of assume that a doctor won’t recommend surgery for us unless we really need it, and unless it’s going to fix us. After all, there are significant risks and costs involved in surgery, so there must be compelling reasons for them to recommend it, right? Turns out that may not be the case.

As they noted, surgery is not regulated in the same way that medications are: “Before a drug can be marketed, it has to go through rigorous testing to show it is safe and effective. Surgery, though, is different. The Food and Drug Administration does not regulate surgical procedures.

After reviewing several clinical trials comparing surgery to not-having-surgery, and studies looking at short term and long term outcomes of surgery, these were there conclusions:

“what happened with spinal fusion, an operation that welds together adjacent vertebrae to relieve back pain from worn-out discs. Unlike most operations, it actually was tested in four clinical trials. The conclusionSurgery was no better than alternative nonsurgical treatments. The studies should have been enough to greatly limit or stop the surgery, but that did not happen, according to a recent report. Instead, spinal fusion rates increased”

“In 2009, the prestigious New England Journal of Medicine published results of separate clinical trials on a popular back operation,vertebroplasty, comparing it to a sham procedure. They found that there was no benefit — pain relief was the same in both groups. Yet it and a similar operation, Kyphoplasty, in which doctors inject a sort of cement into the spine to shore it up, continue to be performed.”

“That was what led Dr. Katz and his colleagues to conduct a clinical trial comparing surgery with physical therapy in middle-aged people with a torn meniscus and knee pain. The result: The surgery offered little to most who had it. Other studies came to the same conclusion, and so did a meta-analysis published last year of nine clinical trials testing the surgery. Patients tended to report less pain — but patients reported less pain no matter what the treatment, even fake surgery.”

“Then came yet another study, published on July 20 in the British Medical Journal. It compared the operation to exercise in patients who did not have osteoarthritis but had knee pain and meniscus tears. Once again, the surgery offered no additional benefit.”

“An accompanying editorial came to a scathing conclusion: The surgery is “a highly questionable practice without supporting evidence of even moderate quality,” adding, “Good evidence has been widely ignored.”


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