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The Truth About Back Surgery

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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 you.

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