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• W2077776858 abstract "In the 1950s, ligature of internal mammary arteries (under local anaesthesia) was an accepted treatment for angina pectoris. Ligature of these thoracic wall arteries was believed to open or create collateral blood vessels to the ischaemic myocardium, although such anastomoses were never detected. Responses seen after mammary arteries had been prepared for ligature but not ligated prompted placebo trials to be done. They showed that sham procedures were as effective as ligatures and that their response was maintained for at least 6 months.1Wall PD The placebo and the placebo response..in: Wall PD Melzack R Textbook of pain. 3rd edn. Churchill-Livingstone, Edinburgh1994: 1297-1307Google Scholar Anaesthesia also evokes a placebo response: sham spinal anaesthesia provides substantial and protracted relief of chronic pain.2Lloyd JW Hughes JT Davies-Jones DAB Relief of severe intractable pain by barbotage of cerebro-spinal fluid..Lancet. 1972; i: 354-355Google ScholarCan history repeat itself? Daniel Burkhoff and colleagues3Burkhoff D Schmidt S Schulman SP et al.Transmyocardial laser revascularisation compared with continued medical therapy for treatment of refractory angina pectoris: a prospective randomised trial..Lancet. 1999; 354: 885-890Summary Full Text Full Text PDF PubMed Scopus (283) Google Scholar report a trial of surgery for angina. After thoracotomy under general anaesthesia, channels were pierced through ischaemic myocardium to the ventricular chamber by means of a laser beam. “Angiogenesis and growth of existing vessels… due to inflammation in response to the microinjuries around the channels” is the putative mechanism of action. Patients were assigned either surgery and medication or medication alone. Sham surgery was not included (ie, placebo response to surgery was ignored). The investigators admit that “improvements may be due to a placebo effect”. However, to admit that bias exists does not remove the obligation to avoid it.Sham procedures may be unethical. But how ethical are methodologically flawed trials? Their results-inevitably biased-will guide other patients' treatment. In the 1950s, ligature of internal mammary arteries (under local anaesthesia) was an accepted treatment for angina pectoris. Ligature of these thoracic wall arteries was believed to open or create collateral blood vessels to the ischaemic myocardium, although such anastomoses were never detected. Responses seen after mammary arteries had been prepared for ligature but not ligated prompted placebo trials to be done. They showed that sham procedures were as effective as ligatures and that their response was maintained for at least 6 months.1Wall PD The placebo and the placebo response..in: Wall PD Melzack R Textbook of pain. 3rd edn. Churchill-Livingstone, Edinburgh1994: 1297-1307Google Scholar Anaesthesia also evokes a placebo response: sham spinal anaesthesia provides substantial and protracted relief of chronic pain.2Lloyd JW Hughes JT Davies-Jones DAB Relief of severe intractable pain by barbotage of cerebro-spinal fluid..Lancet. 1972; i: 354-355Google Scholar Can history repeat itself? Daniel Burkhoff and colleagues3Burkhoff D Schmidt S Schulman SP et al.Transmyocardial laser revascularisation compared with continued medical therapy for treatment of refractory angina pectoris: a prospective randomised trial..Lancet. 1999; 354: 885-890Summary Full Text Full Text PDF PubMed Scopus (283) Google Scholar report a trial of surgery for angina. After thoracotomy under general anaesthesia, channels were pierced through ischaemic myocardium to the ventricular chamber by means of a laser beam. “Angiogenesis and growth of existing vessels… due to inflammation in response to the microinjuries around the channels” is the putative mechanism of action. Patients were assigned either surgery and medication or medication alone. Sham surgery was not included (ie, placebo response to surgery was ignored). The investigators admit that “improvements may be due to a placebo effect”. However, to admit that bias exists does not remove the obligation to avoid it. Sham procedures may be unethical. But how ethical are methodologically flawed trials? Their results-inevitably biased-will guide other patients' treatment." @default.
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• W2077776858 date "1999-12-01" @default.
• W2077776858 modified "2023-09-30" @default.
• W2077776858 title "Transmyocardial laser revascularisation in clinical practice" @default.
• W2077776858 cites W2103165076 @default.
• W2077776858 doi "https://doi.org/10.1016/s0140-6736(05)76765-9" @default.
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