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Why ‘Useless’ Surgery Is Still Popular

New York Times AUG. 3, 2016

  • Take 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 conclusion: Surgery was no better than alternative nonsurgical treatments, like supervised exercise and therapy to help patients deal with their fear of back pain.
  • Spinal fusion rates continued to soar in the United States until 2012, shortly after Blue Cross of North Carolina said it would no longer pay and some other insurers followed suit.
  • “It may be that financial disincentives accomplished something that scientific evidence alone didn’t,” Dr. Deyo said.
  • 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.
  • “I think there is a placebo effect not only on patients but on doctors,” Dr. Kallmes adds. “The successful patient is burned into their memories and the not-so-successful patient is not. Doctors can have a selective memory that leads them to conclude that, ‘Darn it, it works pretty well.’”
  • (surgery for a torn meniscus) 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.
  • 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.”
  • Of course, how they choose might depend on how the choice is presented.
  • “I personally think the operation should not be mentioned,” he says, adding that in his opinion the studies indicate the pain relief after surgery is a placebo effect. But if a doctor says anything, Dr. Guyatt suggests saying this: “We have randomized clinical trials that produce the highest quality of evidence. They strongly suggest that the procedure is next to useless. If there is any benefit, it is very small and there are downsides, expense and potential complications.”