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Do Something!

January 7, 2014

There’s a lot going on relating to the subject of “doing” right now.  Doing is very therapeutic.  It’s often better than doing nothing.  Witness Mary in Downton Abbey, who doesn’t get beyond her grief until given a purpose.  Same with Matthew’s mother.  There was a Jane Austen movie a few years back where a man who is in love with a sick woman feels better because he can go get the woman’s mother.  When I was in labor I begged my anesthesiologist to “do something!”  Then there’s all the bad adventure movies where one person says to another “Don’t just stand there!  Do something!” after which the something to be done is inevitably violent and fiery.

Doctors are known for being can-do types.  Surgeons especially:  “A chance to cut is a chance to cure.”  We are taught to TREAT disease, DRAIN abscesses, PRESCRIBE medications, MAKE people better, all action words.  It is very hard for many of us to a) do nothing, or b) admit there’s nothing to be done.  And in general patients like to have something done.  It makes them feel cared-for, listened-to, validated, plus if there’s really something wrong every once in awhile we can actually help.  This is especially true in the case of pain.  People with pain generally want it to go away as quickly as possible.  Very few like the “wait and see” approach.

Which leads me to knee arthroscopy.  I know I’m a little late to this particular party.  You’ve probably heard about it by now.  A study just published in the New England Journal of Medicine (where God publishes, and where you also can’t get the article unless you pay) suggests that for some kinds of knee injuries, doing nothing is a good as doing something.  It’s a great study, and I’m actually kind of surprised they got a whole bunch of patients to do this.  Very brave, those Fins.  What the researchers did was take everyone with a certain type of torn meniscus in the knee and divide them into two groups.  One got a knee arthroscopy (or knee scope) to clean out the meniscal tear, the other got a fake surgery.  That is, they put everyone under anesthesia, made incisions, put the scope in, but in some people they did the standard repair and in others they just looked around the joint but didn’t actually fix anything.  Guess what? A year later, most patients in both groups said their knees felt better, and the vast majority said they would choose the same method again, even if it was fake!

Now maybe it’s just Finnish people, but I know a few and they are not stupid.  The results of this study back up two earlier, similar studies done in 2002 in Texas and 2008 in Canada.  Aww now, you don’t really think I’m going to start talking smack about Texans and Canadians do you?  The very compelling urge to “do something” or “get something done” is present for doctors and patients all over the world.  Now, sometimes injuries do require patients to do something.  Young people, sports injuries, joint instability, stuff like that.  Like Mary, some people feel better if they take some sort of action, like going to see an orthopedist.  There are a few who will want surgery no matter what the doctor or the data suggest.  And there’s the issue in this country in particular that you don’t get paid for telling someone to take ibuprofen and come back in 3 months, but you get paid a whole lot for sticking a scope in someone’s knee.

But what about those who had fake surgery and said they’d have fake surgery again?  Is this just the comfort of the knowledge that “something was done”?  Placebo effect?  Here is what a 2009 article in Scientific American had to say:

  • In recent decades reports have confirmed the efficacy of various sham treatments in nearly all areas of medicine. Placebos have helped alleviate pain, depression, anxiety, Parkinson’s disease, inflammatory disorders and even cancer.
  • Placebo effects can arise not only from a conscious belief in a drug but also from subconscious associations between recovery and the experience of being treated—from the pinch of a shot to a doctor’s white coat. Such subliminal conditioning can control bodily processes of which we are unaware, such as immune responses and the release of hormones.
  • Researchers have decoded some of the biology of placebo responses, demonstrating that they stem from active processes in the brain.

I especially like the second statement.  Association between recovery and the experience of being treated.  It’s powerful.  It starts when your mother kisses you boo-boo and it’s all better, continues with chicken soup, and can never be completely discounted.

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