Articles by JCS

NEWSWEEK RIPS SPINE SUR

Newsweek

rips spine surgery

by

JCS

The revelations about unnecessary spine surgeries continue to appear in the mainstream media with a cover story in Newsweek magazine, “No! The One Word that Can Save Your Life” by Sharon Begley (August 22, 2011).

The article spoke about many unnecessary surgeries including, of course, spine surgery:

“An MRI typically costs about $3,000 and is designed t spot everything from bulging discs to hairline fractures. Find any of those things, the logic goes, and you can treat the problem surgically. But there’s one fundamental flaw: clinical trials have shown that back surgery, including vertebroplasty (putting special cement on a tiny spinal fracture) and spinal fusion, is no more effective at alleviating ordinary pain than plain-old rest and mild exercise. But like any surgery, it carries risks. Last year the American College of Physicians warned that “routine imaging [for low back pain] is not associated with clinically meaningful benefits but can lead to harms.” That’s because the ‘abnormalities’ seen in an MRI often have nothing to do with the back pain (people without pain have them too), but seeing something on a scan makes a physician feel compelled to get rid of it. “There is a long-standing fallacy among physicians that if you find something different from what you perceive to be ‘normal,’ then it must be the cause of the patient’s problem,” says UNC’s Hadler.

Unquestionably, the need for a paradigm shift in spine care is gaining media momentum. The call for restraint in spine surgery has been growing louder since spine fusion is now considered the biggest medical scam as well as the most expensive surgery in America. In the era of evidence-based healthcare, the facts do not support the massive amount of spine surgeries.

Over the last few months, other mainstream media have also jumped on the unnecessary, risky, and expensive spine surgery scam. For example, here are a few recent media exposés on spine surgery:

  • “Surgery May Not Be the Answer to an Aching Back,” by Joanne Silberner, NPR, April 6, 2010.
  • “Back Surgery May Backfire on Patients in Pain,” by Linda Carroll, MSNBC, Nov. 14, 2010
  • “Top Spine Surgeons Reap Royalties, Medicare Bounty,” by John Carreyrou and Tom McGinty, Wall St. Journal, Dec. 20, 2010
  • “Highest-Paid U.S. Doctors Get Rich with Fusion Surgery Debunked by Studies” by Peter Waldman and David Armstrong, Bloomberg News, Dec. 30, 2010.
  • “Spinal Fusions May Cause More Harm Than Good,” by Terrance Pagel, Daily Health Report, Jan. 20, 2011
  • “Medicare Records Reveal Trail of Troubling Surgeries” by John Carreyrou and Tom McGinty, Wall St. Journal, March 29, 2011

The times are changing when The Wall Street Journal, NPR, and the Bloomberg News expose the ineffectiveness of spinal surgery not to mention the untold cost in human suffering as well as economics. Not only is the public unaware of these risky spine surgeries, the media has developed professional amnesia when it forgets to mention that conservative chiropractic care is now recommended as an initial treatment for back pain. Beginning with the USPHS guideline on acute low back pain in 1994[1], more recent guidelines (including the North American Spine Society[2], the American Pain Society[3], and the Milliman Care Guidelines®[4]) recommend spinal manipulation therapy, a fact omitted in these critical articles.

Another big blow occurred when Blue Cross Blue Shield of North Carolina announced in January, 2011, that it would no longer pay for spinal fusion for back pain in the presence of only disc degeneration or disc herniation. This is a huge policy change that will hopefully have a ripple effect among all state BC/BS and other insurance companies to curtail payment for this epidemic of ineffective spine surgery. [5]

Moreover, WSJ and the NYT in June, 2011, revealed a Senate Finance Committee is investigating whether surgeons who received large sums of money from medical-device giant Medtronic Inc. for consulting and other work failed to note complications associated with a Medtronic bone-growth protein that has become widely used in spinal surgery. As well, Medtronic has been giving million dollar royalties to spine surgeons as inducement to use and to promote their wares.[6]

