[johnb]

Jim, from one spine patient to another that has taken the risks and still has problems, I feel for you and hope you can get some answers regarding your situation. Recently, I've had the opportunity to communicate with two professionals that did not have a stake in my treatment and were outside the traditional doctor patient relationship. The conversations were candid. I only wish I had communicated with them a few years ago before plunging into my treatment decisions. The first is a retired orthopedic surgeon. He is a good friend's father-in-law and was nice enough to chat by phone. He said he was dissapointed with the direction of the industry due to the strong influence the hardware manufacturers had over the decision making process. He said if patients knew about the money spent by the manufacturers on "conferences" at beaches, manipulated research data, bribes and kickbacks masquarading as consultancy agreements, spinal patients would be concerned. He said there are bad apples in all professions but was dissapointed in the growing numbers in his profession compared from when he began practicing to when he retired.

The other professional is a neurosurgeon that is a fraternity brother's older brother who also agreed to share his observations. He's been practicing for 10 years and confirmed what the retired ortho said to me but had some other important observations. He said that the average spine patient isn't "sophisticated enough" and has to rely heavily on the surgeon's recommendations which can make spine patients vulnerable. The payors (insurance companies, medicare, etc) lowering reimbursement rates and rising malpractice insurance premiums are effectively reducing compensation levels so doctors are looking for ways to make up for the offsets in income. One of the obvious ways to make up for these offsets is to perform more surgeries. Candidates who would have been most likely steered toward conservative treatments like I was when younger in my 20's with no nerve involvement and still functional with limitations (very young with a lot to lose) or the elderly. I know of two examples that fit both these situations where the outcomes were awful.

The profit motive is in play and we all need to do our homework and make informed decisions like Mark advises. That simple advice cannot be repeated enough when you consider the high price that can be payed with a poor outcome that can leave you in more pain that is often resistant to treatment, interfere with bowel, bladder, and sexual function, among other serious, life changing complications.

Jim, I know I meandered from your topic a bit but I feel like the profit motive may be an inpediment to you getting answers to your questions. Maybe one day in the future we will go from our family care doc to an intervetional radiologist who does nothing but diagnose and no surgery.

John