Placebo surgery

A review of over 50 placebo-controlled surgery trials shows that fake surgery worked as well as the real surgery in more than half the trials.

One famous study is from an American surgeon Bruce Moseley. 180 patients had such severe knee pain that even the best drugs failed to work. He gave half of them real arthroscopy and the other half placebo arthroscopy, where the incision was made, but no real procedure was performed. The placebo surgery worked as well as the real surgery.

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A comprehensive study published in 1999 found that placebo effects were caused by both expectancy and conditioning.

But some researchers argue that there is something mysterious about how placebos work. While it is easy to see what happens inside the brain to the amygdala, or the other bits involved, it is less clear what moved the amygdala in the first place.

Placebo's as pleasing treatments: History of the concept
  • Plato's cure for headaches involved a leaf coupled with a charm. Without uttering the charm at the moment of application, the remedy was not effective. We would call Plato's "charm" a placebo.
  • In the 18th century, the term "placebo" was used to describe a doctor. In his 1763 book, Dr Pierce describes a visit to his sick friend, saying that he found "Dr Placebo" sitting at her bedside. She said she was well, and Pierce seems to imply that the positive effect Dr Placebo had was due to his great bedside manner, rather than the drops he gave.
  • Eventually, the word "placebo" started being used to describe treatments. In 1752, the Scottish obstetrician William Smellie used some innocent Placemus that his patient "may take between whiles, to beguile the time and please her imagination."

It is accepted that placebos are not ethical because they require deceptions. But this view does not account for the evidence that we don't need deception for placebos to work.
Further mistaken claims:

  • We can only trust placebo controls. New treatments that come along can be compared with a proven effective method. To be effective, it should be at least as good as the old one.
  • Placebo controls provide a constant baseline. This view is based on the view that placebo treatments do not work. It is mistaken. In a systematic review of placebo pills in ulcer trials, the placebo response ranged from 0% to 100% (complete cure.)

Early placebo trials that tested the effects of homoeopathy tablets revealed that doing nothing was better than both homoeopathy and allopathic (standard) medicine.

In the 1990s, Danish medical researchers compared people who take placebos with people who take no treatment at all. They concluded that there is little evidence that placebos, in general, have powerful clinical effects, but the researchers made incorrect comparisons. Today it is widely accepted that placebos are effective for some things, like pain, but not for everything.

Placebos were used in clinical trials in the 18th century to debunk "quack" cures. The so-called "non-quack" cures included bloodletting and feeding patients the undigested material from the intestines of an oriental goat. These needed no trials because they were considered to be so effective.

An example of how powerful placebos are is during the second world war. Supplies of morphine were running out, and a nurse was seen to inject a wounded soldier with saltwater instead of morphine before an operation. The soldier thought it was real morphine and didn't appear to feel any pain.

A placebo can work even if the patient does not believe it is a real treatment.

This can be because patients have a conditioned response to an encounter with their doctor. Just like an arachnophobe's body can react negatively to a spider even if they know it's not poisonous, so a person can react to treatment from a doctor even if they know the doctor is giving them a sugar pill.

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RELATED IDEAS

The placebo effect

The placebo effect happens when a person takes medication that he thinks will help, but the medication has not been proven to be effective for the specific condition.

Placebos work in about 30 percent of patients. Some placebos contain no active ingredient. Other placebos do have active ingredients but aren't proven to work on the patient's particular condition. There are even placebos in the form of surgery, injections, and other types of medical therapies.

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IDEAS

Inflammation

Inflammation, which normally fights infections and heals wounds, also has negative effects on the body.

Studying inflammation's behavior in our bodies has led to a series of breakthroughs, including new kinds of treatments, and immunotherapy.

Apart from research on bodily disorders, new studies are emerging on how the brain and our immune system may be connected.

Problems with how we view scientific studies

The world is full of evidence and studies, some good and some poor.

  • One major problem is that scientific lingo often means something different from everyday language. Words like theory, significant, and control have entirely different meanings in the realm of science.
  • Another problem is that experiments can suffer from problems in how they're designed, how they're analysed, and how scientific journals review them.

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