Whether You Get Back Surgery May Hinge On Your Zip Code

This was a featured headline in the February 24, 2011 edition of the Wall Street Journal.  Also on February 4, 201 an article  entitled: Minnesota's Rate of Five Surgeries Is Higher Than The U.S Average was published in the St. Paul Pioneer Press  The possibility that many of these surgeries are needless, particularly multi-level instrumented fusions being performed to treat low back pain, is only now receiving a high level of national attention and scrutiny. 

The Bloomberg New organization noted in between 2002 and 2008 that the number of fusions performed in the U.S. had doubled to 413,000 a year during that period of time and documented specific examples of financial conflicts of interest on the part of Minnesota spine surgeons.  The March, 2011 issue of the BackLetter has pointed out that there has also been a general dearth of responsible decision making  in spine care.

Not all spine care professionals have continued to be inactive spectators as they have observed some of their colleagues climbing into the deep pockets of the device industry as well as actively misleading their patients into believing that their only choice was extensive spine surgery when such was often actually contra-indicated. 

Is it acceptable that many of the spine care opinion leaders have continued to maintain conflicts of interest and that their research, publications, and guidance have been often flawed and even, at times, fraudulent?  Physician organizations such as the Association for Ethics in Medicine think not.  The American Association of Medical Colleges (AAMC) in “Protecting Subjects, Preserving Trust, Promoting Progress”  specifies  that universities conducting human subjects research should presume “that an individual who holds a significant financial interest in research involving human subjects may not conduct such research.” The AAMC has pointed out that absent “compelling circumstances,” financially interested physicians should not conduct clinical research on human subjects because:

Financial interests in human subjects research are distinct from other interests inherent in academic life that might impart bias or induce improper behavior, because financial interests are discretionary, and because the perception is widespread that they may entail special risks.  Specifically, opportunities to profit from research may affect or appear to affect – a researcher’s judgments about which subjects to enroll, the clinical care provided to subjects, even the proper use of subjects’ confidential health information.  Financial interests also threaten scientific integrity when they foster real or apparent biases in study design, data collection and analysis, adverse event reporting, or the presentation and publication of research findings.

All physicians inherently understand what “the right thing” to do for their patients is about, but many appear to be incapable of taking a stand on this issue even when abuse continues to flourish before their eyes.  It would be truly refreshing to return to a time when physicians could once again trust that the clinical research being published is placed there for one reason and one reason only; to assist us in providing our patients with cost effective, safe and efficacious therapy.

The time has arrived for concerned physicians to take a look at their own moral compasses and assist in participating in a much needed attitude "re-adjustment"; invest some time in supporting organizations which have devoted themselves to placing the patients’ interests first. and focus more on simple, safe, and more effective therapies which deserve a much higher level of support and respect.