By Dr. Mercola
Doctors have been using your mind for decades to help you feel better. Also known as the placebo effect, using pills and therapies known to have no effect on the body can sometimes have a significant effect on your health and wellness.
In medical practice, a placebo is a treatment that appears real, but isn't. Oftentimes researchers use placebos in medical studies to determine if there is a measurable difference between the treatment being tested and the effect your mind has over your body.
Doctors have used pills, therapies and shots in order to effect a change in your health without increasing your risk to potential side effects from other treatments. Research into this effect has found a relationship between what you could reasonably expect from your treatment and your body's response.
In other words, if you expect a pill or shot to lessen your pain, you may experience less pain. However, researchers have also found that placebos have an effect on healing and body chemistry as well, demonstrating the power of your mind on self-healing.
Placebos Harness the Power of Your Mind
While scientists can't determine how they work, they have found there is a hierarchy of effectiveness to placebos. Some placebo treatments just work better than others. For instance:1
- Placebo surgery works better than placebo injections
- Placebo injections work better than placebo pills; color and size of the pill makes a difference
- Sham acupuncture treatment works better than a placebo pill
- The more expensive, the better and the more doses per day, the better the effect
- Telling the patient, "This will relieve your pain" works better than saying "This might help"
Belief has a powerful effect on your mind and healing your body. Interestingly, recent investigations point to a growing effectiveness of placebos among Americans.2 This is having a powerful influence on the development of new painkillers.
The response of clinical trial participants to placebo medications to treat neuropathic pain has increased steadily over a 23-year period between 1990 and 2013.
This change has effectively reduced the margin of benefit between placebos and active drugs. This change makes it much more difficult to establish a statistical difference between placebos and the active medication.
As the response to placebos is getting more powerful, it is more challenging to prove a drug actually does what is intended.3,4
Placebos Work in More Than Medical Treatments
Although the placebo effect appears more frequently in medical treatments, other areas experience similar benefits.
• Research published in The Sport Psychologist found that athletes given an energy drink and told they could lift more weight than normal were able to increase the amount lifted by 4 percent.
• Even when athletes knew they were drinking a placebo, they were still lifting heavier weights than without the supplement.5
• A study published in The Gundersen Medical Journal in 2000 found runners given "super oxygenated water" ran 8 percent faster. The results were consistent across 84 percent of the runners. The drink was just plain water.6
• In 2007, researchers found a 20 percent increased strength in untrained athletes who thought they received amino acids to increase strength but were receiving a placebo.7
• A study in 2008 demonstrated a 22 percent increase in strength in trained athletes who thought they were taking caffeine.
The researchers in this study conditioned the participating athletes to believe they were lifting more weights than they actually were, which made them believe the "drug" was even more powerful.8
Although these percentages may seem small, they can mean the difference between placing in the top three in a professional competition and not placing at all.
Useless Surgery Is More Than Just a Placebo
Before a drug is allowed to be sold on the open market it goes through testing to ensure both safety of the product in human trials and that the benefit to the drug is greater than the benefit of using a placebo.
When the process is not successful, medications can slip through causing significant health problems, as did Duract, Zelnorm, Vioxx, Seldane and many others.
However flawed the system for medication approval may be, there is no similar process for surgical procedures. The expected outcome from rigorous clinical trials that demonstrate a surgical procedure is not beneficial would be that surgeons no longer perform the operation. But that doesn't happen.
For instance, lumbar fusion surgery is used to relieve back pain if your discs are worn. Surgeons use a graft to fuse the bones together, which reduces the flexibility of your spine.
The surgery can last up to four hours, requires physical therapy to return to your normal activities and carries with it a number of significant health risks including:9
✓ Blood clots in the legs that may travel to the lungs
✓ Infection developing in the lungs, bladder or kidney, wound or spine
✓ Heart attack or stroke during surgery
✓ Blood loss
✓ Breathing problems
✓ Reaction to medications used during surgery
✓ Damage to your spinal nerves causing pain, loss of sensation or weakness
✓ Spine is more likely to wear away, both above and below the graft, triggering more problems later
✓ Risks from anesthesia include damaged teeth, nausea and vomiting, respiratory depression or anaphylaxis
Several clinical trials and analysis of surgical procedures published from 2005 through 2014 have demonstrated conservative rehabilitation treatments are as effective as lumbar fusion, or more so, without the associated risk.10,11,12,13
Lumbar fusion is only one of several reimbursed surgical procedures despite research casting doubt on their effectiveness.
