Saturday, April 4, 2009

A pair of article from the April 1st issue of Spine remind us of what real reform in health care we need. While President Obama is at least attempting to get the ball rolling with changes in health care, Electronic Medical Records (EMR), expanded coverage, and "investing" in prevention and wellness aren't going to change today's problems at the root of rocketing health care costs.

One piece at the root of these rocketing costs is excessive use of imaging, surgery, and drugs. Low back pain treatment often gets the full brunt of these high cost, low efficacy procedures. Now, the new issue of Spine shines some light on the harm this approach can cause.

In the first article by Timothy Carey, MD - Practice patterns and evidence in chronic low back pain care - it was found that (surprise) there is an overuse of narcotics and imaging and little use of established beneficial treatment of exercise. The figures quoted in the article report fewer than 30% of LBP suffers had seen a physical therapist in the past year and, worse yet, only 3% had gone through a structured rehabilitation program.

The second article by Sham Maghout Juratli, MD - Mortality After Lumbar Fusion Surgery - there was a finding of alarmingly high percentage of deaths after fusion surgery related to Analgesic overdose. The author comments that:

Analgesic-related deaths are responsible for more deaths and more potential life lost among workers who underwent lumbar fusion than any other cause.
So, instead of treating LBP primarly with research-proven exercise prescription there is an overuse of narcotics and surgery that are leading to increased loss of life!

Maybe rewarding those attempting to use what research shows as effective for LBP instead of shelling out billions for imaging, drugs, and surgery might not only lead to lessening costs but decreased mortality.

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