"Studies Recommend Surgery For You" (But The Studies Can't Be Found)

Seth Robert’s doctor discovered he had a tiny hernia and referred him to a general surgeon, who recommended surgery. Seth, a psychology professor at UC Berkely and author of The Shrangri-La Diet, asked why. “It could get worse,” she said. “Why is it better to have surgery than not,” asked Seth. “Surgery is dangerous, expensive, and time-consuming.” The surgeon said clinical trials showed the benefits of this surgery. “Just use Google, you’ll find them.” Seth tried to find them. His mom, who does medical searching as her job, couldn’t find any completed clinical trials.

When he told the surgeon that he couldn’t find the studies, she said, “Well find some and copy them for you.” Over a month later, the studies had never materialized. Perhaps they don’t exist.

Maybe the doctor is just lazy or busy or misinformed or didn’t feel like having Seth as a patient, or maybe she wanted to bill for unnecessary surgery. Either way, it’s important to ask your doctor questions about the procedures and care they advise, and ask for evidence and more information to back up their recommendations, especially when you’re unsure about their efficacy.

(Photo: aesop)

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  1. anonvmoos says:

    good for seth!

    insert comment about doctors are all ‘practicing’ medicine anyways…

  2. chiieddy says:

    I always ask for the least evasive solution to a problem. Surgery is, by far, the most evasive solution.

  3. bsalamon says:

    I have a bad wrist – slightly torn ligaments and two bible-cysts…Doctor pretty much refuses to do surgery, because it makes no sense
    Maybe some doctors aren’t surgery lovers.

  4. Frank_Trapasso says:

    I prefer surgery. Surgey sounds too risky.

  5. “You need surgery because it costs a–I mean, because there’s studies. Yes, studies.”

    If I had a nickel every time I heard a similar line, I’d have enough money to afford surgery!!

  6. Amy Alkon000 says:

    An epidemiologist I know taught me the word “iatrogenesis” — after I had memory loss for about a month and diminished cognitive ability for about a week following being given the anesthesiology known as “conscious sedation” for a procedure:

    [en.wikipedia.org]

    The terms iatrogenesis and iatrogenic artifact refer to adverse effects or complications caused by or resulting from medical treatment or advice. In addition to harmful consequences of actions by physicians, iatrogenesis can also refer to actions by other healthcare professionals, such as psychologists, therapists, pharmacists, nurses, dentists, and others. Iatrogenisis is not restricted to conventional medicine and can also result from complementary and alternative medicine treatments.

    Some iatrogenic artifacts are clearly defined and easily recognized, such as a complication following a surgical procedure. Some are less obvious and can require significant investigation to identify, such as complex drug interactions. And, some conditions have been described for which it is unknown, unproven or even controversial whether they be iatrogenic or not; this has been encountered particularly with regard to various psychological and chronic pain conditions. Research in these areas is ongoing.

    Causes of iatrogenesis include medical error, negligence, and the adverse effects or interactions of prescription drugs. In the United States, 225,000 deaths per year may be iatrogenic, making it the third leading cause of death.[1]

  7. pemarsh says:

    tell ya what….let him wait till the hernia gets incarcerated at 200am in the er…he will wish he had the surgery then!

  8. jacksbrokenego says:

    Actually – hernia’s can get worse. I’d say the chances of it getting worse are likely far greater than it getting mysteriously better on it’s own. My girlfriend had a ‘tiny hernia’ that did in fact get much worse, about a year later, to the point where she had trouble walking and had to have surgery to correct it.

  9. mariospants says:

    Can’t they do local anesthesia for a hernia operation these days? I thought they could actually do it via an available opening such as your belly button or anus as well.

    Oh well, my recommendation to the guy would be to get the surgery unless he’s comfortable living the rest of his life with a truss or something. It would be idiotic to allow it to get worse (which it will).

    • Nighthawke says:

      @mariospants: Hernia problems are deep-tissue problems. Locals only numb the tissues surrounding the injection points and won’t do much good for the deeper locations.

