Surgery and Clinical Trials: The History and Controversies of Surgical Evidence

Surgeons have long worked to produce objective evidence of the efficacy of their operations. In the nineteenth century, they increasingly used quantification and careful controls to analyse the outcomes of case series. In the twentieth century, sceptics demanded that surgeons perform randomized control trials to determine if operations relieved symptoms and improved survival. The history of these trials and the ensuing controversies has not been well studied by historians, even though it presents a valuable opportunity to examine how and why surgical judgement and standards of knowledge changed over time. Histories of surgical trials can broaden our knowledge of surgical practice and point to the limits of evidence-based medicine.