Monday, March 05, 2018 by Isabelle Z.
Imagine this scenario: It’s been a month since you had a stent operation as part of a clinical study, and you’ve been feeling better than ever. You’re getting back into the physical activities you used to enjoy, and you’re happy you had the stent put in.
At your follow-up appointment, you report the good news to the doctor, who then shares some news of his own: You didn’t actually get a stent. Yes, you went under the knife, and yes, a catheter was directed to your blocked artery, but a balloon was never inflated and a stent was never placed. Instead, you were in the control group and underwent a sham procedure.
Were the improvements all in your head? You might argue that even if your surgery wasn’t legitimate, you feel better now and that’s the most important thing. But what about the millions of people who get stent operations around the world each year? Could they have gotten the same effects without the surgery?
According to research, the answer is yes. A study published in the Lancet of 200 patients with blocked arteries found that those who underwent the sham surgery and those who had the real operation felt equally well six weeks later. Both groups reported feeling less pain than before, and both groups also had better performance on treadmill tests.
It’s a disturbing thought for those who have gotten stent operations and similar surgeries. No one wants to undergo an unnecessary invasive procedure and deal with recovery only to get the same effects that simply believing they had surgery would have provided.
Arthroscopic knee surgery is another operation that fits this bill. With more than two million operations carried out every year to fix cartilage in the knee, it’s the top orthopedic operation. However, studies with sham surgeries and other types of research have found that it does not give the vast majority of patients any advantages; weight loss, exercise and physical therapy work just as well.
Some of the other operations that studies have found show benefits similar to placebo operations include gastric balloons for obesity, vertebroplasty, arthritis surgery, and endometriosis operations.
Before new drugs are approved for marketing, they must prove they are more effective than sugar pills. This is not the case, however, when it comes to surgery, which is particularly mind-boggling when you consider the fact that surgical operations have a far greater placebo effect than medications. And why wouldn’t they? Everyone would like to think that they are going through the stress and pain of surgery and getting incisions and anesthesia for some benefit.
A 2013 meta-analysis of the placebo effect across 79 migraine studies found that sugar pills reduced the headache frequency for 22 percent of participants. Fake acupuncture helped 38 percent of people, while sham surgery led to improvements in 58 percent of people!
Sham surgery studies are very uncommon. In the U.S., many ethics boards are hesitant to allow them. While this view is understandable, it’s also true that these studies could avoid exposing millions of people to the costs and risks of an operation just to gain a placebo effect.
The heart stent study got a lot of publicity when it first came out, but people are still getting these operations in droves. Are their doctors misinformed or just greedy? Experts say that many doctors are merely stuck in their ways, doing what they’ve been trained to do and seeing no reason to stop if people are getting desirable results.
It’s interesting to note that it’s many of these same doctors who will shrug off approaches like homeopathy and say that any improvements people note are down to the placebo effect.
If your doctor is suggesting surgery, it’s a good idea to check out the research supporting its efficacy and find out if lifestyle changes could give you similar results before you agree to go under the knife.
Sources for this article include: