Crooked Outwitting The Back Pain Industry and Getting On The Road To Recovery 1st Edition Cathryn Jakobson Ramin
Crooked Outwitting The Back Pain Industry and Getting On The Road To Recovery 1st Edition Cathryn Jakobson Ramin
Crooked Outwitting The Back Pain Industry and Getting On The Road To Recovery 1st Edition Cathryn Jakobson Ramin
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Dedication
Cover
Title Page
Dedication
Author’s Note
Introduction: A Terrible Affliction
Part I: Problems
1: Back Pain Nation
2: A Tale of Two Tables
3: Hazardous Images
4: Needle Jockeys
5: The Gold Standard
6: Google Your Spine Surgery
7: Replacement Parts
8: The Opioid Wars
Acknowledgments
Bibliography
Notes
Index
About the Author
Also by Cathryn Jakobson Ramin
Copyright
About the Publisher
Author’s Note
The note in my calendar, put there on April 14, 2008, says, “Find a
spine surgeon.” For decades, I’d sought to avoid open warfare with
my back, but on that date, the truce officially ended.
Over the years, I’d spent a fortune on chiropractic care,
acupuncture, physical therapy, and massage. I’d signed up for
Pilates, yoga, Tai Chi, and strength training, but instead of abating,
my pain intensified. By 2007, I could not sit or walk comfortably for
more than a few minutes. My hip ached and my right leg was on
fire. There seemed to be no escaping the pain. Like a rat in a lab
experiment, without a prayer of avoiding the offending stimulus, I
felt anxious, angry, and trapped. When my dear friend Stacey asked
me to join her on a hiking trip in the Peruvian Andes, I told her I
could not manage it. My anatomy was holding me hostage; instead
of climbing mountains, I would be going under the knife.
I thought fixing my back would be as straightforward as fixing a
broken wrist. I’d find a surgeon and get it done. But as I made my
way through overwhelming amounts of material on the Internet, I
saw that I was wrong. As an ordinary patient, I risked drowning in a
sinkhole of hype.
However, as an investigative reporter with three decades of
experience in digging for the facts, I recognized that I’d arrived on
the scene at the ideal moment. Back pain treatment was a
microcosm of everything that was wrong with the health care
system. Back trouble, in all its permutations, costs the United States
roughly $100 billion a year, more than is spent annually to treat
cancer, coronary artery disease, and AIDS (acquired
immunodeficiency syndrome) combined. On a per capita basis, other
nations—chief among them, the United Kingdom, Australia, Canada,
Germany, Sweden, Denmark, the Netherlands, China, and South
Korea—also pay hefty bills.
When I did my first Internet search, I had no idea that I’d spend
six years studying this topic. Nor did I realize that in the interim,
procedures that, for decades, had been upheld as the gold standard
in spine care would be relegated to the dusty and crowded shelves
of misguided medicine. Spine surgeons’ go-to procedure—lumbar
spinal fusion1—would be discredited, primary care doctors would find
that they’d launched a prescription opioid epidemic, and
interventional pain physicians—those who perform epidural spinal
injections—would be faced with evidence that their shots didn’t
work. Federal prosecutors would punish device manufacturers for
selling spinal instrumentation that was inadequately tested. Painkiller
manufacturers and the U.S. Food and Drug Administration would be
found tucked into bed with each other, working the drug approval
process without regard to patients’ best interests. As the story
evolved, the journalist in me relished each appalling revelation. As a
patient, however, I felt as if I’d barely avoided stepping off the curb
in front of a bus. Many people, I realized, were not so lucky: They
got caught in a relentless loop, and were commonly harmed in the
process. As one mother, whose most recent episode of back pain
commenced when she bent forward to hand her toddler a lollipop,
wrote in an e-mail, “In an effort to resolve my back problems, I’ve
had a host of ridiculous medical encounters over the last few years,
some confusing, some offensive, some harmful—and I feel
completely upside down and unclear about how to best find help.”
My goal with Crooked is to set the back pain industry’s offerings in
their proper context, so that patients have the information they need
to make good decisions; to know what works sometimes, what
works rarely, and what can cause harm. With luck, I will spare you
the side effects of “optimism bias”: the very human proclivity to seek
out information that supports your own views, while ignoring that
which does not. Patients have a tendency to overestimate the
benefits of treatments, while underestimating the downside,
especially when in the presence of a health care provider who would
prefer not to admit that he doesn’t know. Whether he or she wears a
white coat, hospital scrubs, or workout gear; cracks your back;
cossets you with heating pads; sticks you with needles; or hands you
a set of free weights (and then ignores you in favor of his Twitter
feed); remember that every stakeholder wants and needs your
business.
Epidemiologist and internist Richard Deyo, a keen thinker about
these issues, and the Kaiser-Permanente Endowed Professor of
Evidence-Based Medicine at Oregon Health and Science University,
summarized the problem: “There’s this very mechanical view of the
human body,” he said, “one that suggests that you can find out
what’s broken and replace it or fix it.
“These expectations did not arise in a vacuum,” he emphasized,
eyebrows lifting slightly above the black frames of his glasses.
“Those of us in the medical profession are probably guilty of creating
them. We seem to be doing more and more, but there’s no evidence
that people are getting better pain relief. [Industry players] are just
making money hand over fist from back pain patients who are
desperate for something that will help them. They’re very easy
targets. Anyone who says he has something that might help can set
up a practice and hang out a shingle without an iota of proof, and
make a pretty good living off of it.”
It is fair to say that all professions—in medicine, commerce,
finance, or government—harbor many who are ethical and well
intentioned, as well as some who are greedy and unscrupulous. It is
not always easy to tell one from the other in advance, or even in
retrospect. And it is remarkably easy, as so many patients have
discovered, to undergo a series of treatments and procedures that
are both unnecessary and terribly destructive.