By Gina Kolata
An estimated 12% of Americans aged 65 and older have osteoarthritis of the knee. A popular operation for arthritis of the knee worked no better than a sham procedure in which patients were sedated while surgeons pretended to operate, researchers are reporting today.
The operation arthroscopic surgery for the pain and stiffness caused by osteoarthritis is performed on about 650,000 people in the US every year, at a cost of about $5,000 per procedure, for a total cost of 3.3 billion dollars every year in the US.
It involves making three small incisions in the knee; inserting an arthroscope, a thin instrument that allows surgeons to see the joint; and then flushing debris from the knee or shaving rough areas of cartilage from the joint and then flushing it.
Tests of knee functions revealed that the operation had not helped, and those who got the placebo surgery reported feeling just as good as those who had had the real operation.
Dr. Baruch Brody, an ethicist at Baylor who helped design the study, described the surgery as a sham.
The study dealt only with arthroscopic surgery for osteoarthritis, not with other common knee operations.
The 180 participants in the study were randomly assigned to have the operation or to have placebo surgery in which surgeons simply made cuts in their knees so the patients would not know if they had the surgery.
The research began when an orthopedic surgeon at the Houston veterans' hospital, Dr. J. Bruce Moseley, who is now the team physician for Houston's two professional basketball teams, approached Dr. Wray suggesting a study that would compare washing the knee joint with washing and scraping in patients with arthritis.
Dr. Wray had a bolder idea.
"She said, `How do you know that what you are seeing is not a placebo effect?' " Dr. Moseley recalled. "My response was, `This is surgery.' She said, `I hate to tell you this, but surgery may have the biggest placebo effect of all.' "
Placebo studies of surgery are almost never done. Many doctors consider them unethical because patients could undergo risks with no benefits. Working with Dr. Brody, the ethicist, the group tried to make the placebo treatment no more dangerous than daily life. Still, of 324 consecutive patients who were asked to participate, 144 declined.
For those who agreed, the day of surgery meant being wheeled into an operating room while neither they nor any of the medical staff knew what their treatment would be. When they were on the operating table, Dr. Moseley, who did all the operations, opened a sealed envelope telling him whether the patient was to have the surgery or not.
Those in the placebo group received a drug that put them to sleep. Unlike those getting the real operation, they did not have general anesthesia.
Dr. Moseley made small cuts in their knees to simulate an operation. He bent and straightened the knee and asked for surgical instruments, just in case the patient was partly conscious. An assistant sloshed water in a bucket to make the sound of a knee being flushed clean.
The paper in The New England Journal is accompanied by two editorials. One, by Sam Horng and Dr. Franklin G. Miller of the National Institutes of Health, asks whether placebo surgery is unethical. The controversy, they wrote, comes because doctors assume that patients in clinical research should not be put at risk if they cannot benefit, and placebo surgery involves risk.
But, they say, clinical research is different from medical therapy; its aim is not to help those in the study but to help future patients.
To be ethical, they say, a study with placebo surgery must meet three criteria: it must not place patients at undue risk; the benefits of learning whether the surgery works must be worth any potential risk to the patients; and the patients must give informed consent.
In the current case, they wrote, all those objectives were met and the study "exemplifies the ethically justified use of placebo surgery."
New York Times July 11, 2002
The New England Journal of Medicine July 11, 2002;347:81-88, 132-133
Long-time readers of this newsletter might remember this information was first posted here over one year ago when it was presented at the Annual Meeting of The American Academy of Orthopedic Surgeons in March of 2001. One of the benefits of this newsletter is you will typically be 1 to 3 years ahead of the rest of the world when it comes to breaking medical news!
Getting back to the present, it sure seems like many traditional medical approaches are being discredited -- what's great is that their dismantling is being documented in the most prestigious journals. Last week, the most widely circulated medical journal in the world, JAMA, published a study showing that Americans were spending 3 billion dollars a year on Premarin but it was not providing the benefits they anticipated; it was, however, increasing their risk of heart disease and breast cancer.
Now, a week later, the New England Journal of Medicine publishes a study exposing how another 3 billion dollars a year is being wasted on a knee scooping surgery for arthritis that relieves the problem no more than a placebo.
Well folks, let me tell you, placebos are a lot cheaper than $5,000 operations.
So what other options are there?
It is important to recognize that the arthritis scooping did work for many people -- and so did the placebo. This is an amazing testimony to the power of your brain at inducing healing changes in your body. The central question is how to harness this power without expensive medications or dangerous surgery.
Remember that whatever you focus your conscious attention on in the real world will typically be achieved. That is precisely what happened with this study. The patients truly believed with every fiber of their being that this expensive and invasive procedure would fix their problem, and superficially it did appear to do just that. Same, though, with those who received the placebo -- a placebo unknown to them, of course. What really healed their bodies were their own minds.
So here you have a real world study, published in one of the most respected journals on earth, providing the theoretical underpinnings of why EFT works. You can easily begin to harness the power of EFT by reviewing my free manual. There are also clinicians who can help you individually.
There are, however, sometimes structural problems that limit EFT from working. When that happens, I find that following the eating plan with special attention to the fish oil will help the inflammation that accompanies arthritis.
The above study was only for knee arthritis. But the surgery referred to, arthroscopy, is also used for knee problems other than arthritis. In my office, instead of surgery, we employ a gentle massage technique from Australia called NST that has proved highly effective for nearly all knee problems, including traumatic injury. We have rarely found the need to refer any patients with knee pain for surgical intervention.
NST helps the body actually repair and recover the damaged tissue. If you are interested in this procedure, please refer to our list of NST practitioners. And health care professionals should consider attending our NST training course in September -- taught by a pioneer in the field and the last NST course available in the United States this year.
To conclude, here is what one of the leading EFT practitioners in the U.S., Dr. Patricia Carrington, wrote to me last week about her experiences with NST:
I want to thank you for steering me to NST via your website. I have now had three treatments of it (and will take more) and am finding it extraordinary, but in unexpected ways. I went to an advanced practitioner listed on your site who fortunately works only 30 minutes from me.
I had scheduled the session because of a hiatus hernia which is quite troublesome for me, but the results came in other areas. Even after the first session my fingers loosened up so much that I am literally typing twice as fast at the keyboard, and using ALL of my fingers on it for the first time in my life actually -- a real joy -- and my walking is so improved
But the most impressive thing, other than the gratifying sense of balance between left and right sides of my body that it has given me, is its mood elevating effect. I feel light and wonderfully happy even under stressful circumstances in what I can only describe as a "new" way .
Dr. Patricia Carrington