We’ve all heard of the placebo effect, but usually we associate it with sugar pills and grandmother remedies. In reality, taking the possibility of a placebo effect into consideration when researching new treatments is of utmost importance. For example, if 100 people are treated with a new medication and 50 make a full recovery within a short time, one could conclude that the treatment is effective. However, if it turns out that 35 improved because of the placebo effect, our opinion regarding the treatment would be completely different, wouldn’t it?
This is clear when it comes to new medications, but why not apply the same logic to surgery? Comparing surgical intervention with placebo is somewhat morally controversial, but from a purely medical perspective, it could make a huge impact on clinical practice globally.
This exact question is the one posed by a research and article published in the renowned “British Medical Journal”. The researchers collected studies of clinical trials in which surgery was compared with a placebo surgery, known as sham surgery, in order to see how this impacted the results. Most of the trials assessed were for minor procedures, with the predominant purpose being improved function and quality of life.
The results in 74% of the trials examined showed improvement among the patients that had the sham (placebo) procedure. Furthermore, in 51% of the cases, the actual treatment was not statistically better than the sham surgery, placing a serious question mark over the actual impact of the tested procedure. These findings are no less than amazing, leaving researchers to wonder regarding existing procedures whose efficacy can be undermined by a sham surgery trial.
Additional research on sham treatment has led to some interesting insights: the placebo effect works mainly on conditions with limited function but it does not improve on more serious conditions such as cancer. Second, the extent of the placebo effect correlates with the complexity and invasiveness of the treatment. Drugs have an effect, but injections are better, and actual surgery is stronger still.
Given that the placebo effect was proven substantial with surgeries, what can a patient do? It is not to say that surgery is not required but rather that consulting with experienced, renowned specialists lowers the risk of unrequired surgery being performed. A specialist is probably more aware of these issues, and is able to identify lower value treatments. Second, having your radiology images reviewed by a specialist is extremely important. Oftentimes, a patient feels pain, has imaging done and a radiologist identifies an incidental finding, meaning another finding that is not actually causing the pain. Based on this, surgeons perform the procedure and the pain goes away, most likely because of the placebo effect rather than because of the actual treatment. Experienced radiologist and specialists have seen enough imaging to recognize incidental findings and will help you find noninvasive alternatives to your ailment. Finally, seek a more holistic treatment, treatment that takes your entire condition, physical and mental into account.