Ethics of placebo use in clinical practice: why we need to look beyond deontology.

Beneficent clinical usage of placebos has been a problem for the application of Kant's deontology in medical ethics, which, in its strictest form, rejects deception universally. Some defenders of deontology have countered this by arguing placebos can be used by a physician without necessarily being deceptive. In this paper we argue that such a manipulation of Kant's absolutism is not credible, and therefore, that we should look beyond deontology in our consideration of placebo usage in clinical practice. We conclude that Kant's deontology cannot be made compatible with placebo use in clinical practice due to the primacy it affords to the principle of autonomy.

The Eden-Hybbinette procedure is one hundred years old! A historical view of the concept and its evolutions.

INTRODUCTION: One hundred years ago, before Bankart, Latarjet or Bristow, Eden and Hybbinette developed a procedure to treat anterior shoulder instability and currently, this eponymous term is known by every shoulder surgeon. The purpose of this review is to summarise the historical "Eden-Hybbinette" procedure and its evolutions during the last century and discuss results. METHOD: On the centenary of the first publication on the "Eden-Hybbinette procedure", a search was conducted on Medline, Google Scholar and in the grey literature, to find its initial concept and description, and the evolutions. RESULTS: The initial procedure was based on the concepts of glenoid bony augmentation (anatomic reconstruction with an autograft from the tibia) and capsulorrhaphy. The main evolutionary themes identified were the origin of the graft (autograft with iliac crest, allograft), graft positioning and fixation (no fixation device, screws), and the surgical approach (split of the subscapularis tendon in open surgery, arthroscopy). Studies with long-term follow-up exhibited good results, considered similar as those with other classic bone-block procedures. Development of osteoarthritis during the following years after the procedure is not usual and not related to the graft unless if there is articular protrusion. CONCLUSION: The Eden-Hybbinette procedure is one of the oldest surgical interventions still commonly used for chronic anterior shoulder instability. The changes to the procedure over the last 100 years allow it to remain a contemporary solution for both primary surgery and revision cases.