The ethics of innovation

![][1] Last summer, researchers from the Veterans Affairs Medical Center (Houston, TX, USA) published the startling results of a placebo‐controlled study of arthroscopic surgery. At no point, they reported, did the patients in the surgery group report less pain or better functioning of the knee than the patients who received placebo surgery—just cutting the knee without further intervention—according to lead investigator J. Bruce Moseley (Moseley et al ., 2002). Scientists have long known about the placebo effects of medical treatments, so the outcome of the study is not necessarily a revelation. What is more surprising is that this type of arthroscopic surgery has never been tested before in a placebo‐controlled study to determine its merits, as is the case for many other forms of surgery and surgical techniques. It raises new and serious questions about the ethics and efficiency of surgical practice and other forms of medical intervention, which, unlike new drugs and medical devices, are not subject to rigorous clinical trials.“Historically, surgical research has not been held to the same scientific, regulatory and ethical standards as other medical research,” said Dorothy Vawter, a bioethicist at the University of Minnesota's Center for Bioethics (Minneapolis, MN, USA). There is a growing debate about whether more control is needed over new surgical innovations. At present, only ∼7% of surgical investigators use a randomized‐study design of any type, according to a report in The Lancet (1999). Another study found that, during the previous four decades, only 10–20% of surgical techniques have undergone any clinical trials (Salzman, 1985). “An increasing emphasis on technological innovation and the practice of describing ’new‘ surgeries to the newspapers before they are formally tested, makes the need for more thoughtful dialogue about what constitutes human research and how to best protect patients’ rights even more urgent,” commented ophthalmologist and … [1]: /embed/graphic-1.gif