DOI: 10.1097/BRS.0b013e3182112a0e
,
Issn Print: 0362-2436
Publication Date: 2011/04/01
Excerpt
We appreciate the comments by Dr. Katz about our analysis of the response of practitioners of vertebroplasty to two double-blind randomized trials demonstrating that this procedure is no more effective in relieving pain associated with vertebral fractures than a sham intervention without the injection of cement. We suggested that physicians who perform this procedure might become “placebo reactors” who believe strongly in the effectiveness of the procedure based on clinical experience. He describes our approach derisively as “psychoanalysis.” However, our aim was not to psychoanalyze practitioners but to suggest an explanatory hypothesis for the strong negative reaction to the results of these randomized trials. Ironically, he performs “psychoanalysis” of his own, concluding that the reason for our paper was a defensive response to criticism of the sham-controlled trials. Indeed, his comments validate our approach by invoking “secondary gains” and “desperate attempts to offer help” to explain the popularity of the procedure among physicians. In addition, the reason he gives for doubting that vertebroplasty is “ineffective compared to placebo”—“the strong opinions that exist, the anatomical basis for the procedure, and by my own personal observations”—reinforce our hypothesis of the practitioner as placebo reactor.
We agree with Dr. Katz that more rigorous research on the effectiveness of vertebroplasty and kyphoplasty is desirable. The propensity of patients to develop placebo responses to this invasive procedure, and of physicians to become placebo reactors based on their clinical experience, underscores the importance of double-blind placebo-controlled trials.
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