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Back in June, the SITU team took charge of the back pages of the Journal of Trauma and Orthopaedics to discuss the key issues around placebo-controlled trials in surgery. However, unless this reward was delivered through your door as a perk of your British Orthopaedic Association membership (or you follow some niche personalities on Twitter), there’s every chance you missed it. Here’s what’s waiting for you...

Placebo surgery: fake news or the real deal

David Beard and Marion Campbell discuss whether it can ever be sensible to propose a placebo-controlled trial in surgery: cutting patients open for science, with the (potentially) therapeutic bit of the operation left out. And, if you get past that hurdle, there’s more on the ‘why’ and the ‘how’ to conduct these trials.

Read the 'Placebo surgery: fake news or the real deal' article. 

Are surgical placebo controls ethically justifiable?

Naomi Merritt and Marcus Jepson share their experiences from the CSAW trial to discuss the challenges of delivering a placebo-controlled trial in surgery. How hard (or easy?!) was it to recruit patients? What were the ‘hidden challenges’? And, what’s the bottom line?

Read the 'Are surgical placebo controls ethically justifiable' article. 

The last word on placebo-controlled surgical trials

A foray into the mind of the orthopaedic surgeon. Abtin Alvand and I discuss whether surgeons will ‘buy in’ to a trial design with a placebo-control. What do you tell the patient before surgery? And, will the trial result change practice?

Read 'The last word on placebo-controlled surgical trials' article. 

The social media perspective

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As expected, opinions are divided on Twitter! The SUcceSS trial features prominently for me and debate about which procedures are appropriate to choose. What does yours say?

Read about the SUcceSS trial. 

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Further reading

ASPIRE guidelines

The Applying Surgical Placebo in Randomised Evaluations (ASPIRE) checklist is available to guide best practices for designing and conducting placebo-controlled trials in surgery.

Read the ASPIRE Guidelines in this abstract.

DITTO framework

The DITTO framework details five stages to guide the design and delivery of invasive placebo interventions in RCTs.

Read the 'Optimizing the design of invasive placebo interventions in randomized controlled trials' abstract. 

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Article Cited: Cousins, S., Blencowe, N. S., Tsang, C., Chalmers, K., Mardanpour, A., Carr, A. J., Campbell, M. K., Cook, J. A., Beard, D. J., & Blazeby, J. M. (2020). Optimizing the design of invasive placebo interventions in randomized controlled trials. The British journal of surgery, 107(9), 1114–1122. https://doi.org/10.1002/bjs.11509. Figure 1. 

Journal of Trauma and Orthopaedics

You can read the rest of the June edition (though, of course, we’ve already highlighted the best articles!)

Read the June edition in this article.