Surgery: the Ultimate Placebo - Ian Harris

Professor Ian Harris takes us on a brilliant journey of scientific discovery, uncovering the true heart of skeptical inquiry via an analysis of common orthopaedic surgical procedures and other medical interventions that have been shown through clinical trials to be no more effective than placebo.

[FarisAlOdaibi]

7:55 Angina example
10:05 Parkinson’s disease example
13:10 Multiple sclerosis example
14:52 emphysema example
18:47 knee pain
20:40 spine surgery
21:52 Injection therapy for pain
24:59 Explain perceived effectiveness
26:29 correlation vs causation
29:33 Improvement not due surgery
30:33 Natural history
34:01 regression to the mean
35:43 concomitant treatment
39:16 perceived improvement: patient vs clinician
41:50 therapeutic envelope
42:38 Intervention: the placebo pill
44:02 Building the ideal placebo
47:02 “Why do we still operated?”
52:00 Determining effectiveness
52:55 Reducing error in estimating the truth
54:55 Why we need blinded randomized trials
55:12 Ethics and Placebo
59:50 One possible solution
1:00:20 Current status of placebo RCT in orthopedics
1:00:44 Summary, questions, and comments

[primavel]

Only 19 comments?? Why isn't this guy famous? Ian, what percentage of modern, allopathic, currently prescribed treatments resulting from office visits to doctors are actually proven effect enough to justify the risk and cost? Can you name any??

[pickngrin]

My left shoulder is testament to this. I had a massive labrum tear and significant arthritis until a peri-labral cyst formed to the point that it impinged my suprascapular nerve and I could no longer externally rotate my shoulder and my infraspinatus was just gone. At my initial consult the surgeon made like he wanted to do a replacement! At the time I was still able to do handstand pushups and lift whatever I wanted when holding it with two hands. I had the repair and my external rotation returned. Now I can do whatever I want!

[RepublikSivizien]

What about typical trauma-operations/emergency stuff? Is it testable?

[BeckyMatthew]

He raises a vaild point, but it is oversimplified in his talk. I wish he didn't dismiss the importance of ethics. There are instances where placebo might be unethical, especially when someone's life is on the line. I'd like to hear his view on how to set trails up in cases like that. Plus, we shouldn't discount the placebo effect. However, it's ethically complicated as to how to utilize placebo.

[ut]

While this analysis is from a skeptical view, skepticism should also be used by the individual regarding a serious decision regarding surgery. There are many times when the decision to have surgery IS rational and valid. I have had many orthopedic surgeries that were successful and if I didn't make the decision for surgery the quality of my life would have been adversely affected. In each case, I was patient and did the appropriate physical therapy (I am a physical therapist) without success. In other words, it is important for the individual to take the appropriate steps to maximize the chances that the problem at hand is not self-limiting and, thus, making the choice for surgery wise.

[muffinberg]

I think we need surgeries. And we do need to increase the amount of them. The sham operations I mean. Let's replace every doctor with an actor. And every medical treatment with a placebo. Because our body looks like to not give a fuck. Let's give the body what it wants. Bunch of endless superstitious shit. Damn I hate to be alive. I can't explain how much I am filled with disgust and repulsed by our experience.