The Placebo Effect and Fake Surgeries

In this article we continue our exploration of the evidence around the placebo effect.

The Placebo Effect

As we already talked about in our previous post, a placebo usually refers to a substance or treatment which has no known medical affect effects. The placebo effect describes the phenomenon whereby some people experience a benefit after the administration of the placebo.

That’s right, even though there is no medical reason why someone should experience a benefit, they do.

The placebo effect is fascinating as we can’t really explain it. We’ve already talked about an interesting experiment that looked at medical students, fake drugs and side-effects (yep, it really is as bizarre as it sounds).

We’re now going to look at one of the most intriguing parts of research into the placebo effect, fake surgeries.

Placebos and Fake  Surgeries

These are particularly fascinating – as well as the actual results they yield, they really highlight the creativity, imagination and dramatic flair of researchers and surgeons.

In these treatments, all of the conditions of an operation, from simulation of anaesthesia to waking up with a surgical scar are replicated. If you think this sounds a bit like the plot-line of a Christopher Nolan film, you’d be correct.

But these measures are important as they really help to control potentially confounding variables.  There’s much debate as to whether it’s ethical to use sham surgeries in trials. For this reason, there are not many studies like this out there.

Sham Orthopaedic Surgery

A brilliant study led by an orthopaedic surgeon called Bruce Moseley (2002) had some remarkable findings.

He looked at knee arthroscopies (operations done through keyhole surgery) which aimed to improve the symptoms of arthritis. They randomized 180 patients to either have the real surgery or the Christopher Nolan type placebo one.

In the placebo surgery, patients received a tranquilizer and painkiller to make sure they were asleep. The knee was prepped and incisions made in the skin at the same points as a real arthroscopy.  The surgeon asked for all instruments and manipulated the knee as if the operation were being performed. Saline was splashed to simulate the sounds of lavage  (I particularly liked this detail of the study, it gives a visual image of a water fight in the operating room).

The patients did not know which surgery they were to have and the surgeon and anesthetist only found out which operation to perform once the patient was in the operation theatre.

The study showed that arthroscopic surgery was no better at improving knee pain and function compared to the placebo procedure. In some cases, those patients who had had the arthroscopic surgery actually had worse function.

So to summarize, patients who had fake surgery did as well, if not better, than patients who had the real operation. Pretty darn insane.

More Sham Orthopaedic Surgey

Sihvonen et al (2013) also did another brilliant study, again looking at knee arthroscopy. This time the trial was done in Finland and the group looked at arthroscopic partial menisectomies. This is a type of keyhole surgery that  removes and shaves knee cartilage in patients with cartilage tears in the knee. 

The team looked at 146 patients who had cartilage tears and randomly assigned them to an arthroscopic partial meniscectomy or sham surgery. Again, the placebo surgery mimicked the true surgery with knee manipulation and sound effects from surgical instruments. 

The results were again intriguing - both groups had improvement outcomes than before the surgery but there was no difference between those who had true surgery and those who had the sham operation. 

Fake Heart Surgery (?!!)

Yep. You read it correctly.

The cardiothoracic surgeon Leonard Cobb led work in this field in 1959.  At the time, there was a belief that patients with angina (chest pain) should be treated with a type of surgery that tied off small vessels in the chest wall.  There was a theory that this increased blood flow to the heart.

Unfortunately, there was a small snag. The snag being that no one had actually proven this theory. Instead, patients were just having this operation willy nilly. 

The researchers looked at 17 patients with angina and randomly selected them to either have the operation or to have a placebo operation.

You’ve probably already guessed the results. Yep, there was no difference in outcomes between the two groups, nearly all the patients experienced an improvement in symptoms.

The Mind-Body Connection

So what does this mean ? Should we all just go to operating rooms, be given a sedative and have a bit of a snooze ? 

Of course not, that would be ridiculous, somewhat expensive and a tad Michael Jacksonesque.  But, like the other research we’ve discussed, this experiment really does show that our thoughts influence how we perceive our health.

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