  10. laserjobs says:

    One thing to always remeber “Everyone is a salesman”

    Good on Seth for actually doing some research before saying yes. Most people will always say yes to an authority in which they are consulting without checking things out first.

  11. Jesse says:

    If something seems unnecessary, it’s always wise to seek a second opinion.

  12. satoru says:

    I’m not sure what research Seth did but not treating a hernia can be a serious problem. The isn’t any indication where this hernia is but depending on where you can get quite a few non-trivial things happening to you. A quick search of Wikipedia:

    It is generally advisable to repair hernias in a timely fashion, in order to prevent complications such as organ dysfunction, gangrene, and multiple organ dysfunction syndrome

    Surgery is always a risk but with current techniques the downtime and side effects are generally small and are considered day surgeries:

    Many patients are managed through day surgery centers, and are able to return to work within a week or two, while heavy activities are prohibited for a longer period. Patients who have their hernias repaired with mesh often recover in a number of days. Surgical complications have been estimated to be up to 10%, but most of them can be easily addressed. They include surgical site infections, nerve and blood vessel injuries, injury to nearby organs, and hernia recurrence.

    Note that the longer you let this go, you get into the area where complications become more of an issue especially with mesh rejection.

  13. Get the hernia fixed, but ask around. I bet you know plenty of people who have had them, and if any of them have had multiple hernias, they’ll give you a good surgeon to go to.

    I walked out of the offices of 4 surgeons before I found the guy to do my (2nd and hopefully last) hernia surgery in May.

    The reason it could get worse is simple. You’d figure a professor would get it, but here goes. You have a small hole now. You’re constantly putting pressure on the edges of that small hole, and it slowly becomes bigger. Before you know it, every time you grab your briefcase in the morning you’re using your other hand to hold in the lump in your groin. I’ve been there, it sucks, endure the 3 weeks of discomfort from the surgery, and get on with your life. Both times I’ve had hernia surgeries done I had them done on Friday and was back at work on Tuesday.

  14. ThinkerTDM says:

    Hernias can get worse. So can a sinus infection. But my doctor doesn’t suggest surgery for that. The issue here is the lack of data showing that surgery can prevent hernias from becoming worse. And the doctor saying it is so doesn’t make it so.

    I applaud Seth for doing the right thing- research. What Seth wanted to find out is whether a surgical procedure showed better outcomes than no surgery for the type of hernia he had.

  15. ThinkerTDM says:

    …and he didn’t find it. He wanted quantifiable data, not a bunch of people on consumerist telling him to get it done.

  16. satoru says:

    Basically a hernia is not a self-limiting disease. It’s not going to ‘go away’ over time like a cold. It can’t be fixed except for surgery.

    It’s of course advisable to get a second opinion for any surgery. Small hernias may not need to be treated if the symptoms are small. Delaying treatment can indeed make things worse though.

  17. opsomath says:

    You know, I was told when I was a 16-year old high school wrestler that I had an inguinal hernia. (the good old “turn your head and cough” one).

    Being young and invincible feeling, I didn’t get it fixed. I’m 24 now, and did a total of 5 years of contact sports after that. I recently got a checkup and had them look for it; they couldn’t find it.

    So, maybe the guy’s got a point?

  18. nsv says:

    Sinus infections go away. I’ve never heard of a hernia that went away. (I’m not an expert and never had a need to research that, though.)

    Maybe step one of the research should be to scan the Internet and see what’s been written in reputable sources. I’m thinking step two should be to get a second and possibly third opinion.

    • ThinkerTDM says:

      @nsv: The article states that he did the research, and couldn’t find it.

      The issue is NOT whether hernias go away. The issue is that the doctor is telling the patient that studies have shown… and when the patient wanted to see these studies, they couldn’t be found.

      It may be that most hernia’s do require surgery. That’s fine. But Seth wanted to see the clinical research. And it wasn’t out there.

      • nsv says:

        @ThinkerTDM: I read the article. The point I was trying to make was that ok, he did the research, now it might be time to ask… amazingly… another doctor.

        Presumably they’re the folks who know the medical stuff. If you go to two or three different doctors and they all tell you the same thing, whether it’s what you want to hear or not, I’d think you’ve got to give their suggestions some weight. Or hey, keep searching the Internet. Someone must have written something this guy wants to read.

