Pushing The Boundaries Of Belief.
There is one area where evidence of the placebo effect would provide extremely compelling evidence of its existence and effectiveness—surgery.
It is common knowledge in medicine that a placebo has no effect on surgery, whose effectiveness is entirely independent of our psychology. After all, going into the body with a scalpel is a precise and unambiguous event. The patient is usually under anaesthesia and there are not many variables from the person’s life, belief system or perceptions that affect how skilful a surgeon is or how he or she does the job. Although a patient’s attitude, beliefs and perceptions can influence the experience of post-surgical pain and the speed of recovery, they have no impact on the actual operation itself.
Or do they? One doctor decided to find out.
Orthopaedic surgeon Bruce Moseley, of the Baylor School of Medicine, wondered which component of the arthroscopy (knee surgery) operation he performed was the most effective and beneficial for his patients, as there are at least two different procedures he could do while working inside a patient’s damaged knee: he could shave damaged knee cartilage or flush floating cartilage debris out of the knee cavity. Both approaches were very common, but there was no data on which was most effective. So, Dr Moseley decided to try to find out.
He consulted with the hospital director and others, who told him that to find an answer he would have to conduct a double-blind study, which would need two groups of patients—each group getting one or the other of the procedures—and a third group to serve as a control. The control group would have to think they had surgery, but not actually have anything done to their damaged knee. Dr Moseley was surprised at the need for a control group, which would make it possible for the study to factor in the placebo effect. He said,
‘All good surgeons know that there is no placebo in surgery.’
But he went ahead and managed to arrange for such a complex study to be carried out. There were three groups of patients— all comprised of men who had greatly reduced activity levels because of knee damage, with some of them even finding the need to use wheelchairs. Each man in each group underwent the arthroscopic surgery;
with one group having the cartilage shaved,
another having their knee cavity flushed,
and the third group being brought into the operating room but not actually having either of the procedures.
Here’s what happened for the third group—the control group—during their ‘fake’ surgery.
To make them believe they were undergoing the procedure, everything was done normally. They were sedated, Dr Moseley made the standard incisions in their knee, but then he did nothing surgical. He faked the operation. He positioned the monitor that he used to see inside the knee and all other equipment exactly where he would have if he were actually going to operate.
He played a video of a real operation on the monitor in case a patient were watching. (Although the patients were sedated, they were not totally unconscious and could watch an actual operation on the monitor; in this case it was all arranged so that they wouldn’t be able to know it was not their knee in the video.)
After 40 minutes he stitched up the small incisions he had made in the knee as if he had performed the operation as usual. Every last detail was accounted for so that the control group could not know they had not received real knee surgery.
The results were totally unexpected.
All three groups improved equally well, although according to received wisdom the men who had not had anything done to their knees should have been in the same debilitating condition as before the study. But they improved too!
They regained motion, had less pain, were able to resume life activities—from walking without pain to playing basketball with their grand kids—that many had given up because of their knee problem.
Even two years later, when the men in the placebo control group were told that nothing had been done to their knee, they still retained the benefits.
Further follow-up six years later found the benefits to be lasting, with no relapses.
This study and its years-long aftermath was a spectacular display of the power of the placebo effect. Dr Moseley concluded:
“My skill as a surgeon had no benefit on these patients. The entire benefit of surgery for osteoarthritis of the knee was down to the placebo effect.”
One of the patients in the control group, Tim Perez, told the reporters of the Discovery Health Channel for a programme on the placebo effect that detailed this study and interviewed Dr Moseley and some of the patients:
“Boy, was I surprised to know that it was the placebo. I couldn’t believe it. How is this possible? Well, in this world anything is possible when you put your mind to it. I know that your mind can work miracles.”
Hi Chris,
Could we make a parallel between “placebo” and rituals? Rituals being a series of gestures in which we believe to perform actions in our 3D world, more or less.
Basically for most of us, we would need in order to focus our mind-heart connection some concrete gestures, rituals in which we believe with all our might in order to perform healing. … ?
Hum… I keep meditating. Thank you!!!