File Size: 1574 KB
Print Length: 437 pages
Publisher: Harper; 1 edition (May 9, 2017)
Publication Date: May 9, 2017
My name I actually Brian Nelson. We are an orthopedic surgeon specializing in spinal column and I am quoted extensively in this visit 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 actually had a chance to get acquainted with a classic researched reporter. You know the type: persistent, devoted to the truth, scholarly, inquisitive, demanding that obscure medical jargon be explained in easily understood terms. The lady spent almost ten years with 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 spinal column pain patients over that past 25 + a number of I have seen every treatment come and go. I have heard reports that would break your heart. I have implemented the exploits of spinal column surgeons I believed should have been jailed to punish them for the trail of broken physiques left in their wake, I saw money damaged an industry designed to enrich providers and private hospitals medical device companies at the expense of patients, I saw doctors collude with attorneys to draw out 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 try 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 personality who shamelessly exploit a process that allows spine proper care to keep dysfunctional.
This wouldn't be considered 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 increased with state of the art search engine marketing. Patients in need of relief are easy marks for clever copy writing promising completely unrealistic success while ignoring risks and costs. Appearance at the number of patients who were prepared 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 doctor within an expensive suit and a starched white coating is not a guarantee of good care several patients are quick to to believe that it is.
I used to tell patients after i was doing surgery which i didn't make any money talking to them. 95% of my income came from operating. And I also figured out early on that as a result of vast difference in orthopedic knowledge between me and my patients, I possibly 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 almost holy trust given to doctors but unfortunately, not all have the character to overcome this enormous conflict with client positions].. The same applies to pain doctors, chiropractors, counselors, injectionists, and so forth All have the ability to offer and perform unnecessary proper care and obtain 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 implies that a major source of income 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 facial skin of the evidence provided in this book supporting the ineffectiveness of opioids, spine surgeries, injections, and MRIs there is little change in frequency.
That our payment incentives have had the unintended result of often harming patients has been recognized by payers (government included) and efforts are underway to alter. 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 actually agree completely with Cathryn about the importance of exercise. It is not that nobody ever needs spinal column surgery or an shot or an MRI. This is that most 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 guidance 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 also give yourself the best hance of being as good as you can be.
Thank you Cathryn for publishing what I believe could be one of the most universally helpful medical books ever written., 1 of my patients recommended the book after she heard an interview with Cathryn on NPR. I actually read it in 2 sittings - it’s compelling and straightforward to understand.
I actually would like to say thanks to Cathryn Ramin for a fantastic job of laying bear the US back pain industry and affirming many of my own views. I am a San Francisco chiropractor and strongly recommend Crooked to anyone with a spine.
Lower back pain is the number one cause of disability PLANET wide, and 80% of the population will experience disabling back pain treatments in their lifetime, I possess! So will you. So be positive.
As an actively exercising chiropractor, I see it all whole day and we do our best to serve these patients, many young and many from the Financial District. Usually patients are first seen by medical doctors or nurse practitioners and have already been referred for x-ray or MRI and received medications for; inflammation, pain, and muscle spams for a diagnosis of non-traumatic back pain treatments without considerable neurological symptoms. These patients have taken their first steps towards the slippery incline toward ever-invasive procedures, injections, medications (including opioids) and often ending in ineffective surgery(s). Degree of pain and severity of condition often do NOT assimialte.
Many of the films I review have indications of normal skeletal aging, such as degenerative disc disease, disc protrusions, disc desiccation, etc. often the very reason for surgical intervention. Cathryn discusses how doctors use these “findings” to get patients to submit to their recommendations. When I have films, I look for contraindications for treatment; malignancy, fracture, etc., not great treat.
As with all professions, there will be truly dedicated physicians who care about patient final results and others who are enthusiastic about their own financial wellbeing at the expense of the patient. A sobering discussion about money, conflicts of interest, and cross-referring should make patients wary to whom they are referred.
