The Knee Surgery that Never Happened

You Are the Placebo
Chapter One

In 1996, orthopedic surgeon Bruce Moseley, then of the Baylor College of Medicine and one of Houston’s leading experts in orthopedic sports medicine, published a trial study based on his experience with ten volunteers—all men who had served in the military and suffered from osteoarthritis of the knee.5 Due to the severity of their conditions, many of these men had a noticeable limp, walked with a cane, or needed some type of assistance to get around.

The study was designed to look at arthroscopic surgery, a popular surgery that involved anesthetizing the patient before making a small incision to insert a fiber-optic instrument called an arthroscope, which the surgeon would use to get a good look at the patient’s joint. In the surgery, the doctor would then scrape and rinse the joint to remove any fragments of degenerated cartilage that were thought to be the cause of the inflammation and pain. At that time, about three-quarters of a million patients received this surgery every year.

In Dr. Moseley’s study, two of the ten men were to be given the standard surgery, called a debridement (where the surgeon scrapes strands of cartilage from the knee joint); three of them were to receive a procedure called a lavage (where high-pressured water is injected through the knee joint, rinsing and flushing out the decayed arthritic material); and five of them would receive sham surgery, in which Dr. Moseley would deftly slice through their skin with a scalpel and then just sew them back up again without performing any medical procedure at all. For those five men, there would be no arthroscope, no scraping of the joint, no removal of bone fragments, and no washing—just an incision and then stitches.

The start of each of the ten procedures was exactly the same: The patient was wheeled into the operating room and given general anesthesia while Dr. Moseley scrubbed up. Once the surgeon entered the operating theater, he would find a sealed envelope waiting for him that would tell him which of the three groups the patient on the table had been randomly assigned to. Dr. Moseley would have no idea what the envelope contained until he actually ripped it open.
After the surgery, all ten of the patients in the study reported greater mobility and less pain. In fact, the men who received “pretend” surgery did just as well as those who’d received debridement or lavage surgery. There was no difference in the results—even six months later. And six years later, when two of the men who’d received the placebo surgery were interviewed, they reported that they were still walking normally, without pain, and had greater mobility.6 They said that they could now perform all the everyday activities that they hadn’t been able to do before the surgery, six years earlier. The men felt as though they’d regained their lives.

Fascinated by the results, Dr. Moseley published another study in 2002 involving 180 patients who were followed for two years after their surgeries.7 Again, all three groups improved, with patients beginning to walk without pain or limping immediately after the surgery. But again, neither of the two groups who actually had the surgery improved any more than the patients who received the placebo surgery—and this held true even after two years.

Could it be possible that these patients got better simply because they had faith and belief in the healing power of the surgeon, the hospital, and even in the gleaming, modern operating room itself? Did they somehow envision a life with a fully healed knee, simply surrender to that possible outcome, and then literally walk right into it? Was Dr. Moseley, in effect, nothing more than a modern-day witch doctor in a white lab coat? And is it possible to attain the same degree of healing when facing something more threatening, maybe something as serious as heart surgery?

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