> "But the decision to operate should be based on the best science, not on the worst-case scenario. If the best evidence tells us that a procedure is not effective, or that the benefits are outweighed by the risks for some patients, then it should not be done."
As long as patients can sue their doctor, no sane doctor will do less than what the patient wants if there is a remote chance the procedure is slightly more effective. A simple but prominent example is the prescription of a generic drug versus the "original". Science tells us that there is absolute no difference. Now you tell the patient - the same patient who feels a very real, "objective" decrease in pain when being injected a saline solution instead of steroids.
And last but not least: the "best science" does not help us if doctors don't know about it. And some treatments are so weird that a doctor won't even consider it. Three anecdotes on that from my last 2 years:
1) British guy with pain in his knee. His doctor has been urging him to operate for years now. But he works in Nigeria on a oil drilling project in a good position and rather would prefer to wait the few years until he retires. The local "joujou"-man told him to rub python fat into his knee. It works for him! He told his doctor in the UK who dismissed that and told him that he might get into trouble for repeatedly rejecting sound medical advice. Shortly after I meet this guy in the Caribbean on his holiday, he tells me that story, I am skeptical and do some googling: 5 Minutes later I find a scientific study that proved that python fat is indeed a very good treatment for his condition. He mailed that to his doctor who read it and now leaves him alone. Snake oil, anyone?
2) Sahrawi ecologist with kidney stones but without the money to pay for the medical procedure to have them removed. He turns to local folk medicine, for a week he drinks a concoction that makes the stones break up and he can pass them naturally pretty much without pain. His doctor in Rabat speaks of a "miracle".
3) Business man in Casablanca was told by his doctor that he either needs surgery on his knee or he should try the traditional desert treatment: Undress, get buried in hot sand, 30 minutes later get into a tent, firmly wrapped. Repeat for 3 days. When I met him he was on his way back from his 5th treatment - he says he does it every 2 years and thereby has avoided surgery for 10 years.