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Surgery is a great placebo

July 26, 2017

Many surgeries have obvious result, such as removing a ruptured spleen. That’s not at all elective. But what about surgery on a joint, for long-term pain relief? How can anyone know that it actually works? The acid test is a blind study: divide patients into two groups, do the surgery on one, and do a sham surgery on the other. In three-quarters of such studies on elective surgeries, the actual surgery works no better than sham surgery. Which isn’t to say it doesn’t work at all:

There’s something powerful about believing that you’re having surgery and that it will fix what ails you. Green hypothesizes that a surgery’s placebo effect is proportional to the elaborateness of the rituals surrounding it, the surgeon’s expressed confidence and enthusiasm for the procedure, and a patient’s belief that it will help.

Without the studies, surgeons would have as much reason to believe the surgeries are working as their patients do:

Surgeons who perform only real surgeries never see the benefits of sham procedures and so may falsely attribute their patients’ success to the surgery without recognizing that regression to the mean and the placebo effect might also contribute.

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