Make exercise as sexy as the scalpel

An excellent short opinion piece by Jørgen Jevne in the British Medical Journal about unnecessary shoulder surgeries, with broad applicability to other orthopedic surgeries. Here are some highlights (with related references):

For over twenty years, surgery has failed to provide superior outcomes compared to conservative therapy for the treatment of subacromial pain syndrome. The results are consistent and with methodology more rigorous, the differences are even smaller, as illustrated by recent systematic reviews. [Saltychev et al]

Shoulder pain remains somewhat of a medical mystery and the ambiguities are nicely illustrated by a 2009 study, which showed that a bursectomy alone had comparable effects to removing the acromion and bursa. [Henkus et al]

Surgeons have generally been reluctant to perform placebo surgery …

The few orthopaedic placebo surgeries that have been published have had discouraging results and created fierce debate within the scientific community. However, a recent systematic review does indeed show that the concept of placebo surgery is both warranted and ethically justified. [Wartolowska et al]

… orthopaedic surgery has enjoyed amnesty from scientific inquiry for far too long. [Aspenberg]

And the coup de grâce, so good I made a picture of it …