Surgery versus Placebo

I believe one of the important research revelations of the early 21st century is that some but not all surgical procedures may not offer any benefit beyond placebo. With 2 new papers being released recently on surgery for meniscus tears and tennis elbow I wanted to document a few of the studies that have been done comparing a surgical procedure to a “sham surgery”.

Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial (2018 Feb):

In this 2-year follow-up of patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after APM [Arthroscopic partial meniscectomy] were no better than those after placebo surgery. No evidence could be found to support the prevailing ideas that patients with presence of mechanical symptoms or certain meniscus tear characteristics or those who have failed initial conservative treatment are more likely to benefit from APM.

Surgical Treatment of Lateral Epicondylitis: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Clinical Trial. (2018 Mar):

With the number of available participants, this study failed to show additional benefit of the surgical excision of the degenerative portion of the ECRB [extensor carpi radialis brevis, a muscle in the forearm that attaches to a ligament in the elbow] over placebo surgery for the management of chronic tennis elbow.

Effects of perceived treatment on quality of life and medical outcomes in a double-blind placebo surgery trial. (2004 Apr):

This study was part of a large double-blind sham surgery-controlled trial designed to determine the effectiveness of transplantation of human embryonic dopamine neurons into the brains of persons with advanced Parkinson’s disease. This portion of the study investigated the quality of life (QOL) of participants during the 1 year of double-blind follow-up…

The placebo effect was very strong in this study, demonstrating the value of placebo-controlled surgical trials.

A controlled trial of arthroscopic surgery for osteoarthritis of the knee. (2002 Jul):

In this controlled trial involving patients with osteoarthritis of the knee, the outcomes after arthroscopic lavage or arthroscopic débridement were no better than those after a placebo procedure.

This study was often cited in relevant meta-analyses:

Not all surgeries are showing a lack of benefit. Here is a trial on laparoscopic excision of endometriosis that shows a benefit compared with placebo.

Laparoscopic excision of endometriosis: a randomized, placebo-controlled trial. (2004 Oct):

Laparoscopic excision of endometriosis is more effective than placebo at reducing pain and improving quality of life. Surgery is associated with a 30% placebo response rate that is not dependent on severity of disease. Approximately 20% of women do not report an improvement after surgery for endometriosis.

This difference highlights the importance of continuing to pursue research evaluating surgical procedures with placebo controls.

Healthy Lifestyle Shopping

I decided rather than a lot of small posts about individual items I would write a list of some of the things I’ve been shopping for with some recommendations. I am still working on a larger buying guide to help people find healthier products. This list is not just new things, but also some things which I continue to find work well. I have no financial connection to any of these products of companies.

  • Countertop Water Filter: Multipure Aquadome
    • I’ve been using this in my home for years and continue to be pleased. I have not yet been convinced that anything else in this price range ($260 for the unit with filter, $75 for replacement filters once a year or so) is as good.
  • Shower Filter: Aquasana AQ-4105
    • I need the extra height provided by the one with the handheld wand but this is now only $60. Like the filter above I’ve been using this for years though I’ve actually tried a few other options but have not found anything I’ve liked as much.
  • Pillows: Organic kapok stuffed
    • A while back I did a lot of searching for reasonably priced healthy pillows. The downside of kapok is that it can compact easily. I have decided to remedy this by buying extra organic kapok fill, but that should be considered in the pricing. I believe this is still cheaper than organic wool but that would be another option.
  • Socks: Organic merino wool socks from Maggie’s Organics
    • This was a recent find. I decided it was important to take better care of my feet and thus worth $15 per pair of socks (Organic Wool Dress Crew). I started with 6 pairs, and after a 1 week trial I was so satisfied I bought another 9 pairs (in less expensive 3 packs). These are currently my everyday socks of choice.
  • Phone Headset – AIRCOM A1 Stereo Headset
    • I’ve tried a number of headsets and these are the best comfort and sound quality I have found so far. Although there are more expensive models, the basic model (which is what I have) is about $30 and a huge step up from the headsets that have come included with my phones and others I have tried.

 

Organic Sheets

I believe in buying high quality products, and linens are no exception. However, when recently searching for sheets I found a variety of options and a wide range of price points. I wanted to document this as a reference for my clients and others who are looking for some high quality sheets or other linens. The price points are based on a queen size sheet set. These are all organic cotton sheets.

Resources:

Research Collected: Evidence for Skepticism of Research

I enjoy reading research and thinking about the implications of research. However, I often have to remind myself that there is reason to be skeptical about any individual study. Often I prefer to wait until a number of studies fit a particular narrative or hypothesis before gaining confidence in that research. When I share research here it’s usually from a “isn’t this interesting” perspective, not a “this is true” perspective. Ideally a lot more research would be replicated than is currently occurring. So far, examinations into reproducibility of research has shown low reproducibility, even on studies which have become actionable in health care fields. This collection is a set of papers examining some issues with the accuracy of scientific research.

Continue reading ‘Research Collected: Evidence for Skepticism of Research’ »

“Demonization and Deception in Cholesterol Research”

I am a fan of Dr. Diamond’s earlier talk but this new one is better. It is more concise and the viewer can see the presentation. This combines many important points on research into cholesterol into 1 informative hour. I recommend watching for anyone who wants a better understanding of the actual research into cholesterol and health.

Embedding has been disabled to click the link to watch:

https://www.youtube.com/watch?v=yX1vBA9bLNk

Ripples of Coca-Cola’s Recent Disclosures

“Last week Coca-Cola disclosed its practice of paying researchers and health professionals millions of dollars. It spent $21.8 million to fund pro-industry research and $96.8 million on partnerships with health organizations, including $2.1 million directly paying health experts…

I wanted to dig deeper into this network of influencers to learn more about the strategy. Why were they chosen? What do they have in common? Where are they most influential?”

 – The New Faces of Coke

Which health organizations have been terminating their sponsorship in the wake of Coca-Cola’s disclosures?

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Inside Out

Inside Out is the first movie I’ve recommended to my clients. It is definitely worth seeing, perhaps more than once. There are a lot of laughs, which are always health promoting, as well as some touching and important observations about the emotional lives of humans.