If I told you that you can get the same relief from your pain with either
a). an invasive, potentially fatal surgery
b). a risk-free sham procedure
which would you pick?
That's the question being prompted by the results of a multi-center, double blind, placebo controlled trial, entitled "A Randomized Trial of Vertebroplasty for Painful Osteoporotic Spinal Fractures", and published in the New England Journal of Medicine in 2009.
This study compared the efficacy of vertebroplasty - a common surgical procedure involving the injection of bone cement into fractured vertebra - to a sham procedure.
In all outcomes measured - overall pain, pain at night, pain at rest, physical functioning, quality of life, and perceived improvement - there was no significant difference between the two groups at any time following the intervention.
Does this mean vertebroplasty is ineffective in relieving pain?
Not at all - it's very effective!
After all, there were significant improvements in all of the measured outcomes at each of the scheduled follow-ups.
But the improvements in the placebo group were just as great!
In fact, the only statistically significant difference between the two groups at all - the total QUALEFFO score at 1 week - favored the placebo group!
This, for me, is another beautiful affirmation of a common theme that is seen throughout many, if not all, aspects of medicine.
While at first blush this idea that we docs don't really know what we're doing or why our therapies are helping may appear unsettling, I actually find the prevalence of the so-called "placebo effect" to be quite liberating.
After all, it implies that the ultimate power to heal ourselves lies within each of us - something that I have been increasingly convinced of throughout my time in practice, and which I wholeheartedly utilize with my patients.
Most patients do possess this capacity for self-healing within themselves, and simply need the proper healing trigger from a well-chosen external source of information.
While I clearly believe that the homeopathic remedy is one of the best such triggers (if you don't know what I'm talking about, look at ... well, pretty much anything else on this site! :) ), a surgical intervention - or mock surgical intervention, as it turns out - can be just as healing.
That is - provided it's matched to the patient who needs it.
IMHO, all forms of medicine have at least some potential for healing inherent within them.
The only question which remains is WHICH medicine will be most healing for THIS given patient.
This is the place where individualization must occur, and where we doctors (IMHO) must set aside our alleged "expertise", and realize that no cookbook protocol can offer the same deeply curative results as a well-matched individualized prescription.
But, if this is true, why is it that the patients in this study improved?
After all, how could they have been well-matched? This was a multi-center, double-blind, placebo-controlled randomized trial, a form of evidence which - in evidence-based medicine circles - is considered to be of higher quality than any other!
But do the subjects in the study really represent a random cross-section of people with osteoporotic spine fractures?
After all, by self-selection, only those who were willing to undergo the invasive vertebral injection would have signed up for this study in the first place!
This suggests that the patients in the study were those who, on some level, found the idea of this invasive treatment to beat least tolerable, if not somewhat appealing.
Thus, IMHO, these study subjects instinctively selected for themselves the treatment that, of all their alternatives, was the most well-matched to them!
Individualization at its finest :)
Interestingly, I also find that this is true in my practice.
I can't count the number of times that I have just discovered a way to treat a certain, very specific condition ...
... and, for the next few days, I'll be barraged by people with just that condition needing just that treatment!
A strange phenomenon, indeed, and one which I had a tendency to dismiss "short-term memory bias" in the past.
That is, until I experienced it so often that I could no longer deny there was something greater going on.
As has been my experience with homeopathy and energetic medicine in general - when I experience something again and again, no matter how inexplicable it may superficially seem, I cannot help but to simply know a deeper truth must lie somewhere therein.
This, IMHO, is the highest form of evidence available.
It is more than evidence - it is simply evident.
It is the kind of truth that you don't need a double-blind, placebo-controlled trial to confirm.
And this is the level at which I prefer to work with my patients.
Although I have nothing against testing, and believe it to be valuable in supporting diagnosis and treatment decisions, I'm not fixated on what your test results suggest that you should or must be suffering from - after all, if you have Fibromyalgia or IBS, this is apparently nothing!.
No, I'm more interested in what is your actual experience.
Your completely subjective, completely unobservable experience. For you, this is truth.
And your own personal truth is, IMHO, to be respected even more highly than the most well-designed placebo-controlled study.
This is the key to deeply individualized treatment.
Which is the key to permanent cure.
And, ultimately, to health itself.