[LMB] OT: Surgical placebos

pouncer at aol.com pouncer at aol.com
Wed Apr 8 19:34:43 BST 2020

Karen Hunt reminds us: 

>some recent [studies ] compared statin drugs to artery stents.
>Both are known treatments, so it's not really wrong to give one or the
>other, and researchers want to know which treatment is better for what set
>of circumstances (for what it's worth, statins have been winning over
>stents for most situations).

First, disclosing a bias, stents seem to me a good example of the
general over-deification of surgeons.  Successfully surgery, which
* IS * a lot more common that it was a century ago,  is so dramatic
and so immediate that many of us in the general public tend to
demand dramatic, immediate, miracles regardless of the technique.
Or cost. Or need.  Reconstructing a breast after cancer is
mentally therapeutic, and so we have an entire surgical industry
boosting the self-regard of certain persons. And certain surgeons.
Stents are so valuable for emergency repairs of heart blockages
that they've be used by too many as the "go to" procedure for
milder and more chronic cases.  Or so I say as a layman. YMMV.

The always reliable US news network NPR ( well, mostly reliable.
Well, somewhat reliable.  Well,  at least as much as the paid
media.  Well … )  reported this year on surgeons doing procedures
on knee cartilage.  All procedures the same, except, after
incisions, some surgeons opened sealed ordered and found 
themselves directed to close up, without doing the work on
the damaged or diseased cartilage.  Interestingly, the results
after recovery and therapy were comparably good for those that
had the "real" procedure and those who had what amounts to 
a placebo surgery. It certainly leads to the question of 
whether the surgery adds anything to the physical therapy.  Or
for that matter whether the expense and emotional investment in
surgery prompts a patient to expect, and experience, better
results.  Again, speaking only as a layman, I suspect the 
cartilage work does help many.  But perhaps not AS many as
the surgeons who believe it helps are expecting. 

Comparing stents -- surgery -- to statins -- drugs -- is related.
In any case it is not a matter of taking an option away from 
patients or doctors.  It should be, though, a continuing process
of measuring how well a new idea works.  All of us have 
some bias in favor of the new and dramatic.  That surgeons
are worse, IMO,  is inescapable given their importance. It will be
a better system when physical therapists, pharmacists, 
nutritionists, allergists, and emotional support animals get
a little more of the regard they're due, even if such regard
comes at the expense, or sacrifice, of surgeons.  

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