FAKE OR SHAM SURGERY. THE ULTIMATE PLACEBO! What is the PLACEBO effect? Your mind can be a powerful healing tool. Your brain can convince your body that a fake treatment is the real thing and thus stimulate healing. This is called the “Placebo Effect”. Doctors and scientists are starting to become more aware of the power of the placebo effect – particularly in surgery, where our hopes and expectations of a dramatic recovery are at their highest. There’s something powerful about believing that you’re having surgery (albeit a fake one) and that it will fix what ails you. Such a fake surgery also known as Placebo or Sham surgery is used in some research trials to test the efficacy of surgical techniques.
How are Sham surgeries used?
In clinical trials for drugs, the subjects are divided into several groups and given doses of the drug or an inert placebo. To see whether a drug works, the response of people in the placebo group is compared to those taking the actual medication.
Studies involving Sham or Placebo surgery work along similar lines. Patients are informed when they enter the study that they may receive an actual surgery, or a fake surgery, ensuring the “informed consent” of the participants. If the surgical procedure being tested is effective, patients who received the real surgery will improve, while placebo patients should see no change. In most of the sham-controlled studies, patients who underwent a sham surgery benefited just as much as those who got the actual surgery. And this is perhaps the greatest contribution of sham surgeries: helping analyze the effectiveness of popular surgical interventions.
How are Sham surgeries performed?
In these fake operations, patients are led to believe that they are having a real surgical procedure. They are taken through all the regular pre- and post- surgical rituals. These include fasting to anaesthesia to incisions made in their skin to look like the genuine operation occurred. However, the doctor does not actually perform the surgery. If the patient is awake during the procedure, the doctor mimics the sounds and sensations of the true surgery.
The Background
There have been very few sham controlled surgical trials to date. In 2009 two trials of vertebroplasty, a procedure to reconstruct vertebrae that break due to bone weakness, found the same improvements in sham and real surgery groups. In the 1950s a common heart procedure, mammary artery ligation, was highly effective for reducing heart pains, but no better than a sham. Additionally, In 2002, a study by Moseley and others concluded that arthroscopic surgeries were no more effective than the sham operation.
The Benefits
Sham surgery has the potential benefit of saving society from the financial burdens of unproven operations. About 695,000 arthroscopic knee surgeries were performed in the US in 2010. In a study published in the NEJM, researchers concluded that patients who underwent the above surgery for meniscus repair, had no greater improvement than those who underwent a sham surgery. Sham operations may be the only option to truly determine whether a benefit from a surgical procedure truly exists.
The Risks and Ethics
In surgical trials, the use of a placebo or a sham surgery, is controversial. This practice faces some complex ethical issues. Some are opposed to it, arguing that a sham surgery, unlike a drug placebo, is not actually inert. Surgery carries many potential risks. Therefore, subjecting people to anaesthesia along with the risks of infection, seems questionable.
However, the success of these procedures has suggested that they do have a place in carefully monitored studies