Marble Falls Few of us who ever had a saw in hand, hovering over a piece of lumber, that have not heard the old adage, “measure twice, cut once”. Something similar might be good advice in making decisions about your own health, especially when it comes to surgeries.
Randomized controlled trials are recognized as the gold standard for determining the efficacy of drugs and other medical treatments. At least in Britain, Australia, and Canada, such trials have finally become prevalent in calculating the effectiveness of surgical procedures. The results demand that many of us think twice and seriously before allowing ourselves to be cut, because the promised results for many are hardly better than placebos.
I’m issuing this warning based on a report in The Economist on random surgical trials that were funded by Britain’s National Institute for Health and Care Research, the equivalent of the US National Institute of Health. Where only 34 such random trials had been conducted on surgical procedures in 2011, the number had soared to 188 by 2023. The results are worth serious attention, since anytime a knife cuts the body, even in modern medicine, we’re in a danger zone.
Here’s what these tests are finding in brief. Appendectomies “turned out to be no better for most patients than a course of antibiotics.” Additionally, “the data show that some widely used surgical procedures, such as spinal fusions and rotator-cuff repairs, have effects indistinguishable from placebo or non-surgical care such as physiotherapy.” “…Prostrate-cancer surgery had no effect on patient mortality 15 years on, but worsened sexual and urological problems.” A trial in Finland and an orthopedic surgeon in Texas agree that people with knee issues “who had real surgery had more problems in the affected knee ten years on than those who had sham surgery (anesthesia following by a superficial incision).” A 2022 study in Jama where researchers “pooled data from 100 surgical trials covering 32 interventions…found that two-thirds of the improvement patients felt after surgery was due, on average, either to the body healing on its own or else to the placebo effects of feeling cared for and prepped for surgery. Only one-third of the benefit…came from the procedure itself.”
Don’t get me wrong, you could be in the lucky one-third that actually benefits from knee surgery or someone whose appendix has burst and surgery is a lifesaver. This is where the measuring twice or more times becomes important. I also have to admit that I’m biased. I’m still walking, sometimes painfully, on a knee that was injured in a high school football injury when I was 17 years old that reputable doctors at the time adamantly demanded that I have surgically repaired. For the most part, I’ve never questioned my decision, partially because it was so central in allowing me to resist the draft over three military physicals that otherwise might have put me in rice fields in Vietnam. So, I gobbled up a sentence when the reporter wrote that “A growing number of studies, in fact, show that the abnormalities in knees, backs and shoulders that orthopedic surgeons try to fix are very common in people who have no symptoms at all.” Furthermore, “All too often…scans reveal abnormalities that are little more than tissue tears; as natural a by-product of ageing as wrinkles and grey hair.” Such a report helps firm up my resistance to such surgery from weakening as the years pile on.
The question is not why the surgery happens when vitally necessary, but why are surgeons recommending surgery when the evidence increasingly says much of it is unnecessary. The answer seems to point to surgeon’s habits and the fact that they’re drinking their own Kool-Aid to justify their practice. Younger surgeons seem more likely to follow the new data and evidence, especially in countries where they are salaried and have no financial motivation to undertake such costly procedures. Almost unbelievably some “some surgeons fear their patients will give them a bad review online, and insurance companies still cover ineffective procedures for fear of losing their customers to competitors,” which points to why healthcare should not be a profit-oriented business. Another reason is patient demand, since many of us are the last to get the news that there’s no quick fix and that some of the fixes might be worthless.
In short, before you go under the knife in many non-life-threatening procedures, make sure you’ve got all the facts, and make your doctor and the surgical referral measure twice or more, before they cut.