Orthopedic surgeon Bruce Mosely published a remarkable study in the New England Journal of Medicine in 2002. His study has shaken surgical treatment to its core. He selected world war II veterans, men in their 70’s who had major knee problems, pain and had great difficulty in walking without assistance.
He divided the men into three groups.
Group one, following the incision just had the knee rinsed with no further treatment.
Group two had the complete, normal surgical procedure – opening, rinsing, trimming and suturing.
Group three was about to make medical history.
They experienced a sham surgery where the procedure was started as if it were the real surgery and three small cuts were made in the knee. Dr. Mosely then went through the same motions as if he were doing the real knee operation. He had a video tape of an actual surgery running in the operating room so he could simulate each stage of the surgical procedure. As he was going through the sham surgery, he could have for the appropriate instruments and make typical comments and sounds that he would usually make for the full forty minutes. The three small surgical cuts were then sutured and nothing therapeutically had been done to the knee. The results were astonishing! All three groups improved and showed great mobility and freedom from pain. None of the groups did better than the placebo group.
One of the subjects could barely walk, was limping in pain with every step and following the sham surgery had no stiffness, tiredness and he no longer dragged his leg. As a matter of fact, he asked for the same operation on his other knee. The patients were followed for six years and the sham surgery subjects sustained their “improvement” without further medical treatment.
Patients who received the “pretend” surgery did as well as those that received debridement or lavage. Some who were barely able to walk before the surgery were now able to run. In some cases, those who received the placebo surgery, at certain points in their recovery process, their reported results were better than those who had actually received arthroscopic surgery.
The question that must be running through your minds about the effectiveness of placebos, as it has through my mind many times is – why? – how do they work? – what are the underlying biochemical mechanisms? No one knows. Lots of theories – explanatory fictions – but no one knows for certain.
Psychologist Dr. Amir Raz suggests that perhaps some form of suggestive or implicit hypnosis may be involved. Perhaps, but having practiced hypnosis for many years, there is no concensus or agreement amongst clinicians as to what hypnosis is or why it works. So we have one explanatory fiction being utilized to help define and understand another explanatory fiction.
One of my teacher’s, Dr. Lee Pulos, favorite definition of hypnosis is that it is the “induction of conviction”. The power of our beliefs that shape our reality.