Economics of sham operations

Dalrymple comes across a paper in the New England Journal of Medicine comparing physical therapy with surgery for meniscal tears in the knees of people with osteoarthritis.

There was no difference in outcome, an important finding since 465,000 people undergo operations for this situation every year in the USA alone.

Actually, says Dalrymple,

the uselessness of operation had been established before — uselessness from the patients’ point of view, that is. Two previous trials had compared real with sham operations, and with no operations at all, and found no difference in the outcome two years later. One might suppose that, in the light of these findings, the 465,000 operations still performed annually constituted something of a scandal.

Dalrymple considers the economic aspect of unnecessary operations. Granted that

unnecessary operations are more expensive than intensive physical therapy, do these operations increase or decrease gross national product? At first sight they do. As everyone knows, operations are not cheap. Without them, the GDP would fall. So would the incomes of those who perform them – orthopædic surgeons, for example, and their hangers-on such as operating room nurses. Presumably their incomes have a multiplier effect, for example on the legal profession. On the other hand, there are opportunity costs of employing money in this rather futile, indeed counterproductive, manner. But would the money in fact be better employed elsewhere? Would not something just as unproductive be done with it?

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