After 1912, when the first arthroscopic surgery (i.e. arthroscopy) was performed by danish physician, Severin Nordentoft, surgeons began performing arthroscopic surgeries to help relieve severe osteoarthritis patients’ knees. For many decades this surgery was considered extremely beneficial, providing up to 50% of patients with real, measurable relief. Arthroscopic surgery worked, doctors believed, by repairing or trimming damaged knee joints that were believed to be the cause of pain.
Then, over a ten year period, famed arthroscopic surgeon, Bruce Moseley, and a team of scientists and physicians led a placebo-controlled study that changed everything…
A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee
In the placebo-controlled study done at Baylor College of Medicine, 180 patients with osteoarthritis were randomly assigned to two groups: Patients in one group received real arthroscopic surgery to clean out their damaged knees. Patients in the other group received placebo surgery which included making incisions into the knee, but nothing more. Neither the patients nor the assessors of the outcome knew who had received the real arthroscopic surgery and who had received the sham surgery.
Patients’ improvement was assessed at multiple points over a two year period, and then again five years later. Amazingly, patients who received the surgery experienced exactly the same improvement as those receiving just the incisions - about 50% of patients in both the placebo and surgical group experienced relief overtime. Some of those who experienced relief from the placebo surgery were able to participate in physical activities they hadn’t been able to participate in for years. The renowned arthroscopic surgeon who performed the surgery, Dr. Bruce Moseley, said afterwards, “My skill as a surgeon had no benefit on these patients. The entire benefit of surgery for osteoarthritis of the knee was down to the placebo effect.”
The study, which took 10 years to perform and was carefully designed by teams of researchers, rocked the medical world. The researchers conducting the study recommended that doctors no longer perform a surgery they had long considered useful because the effects – while extremely beneficial – were all placebo effects. As can be expected, doctors who made their careers on this surgery revolted, and tried to smear the study. Nonetheless, the results had staying power and have since been repeated in follow up studies, and its recommendations were accepted by most arthroscopic surgeons. Today medical boards around the world advise physicians are advised against performing such surgeries.
Conclusion: The Placebo Effect in Sham Arthroscopic Surgery and Beyond
For decades, about 50% of osteoarthritis patients who had arthroscopic surgery experienced about a 50% recovery rate – not due to the medical benefits of the surgery, but due to the psychological and physiological benefits of the placebo effect. If we simply stop providing help to these patients because we understand that the surgeries were ineffective (relative to placebo surgeries), thousands of people who experienced real, life-changing benefits will continue living in pain.
The opportunity is to figure out how to support osteoarthritis patients in harnessing the placebo effect so that the 50% of patients who can experience real, life changing healing do experience real, life changing healing – even if it doesn’t come from surgery. Placebo medicine is an exciting new medical frontier, and newer, more robust placebo help is on its way!