  19. Mr_Human says:

    “Some men with Hernia can safely wait to have surgery”

    This is the title of an article I found when I googled hernia surgery outcomes. Here’s the link:

    [findarticles.com]

  20. BeeBoo says:

    Laparoscopic hernia repair can be more complicated and dangerous than a simple open procedure.

    [www.bmj.com]

    In general, surgeons do surgery unless they think they’ll kill the patient. That’s how they pay their mortgages.

    And in general, hernias get worse, not better, although “watchful waiting” is frequently the best course for health problems.

    This is definitely a situation calling for discussion with a good, well-educated and trusted internist acting as a gatekeeper to services and a second opinion from a surgeon who does a lot of hernia repairs, for no other reason than the fact that the patient lacks confidence in the surgeon. Never have surgery with a surgeon you don’t trust unless you’re not going to trust any surgeon at all.

    • lululucy says:

      @BeeBoo: what BeeBoo said. Find out more about the surgery and do consider it, but DEFINITELY get a different surgeon. The answers the surgeon gave Seth are not acceptable answers, no way no how.

  21. mike says:

    To quote Scrubs: If there’s the slightest medical issue, you just turf the patient right down to us, the real doctors, so we can pick up your slack. You cut, and run, if you will. That’s right, it’s not just a phrase used by political pundits who wear bow ties. It is also the number one reason that all of you should pray to God, or, in your case Rex, Moko, the Samoan Bird King, that you never have to be treated by these flesh hungry butchers.

  22. ConwayKliker says:

    Some things are so well known you don’t need to do a study. For example I’m
    sure there is no study showing that stitches help heal deep lacerations.
    Does that mean you should turn down stitches when you are bleeding all over
    the place? Get a 2nd opinion, but don’t hold your breath on finding the
    hernia research you seek.

  23. lemortede says:

    Wow….
    I mean, you have a tear in the muscle wall that holds your guts in and you are what, waiting for a miracle to fix it.
    They can stay the same for a long time but generally get worse over time.
    I had a friend who put it off for years till his intestine was poking out. He held it in with a tennis ball on a piece of rubber and still put it off..
    Finally it got so bad he HAD to get it fixed, only then it was emergency life saving surgery.
    Get it fixed.

  24. rowlikeagirl says:

    As someone who worked for a while in an orthopedic surgeon’s office, I can tell you that most doctors and nurses operate (pun intended) on autopilot. In their defense, they see roughly the same injuries and ailments day in and day out, so for most of the time, their diagnoses are quick and correct. However, if a patient comes in with a complaint that sounds like one of their typical ailments — but might not be — count on it to be quickly diagnosed and treated as an obvious case of X. Remember, the more patients they see in a day, the more money they make — one of the fundamental flaws in our health-care system. For the record, the doctors and nurses I worked with were very nice people, and I enjoyed working there.

    • amish42 says:

      @rowlikeagirl:

      You’re absolutely right. Doctors tend to make a quick diagnosis based on what they commonly see and treat. Inguinal hernias are common and have been treated for years with surgery. So much so that the question of whether surgery is effective or not goes unquestioned. For Seth, there is evidence out there, but it does not involve US healthcare

      West Afr J Med. 2007 Oct-Dec;26(4):288-92.

      Morbidity and mortality associated with inguinal hernia in Northwestern Nigeria.

      Mbah N.
      Department of Surgery, Usmanu Danfodiyo University Teaching Hospital, P. M. B. 2370, Sokoto, 840001, Nigeria. nonsodr@yahoo.co.uk

