SIX IN TEN Britons have surgery at some point. So do lots of Americans, at a cost of perhaps $500bn a year, a third of all spending on adults in the world’s biggest health-care market. Plenty of these procedure(手术；医疗程序)s save lives, by removing tumours, transplanting new organs or mending broken ones. Many others make life better, say by restoring vision (cataract extraction(白内障摘除术)) or hearing (tympanoplasty(鼓室成形术), for example). Yet a growing body of evidence suggests millions of surgeries performed each year are unnecessary—and, given the risk of complications when a person is sliced open, often worse than useless.(然而，越来越多的证据表明，每年实施的数百万台手术并无必要——而且，考虑到人一旦被切开就有并发症风险，这些手术往往比无用更糟。)
每十个英国人中有六个一生中会接受手术。许多美国人也一样，每年花费可能高达5000亿美元，占这个全球最大医疗市场成年人医疗总支出的三分之一。这些手术中，有很多确实能救命，比如切除肿瘤、移植新器官或修复受损器官。还有许多能改善生活质量，例如恢复视力（白内障摘除术）或听力（比如鼓室成形术）。然而，越来越多的证据表明，每年实施的数百万台手术其实并无必要——而且，考虑到人一旦被切开就有并发症风险，这些手术往往比无用更糟。
Of ten common orthopaedic(骨科的) procedures, a specialty which accounts for a quarter of all operations in Britain and a similar share in America, only three—for carpal tunnel(腕管) and total replacement of knees and hips—offer outcomes that are clearly superior to non-operative care. Six, including common ones like lumbar-spine decompression(腰椎减压术), are no better than drugs, physiotherapy or just Father Time(时间老人；自然痊愈). Similarly, roughly two-thirds of excised appendices could have been fixed with antibiotics and many prostates, around 100,000 of which are operated on in Europe each year, are better off with watchful waiting.(同样，大约三分之二的阑尾切除本可以用抗生素治愈；而许多前列腺手术——欧洲每年约有10万例——其实更适合观察等待。) The list goes on.
在十种常见骨科手术中——骨科在英国占全部手术的四分之一，在美国占比相近——只有三种（腕管手术以及膝关节和髋关节全置换术）的疗效明显优于非手术治疗。有六种，包括腰椎减压术这类常见手术，效果并不比药物、理疗或单纯等待时间治愈更好。同样，大约三分之二的阑尾切除本可以用抗生素治愈；而许多前列腺手术——欧洲每年约有10万例——其实更适合观察等待。这样的例子还有很多。
For patients, needless surgery is a cause of physical pain and, especially in America, financial stress. For stretched(捉襟见肘的；资源紧张的) health-care systems in ageing rich countries, it is a terrible waste of resources. A recent reduction in referral(转诊；转介)s for shoulder operations (just one of the six useless orthopaedic procedures) is saving England’s National Health Service (NHS(英国国民健康服务体系)) around £100m ($134m) a year, or 1% of its total surgical budget.
对患者而言，不必要的手术带来身体疼痛，在美国尤其还带来经济压力。对富裕国家中因人口老龄化而捉襟见肘的医疗体系来说，这是对资源的巨大浪费。最近肩部手术转诊量的减少（肩部手术只是六种无效骨科手术之一）每年为英格兰国民健康服务体系（NHS）节省约1亿英镑（1.34亿美元），相当于其外科总预算的1%。
Jack the knife
手术刀杰克