Placebo controlled trials are needed in a few well selected conditions

Surgical technology has advanced exponentially in recent years, although our attitudes toward its introduction into contemporary practice remain archaic. Whereas strict licensing regulations exist for all novel prescription drugs, surgical innovation is assimilated relatively unchecked. Minimal access technologies have represented a particular problem. Previously, the mainstay of surgical innovation centred on technical modification of standard procedures of surgical care. The studies were therefore based on comparison with gold standard and rarely placebo or sham operations. The advent of minimal access methods, with their promise of reduced trauma associated with surgery, has led to a large increase in proposed roles for surgery, although, as for many current gold standards in surgery, a foundation of robust evidence is lacking.

Moseley and colleagues' recent study has once again raised the spectre of placebo controlled trials in surgery.1 They found that arthroscopic intervention for osteoarthritis of the knee had no increased therapeutic benefit compared with placebo operation. This is an important example, not …