Making Sense of Science: Separating Substance From Spin by Cornelia Dean

Author:Cornelia Dean
Language: eng
Format: epub
Tags: Political Science, Public Policy, Science & Technology Policy, science, Philosophy & Social Aspects, Social Science, Media Studies
Publisher: Harvard University Press
Published: 2017-03-13T00:00:00+00:00

Selling Health

Q: What is the definition of a healthy person?

A: Someone who has been inadequately worked up.

I thought of this old medical joke when a friend of mine developed excruciating back pain. Magnetic resonance imaging (MRI) disclosed that one of the disks in her spine was damaged. She was admitted to a major medical center and prepared for back surgery. But because she was running a slight fever, she could not have the surgery that night. Instead, she was given painkillers and sent home.

That’s where I visited her the next day with another friend, a physician whose specialty is pain. He concluded that her problem was muscle spasms in her lower back and not a bad disk. He treated her for the spasms—the treatment was simple and did not involve drugs—and she immediately felt much better. (She never did have the surgery, and today she is fine.)

As my doctor friend and I walked back to my home, I wondered to myself how a muscle-related treatment could do so much good for someone whose disk damage had been documented by an MRI. Suddenly the answer dawned on me. I asked my friend, “how many people are walking around in fine form, even though they have disk damage?”

After age 50, about 35 percent, he said. So I asked him, “how many people should have disk surgery?” He replied, “practically nobody.” Researchers in Japan who studied seemingly healthy, pain-free people found disk degeneration in 17 percent of men and 12 percent of women in their twenties. By age 60, the numbers had risen to 86 and 89 percent.23

Though underlying rates of disk damage do not appear to vary much from country to country, rates of spine surgery are highest in the United States. According to the National Institutes of Health, “There remains little or no medical, clinical, or surgical evidence to support such variability.”24

A few years after my friend’s experience, a sports orthopedist in Gulf Breeze, Florida, reported what happened when he did MRI scans on the shoulders of thirty-one professional baseball pitchers, none of whom was having pain or any other shoulder problem. The images showed abnormal shoulder cartilage in 90 percent, and abnormal rotator cuff tendons in 87 percent. “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an MRI,” the doctor said.25

Ordinarily, true double-blind clinical trials of surgical procedures are not done, because they would require patients in the control group to undergo pointless “sham” surgery with the attendant risks of anesthesia and a hospital stay. But in a report in 2002 researchers in Texas described what happened when they subjected people with arthritic knee pain to a randomized clinical trial in which some underwent one of two forms of arthroscopic knee surgery and the third group underwent a sham operation. At several points over the next two years, patients and medical practitioners assessed the results in terms of pain, function, and tests like climbing stairs. “At no point did either of the intervention groups report less pain or better function than the placebo group,” the researchers reported.

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