      BACKGROUND: Treatment of uncomplicated inguinal hernia is relatively simple and the outcome is often favourable. Complicated hernias are fraught with increased mortality with and without operative management.
      OBJECTIVE: To determine the scope of adverse events which attend the management of inguinal hernia in extreme northwestern region of Nigeria.
      METHODS: Subjects. From the hospital records department, the case folders of all patients with the clinical diagnosis of hernia seen between January 2000 and December 2002 were retieved. Of the cases identified, 227 patients diagnosed of inguinal hernia, either alone or in combination with other forms of hernia formed the basis of this report. Relevant data extracted and analyzed included the patient’s demographics, clinical details, treatment offered and outcome.
      RESULTS: Two hundred and fifty three inguinal hernias in 227 individuals were seen.. This represented 76.9% of patients diagnosed of external abdominal hernias., 16 times more commonly in males than females. Fifty two (20.6%) hernias presented as acute abdominal emergencies while 225 hernias in 199 patients were repaired. Local anesthesia was used in 32 (16.1%) of the patients with 33 (14.7%) inguinal hernias. Four (1.8%) individuals were managed on day case basis. Twelve (5.3%) deaths occurred in this series, three of which were pre-operative. At a mean follow up of 7 months (range 1-23 months), 1 (0.4%) hernia recurrence was noted.
      CONCLUSION: Complicated inguinal hernias and their emergency surgical treatment are associated with increased mortality in our environment. Prophylactic elective herniorrhaphy is recommended as a safeguard for inguinal hernia as soon as identified irrespective of patient’s age.

      While it comes from Africa, I believe that this answers Seth’s question about the effectiveness of surgery. However, if he truly wants to find a clinical trial comparing surgery vs. no-surgery for inguinal hernias, he will not find it. Withholding surgery in inguinal hernia repair is considered unethical because it is a standard of care that readily fixes and addresses the problem. The only studies that he will find will be clinical trials that compare types of surgery against one another.

  25. khiltd says:

    I developed a minor sliding hiatal hernia after a prolonged bout of coughing due to an upper respiratory condition that the air quality in Houston refused to let go away. I was treated by three different doctors who all agreed that surgery was completely unnecessary and that the condition would abate once the coughing was kept under control. All three of them were right and I have no problems related to this hernia to this day, however any insurance company I divulge this information to refuses to provide me with coverage until I have surgery to fix a problem that went away 10 years ago.

  26. Jesse says:

    If Mr. Robert’s suggestion is that the doctor recommended surgery to bolster his/her bottom line that a little far fetched in my opinion.

    I am not a doctor, but in my view risk is not completely on the patient when it comes to surgery. There is also risk exposure with performing surgery to the doctor. Something can go wrong during any surgical procedure and if the surgery is ill-advised, then the doctor is looking at a lawsuit at the very least and possibly even having their license to practice medicine taken away. They have reasoning to not recommend surgery too in my book.

    The reasoning for the surgery is a little slim, but the Mr. Roberts can always go back to the surgeon and ask for more clarificiation or seek a second opinion by someone who is more willing to take the time to back his/her diagnosis.

  27. mizmoose says:

    This is a common problem. Doctors think they’ve read studies that claim that X is best treated with Y, and either they haven’t, or they’ve read ONE somewhere.

    Worse is when published studies (in peer-reviewed journals!) quote “facts” that are unproven or come from a flawed or since-retracted study. Then this study is quoted in another study… and so it snowballs.

    This is how you get things like 13 yr olds getting gastric bypass surgery. (There’s no proof that the surgery works — on anyone. There’s NO 10-year post-surgical data that says patients keep the weight off. There’s ONE study that claims to be long-term but only a small fraction of the patients in the study were more than 2 years past the surgery date.

    And Weight Loss Surgery doctors constantly use this study as “proof” that the surgery works long-term.)

  28. splsplinter24 says:

    Surgery is a very common and effective treatment for hernias. ALL surgeries have inherent risk. Hernia operations tend to be the most common and safe.

    And, as always, I ask…who has the most informed opinion in this case: a patient with google, or a doctor with a medical education?

  29. MrMold says:

    What a newbie. Most of the studies done on surgery were completed when paper was the medium. Google is great for stuff after the 1990s but not as good as a library for anything before then.

    Surgeons will operate if the patient persists. All that plasticizing of Hollywood and Florida would not take place without persistent patients.

    Seth has confused knowledge of psychology with medical knowledge. Simply put, one should not assume expertise unless one actually has it. And, I really don’t feel comfortable with a diet book author’s scientific credentials.

