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http://www.nytimes.com/2016/08/04/upshot/the-right-to-know-that-an-operation-is-next-to-useless.html

Here is my comment, we'll see if they post it. I would encourage others to comment as well. Liberal decision makers do read the Times.

Here we go again.... it gets so tiring fighting the liberal crusade against procedural medicine, which NYT is wholly a participant in. There is a war going on here that no one talks about. It's about population based medicine vs individualized care. Those who pay for care would love to go population based. It seems pretty easy to show no benefit for a procedure when you try to study its use over a wide population base. All you need to do is tweak the methods, or the patient selection- and voila! No benefit. Take the vertebroplasty study for example. Those of us in the field know the procedure works like a miracle in well selected patients- those with pain severe enough they might choose not to participate in a study where one possibility is being assigned to a control group, and suffering until the investigators let them cross over to the treatment arm. Look at the sham intervention they chose- blockade of the facet joints around the fracture. Patients whose pain was mild enough that they signed up for the study in the first place might have been suffering from joint pain instead of fracture pain- which was treated with the sham procedure! To anyone inclined to believe these anti-procedure articles published by the NYT, I suggest you review the original studies with someone knowledgable in the field who can shine a critical eye on this scam.
 

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http://www.nytimes.com/2016/08/04/upshot/the-right-to-know-that-an-operation-is-next-to-useless.html

Here is my comment, we'll see if they post it. I would encourage others to comment as well. Liberal decision makers do read the Times.

Here we go again.... it gets so tiring fighting the liberal crusade against procedural medicine, which NYT is wholly a participant in. There is a war going on here that no one talks about. It's about population based medicine vs individualized care. Those who pay for care would love to go population based. It seems pretty easy to show no benefit for a procedure when you try to study its use over a wide population base. All you need to do is tweak the methods, or the patient selection- and voila! No benefit. Take the vertebroplasty study for example. Those of us in the field know the procedure works like a miracle in well selected patients- those with pain severe enough they might choose not to participate in a study where one possibility is being assigned to a control group, and suffering until the investigators let them cross over to the treatment arm. Look at the sham intervention they chose- blockade of the facet joints around the fracture. Patients whose pain was mild enough that they signed up for the study in the first place might have been suffering from joint pain instead of fracture pain- which was treated with the sham procedure! To anyone inclined to believe these anti-procedure articles published by the NYT, I suggest you review the original studies with someone knowledgable in the field who can shine a critical eye on this scam.
I happen to agree with most of the article. I think the industry in this country surrounding the overall treatment of chronic LBP leaves much to be desired. Mostly driven by capitalistic healthcare (so no offense but not shocking you dont agree with it as its your income driver). I think articles like this will have insurance companies getting a little tighter with authorizations and payments. Of course I think some procedures and some surgeries are beneficial. But I cant deny the extreme excess I witnessed all in order to boost physician/asc revenue while patient gets opiates and insurance company/workers comp pays bill.
 
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I happen to agree with most of the article. I think the industry in this country surrounding the overall treatment of chronic LBP leaves much to be desired. Mostly driven by capitalistic healthcare (so no offense but not shocking you dont agree with it as its your income driver). I think articles like this will have insurance companies getting a little tighter with authorizations and payments. Of course I think some procedures and some surgeries are beneficial. But I cant deny the extreme excess I witnessed all in order to boost physician/asc revenue while patient gets opiates and insurance company/workers comp pays bill.
If the problem is profiteering doctors, find a way to deal with that. But don't close the door on access for all using these BS studies.
 
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http://www.nytimes.com/2016/08/04/upshot/the-right-to-know-that-an-operation-is-next-to-useless.html

Here is my comment, we'll see if they post it. I would encourage others to comment as well. Liberal decision makers do read the Times.

Here we go again.... it gets so tiring fighting the liberal crusade against procedural medicine, which NYT is wholly a participant in. There is a war going on here that no one talks about. It's about population based medicine vs individualized care. Those who pay for care would love to go population based. It seems pretty easy to show no benefit for a procedure when you try to study its use over a wide population base. All you need to do is tweak the methods, or the patient selection- and voila! No benefit. Take the vertebroplasty study for example. Those of us in the field know the procedure works like a miracle in well selected patients- those with pain severe enough they might choose not to participate in a study where one possibility is being assigned to a control group, and suffering until the investigators let them cross over to the treatment arm. Look at the sham intervention they chose- blockade of the facet joints around the fracture. Patients whose pain was mild enough that they signed up for the study in the first place might have been suffering from joint pain instead of fracture pain- which was treated with the sham procedure! To anyone inclined to believe these anti-procedure articles published by the NYT, I suggest you review the original studies with someone knowledgable in the field who can shine a critical eye on this scam.
So you think fusion helps back pain?
 

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The problem is that "procedural medicine" or surgery doesn't always work all the time. There is a failure rate. Patients don't like to hear this. You rely on the judgment of your surgeon to optimize your outcome.

Otherwise, NYT is biased towards collectivist/population-based/employed-MD/health system driven medicine. Having said that I do think there is too much useless surgery being performed.

Hillary will fix you.
 
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powermd

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So you think fusion helps back pain?
Of course not. But let's not throw out the baby with the bath water. The procedure may have some utility, just not as a treatment "to relieve back pain from worn out discs."

My problem with articles like this is they fail to concede to the layperson audience the limitations in the data upon which these judgments are made.
 
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interesting to note that this thread sits right above the Three level transforaminal" thread this morning....
 
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I think the socialists want us to give the patients a hug and send them home....
 

