The acclaimed author of Carved in Sand—a veteran investigative journalist who endured persistent back pain for decades—delivers the definitive book on the subject: an essential examination of all facets of the back pain industry, exploring what works, what doesn’t, what may cause harm, and how to get on the road to recovery.
In her effort to manage her chronic back pain, investigative reporter Cathryn Jakobson Ramin spent years and a small fortune on a panoply of treatments. But her discomfort only intensified, leaving her feeling frustrated and perplexed. As she searched for better solutions, she exposed a much bigger problem. Costing roughly $100 billion a year, spine medicine—often ineffective and sometimes harmful —exemplified the worst aspects of the U.S. health care system.The result of six years of intensive investigation, Crooked offers a startling look at the poorly identified risks of spine medicine, and provides practical advice and solutions. Ramin interviewed scores of spine surgeons, pain management doctors, physical medicine and rehabilitation physicians, exercise physiologists, physical therapists, chiropractors, specialized bodywork practitioners. She met with many patients whose pain and desperation led them to make life-altering decisions, and with others who triumphed over their limitations.
- Lets start with the most important aspect of this book. If you suffer from back or neck pain, this is a MUST read so that you can avoid the cascade of evaluations and treatments that are unlikely to help and often cause great harm (not to mention the enormous and unnecessary expense)..
My name I Brian Nelson. I am an orthopedic surgeon specializing in spine and I am quoted extensively in this tour de force. I first met Cathryn many years ago after she was given my name by a colleague. She called me for the first of many interviews and I had a chance to get acquainted with a classic investigative reporter. You know the type: persistent, devoted to the truth, scholarly, curious, demanding that obscure medical jargon be explained in easily understood terms. She spent almost ten years on this book which likely explains why it is so outstanding, and carries such credibility. Meticulously sourced and backed up with peer reviewed research, you can believe what she has written.
I supervised the treatment of approximately 150,000 spine pain patients over that past 25 + years and I have seen every treatment come and go. I have heard stories that would break your heart. I have followed the exploits of spine surgeons I believed should have been jailed to punish them for the trail of broken bodies left in their wake, I saw money corrupt an industry designed to enrich providers and hospitals medical device companies at the expense of patients, I saw doctors collude with attorneys to extract as much money as possible from insurance companies. You may find Cathryn’s book infuriating but after finishing it, she may have been too lenient.
Too be clear, I also know many reputable practitioners who consistently strive to deliver the right care to patients regardless of the financial concern. I know many fine surgeons, chiropractors, physiatrists, pain doctors, etc. who are a credit to their profession. Nevertheless, there are far too many of the opposite character who shamelessly exploit a system that allows spine care to remain dysfunctional.
This wouldn’t be a huge problem if patients could differentiate the good from the bad but they cannot. As Cathryn so amply demonstrates, patients are easily fooled by professional web sites enhanced with state of the art search engine optimization. Patients desperate for relief are easy marks for slick copy writing promising completely unrealistic success rates while ignoring risks and costs. Look at the number of patients who were willing to pay tens of thousands of dollars out of pocket for unproven treatments that often made them worse. I was always astounded in my own town (Minneapolis) that surgeons known to have terrible outcomes were nevertheless full. A nice office with an espresso machine and a smiling surgeon in an expensive suit and a starched white coat is no guarantee of good care but many patients are quick to to believe that it is.
I used to tell patients when I was doing surgery that I didn’t make any money talking to them. 95% of my income came from operating. And I also learned early on that because of the vast difference in orthopedic knowledge between me and my patients, I could talk most anyone into surgery if I tried (“He would never tell me I needed surgery if it wasn’t true”). This is a sacred trust given to surgeons but unfortunately, not all have the character to overcome this enormous conflict of interest.. The same applies to pain doctors, chiropractors, therapists, injectionists, etc. All have the ability to offer and perform unnecessary care and get paid for it. Health care providers- including hospitals- are well aware of how much they earn and what their expenses are. If new medical evidence shows that a major source of revenue is ineffective, how many will discontinue its use and perhaps go into the red for their practice or hospital? This is why , even in the face of the evidence provided in this book supporting the ineffectiveness of opioids, spine surgeries, injections, and MRIs there has been little change in frequency.
That our payment incentives have had the unintended consequence of often harming patients has been recognized by payers (government included) and efforts are underway to change. Can we devise a system that pays for outcomes rather than paying for services regardless of effectiveness? Unless we do, I fear things will not change.
Finally, I agree completely with Cathryn about the importance of exercise. It is not that no one ever needs spine surgery or an injection or an MRI. It is that the vast majority of patients should not undergo these procedures unless they given themselves the chance to avoid them by engaging in a good intensive exercise program along with counseling in fear avoidance or underlying false beliefs creating tension. Get on a program and stay with it for the rest of your life and you give yourself the best hance of being as good as you can be.