Is surgery a placebo?

From Martin Hutchison in BBC News:

In the early days of medicine, physicians might diagnose patients using bumps on their head, or dispense a couple of leeches to draw off “ill humours”.
Yet a medieval doctor might give a more confident response than his modern equivalent if a patient asked for the evidence to support their treatment.
These days, it seems many of our “tried and tested” approaches to disease are nothing of the kind.

Researchers writing recently in the British Journal of Surgery concluded the practice of daubing patients with a disinfectant skin gel prior to operations made little or no difference to the rate of infections they suffered afterwards. Simple soap and water was just as effective.

However, despite this, it’s more than likely that, in future, waking up after your operation in many British hospitals, you’ll have that tell-tale orange stain around your wound. You’ll have been given a treatment that doesn’t work.

Read more here. The article goes on to describe a study by Andrew Booth at the School of Health and Related Research in Sheffield that found that 15-20% of health care facilities in Britain used treatments that “did not have a shred of worthwhile evidence to support their use.” There are of course, many unfortunate consequences of this. The first is that patients often aren’t getting the treatment that they need. Second some of the ill-informed treatments are actually harmful. One example mentioned by the piece is the test for prostate specific antigen (PSA) which is done as a screening test for prostate cancer despite the fact that those who have the test performed are just as likely to die from prostate cancer as though who don’t. Moreover the use of the test may end causing someone to have an unnecessary surgery performed.

This last issue, unnecessary surgery, made me wonder. Just how scientific are surgeries in general? After all it’s not so easy to give someone the sugar-pill equivalent of a surgery to really “subtract out” the placebo effect in the standard double-blind fashion. To really test the efficacy of a given surgical procedure you’d have to give some group of people a scar and tell them you’ve actually performed the surgery, and since this enters an ethically gray area (to say the least), it hasn’t to my knowledge, been done. Furthermore if the placebo effect really does have something to do with “the power of suggestion” then one would expect the placebo effect to be extremely high in the case of surgeries since one is literally removing a tumor or repairing a malfunctioning organ, in a very dramatic and immediate fashion. In fact, saline injections are very useful in burn victims when they are told that they’re being given a very strong painkiller. So the invaseiveness of a procedure seems to increase the placebo effect. Another important factor is the niceness of the doctor prescribing the treatment, which also increases the effect of the placebo.

So sometimes placebos are useful. But not all of the time of course. A Danish study of placebos found that 48% of general practitioners had prescribed a placebo in the last year. The placebo prescriptions range from vitamins for fatigue, to antibiotics for viral infections (even though antibiotics only kill bacteria, not viruses) which is certainly not a good thing since natural selection will give rise to ever nastier antibiotic resistant super-bacteria! So I’m more or less on the pro-placebo side of the debate, but only if those Danish doctors switch to a more inert placebo for viral infections. So Danes, if you’re reading, here are some suggestions for harmless placebos: vitamins(!), eat more vegetables, vote for Bill Richardson for President, comment on ..dotted and undotted dotterings.., and of course more ice cream from Scoops!