What may cause surgeons to recommend surgeries that don't have a demonstrable benefit margin above other less invasive treatment options, such as a structured rehabilitation program?
Physician Perspective on Outcomes
In 2009, research was published in the New England Journal of Medicine, studying the long term effect of vertebroplasty to treat vertebral compression fractures compared to a placebo procedure.14 The results between the two procedures had no statistical differences; both groups experienced the same pain relief.
Dr. David Kallmes of Mayo Clinic and lead author of the research, theorized physicians perform surgical procedures that have not demonstrated greater benefit than a non-invasive treatment since insurance companies continue to reimburse for the surgery, and surgeons may have a greater tendency to remember their patients who seemed better after the procedure. Quoted in The New York Times, Kallmes said:15
"When you read a study, you reflect on whether it is representative of your patient population. It is easy to conclude that the answer is 'no.' The mean age in the study is different or 'I do it differently.'
I think there is a placebo effect not only on patients but on doctors. The successful patient is burned into their memories and the not-so-successful patient is not. Doctors can have selective memory that leads them to conclude that, 'Darn it, it works pretty well.'"
Other surgical procedures physicians continue to perform, although research demonstrates the invasive procedure is as effective, or less effective than non-invasive rehabilitation, include meniscus repair (knee) with osteoarthritis16 and meniscus repair without osteoarthritis.17
Insurance Companies May Hold the Key
The research evaluating the benefits of spinal fusion should have been enough to curtail the number of fusion surgeries performed throughout the U.S. Unfortunately, the number only continued to climb. Between 2000 and 2009, following the publication of several research trials negating the benefit of fusion surgery, the number of procedures increased 2.4-fold, and six-fold over the past 20 years.18,19
The rates did not begin to drop until 2012 when Blue Cross Blue Shield of North Carolina declined to pay for spinal fusion surgery any further, and several other insurers followed suit.
However, although insurance companies appear to be reading the research, others want to continue to perform surgical procedures from which you won't benefit more than a rigorous rehabilitation program.20 Law firms are advising you to fight the insurance company to pay for a procedure with higher risk than rehabilitation, but no larger benefit margin.
Ultimately It Is Your Choice
While it may seem as if you don't have a choice in your treatment plan, ultimately it is your body and you who will experience any side effects or problems from a procedure. However, the choice you make may depend upon how the options are presented to you.
In response to an article about clinical trial data, Dr. Gordon H. Guyatt, a professor of medicine and epidemiology at McMaster University, wrote an editorial in The British Medical Journal, quoted in Clinicient and The New York Times, in which he said:21,22
"I personally think the operation should not be mentioned. But if a doctor says anything, say this: '[W]e have randomized clinical trials that produce the highest quality of evidence. They strongly suggest that the procedure is next to useless. If there is any benefit, it is very small and there are downsides, expense, and potential complications.'I cannot imagine that anyone would say, 'Go ahead. I will go for it.'"
What Can You Do Reduce Your Risk of Useless Surgery?
You are responsible for your health, for what you eat, for the procedures you agree to undergo and for the medication you take. In a fast-paced, one-pill-does-it-all society it can be tempting to take the advice of the first physician you work with, especially if they promise you exactly what you want to hear.
But, like everything else in life, there are two sides to each coin. Even after a surgical procedure, you will need rehabilitation to prevent the damage from occurring again and to regain strength and endurance to enjoy your life. Whether you do the work of rehabilitation after surgery or instead of surgery, you will likely need it to regain your health.
Unfortunately, there are no quick and easy answers to repairing and strengthening the complex human body. However, you may reduce your risk potential and possible long-term side effects by researching the recommended surgical procedure, getting a second opinion and considering a rigorous rehabilitation program.
Staying and remaining healthy requires you eat a science-based nutritional diet, move throughout the day, get eight hours of sleep each night and engage in stress reduction practices that work for you. Although you may find surgery to be necessary, you will improve your recovery time by incorporating each of these health practices on a daily basis.