Ian Harris - Too much medicine and placebos in surgery
Ian Harris is a practicing orthopedic surgeon and academic based in Sydney, Australia. He is a Professor of Orthopaedic Surgery at the University of New South Wales and Honorary Professor at the School of Public Health at the University of Sydney. He has published over 350 peer-reviewed articles and achieved approximately AUD50M in grant funding. His research interests are clinical in nature and are focussed on the effectiveness of surgical interventions using randomised trials and registry and cohort studies. He has also written two popular books: "Surgery, the Ultimate Placebo" (2016) and "Hippocrasy, How Doctors Are Betraying Their Oath" (2021).
Abstract
The scientific support of medical practice is weaker than commonly supposed. The lack of evidence, and poor quality of existing evidence has led to practitioners consistently overestimating the benefits and underestimating the harms of the interventions they prescribe. This bias, and the system under which medicine is conducted (in which healthcare turnover is prioritised, rather than health) combine to produce too much medicine. Consequently, it has been estimated that 1/3 of all health care is low value and a further 10% is harmful.
A higher standard of scientific evaluation of health care interventions is required. In surgery for example, most procedures are only supported by observational evidence and tradition. More recently, higher quality trials have shown many common procedures to be ineffective. Surgical placebo trials are now being performed and they extend the maxim that the more rigorously a procedure is evaluated, the less effective it appears.
For too long, medical practices, particularly surgery, have persisted without supporting evidence, or with evidence of ineffectiveness. Medicine requires the same scientific rigour applicable to other areas of scientific endeavour.
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