Abstract
ObjectivesTo survey surgeons on their beliefs and attitudes towards the use of placebo in surgery.MethodsBritish orthopedic shoulder surgeons, attending a national conference in the United Kingdom, were asked to complete a self-report online questionnaire about their beliefs and attitudes towards the use of placebo related to surgical intervention. The survey included questions about ethical issues, the mechanism of placebo effects, and any concerns regarding its use.Results100 surgeons who participated in the survey believed that placebo surgery is ethically acceptable (96%), especially as a part of a clinical trial (46%). Respondents thought that a placebo effect in surgery is real i.e. has a scientific basis (92%), that placebo can be therapeutically beneficial (77%), and that it involves psychological mechanisms (96%). Over half of the respondents (58%) have used a surgical procedure with a significant placebo component at least once in their professional career. Their main concern about placebo use in surgery was that it might involve an element of deception.Conclusions and ImplicationsSurgeons generally agreed that a placebo component to surgical intervention might exist. They also supported placebo use in clinical trials and considered it ethical, providing it does not involve deception of patients. More studies are needed, particularly among other surgical specialties and with larger numbers of participants, to better understand the use of placebo in surgery.
Highlights
The placebo effect is a behavioral and clinical response to the meaning of treatment
The placebo effect is influenced by the previous experiences as well as the beliefs and expectations about the treatment [5,6,7]
Placebo is frequently used in pharmacological randomized clinical trials but its role in surgical trials is less widely accepted [8,9,10]
Summary
The placebo effect is a behavioral and clinical response to the meaning of treatment. As surgery is often performed to improve quality of life, as opposed to the preservation of life, the outcomes measured are more subjective and often depend on patients’ and assessors’ perception of pain, function, or quality of life. These subjective outcomes are prone to bias in an open-label design [11]. A placebo effect, as well as its negative counterpart, i.e., nocebo effect, has to be considered while interpreting results of trials with subjective outcomes, especially if the group with active intervention is compared with patients without surgery, e.g., the waiting list
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