143. "The Placebo Effect in Surgery: Are Common Operations Ineffective? with Orthopedic Surgeon Ian Harris"

In this episode of the Radically Genuine Podcast, Dr. Roger McFillin is joined by Dr. Ian Harris, an esteemed orthopedic surgeon in clinical practice in Sydney, Australia. He is a professor of orthopedic surgery with a PhD in evidence based medicine and surgery. He directs a research unit that focuses on outcomes of surgery and has published and presented widely in the field of surgical outcomes. He is the author of “Surgery, The Ultimate Placebo” and co-authored the book “Hippocrasy: How doctors are betraying their oath.”They explore the power of the mind in healing and the implications of placebo effects in surgical outcomes. From knee arthroscopies to spinal fusions, discover how expectations can influence recovery and why some common surgeries may not be as effective as believed. Gain insights into the scientific scrutiny of surgical procedures and the importance of rigorous evidence in medical practices. This conversation challenges conventional medical wisdom and highlights the need for transparency and patient-centered care.Timestamps and Key Points:Introduction (0:00 - 2:25)- Dr. Roger McFillin introduces the podcast and the topic of the placebo effect in medical interventions.- Brief explanation of the placebo effect and its significance in mental health and pain management.Guest Introduction (2:25 - 2:57)- Introduction of Professor Ian Harris, an orthopedic surgeon and professor with a PhD in evidence-based medicine.- Highlight his research focus on surgical outcomes and his books, "Surgery, The Ultimate Placebo" and "Hypocrisy, How Doctors Are Betraying Their Oath."Placebo Effect in Mental Health and Surgery (2:57 - 5:18)- Discussion on how placebo treatments can rival actual drugs in mental health.- Exploration of the placebo effect's impact on invasive medical interventions and surgeries.Understanding Placebo in Surgery (5:18 - 9:20)- Professor Harris explains the definition and confusion around the term "placebo."- Introduction of the concept of non-specific effects and how they relate to surgical outcomes.Scientific Scrutiny of Surgeries (9:20 - 17:25)- Explanation of how rigorous scientific studies (three-arm studies) help to understand the true effectiveness of surgical procedures.- Comparison of active treatment, placebo surgery, and no treatment groups.Surgeon’s Perspective and Clinical Decisions (17:25 - 19:53)- Professor Harris shares his journey from a general orthopedic surgeon to an evidence-based practitioner.- Discussion on observational versus experimental evidence in surgery.Examples of Ineffective Surgeries (19:53 - 27:59)- Specific examples of common surgeries with questionable effectiveness, such as arthroscopic knee surgeries and spine fusions.- Mention of geographic variations in surgical rates and the influence of financial incentives.Patient Expectations and Ethical Implications (27:59 - 33:32)- The role of patient expectations in treatment outcomes.- Ethical considerations of using placebo treatments and the importance of informed consent.Challenges in Medical Evidence (33:32 - 41:33)- Discussion on the flawed nature of much medical evidence, as highlighted by Dr. John Ioannidis' research.- The systemic issues in medical training and the influence of pharmaceutical companies on medical guidelines.The Role of Science in Medicine (41:33 - 57:18)- Emphasis on the need for scientific rigor in clinical practice.- The benefits of systems like Australia's Pharmaceutical Benefits Scheme and the limitations of pre-existing medical procedures.Conclusion (57:18 - 59:22)- Key takeaways from the conversation.- Encouragement for medical professionals to provide evidence-based care and for patients to seek informed consent.- Thanking Professor Harris for his insights and promoting his book for further reading.Closing Remarks (59:22 - 59:26)- Dr. McFillin closes the episode with a reminder of the podcast’s mission to provide radically genuine conversations on important topics.Note: This podcast episode is designed solely for informational and educational purposes, without endorsing or promoting any specific medical treatments. 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