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Sham Surgery

Can healing take place without treatment?

In 2004, a radiologist at the Mayo Clinic in Minnesota, one of the American’s most prestigious hospitals, named Dr. David Kallmes decided to try a bizarre experiment. For many years, he had been performing an operation called a vertebroplasty, in which broken backs are healed through the injection of a medical cement. The procedure had always been very successful, relieving severe pain and allowing people to walk and exercise without difficulty. However, one thing had always puzzled Dr. Kallmes: that occasionally the operation would go wrong (for example, if cement was injected into the wrong vertebra) but patents would still appear to get better.

In order to investigate this further, Kallmes conducted a trial of 131 patients where half of them would receive a real vertebroplasty, and the others would have a fake operation. In the latter, patients were wheeled into the operating theatre and given an anesthetic but rather than being injected with the cement, they were simply pressed hard on the back. The results found that both groups experienced the same amount of pain relief, and the same amount of improvement in function, that is, in walking, climbing stairs, and other forms of exercise.

This is an aspect of the placebo effect known as “sham surgery.” This is when surgeons literally pretend to do an operation, doing everything they would normally do - for example, making an incision, picking up instruments, giving instructions to colleagues, then closing the incision - but without actually making an intervention. Although this seems to defy common sense, many other trials of sham surgery have had positive results. In a Finnish study published in 2013, sham surgery was performed on patients suffering from torn knee ligaments, and in severe pain. Even though the sham surgery patients were anesthetized, surgeons went through the whole ritual of an operation in meticulous detail, passing instruments and making the normal sounds associated with an operation. But again, the incision was closed without any procedure being carried out. Some patients received real treatment too, and the results were compared. Once again, no significant difference was found between them. Patients who had had sham surgery reported the same degree of pain relief and improved function.

Shortly after this trial, researchers published a comprehensive review of every recorded trial of sham surgery and found 53 cases where it was practiced alongside normal surgical procedures. They found that sham surgery was beneficial in 74 percent of trials, and in half of them, it was beneficial to the same degree as the actual procedure. In some cases, it was found to be more beneficial than the actual procedure.

Some scientists believe that the success of sham surgery simply shows that a lot of unnecessary operations are being carried out. (And indeed, since these findings have been published, U.S. insurance companies have been less willing to fund operations such as vertebroplasties.) This may be true to an extent, but surely the important point is that, if patients gain benefits from both the real and fake surgery, then this doesn’t mean that the real surgery doesn’t work, only that the fake surgery also works, but from a different source; namely from the patient’s own subconscious self-healing abilities.

The placebo effect has become so familiar nowadays that we may need to remind ourselves of how bizarre it really is. Isn't it incredibly strange that healing and pain relief can apparently take place without any actual treatment? It appears that, even now, most scientists, don’t grasp the full implications of the placebo effect: that the human mind has the capacity to powerfully influence almost any aspect of our physiology, including the alleviation of a massive range of symptoms and even a healing of many conditions. And in turn, this implies that our normal concept of the relationship between the mind and the body may be wrong. It suggests that the mind is not just generated by physical processes in the brain, but that it is in some sense primary.

Steve Taylor, Ph.D., is a senior lecturer in psychology at Leeds Beckett University, UK.

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