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Surgery, The Ultimate Placebo: A Surgeon Cuts through the Evidence
For many complaints and conditions, the benefits from surgery are lower, and the risks higher, than you or your surgeon think. In this book you will see how commonly performed operations can be found to be useless or even harmful when properly evaluated. That these claims come from an experienced, practicing orthopedic surgeon who performs many of these operations himself, makes the unsettling argument particularly compelling. Of course no surgeon is recommending invasive surgery in bad faith, but Ian Harris argues that the evidence for the success for many common operations, including knee arthroscopies, back fusion or cardiac stenting, become current accepted practice without full examination of the evidence.
240 pages, Paperback
Published May 1, 2016
31 people are currently reading
441 people want to read
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Displaying 1 - 26 of 26 reviews
October 7, 2021
GREAT BOOK! This is required reading for all patients, in other words for everybody, because we are all patients sooner or later. This book did start out a little bit slow for me, because it was all familiar to me at the beginning, but the book kept getting better and better as it went, because more and more inside secrets were revealed about surgery and surgical specialties. This book very clearly points out the lack of treatment transparency in healthcare for patients. Most patients have no idea of the important outcome measures they need to know before undergoing surgery or any other medical treatment. WE NEED TO FIX THIS. Medicine is very seldom a hard science, and this book explains why by focusing on placebo and sham controlled medical trials. The medical statistic that everyone needs to know, which is not mentioned in the book, is the "net treatment benefit for the patient" using the outcome measure most important to the patient. IF YOU WANT TO BE YOUR OWN BEST HEALTHCARE ADVOCATE, THIS IS A MUST READ BOOK FOR YOU.
August 17, 2024
I heard the author speak at a conference and wanted to read more about this topic, which is why I read this book.
I had not known that surgical procedures do not need to pass through clinical trials (unlike pharmacological treatments) before they can be used in patients, so this was eye opening. I thought Harris gave an excellent explanation of why patients seem to improve regardless of treatment (e.g. the power of biology and natural healing, regression to the mean, the psychological benefit of any action, wanting to please their doctor). The explanation of why surgeons continue to use "what has always been done", even though it may not actually be helpful, and the fallacy of comparing new interventions to the standard surgery was also very clearly explained. I also liked how he raised the question of measuring inappropriate outcomes (e.g. treating the X-ray and not the patient). I skimmed over a lot of the parts on particular surgeries - this is not my main interest.
I was very glad he mentioned that some surgeries (like hip replacements!) are life-changing. It's not all bad.
Ian Harris has written some essays on this topic in "The Conversation" which would be worth reading and passing on to family and friends who may be less interested in a longer book. Here's a list of them.
I had not known that surgical procedures do not need to pass through clinical trials (unlike pharmacological treatments) before they can be used in patients, so this was eye opening. I thought Harris gave an excellent explanation of why patients seem to improve regardless of treatment (e.g. the power of biology and natural healing, regression to the mean, the psychological benefit of any action, wanting to please their doctor). The explanation of why surgeons continue to use "what has always been done", even though it may not actually be helpful, and the fallacy of comparing new interventions to the standard surgery was also very clearly explained. I also liked how he raised the question of measuring inappropriate outcomes (e.g. treating the X-ray and not the patient). I skimmed over a lot of the parts on particular surgeries - this is not my main interest.
I was very glad he mentioned that some surgeries (like hip replacements!) are life-changing. It's not all bad.
Ian Harris has written some essays on this topic in "The Conversation" which would be worth reading and passing on to family and friends who may be less interested in a longer book. Here's a list of them.
August 16, 2024
The belief in surgery is so powerful that people believe it is needed even when there is nothing wrong with them.
Harris is an orthopaedic surgeon in Australia who has written a short book about the lack of evidence in common medical treatments, specifically surgical treatments.
As an orthopaedic surgeon myself, I found this to be a readable and relatable work which tries to instill the following in the lay reader: basic statistical principles are often misunderstood, even by physicians. So many treatments have been established without good evidence, and their primacy makes them seem like a standard of care that shouldn't be upended. And biological plausibility ("that makes sense") is a well-intentioned form of casuistry that can lead to unhelpful treatments becoming widespread (legions of examples abound).
I found a number of concepts worth lingering on. Harris talks at length about biological plausibility. In his words:
The biologically plausible mechanism: Biological plausibility is a requirement for any treatment, but it does not supply its own proof of causality; it merely provides a possible explanation (which may direct future research).
and:
...the problem is that people tend to take a biologically plausible mechanism as evidence of effectiveness, and that it ain’t.
This simplistic thinking can lead to waste or harm. There are many examples in which:
...well-intentioned, honest surgeons who do [this] procedure because they have seen previous patients improve afterwards, because it is a recognised procedure, because they believe it might help and is at least worth a try, and because they want to offer the patient ‘active’ treatment rather than reassurance, are, on average, harming patients and providing no benefit.