Unfortunately, this spine surgery scam and associated opioid drug addiction (“Hillbilly Heroin”) from failed back surgery and chronic LBP has not deterred the public from seeking ineffective medical care since the medical profession still dominates the back pain business: the majority of patients (61%) received MD care for spinal pain, followed by those who received DC (28%) and MD/PT (11%) care.[7]

Despite the numerous international guidelines that recommend chiropractic care for non-specific LBP, the positive public polls (Gallup, TRICARE, Consumer Report), the comparative clinical studies (AHCPR, Manga, NICE), and the researchers who chide the disc theory as “incidentalomas” (Boden, Deyo, Jensen), the medical profession rarely refers LBP cases to DCs as the guidelines recommend.

This should make every DC scream with disgust; instead I hear few complaints. It appears we have accepted our plight since there is no outcry to the public.  We have no PR aimed at the errors of the medical methods or the fallacy of the disc theory. Nor do the national associations seem disturbed at the thousands of unnecessary spine surgeries performed each year costing millions in lost work days and billions of dollars.

Indeed, the average back pain patient can expect a very expensive and bumpy ride on the medical gravy train, starting with pain pills and muscle relaxors, then ESI, then MRI/CT scans, and finally after drugs and shots fail, the inevitable trip to the train’s conductor—the spine surgeon. Plus, many can expect to repeat this trip with repeat surgeries. It just never ends once they get on the medical gravy train.

But what has the chiropractic profession done to alter this railroading of patients to the $100,000+ spine surgery scam? I’m afraid to say, relatively nothing. Indeed, when was the last time the president of the ACA, ACC, or ICA has been on cable news lambasting spine surgery? Where is the PSA urging patients to visit a chiropractor before drugs, shots, or surgery as the guidelines suggest? Just where is our good advice?

Instead of touting this spine surgery scam for what it is—sheer exploitation of unsuspecting patients, some in our leadership say nothing while others seem afraid to speak out against the medical profession—the purveyors of this scam? When Newsweek and other national news organizations are criticizing these spine scams, why aren’t we?

Indeed, when was the last time any chiropractic leader was heard on national news complaining of the overuse of drugs, shots, and surgery while touting the effectiveness of chiro care? The time is now to come out with this important message—the proof is there along with the guidelines. Now with national news media changing the public’s mind, we must position ourselves as the natural alternative to the medical madness.

We know that chiropractic care could lower healthcare costs, reduce workplace disability, and avoid permanent failed back surgery syndrome and the associated consequences of drug abuse and depression.

What we need is an outspoken leadership willing to get in front of the TV news cameras to challenge this massive onslaught of ineffective medical methods. The proof is there, but we need to tell our story to the public since the medical society will never tell the truth on this matter.

This is why I wrote my book, The Medical War Against Chiropractors.



[1] Bigos et al. US Dept. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Clinical Practice Guideline, Number 14: Acute Low Back Problems in Adults AHCPR Publication No. 95-0642, (December 1994)

[1] Ibid. p. 90.

[2] Freeman MD and Mayer JM, NASS Contemporary Concepts in Spine Care: Spinal Manipulation Therapy For Acute Low Back Pain, The Spine Journal  2010October; 10 (10):918-940

[3] Chou R, et al., Diagnosis and Treatment of Low Back Pain:  A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society, Low Back Pain Guidelines Panel, Annals of Internal Medicine 2007 October 2; 147  (7):478-491

[4] Milliman Care Guidelines for Lumbar Fusions, Low Back Pain and Lumbar Spine Conditions—Referral Management, www.allmedmd.com

[5] http://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/lumbar_spine_fusion_surgery.pdf

[6]Top Spine Surgeons Reap Royalties, Medicare Bounty,” by John Carreyrou and Tom McGinty, Wall St. Journal, Dec. 20, 2010  

[7] Julia Chevan, Daniel L. Riddle, Factors Associated With Care Seeking From Physicians, Physical Therapists, or Chiropractors by Persons With Spinal Pain: A Population-Based Study, J Orthop Sports Phys Ther 2011;41(7):467-476

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