- Economics
- Political Philosophy
- Education
- Answering Challenges to Advanced Economies
- Reforming Education
- Understanding the Effects of Technology on Economics and Governance
What if the surgery that fixed your knee did no better than fake surgery? EconTalk host Russ Roberts speaks with Dr. John Mandrola about a striking clinical trial in which patients who received sham knee surgery (a real incision, but no actual repair) did as well or better than those who had the actual procedure — one performed 700,000 times annually in the US. The conversation ranges from the power of placebo and nocebo effects (how expectation of harm can cause real suffering) to the broader philosophy of "medical conservatism" — the idea that humility, watchful waiting, and honest counsel often serve patients better than the knife. Mandrola argues that financial incentives, professional identity, and language itself ("bone-on-bone," "the widowmaker") conspire to push patients toward interventions that can do more harm than good.
Listen to the episode here.
ABOUT THE SPEAKER
Dr John Mandrola is a cardiac electrophysiologist based at Baptist Health in Louisville, Kentucky. In addition to his clinical work, he is widely recognised as a leading voice in contemporary cardiology through his writing, podcasting and public engagement. Dr Mandrola is known for his clear, patient-focused commentary on cardiovascular care, evidence-based medicine and the responsible use of medical technology.
RELATED SOURCES
- Dr. John Mandrola's Website
- Stop and Think Substack
- Sensible Medicine Substack
- "Bravery (and Humility) is Needed to do Proper Medical Science" by John Mandrola in Sensible Medicine. May 2026
- "Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear" by Raine Sihvonen, M.D., Mika Paavola, M.D., Ph.D., Antti Malmivaara, M.D., Ph.D., Ari Itälä, M.D., Ph.D., Antti Joukainen, M.D., Ph.D., Heikki Nurmi, M.D., Juha Kalske, M.D., and Teppo L.N. Järvinen, M.D., Ph.D., for the Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group, in The New England Journal of Medicine. 2013
- "A Placebo-Controlled Trial of Percutaneous Coronary Intervention for Stable Angina" by Christopher A.Rajkumar et al. in The New England Journal of Medicine. November 2023
- Nocebo Trial "N-of-1 Trial of a Statin, Placebo, or No Treatment to Assess Side Effects" by Frances A.Wood et al. in The New England Journal of Medicine. 2020
- Cement in Vertebrae Study "Vertebroplasty and the Placebo Response" by Franklin G Miller, David F Kallmes, and Rachelle Buchbinder in Radiology. June 2011
- Adam Cifu on Ending Medical Reversal on EconTalk
- Adam Cifu on the Case for Being a Medical Conservative on EconTalk
- "Finnish Degenerative Meniscal Lesion Study (FIDELITY): a protocol for a randomised, placebo surgery controlled trial on the efficacy of arthroscopic partial meniscectomy for patients with degenerative meniscus injury with a novel 'RCT within-a-cohort' study design" by Raine Sihvonen, Mika Paavola, Antti Malmivaara, Teppo L N Järvinen in BMJ Open. March 2013
- Vinay Prasad on Cancer Screening on EconTalk
- Eric Topol's EconTalk Archives
- "The Case for Being a Medical Conservative" by John Mandrola, MD; Adam Cifu, MDb; Vinay Prasad, MD, MPHc; Andrew Foy, MD in The American Journal of Medicine. August 2019
- This Week in Cardiology Podcast
- The Vision of the Anointed: Self-Congratulation as a Basis for Social Policy by Thomas Sowell on Amazon.com
