The Truth About Back Surgery
Johnson's story wouldn't surprise Charles Rosen, M.D., clinical professor of
orthopedic surgery at the University of California, Irvine, School of Medicine.
"An enormous number of back surgeries don't give patients long-term relief," he
says. There's even a term for what happens when an operation doesn't improve a
patient's condition — "failed back surgery syndrome," said to be the only
diagnosis named for a treatment that hasn't worked.
It gets worse. This is an area of medicine that's been tainted by
suspiciously cozy relationships between industry and doctors. In July, for
example, Jeffrey Wang, M.D., was dismissed from his post as executive
codirector of the UCLA Comprehensive Spine Center for not disclosing about half
a million dollars in payments he'd received from companies whose surgical
products he was researching. (The David Geffen School of Medicine at UCLA,
where Dr. Wang is still on the faculty, is looking into the matter.) And in a
2006 settlement with the Department of Justice, medical-device manufacturer
Medtronic agreed to pay $40 million to settle allegations that one of the
company's divisions had paid kickbacks to doctors to induce them to use the
division's spinal products. The company, which also entered into a five-year
Corporate Integrity Agreement (to ensure that relationships with physicians are
appropriate), has denied any wrongdoing or illegal activity.
Such activities affect the treatment you receive.
"Kickbacks...corrupt physicians' medical judgment," said Peter Keisler,
assistant attorney general for the Department of Justice's civil division, in
announcing the Medtronic settlement. And these physicians can, in turn, sway
other doctors' decision-making. "These are often prominent surgeons, the ones
in leadership positions in medical societies and on the boards of major
journals," says Dr. Rosen, who is also founder and president of the Association
for Medical Ethics. They write the articles that drive treatment methods and
device acceptance — influence that undoubtedly contributes to a vast number of
unnecessary operations. In the U.S., more than 1,150,000 people go under the
knife for spinal problems every year, a rate double that of most developed
countries and five times that of the United Kingdom, says Dr. Deyo. Yet the
outcomes have been no better. "Maybe 5 percent of patients with back pain need
surgery," says Dr. Rosen.
So whom can you believe, and what does help? There's little
consensus. Indeed, last June, when the prestigious Institute of Medicine
announced it would evaluate the effectiveness of approaches for 100 health
issues, lower-back pain was placed in the "highest priority" group.
There is no one best way to treat everyone. But the chance of finding relief
for ongoing pain unquestionably lies in understanding what has gone wrong —
often not an easy task — and then seeing the most appropriate specialist for
your problem and asking the right questions. With back problems, perhaps more
than with any other medical condition, getting the best care really is up to