By: 19 April 2019
Book review: Surgery, The Ultimate Placebo

Author: Ian Harris, an experienced and practicing orthopaedic surgeon

Publisher: New South Publishing
Year: 2016

What if many of the commonly performed surgeries were no better than placebo and surgeons performing them were no better than practitioners of alternative medicine?

That is the tantalising message that Prof Ian Harris has put forth in his latest book, a thought-provoking, well-researched and informative book addressed to a specialised audience within surgery and medicine, but also of value to a general audience.

This book cuts through the evidence to show how commonly performed operations can be useless or harmful. This is true for invasive procedures that seem to improve subjective symptoms without a change in the objective symptoms. The overestimation of effect of surgery is due to the way we perceive it.

Dr Harris explains the lack of research behind several current common surgical procedures, such as back fusion, knee arthroscopy, shoulder surgery for impingement, C-section, hysterectomy and others.

The book comes in nine chapters:

1 – Discusses the placebo effect and the history

2 – Explains why there is good and bad science

3 – How surgery fits the bill of the ultimate placebo

4 – Find how commonly performed operations have been found to be useless

5 – Looks at operations that have not stood the test of time

6 – What current operations might be discarded in the future?

7 – How human nature maintains placebos

8 – What’s wrong with using placebo surgery?

9 – What can we do about it?

Medicine is the art of amusing the patient until nature cures the disease, and nobody has to have surgery. Many studies about the effectiveness of operations have failed the test of reproducibility as the patients’ enthusiasm to see the treatment work can bias the results.

Reading this book, you will understand how human nature perceives the body as a physical machine rather than a biological organ, we then fall in the mindset of thinking that we need to fix tissue damage to get better, and how patients perceive non-operative treatment as no treatment.

My only significant complaint is that I would have liked citations to studies clearly footnoted to allow the reader to go back and review for better understanding. But I also understand that this book tries to embrace a larger non-medical audience that might be intimidated by text littered with citations and footnotes.

I would encourage everyone to read this. It is truly fascinating and very revealing. The messages from this important book have been bravely and clearly articulated, with good grace and humour. For anyone doing or having surgery, or considering doing or having surgery, this is a must read. The uncomfortable reading should result in the important question, the placebo risk may be real, but is it worth the cost and the risks?

If any publishers would like their orthopaedic books reviewed in OPN, please email Firas Arnaout on