[ordinaryperson]

Without specifics this article is not helpful.

I've had 5 orthopedic surgeries and they were transformative -- and this article is written by an orthopedist!

There's some data [1] against these operations:

- Arthoscopic knee surgery

- Subacromial shoulder decompression

- Acromioplasty for rotator cuffs

- Vertebroplasty for the spine

That's 4 techniques out of...how many exactly?

It's just an n=1 anecdote but my surgeries absolutely changed my life for the better. I don't want to get into the gory details but I feel incredibly grateful to have had such talented surgeons.

You can argue placebo but my years of ineffective physical therapy suggest otherwise.

Instead of saying "Surgery, the Ultimate Placebo" this article should say "A handful of specific surgeries shown to be no better than a placebo" -- generically describing all surgeries as a placebo is clickbait, in my non-medical-professional opinion.

[1] https://www.realclearscience.com/blog/2020/11/07/some_surger...

[OJFord]

> It's just an n=1 anecdote but my surgeries absolutely changed my life for the better. [...] You can argue placebo but my years of ineffective physical therapy suggest otherwise.

They don't though, do they. You can't disprove placebo with N=1.

If the placebo is the act of surgery then anything not surgery not working doesn't mean that the surgery worked by not placebo means.

But who cares how, it worked!

[ordinaryperson]

So cynical. I hope you're never in debilitating physical pain, only to have other people dismiss the effect of surgical intervention as a figment of your imagination.

It's not just about the sample size, I could get into the anatomy of my injuries but I don't want to divulge more of my medical privacy than I already have.

Suffice to say that when certain things are torn or detached surgical intervention is often the only way to re-attach or restore function to the affected joints. No mount of wishing it way mentally is going to change that.

[medlyyy]

I think you're misunderstanding what "placebo effect" means. Colloquially it's applied to things that "do nothing," or have only a psychological impact but in reality the placebo effect continues to work even when people are fully aware that what they are taking is a placebo:

1. https://onlinelibrary.wiley.com/doi/full/10.1111/jebm.12251 2. https://www.sciencedirect.com/science/article/pii/S152659001...

So the situation is more complicated than "figment of your imagination" or "wishing it away" (this doesn't work and isn't what placebo is referring to by they way - you have to actually receive a treatment even if that treatment has no direct effect) - it's clearly a real biological effect. Just the mechanisms are more obscure.

There's obviously a limit to what placebo effects can accomplish even if they can be positive, and I think the goal & point made is that because surgery is inherently risky, there should be an expectation of benefit over and above what can be accomplished with risk-free methods; ie., that surgeries which are shown to be only as effective as placebo should probably not be performed.

[fooblat]

I find those studies problematic. In the ones I read from your links, the doctor says something along the lines of "this pill is a placebo. It means it has no active ingredients. However, the 'placebo effect' is known to be powerful and if you take these pills as instructed they can still help you..."

As I understand it, a big part of the placebo effect is setting the expectation that the treatment will help. And it is only known to help in subjective conditions, such as pain.

I expect we might see different results if the doctor said something more like "This pill has no active ingredients and does nothing. We are giving it to you to see if you will imagine that it worked anyway."

Kissing a child's scraped knee is not a treatment but, it along with a reassuring "there, all better!" works wonders for the child anyway. They are comforted and relived.

[tsimionescu]

There is as yet no reason to think placebo is a 'real' effect, except for cases of subjective symptoms or body functions under conscious control (directly like breathing rhythm or indirectly like pulse).

For all other cases, like infections or tumors, the placebo effect seems to only be a measure of poorly understood differences in natural processes, which can cause spontaneous remissions at unpredictable rates.

The act of giving fake medicine to the control group has no direct effect on the people taking it - the idealized study results would almost certainly be the same if the control group received no medication at all. However, the reported data would be much harder to trust, as it would be obvious for the data collectors and pacients which group they are part of, making it trivial for them to misreport data and symptoms to influence the result in the direction they desire (whether consciously or not).

That is the real reason for the double blind study design in most tteatments - fear of fake data, not any mysterious healing/detrimental effects from the act of taking sugar pills.

[jartelt]

Regarding something like your rotator cup issue: it's not simply a question of doing no treatment (you just having a painful shoulder) vs. having your surgery. It is more does having your rotator cup surgery and associated post-op rehab statistically work better than having a "sham" placebo surgery and doing the associated post-op rehab. People can begin to feel better after having placebo surgeries where nothing was actually repaired.

Below is a study seeking to measure the efficacy of rotator cuff surgeries. The point is that even this surgery, which I think you had performed and were happy with, does not necessarily have clear, proven efficacy vs. a placebo surgery.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530362/

[inakarmacoma]

The improvements from okeechobee Placebo are demonstrably real. We don't always understand why/how, but... the sugar pill, for example, in combination with your body and mind are very literally resulting in improvement. Placebo does not mean fake nor tricked. The efficacy is absolutely fascinating, though.

[tsimionescu]

That is only true for subjective symptoms like pain or anxiety, or for objective symptoms where there is some measure of conscious control, like blood pressure or pulse.

But there is no proof whatsoever of any kind of real placebo effect for body functions with no direct conscious control, such as immune function improvements from placebos.

[OJFord]

Please allow me to reiterate: who cares how, it worked!

If I ever suffer debilitating physical pain, as I'm sorry you did and I hope I do not, the only thing I shall care about is that it stops.

Please understand that I'm not advocating for an end to the surgery that spared you that, whatever the means by which it did so.

[Siira]

I’ve seen debilitating physical pain gone by “meditation.” I myself have had pain in my chest and throat out of anxiety. Pain is ultimately a perception the brain makes, not a physical attribute.

[hef19898]

Orthopedic surgery is, IMHO, one the most "controversial" medical fields. Ask an orthopedic surgeon, and the answer will be in most cases surgery. Ask a non-surgeon orthopedic, and the answer will be therapy. Source: Having gone through some consultations, and having family that spent their professional career in orthopedic rehab.

Thing is, for every case one of the above might wrong there are two cases they might be right. Sometimes both are right.

Personally, I choose to forgo surgery. I have no intention to become a professional athlete or compete again, so I stick with my original parts, so to say. I did stop snowboarding and kickboxing, so. My knees really don't like these sports anymore. And I don't like them enough to go through surgery. I switched to boxing and skiing. I am rather sure that I would chosen surgery like 10 years or so ago.

[grumple]

If a surgery’s effectiveness has not been evaluated vs a placebo, you cannot assume it to be effective based on anecdotes. Obviously there are many surgeries that are effective (repeating broken limbs, emergency surgeries, etc). Those surgeries having to do with pain relief are more nebulous.

My partner is a physical therapist, and in cases where it’s ineffective, it’s often because the patient is noncompliant or is doing it just to check off that “attempt” prior to surgery. A relative, as an example, goes to PT for all sorts of issues, but her real problems are psychological/neurological (due to brain damage); no amount of PT will ever heal her mind or change her excessive perception of pain.

[rozab]

It's really interesting how people with theoretical knowledge of what the placebo effect is can still refuse to believe in it in practice. From my experience, I think a lot of doctors don't really believe in these effects.

[appleflaxen]

You and Sam's mum have the best health care ever.

[voxl]

So the surgeon found water for you. Good for you, I'd rather listen to the data.