Dr. Means' recommendations regarding the re-naming of "sham" surgery as "placebo" surgery is very appropriate. While we, as orthopaedic surgeons, may not want to admit it, our explanation of a condition or disease to a patient or the goals of surgery can bias a patient's decision. Even inclusion in a "sham" or "placebo" trial can give the patient a "therapeutic misconception."

In addition to merely changing the terminology, physician-researchers should and will need to follow strict guidelines when embarking on such studies. "Placebo" surgery has a role in our profession as we move forward.

To The Editor:

I think we would all agree that Prospective Randomized Controlled Trials (PRCTs) are the best way for us to determine standards of care in the practice of evidence based medicine. The article by Mehta et al.(1) was an excellent review of the ethics involving, and need for, so called sham surgery. Perhaps one small way to decrease resistance to the concept of sham surgery would be a simple name change. I imagine that IRBs and our patients are reluctant to consider something with such a negative connotation as "sham".

A PubMed(2) text search of "sham surgery" vs. "placebo surgery" reveals nearly 40 times as many results for the former (1277 vs. 33). Using "placebo surgery" instead, as Moseley et al.(3) did, may be helpful in allowing us, our patients, and the general public to more open-mindedly consider the option.

The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated .

References:

1. Samir Mehta, Thomas G. Myers, Jess H. Lonner, G. Russell Huffman, and Brian J. Sennett. The Ethics of Sham Surgery in Clinical Orthopaedic Research. J Bone Joint Surg Am 2007; 89: 1650-1653.

2. http://www.ncbi.nlm.nih.gov/sites/entrez

3. Moseley JB, O'Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH, Hollingsworth JC, Ashton CM, Wray NP. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002;347:81-88.