A Tale of Placebo: Arthritis of the Knee

March 14, 2016 Health & Healing, Pain, Placebo No Comments

Generally, people do not easily relate placebo to surgery. Think again.

Bruce Moseley is an American orthopedic surgeon with a peculiar story to tell.

In the early 1990s, he was widely regarded as an expert on knee arthroscopy. Receiving excellent feedback from many patients, he wanted to know how effective these operations were. This is no easy matter in surgery. The ‘Gold standard’ of clinical trials is the double-blind study, in which the outcomes of two groups are compared. The subjects of one group receive therapy – those of the other group, not. Subjects do not know before nor after the procedure to which group they belong. In surgery, of course, this means one has to incise the skin of a number of people without doing anything else. Not so ethical…

Moreover, Moseley himself was no believer in the power of mind over body. He just wanted to know.

In this case, it was deemed ethical in view of the stakes. So a first study was conducted during the summer of 1994. Ten people with osteoarthritis in the knee were operated on. Two received the standard procedure: scraping and rinsing of the knee joint. Three received the rinsing alone. Five were incised as the others and received nothing more. The study revealed no clinical difference between the outcomes of these groups.

An expanded version of the study was then conducted with 180 patients, again in 3 groups, each of 60 patients. And again, there was, in the words of Moseley himself:

“no superiority of the arthroscopic treatments over the placebo procedure in relieving pain or improving function.”

This means that the complete effectiveness of the operations had been due to placebo… But wait a minute: in those days, more than 650.000 of such operations were performed in the US, at a cost of $5000 each, every year.

Indeed: billions of dollars!

Not to speak of the human cost.

Meanwhile, we are left with yet another intriguing question:

What is the placebo effect of other surgical procedures?

Some widely respected ones have shown to be quite placebogenic. Most… have not been investigated. And they never will. Yet the ethics go in two directions: that of the clinical study itself, and that of what such study may reveal. At present, probably huge costs in money and suffering are involved in surgical procedures that are far less effective than we think.

Or… Should we take advantage of the placebo and make a lot of skin incisions while telling patients that they are receiving effective surgery?

I am kidding. My answer is: absolutely not!

But we should try harder to understand placebo and to make use of it in open ways.

No need for incisions then or other negative effects. Instead: an immensely powerful mega-psychotherapy!

Leave a Reply

Related Posts

Is There Coherence in Heart Coherence?

On a basis of meditation, heart coherence claims to make the heart rate more ‘coherent’ and through this coherency, to positively influence health and well-being in many ways. It’s nice to say that the heart is important. Many people love it and heart coherence does say so. According to me, its further claims are unsubstantiated, Read the full article…

11. Depression: in need of the lost soul

According to medical textbooks, depression is defined on the one hand as a number of symptoms: seeing the future bleak, having profound feelings of guilt and hopelessness, appetite and sleep disturbances etc. On the other hand, it’s looked upon as a hormonal or brain transmitter disorder. ◊◊◊ So we have the symptoms and we have Read the full article…

Addictive Behavior = Communication

ADDICTIVE BEHAVIOUR = SYMPTOM = SYMBOL Addictive behavior (overeating, smoking…) is a symptom, comparable to other symptoms. So you can approach it – just like all other symptoms – in 2 ways: the symptom as a not-symbolic entity. In this case, the behavior is something that you just want to get rid of as quickly Read the full article…

Translate »