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Confessions of a Sydney surgeon: why your operation may not work
- sp332 11y agoThere was a study where knee surgeons just made an incision in the skin and told the patient the procedure was done. The result was about the same rate of success, and a lot less risk of complications. I can't find a date on this article but it's at least from 2010 if not older. http://abcnews.go.com/Health/story?id=116879&page=1 http://abcnews.go.com/Health/story?id=116879&page=1
- vitd 11y agoIsn't it unethical to lie to a patient? Isn't that grounds for a malpractice suit?
- felipemora 11y agoAs part of a study? No. This is how studies are done. Give one set of people the real medicine and another people the fake one and see what happens. They are told before hand that they could receive the fake medicine/treatment and they must agree to the study.
- jrimclean 11y agoNot if they agreed to be part of a study. Otherwise, no one could use a placebo.
- lawpoop 11y agoIn a study, patients aren't lied to exactly; they're told their either going to receive a real treatment or a phony one, but they won't know which.
- lawpoop 11y agoWouldn't they have to do a bit more, to induce pain, swelling, soreness and such, for the patient to think surgery on their knee had actually been performed?
- analog31 11y agoAppendectomy: The possibility of dying from a ruptured appendix is enough for surgeons to recommend this procedure but several studies have shown that antibiotics alone are also effective. The recurrence rate is higher with antibiotics, but the surgical complications are lower. I can think of a reason why the recurrence rate for appendectomy is lower than for antibiotics. ;-)
- chris_wot 11y agolol! I just emailed the reporter.
- ivraatiems 11y agoI was with the article until this statement... Appendicitis is a medical emergency and suggesting you can just take antibiotics and it'll go away, or that antibiotics (a group of medicines with their own problems) are preferable to an established and very effective treatment feels irresponsible to me. Even if that's true, if you are experiencing appendicitis you NEED to talk to a doctor and you likely NEED to consider surgery.
- contingencies 11y agoSorry but I trust a surgeon's opinion, especially one who is willing to step forward publicly and challenge the status quo at risk of their reputation, far more than some random internet user.
- sandworm101 11y agoMuch probably turns on the progression of the disease at the point of diagnosis. An infection only detected as an elevated white cell count in a clinic, without any localized pain/swelling, may be treatable with antibiotics. And that is probably safer than the knife. But an ER patient howling in pain with an appendix swollen and about to burst is no candidate for pills.
- chris_wot 11y agoYes, but the recurrence rate will be lower if you get an appendectomy.
- ryanmarsh 11y agoA couple of years ago I slipped (herniated) two lumbar disks. Both of the surgeons I consulted begged me NOT to get surgery (one with tears in his eyes). I'm ever so grateful that there are surgeons out there who will push back. Contrast that with when I went to an orthopedic specialist about knee pain from running. In less than two minutes of consultation he told me he wanted to snip my tight IT bands. My jaw was on the floor. I was nothing but meat and a paycheck. Thankfully acupuncture has given me back the ability to sit/run/lift/stand. I'm so grateful I didn't get surgery in either case.
- sosuke 11y agoAcupuncture, there has been so much FUD spread about alternative medicine that I have no idea what to trust anymore. It isn't even covered by most insurance. What is real, who to trust.
- mjevans 11y agoTrust results. For some people the best medicine is guided by some change from within. I believe that as far as positive outcomes are concerned (ruling out helpful communities and other factors) the actual reason that placebos and that any organized system of belief work for some people is the same. They want to, and believe that they will, get better; thus they do, or at least they learn to cope. It's pretty much a psychological solution. You can talk your way out of some problems; but not all problems. Some things require physical changes driven by external (alien to the self) forces.
- threeseed 11y agoThe problem is that due to the placebo effect you will never know what is real or not. That said I would suspect that a lot of alternative medicines have therepeutic benefits. We just don't know why or how.
- maccard 11y agoI had a herniated disc - incredibly painful and it had terrible affects on my mood and my weight as well. I found that most of the effective treatments were ones that put me in a better mental state even if they had no effect on the pain. As someone else said; trust results!
- fpoling 11y agoThis is no limited to Australia. I know a person in Russia who consulted 3 or 4 surgeons regarding her foot problem. The advise was always to perform a complex operation that would leave her with crutches for at least 3 months. Finally somebody recommended another doctor. His advise was to make a hole in shoe insole around problematic area and see how things go. Then 9 months later she spent a month at sea and that mostly cured the problem.
- jensen123 11y agoCaldwell Esselstyn has proven that it's possible to cure heart disease such as angina with a low-fat, plant-based diet. He's written a book about this 20 year study: Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure. I find it interesting that most doctors are continuing to recommend things like cardiac stenting. Maybe it's money? I wonder if they even mention diet to their patients? Or is it the patients that are the problem - even if doctors mention diet, do many patients continue to eat unhealthy?
