Why do I mention sham surgery? Because in the 1950's, there was a popular surgical procedure to treat angina pectoris (cardiac chest pain) in which the internal mammary artery was tied off. But then, a surgeon named H.K. Beecher described the placebo effect of such surgery in a classic paper following a randomized trial of internal mammary artery ligation versus a sham operation. Thereafter, this surgical procedure was no longer done: it was the placebo effect, not the tying off of an artery, that resulted in the improvement.
I think that the current procedures for surgical treatment of diabetes fall into much the same category: the desire of the patient to succeed in weight loss as well as to obtain improved diabetes control needs to be accounted for, at least by a subgroup receiving identical lifestyle interventions without surgery, and with the instructors blinded to whether the patient did or did not have the surgery. And if sham surgery could be approved by the IRB approving the conduct of the trial, then include a sham surgery subgroup in the study.
So, again, my advice to people asking about having surgery to treat their diabetes: Realize that this is experimental surgery. And as such, this surgery should only be undertaken in a clinical trial setting, with a highly qualified team, and appropriate safeguards so that subsequent publication of the results can help future physicians to thoroughly understand the advantages and disadvantages of such surgery.
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