  30. junip says:

    This reminds me of the time I got a new dentist and needed a filling put in. After finding out all the stuff about metal fillings being bad and that more of your tooth has to be drilled away to put them in, I asked the dentist why he thought metal fillings were better than the amalgam ones that look like your normal tooth. He said that the amalgam ones often crack and fall out. Already having one of those fillings in my mouth for some time with no problems, I took his response as really meaning “I don’t know how to put the amalgam ones in correctly, so I always suggest metal.” He had also seemed kind of pissed I’d even questioned him.

    Needless to say I went to a different dentist who didn’t see a problem with the more natural looking fillings.

    Oh, and that time that a doctor wrote me a prescription for hives before I even had time to finish my sentence about what was happening. She said as she was handing me the prescription “We don’t know why this works, but it does.” That one went in the trash, and I cancelled my follow-up appt.

    Just because they’re doctors, doesn’t mean they’re right.

  31. simplekismet says:

    I think it’s really great that Seth’s attempting to do his research, but Google won’t work for this kind of thing. You need to go to a university or library so you can have access to something like PubMed. Since most people don’t have access to those things… get a second (or third, or fourth) opinion, and don’t go into surgery until you have a surgeon you’re comfortable with who makes you feel comfortable with the surgery.

    A PubMed search for “hernia morbidity and mortality” yielded 355 results, “hernia treatment” upwards of 25,000. That’s a lot to sift through… so I’d reckon that just because he didn’t find it, doesn’t mean it doesn’t exist. BUT if a doctor is going to use a journal article (clinical trials will eventually be written up in a journal somewhere) as justification for a procedure, he should damn well be able to tell you what article he’s using.

    The problem here isn’t that the doctor gave him bum advice but that the doctor’s bedside manner sucks. Find a new doctor (and please don’t ignore the hernia).

  32. mwshook says:

    Here’s what I could find on a quick search of pubmed:
    Emergency Presentation of Abdominal Hernias: Outcome and Re….
    This is not a great study, but its findings seem reasonable. In all truth, any seminal studies done on hernia repair were probably done long before the advent of the Internet. If you really wanted to research this, you would need to go to a medical library and sit down with the paper journals.

    To summarize the findings of this study, of the patients who presented to an ER with a hernia requiring emergent surgery, 46% had complications. Although the patients ranged in age from 5-92, the average age was 77.

    So… Based on the data from this one little study from 2007, the question may be phrased as “Do you want a simple surgery now? Or take the chance you will need major emergency surgery when you are elderly?” There’s probably not a clear answer to this question, and good luck finding hard numbers.

  33. bones says:

    The lump obviously has gotten bigger or else Seth wouldn’t have noticed it, and yes chances are that it will get bigger and more painful, and if Seth ignores it long enough it can become strangulated and result in emergent surgery with a colectomy and a temporary colostomy, and if Seth is lucky enough it will end with the strangulated bowel necrosing and he can end up with peritonitis, sepsis, and death as a consequence. So Seth has a choice fix a “small” hernia, which is always easier and safer or wait, risk death, end up with a colostomy and then he can have 2 holes to close with the major disfigurement that goes with the “large” incisions/holes necessary to fix what should have been fixed when it was “small”. By the way, the average general surgeon gets paid about $200 for this operation so they aren’t going to recommend spending 2-3 hours at the hospital and subsequent “free” office visits (they only get paid for the operation, post op checks are covered in the surgery charge) they recommend it because they don’t want your stupidity to cause your demise.

  34. dragonfire81 says:

    It’s amazing how much doctors or medical personnel can bs someone so easily by saying “studies have shown that…”

  35. DrDigg says:

    Here you go. But to be honest this stuff is so old that it is primarily in textbooks. Trust your doctor and get your hernia repaired before you end up in the er in the middle of the night with an incarcerated hernia.

    Inguinal hernia: obligatory indication for elective surgery? A prospective assessment of quality of life before and after plug and patch inguinal hernia repair.

    Langenbecks Arch Surg. 2003 Feb;387(11-12):417-20. Epub 2003 Jan 11.

