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Spinal Instrumentation:
An Obscene Industry? |
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It is a sad state of affairs indeed when health
care establishments loose their way and forget their ethics and
integrity (the basic reasons as to why they exist). Such
a situation is particularly distressing, because it preys on the
trust being extended by the unsuspecting patient when they place
their personal destiny in the hands of physicians. A
patient should rightfully believe that the care being
recommended for them will reflect the principles of the
Hippocratic oath or, simply follow William James Mayo's (son
of the founder of the Mayo Clinic) credo that "the patient's
interests come first."When such is not the case there
then becomes an urgent need for identification and remedy. On December 30,
2006 the New York Times published "The
Spine As A Profit Center" written by Reed Abelson. |
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This article, along with other previous articles,
has pointed out that spinal fusion surgery has become
one of the most lucrative areas of medicine for
spine surgeons, instrumentation manufacturers, and
for hospitals. Professional concerns
regarding the overuse of this technology as a means
of profit for all concerned (other than the patient)
have been emerging for a number of years now with
little restraint or control in evidence. |
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Conflicts
of interest have existed, to some degree, in health
care from its inception. Typically, these were apparent to a
discerning patient thus allowing them to better direct their
health care decisions. When these conflicts are, however,
hidden from view and become progressively more obscene, the time
has come for concerned individuals and organizations to take
appropriate action.
Multi-level pedicle screw spinal fusion surgery performed as a
treatment for back pain
alone has clearly emerged as the endeavor in which
the greatest conflicts of interest have arisen.
Professor Klaus-Peter Schulitz made
this important observation in 2004: |
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It is unfortunate, but true, that the use of pedicle screw
fixation as a primary means of addressing low back pain has now
become big business for spine mechanics (as opposed to true
spine surgeons) and for some hospitals
who have avoided informing patients of the true risks or other alternatives.
It is also unfortunate, but true, that this practice, has led to
an inordinate number of "failed
back surgery" patients. In fact, this practice
has now reached the level of being a
serious public health pandemic.
One encouraging occurrence has been the creation of an
"Association of Ethical Spine Surgeons."
The AESS
has created ethical guidelines designed to minimize conflicts of
interest in the spine surgeon community. It's President,
Charles D. Rosen believes that there is a great need, at the
present time. to restore trust in the spine surgery profession.
He has been supported in this effort by a group of spine surgeon
colleagues who have shared his concerns (this Editor is pleased
to be a member of this group).
The AESS is now actively pressing to limit the
undue influence of commercial bias in the care of patients.
The AESS believes that this conflict of interest has pervaded
the leadership of spine organizations and has thus subverted
their decision-making process. The AESS has begun to
formally request that, from this point on, that officers and board
members of these organizations be chosen only from the majority
of members who have no significant financial bias with the spine
implant industry. Recently Dr. Rosen sent the AESS
position on this to the membership of the North American Spine
Society (NASS) for their review. Commentary on this has
proved to be
interesting and worthy of reviewing.
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