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We pose two questions in this paper. First: how much surgery is unnecessary? The answer to this question is important for evidence-based medicine and for public policy. In the United States, the most commonly done surgeries are for gynecological (cesarean sections and hysterectomies) and cardiac (stents and bypasses). Conservative estimates are that at least half of all gynecological surgeries should not be done. Despite considerable efforts, the efficacy of newer cardiac surgeries has not been established. Small area analysis and considerations of sham surgery and preventive surgery cast further doubt on the necessity of much surgery. Second: what is meant by the concept of ?unnecessary?? The answer to this problem requires a sociological as well as a medical perspective. We trace the changes in the meaning of this concept. In the final analysis, the notion of unnecessary cannot be understood outside of the medical model. How much surgery is unnecessary depends on what is meant by ?necessary? surgery, a concept hitherto seen as self-evident and therefore unconsidered. [ABSTRACT FROM AUTHOR]

Sociologists routinely ask "what if..." questions which are really "thought experiments" without theoretical or methodological rigor. Thought experiments have a long history of use not only in physics, but also in other intellectual disciplines. In this paper we explore and assess thought experiments as a method for sociological research. As illustration, we consider the immediate decriminalization of all narcotics and opiates. Thought experiments have three logical characteristics. They must be autonomous, meaning that the experiment's method and conclusion are not dependent on any real laboratory apparatus; they must rely on mental imagery; and they must have an element of bizarreness that asserts its independence from the real world and indicates no intention of execution. In assessing the method, we raise six issues: prediction, complexity, ceteris paribus, sampling, "t-3," and relevance. We conclude, following Thomas Kuhn, that at minimum thought experiments can help us understand the scientist's conceptual apparatus. Yet it is also possible that thought experiments can help us understand the real world. [ABSTRACT FROM AUTHOR]