Category: Surgical Procedures
ORBITA: Another clinical trial demonstrating the need for sham controls in surgical trials
Last week, the results of ORBITA were published. This clinical trial tested coronary angioplasty and stenting versus optimal medical management in patients with single-vessel coronary artery disease. It was a resoundingly negative trial, meaning that adding stenting to drug management didn't result in detectable clinical improvement. What was distinctive about this trial is that it used a sham procedure (i.e., placebo) control,...
Naturopaths are fake doctors cosplaying real doctors (even the ones running dubious stem cell clinics)
Naturopaths are fake doctors who, increasingly, are cosplaying real doctors. Not surprisingly, because naturopaths go where quacking takes them, they've started to open their very own dubious stem cell clinics, thus combining the worst of both worlds, their "natural" quackery with dubious unproven but "high tech" treatments being peddled by the worst of real doctors.
In Pursuit of Patient Safety
[Editor’s note: With Dr. Gorski enjoying a vacation to recharge his batteries, we present a second offering from contributor James Thomas. Enjoy!] Advocates of CAM* (Complementary and Alternative Medicine) have long argued that mainstream medicine is a dangerous undertaking using toxic drugs and invasive interventions that often do more harm than good, while the various quackeries huddled under the CAM umbrella are...
Carotid Artery Stenosis: Surgery, Stent, or Nonsurgical Stroke Prevention?
The carotid artery in the neck is a common site of atherosclerosis. As plaque builds up, it leaves less room for blood flow and can cause strokes through clotting or embolization. Carotid stenosis is defined as a greater than 70% narrowing of the lumen (the space through which the blood flows in an artery). It can cause symptoms, including transient ischemic attacks...
The cost of repealing mandatory motorcycle helmet laws
It’s a seldom mentioned aspect of my professional history that I used to do a lot of trauma surgery in my youth. I did my residency at a program that included a county hospital with a busy trauma program where I saw quite a bit of vehicular carnage and an urban hospital (which has since closed) where I saw a fair amount...
You’ve been diagnosed with breast cancer. How soon do you need treatment?
Timely surgery for breast cancer is obviously better than delaying surgery, but how long can a patient safely wait for surgery once diagnosed. Because a randomized controlled clinical trial to answer this question would be unethical, this has been a difficult question to answer. Fortunately, a new study provides an estimate of how much of a delay it takes before outcomes start...
On “integrative medicine” and walking and chewing gum at the same time
Evidence matters. Science matters. However, when advocates of "integrating" quackery into medicine via the vehicle of "integrative medicine" invoke weak science and poor quality evidence in conventional medicine in response to criticism, what they are really doing is deflecting attention away from their quackery. More importantly, advocates of science-based medicine are capable of walking and chewing gum at the same time. We...
An Alternative to Appendectomy: Antibiotics
My title doesn’t refer to alternative medicine, it refers to an alternative within medicine: treating appendicitis with antibiotics instead of surgery. You may be surprised to learn that patients with appendicitis don’t always automatically need an appendectomy. A recent randomized controlled trial in Finland compared surgery to medical treatment. History of appendicitis treatment There is an excellent, detailed history of appendicitis available...
Should placebos be used in randomized controlled trials of surgical interventions?
Trials of new experimental drugs frequently compare them to placebo, particularly when there is a large subjective component to the disease being treated, such as pain. In contrast, placebo-controlled trials are rarely undertaken in surgery, mainly because it's been considered ethically dicey to do sham surgery on one group. Should this change? Should we be more open to doing randomized, placebo-controlled surgery...
Angelina Jolie, surgical strategies for cancer prevention, and genetics denialism (revisited)
Sometimes, weird things happen when I’m at meetings. For example, I just got home from the Society of Surgical Oncology (SSO) meeting in Houston over the weekend. Now, one thing I like about this meeting is that, unlike so many other meetings these days—cough, cough, ASCO, I’m looking at you—at the SSO there wasn’t a single talk I could find about “complementary...