Do Less, Heal More: The Case for Medical Conservatism (with John Mandrola)

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4.7 • 4.4K Ratings

🗓️ 29 June 2026

⏱️ 60 minutes

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Summary

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 U.S. 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.

Transcript

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0:00.0	Welcome to Econ Talk, Conversations for the Curious, part of the Library of Economics and Liberty.
0:07.9	I'm your host, Russ Roberts, of Sholem College in Jerusalem and Stanford University's Hoover Institution.
0:13.8	Go to EconTalk.org, where you can subscribe, comment on this episode, and find links and other information related to today's conversation.
0:21.2	You'll also find our archives with every episode we've done going back to 2006.
0:26.7	Our email address is mail at econTalk.org. We'd love to hear from you.
0:36.6	Today is May 20. It's 2026. And before introducing today's guest, I want to let listeners know.
0:42.4	We'll be doing an e-contalk book club around the Iliad by Homer. The first episode of that
0:49.5	book club will be with Ido Chevroni of Shalem College here in Jerusalem, who's been teaching the
0:55.8	Elliott here for over a decade, and that will air, if all goes as planned on July 6th,
1:01.4	that will provide some useful context on the book to help you get started, and we'll have at least
1:06.7	one, if not two or more. We'll see how many episodes in the weeks that follow. And we will be using the Fagel's translation, but there are many others to choose from.
1:16.6	And now for today's guest, Dr. John Mandrola.
1:19.6	John is a cardiac electrophysiologist, which is a specialization in heart rhythm disorders.
1:26.6	Our conversation today is based on an article he wrote
1:29.9	for the Substact Sensible Medicine,
1:32.3	which he edits with past Econ Talk guest Adam Seifu.
1:36.8	John, welcome to Econ Talk.
1:39.2	Well, thanks for having me.
1:40.2	It's a real honor to be on a podcast
1:41.9	that hosted Milton Friedman and Thomas Sol,
1:44.0	so I'm quite excited.
1:45.0	Well, thank you.
	...

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