If placebo surgery didn't violate the Hippocratic edict "First, do no harm," what did?
It may be that "placebo surgery" isn't such an oxymoron after all.
Over the next decades, the whole idea of placebo surgery fell out of favor with ethicists and patient advocates.
The controversy, they wrote, comes because doctors assume that patients in clinical research should not be put at risk if they cannot benefit, and placebo surgery involves risk.
One, by Sam Horng and Dr. Franklin G. Miller of the National Institutes of Health, asks whether placebo surgery is unethical.
If placebo surgery makes sense, it makes sense because of the growing body of evidence for the strength of the placebo effect in general.
In the current case, they wrote, all those objectives were met and the study "exemplifies the ethically justified use of placebo surgery".
It was a popular technique -- 90percentt of patients reported that it helped -- but when Cobb compared it with placebo surgery in which he made incisions but did not tie off the arteries, the sham operations proved just as successful.
The 180 participants in the study were randomly assigned to have the operation or to have placebo surgery in which surgeons simply made cuts in their knees so the patients would not know if they had the surgery.
Tests of knee functions revealed that the operation had not helped, and those who got the placebo surgery reported feeling just as good as those who had had the real operation.
Some doctors argue, with reason, that the new enthusiasm for placebo surgery is driven by hospital bean counters and insurers who want hard evidence that an expensive procedure works before they'll pay for it.
