[mmglobal]

Man-oh-man, with spine surgery, as it is with information you get from newspapers, it's buyer beware! I read the article and have seen many studies and papers presented that show similar data.

It has been said that: "70% of the people with mental health issues who go to psychiatrists get better. 70% of people with mental health issues who don't go to psychiatrists get better." It would seem as if shrinks have no effect? I don't think so... I contend that the numbers may be correct, but it's not the same people!!! Some who got better through psychiatry would not have gotten better without it. Some who did not get better with psychiatry would have gotten better without it.

What are the factors involved? Patient selection AND doctor selection! Sadly, I have too many clients who's doctors did the wrong surgery. You would not believe how egregious this is. "I cannot do the surgery you need, so I'm going to do a surgery that I can do." People who have very clear indications of major pain generators at levels that are simply not addressed. They don't say, "I can't do that... here is the name of someone who can." They do a surgery that has no chance of working in the hope that some improvement will be enough to satisfy the patient. This is an example of bad patient selection and bad doctor selection. Unfortunately this is all too real, but this has nothing to do with the surgery being good or bad. Cases like these are included in the numbers that will be used to determine if the surgery is good or bad.

Many spine patients understand that our problems may improve. Disc herniations may shrink. Unstable and painful situations may stabilize and get better. That is why I suffered, functionally disabled for 2 years while I was afraid to proceed with surgery. Do we know who will get better and who wont? Not really, but there are some who obviously have a better chance than others.

It does not surprise me that a literature review will turn up much supporting data that makes it seem as if this spine surgery business is crap. I think that you can substitute ADR for fusion in the reports... they'll dig up the bad surgery studies and juxtapose them with the good conservative treatment studies. (Ya think the insurance companies would like to have more political cover to deny surgery?)

As I support patients through the decision making process we always discuss my question number 2.... "do you have any reasonable expectation that this will get substantially better without surgical intervention." For some the answer is maybe... for those who haven't been in this long enough, the answer is "I don't know"... for some, there is no way that things are reversing and their options are limited.

If they stratified the population into groups by severity of pathology and other relevant factors, they'd learn that there are some groups that are frequently operated on that should not have surgery, while there are other groups that don't stand a chance without surgery. Broad statements about a broad overview of a broad population have little value.

To answer Dale's specific question, I don't think that this improves our situation with insurance companies. I don't believe that insurance decisions are based on appropriateness of medical care or common sense or ??? I believe that it's about money and studies like these are designed to give them more ammunition and further embolden them to make more of the outrageous decisions that we all see over and over.