Another fascinating hot take: he suggests that the ethical and legal restrictions on research and clinical care are inverted. As here:
The current ethical environment is one that holds back research into the effectiveness of surgical treatments, but does little to reduce the rate of ineffective treatments currently performed. Ethics committees (institutional review boards: IRBs in the US) are now firmly entrenched in the research environment such that clinical research can only be performed with their approval. Clinical practice, however, is not subject to such approval, yet in many cases the risk of harm (individually and to society) from clinical practice is greater. Therefore, researchers are being held to a higher standard than clinicians...
and:
...there are no ethical restrictions on what type of procedure you perform, but if you want to measure the results of that procedure, you need approval.
There may be edge cases (rare, orphan diseases or deformities, do-we-need-a-parachute-randomized-trial) type examples, but for the majority of the text Harris does a measured job of anticipating objections, and being honest about how much better he thinks we can get. For example, he is a proponent of better scientific literacy, so patients can be informed of their decisions, but recognizes that may not occur:
What might be stretching things is to expect governments to educate people in critical thinking.
Utimately, there are some provocative takes, and many that are fairly fresh in my world. Like the idea that surgeries could be closely regulated, analogous to the way drugs are regulated.
Perhaps the best summary of the text is as follows, and I firmly agree:
We need to create scientists who practice medicine, not doctors who know about medicine but little about the science that supports it.
Harris is an orthopaedic surgeon in Australia who has written a short book about the lack of evidence in common medical treatments, specifically surgical treatments.
As an orthopaedic surgeon myself, I found this to be a readable and relatable work which tries to instill the following in the lay reader: basic statistical principles are often misunderstood, even by physicians. So many treatments have been established without good evidence, and their primacy makes them seem like a standard of care that shouldn't be upended. And biological plausibility ("that makes sense") is a well-intentioned form of casuistry that can lead to unhelpful treatments becoming widespread (legions of examples abound).
I found a number of concepts worth lingering on. Harris talks at length about biological plausibility. In his words:
The biologically plausible mechanism: Biological plausibility is a requirement for any treatment, but it does not supply its own proof of causality; it merely provides a possible explanation (which may direct future research).
and:
...the problem is that people tend to take a biologically plausible mechanism as evidence of effectiveness, and that it ain’t.
This simplistic thinking can lead to waste or harm. There are many examples in which:
...well-intentioned, honest surgeons who do [this] procedure because they have seen previous patients improve afterwards, because it is a recognised procedure, because they believe it might help and is at least worth a try, and because they want to offer the patient ‘active’ treatment rather than reassurance, are, on average, harming patients and providing no benefit.
Another fascinating hot take: he suggests that the ethical and legal restrictions on research and clinical care are inverted. As here:
The current ethical environment is one that holds back research into the effectiveness of surgical treatments, but does little to reduce the rate of ineffective treatments currently performed. Ethics committees (institutional review boards: IRBs in the US) are now firmly entrenched in the research environment such that clinical research can only be performed with their approval. Clinical practice, however, is not subject to such approval, yet in many cases the risk of harm (individually and to society) from clinical practice is greater. Therefore, researchers are being held to a higher standard than clinicians...
and:
...there are no ethical restrictions on what type of procedure you perform, but if you want to measure the results of that procedure, you need approval.
There may be edge cases (rare, orphan diseases or deformities, do-we-need-a-parachute-randomized-trial) type examples, but for the majority of the text Harris does a measured job of anticipating objections, and being honest about how much better he thinks we can get. For example, he is a proponent of better scientific literacy, so patients can be informed of their decisions, but recognizes that may not occur:
What might be stretching things is to expect governments to educate people in critical thinking.
Utimately, there are some provocative takes, and many that are fairly fresh in my world. Like the idea that surgeries could be closely regulated, analogous to the way drugs are regulated.
Perhaps the best summary of the text is as follows, and I firmly agree:
We need to create scientists who practice medicine, not doctors who know about medicine but little about the science that supports it.
August 13, 2024
Clear and honest... should be required reading for all MDs
A clear and honest description of a serious societal problem. A must read for any MD, but ordinary folks would really benefit as well. The credulity of the average patient often puts them in harm's way, as the author makes clear. The deification of doctors and the magical way medicine is portrayed in movies, TV, and the fawning press doesn't help either.
A clear and honest description of a serious societal problem. A must read for any MD, but ordinary folks would really benefit as well. The credulity of the average patient often puts them in harm's way, as the author makes clear. The deification of doctors and the magical way medicine is portrayed in movies, TV, and the fawning press doesn't help either.
