DOCTORS are calling for new surgical techniques to be subjected to the same level of evaluation as new drugs amid fears some procedures don't work and could be harming patients.
Surgeon and director of the Whitlam Orthopaedic Research Centre Ian Harris said less than half of the operations performed in Australia had been evaluated by rigorous trials to check they were better than placebos or non-operative alternatives.
Together with rheumatologist Rachelle Buchbinder, Professor Harris wrote in The Medical Journal of Australia this week that without such trials, it is difficult to know whether patients are truly improving after some procedures.
Their concern comes as debate rages about the merits of several common operations, including arthroscopy for osteoarthritis of the knee, spine fusion surgery for low back pain and carotid artery surgery for people with blockages in their necks.
In all three cases, there is mounting evidence the procedures are either ineffective or less useful than other treatments while exposing patients to the risks of surgery, which include potentially life-threatening infections and blood clots.
Professor Harris and Professor Buchbinder said although there had been increasing recognition of the importance of evidence to inform medical practice, ''changing of clinician beliefs and behaviour, even in the face of credible evidence, remains highly challenging''.
While commercial interests are potentially at play for surgeons, Professor Harris said too much medical training was based on mentoring rather than up-to-date science. This created a sense of ''prevailing wisdom'' among doctors who continued to perform procedures for many years despite evidence they should be dumped for other treatments.
''We often know something doesn't work, but out there are thousands and thousands of doctors who have been taught certain procedures and that's all they do. How do you get them to change and how do you change the expectations of patients?'' Professor Harris said.
Professor Buchbinder, director of Monash University clinical epidemiology at Cabrini Health, said many surgeons might not believe the evidence either and look for reasons to challenge it.
''I think surgeons are much more likely to believe their own experience and not understand the role of the placebo effect in making their patients better, which is probably heightened by having an operation,'' she said.
To start working on the problem, Professor Harris and Professor Buchbinder said new procedures should be subjected to the same level of evaluation as new drugs, which are tested in clinical trials over many years before they can be used.
The surgical director of the Australian safety and efficacy register of new procedures at the Royal Australasian College of Surgeons, Guy Maddern, agreed with the need for more trials, but said it was difficult to get funding. Although it could take a long time to convince surgeons of new evidence, attitudes were changing, he said.
