Think Twice Before Getting Knee Surgery

During the 4,000-year history of medicine, doctors have done terrible things to patients. We gave them arsenic and mercury; we bled them; we made them vomit, and we gave them laxatives; we made them hot, and we made them cold. A lot of this was nonsense, sometimes dangerous and even deadly. You would expect that eventually patients would catch on and learn to avoid doctors, but most didn’t. Many got better despite the dreadful treatments and felt only gratitude.

The magic of medical success has always been, and, to a large extent, still is, the remarkable power of the placebo effect: getting better due to a tincture of time and the magical power of hopeful expectations. Many popular treatments are popular more because of placebo effect than because of any physiologic changes. Placebo is the best medicine ever invented.

The placebo effect is endlessly fascinating. We know that two pills produce a greater placebo effect than one, that brand-name pills work better than their generic equivalents, that expensive pills are more powerful, and that placebos work even when patients know they are placebos. And placebo injections work even better than placebo pills.

The study of the placebo effect in surgery has lagged far behind the study of its role in medicine, because doing placebo surgery is harder than giving a placebo pill. Yet there is every reason to believe that surgery is especially prone to placebo effects. The more dramatic the procedure, the more likely it raises hope of cure. “Quick, operate before the patient gets better” is one of those jokes that orthopedic surgeons tell among themselves, barely covering a hard truth: that a lot of elective surgery might be unnecessary or even harmful.

Dr. Teppo Jarvinen is the orthopedic surgeon best qualified to explain this issue. As the Jane and Aatos —> Read More