Cathryn will a fantastic job of presenting the shortcomings of much of the medical industrial complicated including the chiropractic industry. Too often chiropractors count on the subluxation model rather than incorporating exercises, ergonomics and soft cells therapies and over treatment is a concern. For better or worse, insurance coverage often drives the methods doctors get paid for and therefore are willing to perform. In the chiropractic industry, this has often been distilled down to the adjustment. So if your plan has chiropractic, be aware that your doctor may be getting paid as little as for that visit and it is impractical to expect to obtain the treatment that you really need, even if the physician has the skill to provide it. The medical model is cost for service and the more complicated the procedure the better the reimbursement. -100 thousand for back surgery, why would a surgeon recommend exercises, P. T., chiropractic, or biofeedback?
In general, medical doctors and specifically, surgeons have considerable cultural authority and people listen. Patients don’t understand how their bodies work and don’t have the knowledge to question doctors. They seldom realize that 25% of patients with disc herniations have NO back pain, a classic indication for surgery. When the surgery is “successful” (no more herniation on MRI), but the symptoms remain or aggravate, further surgery is suggested until failed back surgery symptoms cause the patient to be relegated to the opioid and often heroin wasteland.
As Cathryn points out, “discs seldom slip”. They are safely attached to the endplates of the vertebral physiques, but they do bulge and herniate. The good news is that the older you are, the less likely they are to herniate, because they dry out. Imagine having the L5/S1 disc removed. That final disc supports your entire chest muscles weight. It is the only structural support that connects your top half of your body with the bottom 50 percent and now someone is going to chisels and drill out that disc and fuse it, removing all movement. Imagine all the scar tissue that develops from such a procedure. Frequently, this is done without aggressive and failed conservative remedy first? Insane.
Cathryn discusses our sedentary lifestyles with too much sitting, with ahead head posture and a flexed (c-curved) spine leading to; deconditioning, muscle loss muscle spam and pain. Proper reconditioning with exercises and soft tissue work can make such a distinction. The psoas, piriformis, quadratus lumborum, erectors spinae and gluteal muscles are all so important for shoe stability. She talks about pain avoidance behavior that further worsens the deconditioning.
Inside the second half of the book, Cathryn provides many solutions for patients with back pain treatments, but regrettably, there is not a single size fits all, as would be expected. Some patients do well with McKenzie spinal extension, others with Cox flexion muddiness. McGill an “extension” recommend, suggests strengthening before extending; Gary Cook says that you can’t provide a stableness solution to a mobility problem with his successful Functional Movement Screen methods. Active Release and Graston work on soft tissue and facial adhesions to promote oxygenation, reduce muscle junk mail and improve movement, hence decreasing pain. There is Yoga, Tai Chi, Feldenkries and others therapies. 1 theme that keeps coming back is the importance of proper body conditioning with correctly executed exercises and decreasing the spinal insults of poor posture and ineffective body mechanics.
I tell my patients that there is no free lunch. We all pay with our money and time. It just depends where you want to pay either - at the gym, fitness expert, yoga exercises, chiropractor, on meds, surgery, P. T., and so forth We have only one body and how we use or abuse it will often determine our quality of life and the likelihood of back problems is almost inevitable in our society. As for myself, I actually occasionally have low back again tightness and pain, especially after a 3-hour squash workout, but I consider my self recovered.
I actually have already recommended this book to a back again pain sufferer who called me from North Carolina for advice.
I strongly recommend this guide. Thank you Cathryn for your hard work and insights.
Kai Tiltmann, I acquired this guide for my 64 year-old father who has been plagued with back pain for over 3 decades. This individual is unusually tall and contains injured his back too many times during his life. He's tried chiropractic care, essential, and is now looking into a major surgery that could potentially put him in a wheelchair. 1 physician looked at his x-rays and said that no chiropractor should be touching his back unless of course he wants to end up paralyzed. His case is severe, and is getting worse with age now. I think that before he makes any selections regarding surgery and before he sees another chiropractor, he needs to read this book. He was not wanting to even read it as they figured it would do little to help him. Now that he's finished it, he has a much different view on the proper care he has received during the past and is now rethinking his original plan for surgery. He said that he realizes now that all of the adjustments and remedy that he had over the years, never fixed what was actually wrong with his back again. This made me realize how little education people have when it comes to back pain treatments and their options. I am really happy that he read this book with an open mind, and the author did a lot of research to reveal the back again pain industry. Now my father can make better selections for himself moving forward.
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