Ops that are just a stitch-up: How patients can be healed by telling them they've had surgery – even when it's all a sham
23:58 GMT, 9 July 2012
The situation sounds like a sick practical joke: you are admitted to hospital for an important operation, and the staff give you an anaesthetic and wheel you into surgery.
But unknown to you, the surgeon merely makes a few tiny cuts on your skin.
They do this on the part of your body where you are supposed to have been opened up — then send you back to the ward and tell you the op was a success.
Fake operations are sometimes turning out to be highly effective. Such results are undermining the worth of commonly performed procedures
The strange fact, however, is that such medical fakery can actually produce cures.
This procedure, called ‘sham surgery’ by doctors, can even cure as many people as the real operations they mimic.
Indeed, sham surgery is known to have a remarkably high success with arthritic knee joints, damaged backs and even serious illnesses such as Parkinson’s and heart disease.
It gives a whole new meaning to the term operating ‘theatre’.
Sham surgery’s amazing success is attributed to the placebo effect — the self-curing power of the human mind and body that can be unleashed when a person is led to believe they have received a powerful therapy.
In trials of new drugs, the placebo power is generated by giving some of the participants a chemically inactive sugar pill.
Their health is then compared with people on the real pills. If the drug can cure more people than the placebo, it is considered to be effective.
But can surgical ops be tested in the same way
This question has inspired some surgeons to perform fake surgery on patients, then compare their outcomes with people who had the real thing.
And the fake operations are sometimes turning out to be highly effective.
Such results are undermining the worth of commonly performed procedures.
Sham surgery's amazing success is attributed to the placebo effect – the self-curing power of the human mind and body that can be unleashed when a person is led to believe they have received a powerful therapy
And they are also opening a rift in medicine: can it ever be right to con someone into believing they have had invasive surgery when nothing of the sort happened
Sham surgery’s potential was highlighted last week, with new research showing the past ten years have seen a big drop in the number of knee arthroscopy operations carried out in the U.S.
Knee arthroscopy remains one of the most common orthopaedic procedures.
This keyhole surgery is often performed on patients with arthritis to remove torn or floating cartilage that can interfere with the movement of the joint.
The procedure is also called arthroscopic lavage or arthroscopic debridement.
Ten years ago, surgeons in Houston, Texas, gave 180 patients with knee osteoarthritis either real arthroscopic surgery or simply made three scalpel incisions around their knee.
The results, published in the New England Journal Of Medicine, were amazing.
‘The outcomes after arthroscopic lavage or arthroscopic debridement were no better than those after a placebo procedure,’ said lead researcher, J. Bruce Moseley.
In both cases, the patients said their pain had been relieved. But it seems this benefit comes from the power of the patient’s mind, not the surgeon’s scalpel.
A decade on, the number of knee arthro-scopy ops performed each year in America has almost halved, according to analysis by investigators at the Cleveland Clinic.
Nevertheless, in Britain the operation remains popular: according to the analyst company Dr Foster, in 2007 surgeons performed more than 100,000, many for arthritis.
But how many were needed It is not only that such operations may be unnecessary, causing needless anxiety as well as cost to the NHS.
Surgery exposes patients to risks of unintended harm from the procedure or infections caught in hospital.
Knee arthroscopy for arthritis is not the only op to be undermined by sham surgery.
Studies on brain surgery aimed at treating the symptoms of Parkinson’s disease have also revealed a strong placebo benefit.
In one surgery study in 2004, 12 Parkinson’s patients had extra neurons transplanted into their brains in the hope they would produce the chemical transmitter dopamine in sufficient amounts to alleviate symptoms.
Lack of dopamine is believed to cause the disease.
After the operation, the patients’ symptoms cleared visibly. The improvements were noticeable a year later.
But the same kind of improvements were also seen in 18 Parkinson’s patients who had received fake surgery — incision marks on their scalps, but no transplants, says the report in the Archives Of General Psychiatry.
Meanwhile, the worth of a common spinal procedure has been questioned by Australian research.
Vertebroplasty, involves injecting medical cement into a fractured spinal bone to strengthen it and alleviate pain.
It is often performed on women suffering osteoporosis.
Surgery exposes patients to risks of unintended harm from the procedure or infections caught in hospital
In a recent study led by Dr Rachelle Buchbinder, of Monash University, Melbourne, 35 patients were given the surgery, while 36 underwent a sham procedure.
Surgeons just tapped against the spine, making them believe the needle was being inserted into the bone.
The patients who had the sham surgery said they experienced the same pain relief as those who had the real operation.
Medical texts are littered with such findings.
Other studies have found tying off arteries in the chest to treat the pain of angina (a once common procedure) helps 90 per cent of patients — but so does a fake operation using cut marks.
For decades, such placebo effects have been ignored as a quirk by conventional medicine.
But brain scans are revealing how our sense of belief and expectation can release opioids, the brain’s home-made opium-like substances.
Thus, a placebo can produce real pain-killing chemicals.
Given our emerging knowledge about surgical placebos, it might make sense to try a great deal more fakery in the operating theatre, to tease out which ops work and which simply harness our bodies’ curative powers.
However, British ethics experts are extremely cautious. Last December, Richard Huxtable, deputy director of Bristol University’s Centre For Ethics In Medicine, warned patients can feel exploited if they learn they are in a trial where they may be given fake treatment.
A paper he co-authored in the journal Bioethics surveyed people with Parkinson’s disease, and reported how one respondent thought the idea of fooling patients in the interests of science ‘sounded like something out of Nazi Germany’.
But Professor Peter Kay, consultant orthopaedic surgeon from the Royal College of Surgeons, agrees going under the knife will always create some degree of placebo effect, but says most surgical procedures are far more effective than sham treatments.
‘We can’t ethically give patients sham surgical procedures in the NHS as it may involve cutting a patient’s skin and even giving a general anaesthetic,’ he says.
‘However, we should try to work out where this placebo effect comes from and see if we can capture it.’
Professor Marion Campbell, director of the Health Services Research Unit at Aberdeen University, is pessimistic about the future of sham surgery.
She surveyed hundreds of British surgeons, anaesthetists and medical ethicists and concluded sham surgery trials in Britain would be very difficult because our medical profession is riven by ‘opposing and often strongly held opinions about surgical placebos’.
We might wonder if there is another reason British surgeons might resist placebo trials.
They may be worried that sham surgery could expose the fact their scrubs are the equivalent of the emperor’s new clothes.
It would seem a great pity if sham surgery trials fail to take place in this country.
For while patients may worry they may, in rare cases, be given treatment that is faked, it is surely even more of a concern if some of our most frequently conducted operations do, in fact, serve no good at all, and only expose us to the very real risks involved of going under the surgeon’s knife.