September 3, 2016
I really wanted to like this book as I chose it to read for book club. I found this book relatively easy to read but aside from a few interesting parts was quite boring and to be honest there weren't a lot of things I wasn't already aware of.
It was a rather brave move by an Australian Orthopaedic surgeon who makes his living via surgery to actually question whether surgery is always necessary. The book essentially discussed various surgeries and their effectiveness. It discussed common surgeries that are routinely performed that are possibly no more effective then a placebo. A lot can be said for the psychological impact of placebos and ultimately the need for surgery really needs to be done case by case.
People in society tend to put their doctors on a pedestal. When we are unwell we want to be fixed and put trust in our doctor that they will fix us regardless of the cost or procedure involved. People are generally impatient and think surgery will be a quick fix whereas letting nature heal ourselves naturally takes much longer. Thus the ethics of whether surgery should or should not be performed is in question.
People need to interact with doctors more and ask appropriate questions to get the best result. I find it rather interesting that many surgeries are performed with unproven trials but since a particular procedure may have worked on one person it might be worth the risk to try it again. With the threat of law suits and people's mindset that surgery is the best option, doctors should be able to be honest and say they should avoid surgery as it might not be beneficial (depending on the procedure of course). Having said that though, many people just do not accept non-operative treatments as an option.
Surgery is usually driven by successful results. Surgery also can be just an option but not always a necessity. All the risks and benefits of surgery need to be considered. I really liked the quote by Voltaire: "the art of medicine consists of amusing the patient while nature cures the disease!"
Ultimately doctors should advise a patient and then let the patient make the decision of what they want to do. It also seems that older surgeons tend to treat patients more conservatively and often try non-operative methods first before surgery, whereas young surgeons can often be too aggressive as they are keen to do a lot of surgeries. The young surgeons say older surgeons were too cautious and out of touch. I guess it's really up to the patient of building a rapport with their doctor and making a decision that is the most beneficial. All in all, this book was a though provoking book . I can't say I really enjoyed reading it but it was interesting.
It was a rather brave move by an Australian Orthopaedic surgeon who makes his living via surgery to actually question whether surgery is always necessary. The book essentially discussed various surgeries and their effectiveness. It discussed common surgeries that are routinely performed that are possibly no more effective then a placebo. A lot can be said for the psychological impact of placebos and ultimately the need for surgery really needs to be done case by case.
People in society tend to put their doctors on a pedestal. When we are unwell we want to be fixed and put trust in our doctor that they will fix us regardless of the cost or procedure involved. People are generally impatient and think surgery will be a quick fix whereas letting nature heal ourselves naturally takes much longer. Thus the ethics of whether surgery should or should not be performed is in question.
People need to interact with doctors more and ask appropriate questions to get the best result. I find it rather interesting that many surgeries are performed with unproven trials but since a particular procedure may have worked on one person it might be worth the risk to try it again. With the threat of law suits and people's mindset that surgery is the best option, doctors should be able to be honest and say they should avoid surgery as it might not be beneficial (depending on the procedure of course). Having said that though, many people just do not accept non-operative treatments as an option.
Surgery is usually driven by successful results. Surgery also can be just an option but not always a necessity. All the risks and benefits of surgery need to be considered. I really liked the quote by Voltaire: "the art of medicine consists of amusing the patient while nature cures the disease!"
Ultimately doctors should advise a patient and then let the patient make the decision of what they want to do. It also seems that older surgeons tend to treat patients more conservatively and often try non-operative methods first before surgery, whereas young surgeons can often be too aggressive as they are keen to do a lot of surgeries. The young surgeons say older surgeons were too cautious and out of touch. I guess it's really up to the patient of building a rapport with their doctor and making a decision that is the most beneficial. All in all, this book was a though provoking book . I can't say I really enjoyed reading it but it was interesting.
June 19, 2016
This is a fine exploration of the placebo effect. It is written so well, that the technical side does not become boring. And at the same time raises the question of quality in the medical research with an accent put on surgery.
September 12, 2017
Quite an interesting book to read. I should let you know, up front, that I'm one of the practitioners of 'alternative medicine' that the author takes a swipe at. Despite this, the material is interesting (even more so if you're considering surgery). Easy to read too.
November 21, 2024
i had to read this book for work. may or may not have skimmed a lot of this because it was example after example of why surgery is not always the best or safest choice….literally written by a surgeon! it was interesting to read because the guy is australian and therefore spells things differently. also the book was written relatively informally so he joked around and used slang in his writing. this book took me so long to finish because i kept leaving it at work instead of bringing it home to read. now i just have to write my book report and im one step closer to certification at work!
November 23, 2023
I enjoyed the critical thinking embedded in the theories of this book; however, it’s quite repetitive. I think it will change the way I review scientific literature and apply that to patients. But it’s also exhausting to realize how much false data is out there. At least I didn’t bend the book spine even once!
