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Sham surgery gets a plug

This article was originally published in The Gray Sheet

Executive Summary

Trial evaluating 180 patients who received arthroscopic débridement, lavage or placebo surgical knee treatment for osteoarthritis indicates health care researchers "should not underestimate the placebo effect, regardless of its mechanism," according to investigators Bruce Moseley, MD, Houston Veterans Affairs Medical Center, et al. Published in the July 11 New England Journal of Medicine, the study showed outcomes for arthroscopic procedures were no better than placebo. NIH Clinical Center officials Sam Horng and Franklin Miller, PhD, opine in an accompanying article that "a full ethical assessment [of sham surgery] must include consideration of the consequences of not conducting rigorous trials of surgery." Horng and Miller cite Moseley's data indicating that the costs of arthroscopic surgery in the U.S. total approximately $3.25 bil. per year. NEJM editorialists David Felson, MD/MPH, Boston University, and Joseph Buckwalter, MD, University of Iowa, explain that "inclusion of a sham-arthroscopy group with the use of blinding provides evidence of much higher quality" than that available from previous trials...

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