Placebo Surgery

  From’s Monday’s desk calendar:

This comic reminds me of a story that I heard about on the Skeptics’ Guide to the Universe a while back (apologies – I can’t find the episode in a brief search of the website) about vertebroplasty, a surgery that has been used to relieve pain associated with some vertebral fractures. Bone cement is injected into the fracture, and patients who receive the surgery report immediate pain relief afterwards. But a sham procedure seems to produce the same effects. From a 2009 article in the Wall Street Journal:

The federally funded study signed up 131 patients in the U.S., Britain and Australia. Half of them received a vertebroplasty, in which the back is numbed, an injection is made into the vertebra, and bone cement is injected by a radiologist or spine surgeon to shore up a fracture. The other group of patients received a sham procedure, including the numbing, but no injection. The doctor opened the container of bone cement so its scent would fill the operating room to disguise whether these patients were receiving a real surgery or not.

After a month, both groups saw a substantial reduction in various measures of disability and pain, assessed by a questionnaire. But the reductions were a statistical tie—the actual procedure yielded no gain beyond the placebo effect of the sham surgery.

There was a second major study that appears to confirm these findings. But the verdict is still out and there is a bit of a controversy around the effectiveness of vertebroplasty.

Pain management is what we’re talking about. This doesn’t sound like a surgery that’s necessary to stabilize a fracture to keep it from getting worse. It’s not needed to cause a structural change or to evoke a physiological effect. It’s done to relieve subjectively perceived and reported pain so people can get about their day. We have so much still to learn about pain management, don’t we?

Aside from the findings, I also think it’s a pretty neat example of how so-called “western medicine” is willing to examine itself and to make changes – or at least start conversations about potentially making changes – based on new science and data.

Placebo Surgery