- chris_wot 11y agoI don't disagree that diet is important in reducing heart disease (and a lot of other things besides) but I'd be very cautious before listening to someone who claims he has a "revolutionary" cure. In the case of Caldwell Esselstyn, a quick Google search took me to my favourite skeptic blog: Science Based Medicine: https://www.sciencebasedmedicine.org/bill-clintons-diet/ https://www.sciencebasedmedicine.org/bill-clintons-diet/ Get about halfway down. I remain skeptical!
- karmicthreat 11y agoAn important part of a treatment is patient compliance. Even if a treatment is 100% effective, if the patient can't or won't comply then it is useless. A 100% Plant based diet would be difficult for most people. Also it would take quite a bit of time for the diet to be effective. A stent is an immediate solution.
- ehnto 11y agoMy anecdotal inference is that they will recommend pills and surgery more often than diet and excercise, because most people want the quick fix solution and that it is very difficult to get someone to adhere to diets and excercise. Again anecdotally, but consider the stories from people with diabetes who still won't eat well even when their foot was just amputated due to that behaviour.
- na85 11y agoWhat a lot of people seem to overlook is that, in the developed world, you have a 1% chance of death every time you go under general anesthesia.
- AznHisoka 11y agocitation? This to me sounds incredibly high.
- pgrote 11y agoIt is much lower. http://healthland.time.com/2011/08/04/under-the-knife-study-shows-rising-death-rates-from-general-anesthesia/ http://healthland.time.com/2011/08/04/under-the-knife-study-... "People have always been afraid of general anesthesia. Many fear they won’t wake up from this “artificial sleep” — actually more of a coma, albeit drug-induced and reversible. In the 1940s, for every one million patients operated on under full anesthesia, 640 died. By the end of the 1980s, fatalities were down to four per every million, thanks to modern safety standards and better medical training. However, a recent article published in the Deutsches Ärzteblatt, the German Medical Association’s official international science journal, shows that after decades of decline, the worldwide death rate during full anesthesia is back on the rise, to about seven patients in every million. And the number of deaths within a year after a general anesthesia is frighteningly high: one in 20. In the over-65 age group, it’s one in 10."
- jlg23 11y ago> "But the decision to operate should be based on the best science, not on the worst-case scenario. If the best evidence tells us that a procedure is not effective, or that the benefits are outweighed by the risks for some patients, then it should not be done." As long as patients can sue their doctor, no sane doctor will do less than what the patient wants if there is a remote chance the procedure is slightly more effective. A simple but prominent example is the prescription of a generic drug versus the "original". Science tells us that there is absolute no difference. Now you tell the patient - the same patient who feels a very real, "objective" decrease in pain when being injected a saline solution instead of steroids. And last but not least: the "best science" does not help us if doctors don't know about it. And some treatments are so weird that a doctor won't even consider it. Three anecdotes on that from my last 2 years: 1) British guy with pain in his knee. His doctor has been urging him to operate for years now. But he works in Nigeria on a oil drilling project in a good position and rather would prefer to wait the few years until he retires. The local "joujou"-man told him to rub python fat into his knee. It works for him! He told his doctor in the UK who dismissed that and told him that he might get into trouble for repeatedly rejecting sound medical advice. Shortly after I meet this guy in the Caribbean on his holiday, he tells me that story, I am skeptical and do some googling: 5 Minutes later I find a scientific study that proved that python fat is indeed a very good treatment for his condition. He mailed that to his doctor who read it and now leaves him alone. Snake oil, anyone? 2) Sahrawi ecologist with kidney stones but without the money to pay for the medical procedure to have them removed. He turns to local folk medicine, for a week he drinks a concoction that makes the stones break up and he can pass them naturally pretty much without pain. His doctor in Rabat speaks of a "miracle". 3) Business man in Casablanca was told by his doctor that he either needs surgery on his knee or he should try the traditional desert treatment: Undress, get buried in hot sand, 30 minutes later get into a tent, firmly wrapped. Repeat for 3 days. When I met him he was on his way back from his 5th treatment - he says he does it every 2 years and thereby has avoided surgery for 10 years.
- evan_ 11y agoYou should put that third guy in touch with the first guy.
- justinclift 11y ago
- pasbesoin 11y agoA few personal experiences, and the stories of many family and friends, have left me with the strong opinion that surgery is a very reluctant, last resort. Not my worst experiences, but two similar injuries left me with very differing experiences, as comparative examples. In the first one, the doctor wanted to get me into (arthroscopic, fortunately) surgery right away, without even doing an MRI. In the second, a different doctor said that, even if surgery were eventually warranted/needed, the condition had left me too weak to be a good surgical candidate. So, see a PT and work and strength-building, and see how I tolerated it. The first doctor racked up a big bill and produced no positive effect. The second doctor saw me for one visit, got me to a good PT / rehab program, and helped me make a full recovery. Anecdote, sure. But, combined with some other singular, not positive experiences: I'll go under the knife only when I have no other choice.