The ethics of innovation

The ethics of innovation

Should innovative surgery be exempt from clinical trials and regulations?

Last summer, researchers from the Veterans Affairs Medical Center (Houston, TX, USA) published the startling results of a placebo-controlled study of arthroscopic surgery. At no point, they reported, did the patients in the surgery group report less pain or better functioning of the knee than the patients who received placebo surgery—just cutting the knee without further intervention—according to lead investigator J. Bruce Moseley (Moseley et al., 2002). Scientists have long known about the placebo effects of medical treatments, so the outcome of the study is not necessarily a revelation. What is more surprising is that this type of arthroscopic surgery has never been tested before in a placebo-controlled study to determine its merits, as is the case for many other forms of surgery and surgical techniques. It raises new and serious questions about the ethics and efficiency of surgical practice and other forms of medical intervention, which, unlike new drugs and medical devices, are not subject to rigorous clinical trials.

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