    CONCLUSIONS: Plug and patch repair of unilateral inguinal hernia improves quality of life with a very low rate of procedural complications. Regarding freedom from pain, vitality, and physical activity there is significant improvement as compared to preoperatively. Therefore inguinal hernia repair should be intended in all elective cases and plug and patch repair appears as an excellent technique to improve quality of life.

  36. dakker says:

    From personal experience, i had a hernia i ignored for a couple of years….then it got painful, painful to the point of my not being able to get up and walk and i was forced to go the the ER
    –> i would recommend not letting it get to that point.
    If you can’t afford it wait a bit and save. The surgery for something like that isn’t terribly prohibitive with or without insurance as i had mine done without and it didn’t cost an arm and a leg.

  37. lovelyivy says:

    I had surgery to remove fibroids a few months ago- my doctor suggested I learn to live with them at first, until tests indicated that they may have begun to impede my kidney functions. Even then he went with the least invasive surgical option, which had me back at work in three weeks. I love my doctor!

  38. jimmydeweasel says:

    I found where 9 out of 10 doctors recommend Chesterfields. You aren’t looking hard enough.

  39. ElizabethD says:

    Jeez. Hernia repair is such a piece of cake and can prevent really gross problems. I think in many cases it’s “in and out” surgery where you don’t even spend a night in the hospital. Especially with a “tiny” hernia — don’t they do those laparascopically now?. I say DO IT and fuggedaboutit.

  40. Tonguetied says:

    “it’s “in and out” surgery” but it does take a while to recover!

    I can’t say one way or the other about the studies but I know that in just the month or so I had to wait for my surgery that I was surely ready for it by the time the date rolled around. I haven’t ever heard of using a tennis ball though!

    I know “the plural of anecdote is not ‘data'” but there you go…

  41. jimconsumer says:

    You have an evil doctor. They exist. I didn’t think they could, but they do.

    I went to see an ENT once about a polyp found in my sinuses after an MRI for a mild head injury. He said I had a “deviated septum” (nose bone that isn’t perfectly straight, though you can only tell it on x-rays) and that surgery to repair it was necessary, and that the polyp had to be removed, plus a bunch of other nasal surgery. Then he recommended a bunch of extra procedures (another MRI, done by his friend in the next office over, even though I’d already had an MRI done at the hospital – “I can’t use this one, you need another one, and my buddy next door can do it right now for half the price of anyone else in the area.”).

    He was running a scam. His buddy billed my insurance company more than the ER at the hospital did for the MRI. My insurance company looked over his diagnosis and refused to pay, considering it elective surgery. I was upset at first (insurance company screwing me?), but after some research and a second opinion, was glad they had. The “polyp” was completely normal, present in a large % of the population and causes no problems; the “deviated septum” is also something that most people have and surgery for such is almost purely cosmetic and really only fixes a crooked nose caused by a severe deviated septum (my nose looks perfectly normal and my nose bone is deviated to the extent virtually everyone else’s is). Second opinion not only didn’t recommend surgery, he refused to perform surgery on moral grounds because I simply didn’t need it and there was nothing to gain and everything to lose.

    Thank God I got that second opinion.

    Lesson learned: Doctors are people and some people are evil and evil doctors will perform all kinds of unnecessary procedures on you, yes even cutting you up and doing things that don’t need done, for money. They exist. This guy trumped his own private surgical suite in his own office as a major bonus and had a million reasons why it was better than the hospital. As it turns out, he’d lost his surgical privileges at the hospital for being, well, immoral and evil. These are the sorts of facilities where people die while the surgeon does nothing to help you because he’s the one who fucked up and doesn’t want to go to jail.

  42. MikeH30 says:

    the biggest example of this is circumcision, no study has ever shown it’s beneficial enough to do as a preventative measure as there is no benefit that isn’t easily treatable before the patient is old enough to decide on their own

    but if a doctor can make $500 per circumcision for 10 minutes of work that’s pretty good, and if he circumcises 3 a day that’s well over $500,000

    the defenseless are the biggest victims of this