Blog article

I attended our massage conference in October this year. The keynote speaker was Ian Harris a surgeon at Liverpool hospital, Professor of orthopaedic surgery at UNSW and Honary Professor of The School of Public Health at The University of Sydney. He discussed in a nutshell that the evidence for having surgery is very lacking and that experiments comparing surgery to no surgery were not significantly different. The following examples given were quite amazing:

1. Re arthroscopy for the knee

Sham surgery was done where no arthroscopy occurred vs a true arthroscopy. There was no difference in outcome.

2. Taking out a knee meniscus vs pretending to take out the meniscus. No difference in outcome. 

3. Parkinson's disease - This disease is due to a lack of dopamine being produced by the brain. So they transplanted cells into the brain to release dopamine and Parkinsons reduced. They then compared this to putting cells in the brain with no dopamine in them. There was no difference in results.

4. Spinal fusion of the lumbar spine - This is a very common procedure. In the US 300-400,000 of these procedures are done per year. Results have shown that the surgery is no better than alternative therapies. And risks and costs are very high.

5. injection of corticosteroids for various musculo skeletal pain. There has been a 7x increase in the US in 10 years. And a similar increase in Australia. There was no benefit over placebo ( having no injection).

However, there was a percieved effectiveness by the patient and surgeon. The patient  perceives a 44% improvement, whilst the surgeon perceives a 66% improvement.

In general the clinicians overestimate the benefits and underestimate the harm! 

So why do surgeons still operate?

a) They believe in the effectiveness of the surgery

b) There is a patient demand

c) The failure of non-operative treatment

d) Lack of alternatives e.g. knee replacement

e) 2/3rds of patients get better with arthroscopy

And, physicians will not discard therapies validated by their training and their own experience on account of someone else's numbers in a placebo trial.

There are double standards in clinical practice ethics. That is:

In practice surgeons do not need ethics for a new procedure. In research need to get ethics approved! 

For example in back surgery the procedure is based on plausability tests and observations. And, there is uncertainty regarding the true effectiveness/harm done by the procedure! 

And currently, the perceived effectiveness is greater than the true effectiveness. 

So, as a massage therapist what do we say to a patient who is thinking of having a knee arthroscopy? 

a) Get 2 or 3 opinions to make a decision.

b) What is the difference to me if I have or do not have surgery?

c) What is the risk to me to get the benefit? 

d) What are the survival rates of having or not having an operation e.g. cancer or PSA levels? 

Mostly we do not ask any of these questions or get answers from different surgeons. We need to, to make an informed choice.

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