An estimated 12% of Americansaged 65 and older have osteoarthritis of the knee. A popular operationfor arthritis of the knee worked no better than a sham procedure in whichpatients were sedated while surgeons pretended to operate, researchersare reporting today.
The operation arthroscopicsurgery for the pain and stiffness caused by osteoarthritis is performedon about 650,000 people in the US everyyear, at a cost of about $5,000 per procedure, for a total cost of 3.3billion dollars every year in the US.
It involves making three smallincisions in the knee; inserting an arthroscope, a thin instrument thatallows surgeons to see the joint; and then flushing debris from the kneeor shaving rough areas of cartilage from the joint and then flushing it.
Tests of knee functions revealedthat the operation had not helped, and those who got the placebo surgeryreported feeling just as good as those who had had the real operation.
Dr. Baruch Brody, an ethicistat Baylor who helped design the study, described the surgery as a sham.
The study dealt only with arthroscopicsurgery for osteoarthritis, not with other common knee operations.
The 180 participants in thestudy were randomly assigned to have the operation or to have placebosurgery in which surgeons simply made cuts in their knees so the patientswould not know if they had the surgery.
The research began when anorthopedic surgeon at the Houston veterans' hospital, Dr. J. Bruce Moseley,who is now the team physician for Houston's two professional basketballteams, approached Dr. Wray suggesting a study that would compare washingthe knee joint with washing and scraping in patients with arthritis.
Dr. Wray had a bolder idea.
"She said, `How do youknow that what you are seeing is not a placebo effect?' " Dr. Moseleyrecalled. "My response was, `This is surgery.' She said, `I hateto tell you this, but surgery may have the biggest placebo effect of all.'"
Placebo studies of surgeryare almost never done. Many doctors consider them unethical because patientscould undergo risks with no benefits. Working with Dr. Brody, the ethicist,the group tried to make the placebo treatment no more dangerous than dailylife. Still, of 324 consecutive patients who were asked to participate,144 declined.
For those who agreed, the dayof surgery meant being wheeled into an operating room while neither theynor any of the medical staff knew what their treatment would be. Whenthey were on the operating table, Dr. Moseley, who did all the operations,opened a sealed envelope telling him whether the patient was to have thesurgery or not.
Those in the placebo groupreceived a drug that put them to sleep. Unlike those getting the realoperation, they did not have general anesthesia.
Dr. Moseley made small cutsin their knees to simulate an operation. He bent and straightened theknee and asked for surgical instruments, just in case the patient waspartly conscious. An assistant sloshed water in a bucket to make the soundof a knee being flushed clean.
The paper in The New EnglandJournal is accompanied by two editorials. One, by Sam Horng and Dr. FranklinG. Miller of the National Institutes of Health, asks whether placebo surgeryis unethical. The controversy, they wrote, comes because doctors assumethat patients in clinical research should not be put at risk if they cannotbenefit, and placebo surgery involves risk.
But, they say, clinical researchis different from medical therapy; its aim is not to help those in thestudy but to help future patients.
To be ethical, they say, astudy with placebo surgery must meet three criteria: it must not placepatients at undue risk; the benefits of learning whether the surgery worksmust be worth any potential risk to the patients; and the patients mustgive informed consent.
In the current case, they wrote,all those objectives were met and the study "exemplifies the ethicallyjustified use of placebo surgery."
NewYork Times July 11, 2002
TheNew England Journal of Medicine July 11, 2002;347:81-88, 132-133
Long-time readers of thisnewsletter might remember this information was firstposted here over one year ago when it was presented at the AnnualMeeting 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 3years ahead of the rest of the world when it comes to breaking medicalnews!
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 mostprestigious journals. Last week, the most widely circulated medical journalin the world, JAMA, published astudy showing that Americans were spending 3 billion dollars ayear 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 NewEngland Journal of Medicine publishes a study exposing how another 3 billiondollars a year is being wasted on a knee scooping surgery for arthritisthat relieves the problem no more than a placebo.
Well folks, let me tellyou, placebos are a lot cheaper than $5,000 operations.
So what other options arethere?
It is important to recognizethat the arthritis scooping did work for many people -- and so did theplacebo. This is an amazing testimony to the power of your brain at inducinghealing changes in your body. The central question is how to harness thispower without expensive medications or dangerous surgery.
Remember that whatever youfocus your conscious attention on in the real world will typically beachieved. That is precisely what happened with this study. The patientstruly believed with every fiber of their being that this expensive andinvasive procedure would fix their problem, and superficially it did appearto do just that. Same, though, with those who received the placebo --a placebo unknown to them, of course. What really healed their bodieswere their own minds.
So here youhave a real world study, published in one of the most respectedjournals on earth, providing the theoretical underpinningsof why EFT works.You can easily begin to harness the power of EFT by reviewingmy free manual.There are also clinicianswho can help you individually.
There are, however, sometimesstructural problems that limit EFT from working. When thathappens, I find that following the eatingplan with special attention to the fish oil will helpthe inflammation that accompanies arthritis.
The above study was onlyfor knee arthritis. But the surgery referred to, arthroscopy,is also used for knee problems other than arthritis. In myoffice, instead of surgery, we employ a gentle massage techniquefrom Australia called NSTthat has proved highly effective for nearly all knee problems,including traumatic injury. We have rarely found the needto refer any patients with knee pain for surgical intervention.
NST helps the body actuallyrepair 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 NSTtraining course in September -- taught by a pioneer in the fieldand the last NST course available in the United States this year.
To conclude, here is whatone 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 steeringme to NST via your website. I have now had three treatments of it (andwill take more) and am finding it extraordinary, but in unexpected ways.I went to an advanced practitioner listed on your site who fortunatelyworks only 30 minutes from me.
I had scheduled the sessionbecause of a hiatus hernia which is quite troublesome for me, but theresults came in other areas. Even after the first session my fingersloosened up so much that I am literally typing twice as fast at thekeyboard, and using ALL of my fingers on it for the first time in mylife 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 sidesof my body that it has given me, is its mood elevating effect. I feellight and wonderfully happy even under stressful circumstances in whatI can only describe as a "new" way .
Dr. Patricia Carrington