February 24, 2019
What a very interesting and informative read. Thank you for answering some questions that I had relating to surgery and how necessary it is. Being a massage therapist and helping patients recover from surgery that I believe they could have done without is something I see quite often. Unfortunately the damage is already done by the surgery and that cannot be undone. I'm all about patient education and will be looking to educate everyone who comes into my clinic to ask questions before going for surgery or having the injection. Big respect to Ian Harris, being a surgeon himself and owning up to all that is revealed in the book. THANK YOU for this fantastic and educative piece.
February 13, 2019
Excellent book highlighting the fallacies of Surgery in today's world.
Provides a convincing case for the need for more scientifically literate doctors to promote the growth of Evidence Based Medicine.
Easy to read and absolutely essential to understand the merits and drawbacks of surgery
Provides a convincing case for the need for more scientifically literate doctors to promote the growth of Evidence Based Medicine.
Easy to read and absolutely essential to understand the merits and drawbacks of surgery
February 6, 2017
I found this such an interesting read. Written by a NSW surgeon this book will make you reconsider a lot of popular surgery and question it's actual effectiveness. I found this a very interesting read due to knowing a few people, including myself, who have had some of the questionable surgeries and the general consensus matches the books hypothesis on how satisfied patients are with their surgery and left them questioning the actual benefit and necessity of the surgery. The book raised a heap of interesting points about the scientific validity of many popular surgeries and called for changes to be made to the current system in order to prevent unnecessary surgeries being undertaken.
May 12, 2018
Fantastic overview of how surgery isn't as effective as is commonly thought to be. A must read for anybody interested in the medical field or is/has family dealing with medical issues.
December 31, 2018
A very eye opening and scientifically written book for anyone inside or outside of the medical field. It changed my view on surgery and the effect (or lack of it) it has.
November 3, 2024
An interesting read on many procedures that don't actually help at best and make things worse at worst.
Explaining how surgeons are? were? taught, and the incredible lack of testing and evidence for these procedures in the first place.
Shocking and something everyone should read.
Explaining how surgeons are? were? taught, and the incredible lack of testing and evidence for these procedures in the first place.
Shocking and something everyone should read.
April 29, 2025
Linguagem extremamente acessível, por mais que seja por essência, um livro de caráter científico/acadêmico, o autor se preocupou em tornar o tema palatável para todos os públicos, profissionais da saúde, pesquisadores e principalmente aos pacientes.
October 8, 2025
I would've liked to read more about the practicalities of what a placebo/"sham" surgery actually looks like. How does it work? Do the surgeons dress all up in scrubs and then do nothing? Do they have to make a scar look convincing?
May 31, 2017
While I am no medical expert I thought this book was very good. Easy to understand and rather thought provoking.
June 6, 2018
Entertaining read presented coherently.
June 25, 2018
other books make the same point better in less biased fashion
best description on why sub group analysis is flawed
best description on why sub group analysis is flawed
May 6, 2019
An interesting, well argued book on a controversial topic.
September 4, 2021
Every med student should read this book!
November 26, 2019
A very mind opening book regardless of your background either medical or not
We put a lot of faith in the hands of a surgeon but unfortunately the evidence of a given treatment being useful is less than we would like to admit
Very accessible style and thoughtful insights although the explanation of the placebo effect can be mildly confusing but it's rare to see one so complete even in medical literature
Lots of surprises, but as usual assuming nature works in a linear fashion won't be a guarantee of success, insist of assuming a superficial knowledge of mechanisms is enough to dictate therapy is fruitless sadly that pattern repeats itself through all medicine
Always question and keep on questioning! Suren der will only hurt!
We put a lot of faith in the hands of a surgeon but unfortunately the evidence of a given treatment being useful is less than we would like to admit
Very accessible style and thoughtful insights although the explanation of the placebo effect can be mildly confusing but it's rare to see one so complete even in medical literature
Lots of surprises, but as usual assuming nature works in a linear fashion won't be a guarantee of success, insist of assuming a superficial knowledge of mechanisms is enough to dictate therapy is fruitless sadly that pattern repeats itself through all medicine
Always question and keep on questioning! Suren der will only hurt!
April 26, 2016
I did enjoy this book. It is probably more technical than other books I've read regarding research (such as those by Ben Goldacre) but was still enjoyable and I learnt a lot. In particular, I enjoyed where the book related information directly to NSW or Australia rather than using American or UK examples constantly.
August 3, 2016
Very interesting.
April 17, 2017
A book that take us through the working of placebos and also why it's so important to rely on good scientific studies rather then the subjective feeling that a treatment work.
Displaying 1 - 26 of 26 reviews