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what if, statistically speaking, this approach works as well as procedures?
What if flossing your teeth works but you don't have the statistics to prove it? Do it anyway....you gonna tell your kids to stop flossing also???

Statistics is an art form, you can make it say what you want. And limited statistical power doesn't mean something doesn't work, it means it's indeterminate , which isn't terrible in my book.

That's the thinking you'd expect from a robot....There is room for common sense at times. Try the hugging though, and let me know your preliminary data. ;)
 

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What if flossing your teeth works but you don't have the statistics to prove it? Do it anyway....you gonna tell your kids to stop flossing also
to reply: http://www.npr.org/sections/health-shots/2016/08/02/488378699/does-flossing-help-or-not-the-evidence-is-mixed-at-best

my kids have been taught to floss, but arent told to do so. they are told to brush their teeth though.
Statistics is an art form, you can make it say what you want. And limited statistical power doesn't mean something doesn't work, it means it's indeterminate , which isn't terrible in my book.
yes, agree. but it depends on the study. im sure many of these studies have limited statistical power. but not all. it does not appear, on initial glance, that the vertebroplasty study or the knee meta-analysis lacked statistical power.

and fyi, all the patients that i have hugged are doing quite well, not on opioids. then again...
“The successful patient is burned into their memories and the not-so-successful patient is not. Doctors can have a selective memory that leads them to conclude that, ‘Darn it, it works pretty well.’”
if we could add financial ramifications for not performing the study/injection/surgery, then we and the patients would be so much better off, imo.

as you know, i believe that $$$ and the pursuit of Benjamins is what has ruined health care - physicians, nurses, hospitals, insurances, etc.
 

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If the problem is profiteering doctors, find a way to deal with that. But don't close the door on access for all using these BS studies.
This IS the way to deal with that. If the doctors you go to for treatment are not being honest/making claims that data doesnt support then journalists are going to alert the public. I left pain because I thought I wasnt helping people and that my primary purpose was to create revenue. Seems others agree. Not surprised that the ones being targeted (spine surgeons and pain docs) dismiss these claims. I believe them. I do honestly believe that if pain management as an entire field vanished, no one would really care aside for the pain docs and drug addicted patients. Cant say that about too many other fields of medicine. Its important to have your eyes open to what you are actually doing day to day.
 

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This IS the way to deal with that. If the doctors you go to for treatment are not being honest/making claims that data doesnt support then journalists are going to alert the public. I left pain because I thought I wasnt helping people and that my primary purpose was to create revenue. Seems others agree. Not surprised that the ones being targeted (spine surgeons and pain docs) dismiss these claims. I believe them. I do honestly believe that if pain management as an entire field vanished, no one would really care aside for the pain docs and drug addicted patients. Cant say that about too many other fields of medicine. Its important to have your eyes open to what you are actually doing day to day.
Sounds like you've experienced a lot of growing pains over the last 9 years or so. Not everyone is suited for a career in pain medicine.

http://forums.studentdoctor.net/threads/switch-to-pmr-for-this-ms3.395450/
 
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Sounds like you've experienced a lot of growing pains over the last 9 years or so. Not everyone is suited for a career in pain medicine.

http://forums.studentdoctor.net/threads/switch-to-pmr-for-this-ms3.395450/
I was the chief at a large pain program. I was in PP for less than one year. I wouldnt call them growing pains so much as gaining experience. I once was very committed to and interested in IPM, now, as you can see, I think its a scam. I find your researching my old posts a little creepy. Im sure you and many others disagree with my point of view, but despite what you want to believe it is a very well educated point of view based on my real world experience. I think 10% of injections that are done are actually legit. I think the field has spun out of control and is a result of capitalism. The public is catching on, but dont worry keep writing scripts and booking fluoro time as long as it pays the bills right!!
 
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I once was very committed to and interested in IPM, now, as you can see, I think its a scam.
Would respectfully disagree with this assessment. While with any profession, there seems to be some with less than ethical behavior, to generalize IPM as a 'scam' is myopic.

What specialty did you end up in?
 

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I was the chief at a large pain program. I was in PP for less than one year. I wouldnt call them growing pains so much as gaining experience. I once was very committed to and interested in IPM, now, as you can see, I think its a scam. I find your researching my old posts a little creepy. Im sure you and many others disagree with my point of view, but despite what you want to believe it is a very well educated point of view based on my real world experience. I think 10% of injections that are done are actually legit. I think the field has spun out of control and is a result of capitalism. The public is catching on, but dont worry keep writing scripts and booking fluoro time as long as it pays the bills right!!
I've advised countless med students and residents on career issues especially related to PM&R and Pain. Pain is a high burn-out specialty. I remember your quandary.
 

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I'm sorry they put the article about vertebroplasty in there because it was a lousy article, and because the practice of a whole field changed after a single flawed article with a small N.
That is not true of the other examples discussed in the article.
 

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I was the chief at a large pain program. I was in PP for less than one year. I wouldnt call them growing pains so much as gaining experience. I once was very committed to and interested in IPM, now, as you can see, I think its a scam. I find your researching my old posts a little creepy. Im sure you and many others disagree with my point of view, but despite what you want to believe it is a very well educated point of view based on my real world experience. I think 10% of injections that are done are actually legit. I think the field has spun out of control and is a result of capitalism. The public is catching on, but dont worry keep writing scripts and booking fluoro time as long as it pays the bills right!!
Sounds like you got it all figured out.... Everything is based on capitalism in this country, that's not a reason to call it a scam. Based on that logic and Medicare pro publica data Optho is the worst. You think all those glaucoma money making injections are legit as well???
 
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to reply: http://www.npr.org/sections/health-shots/2016/08/02/488378699/does-flossing-help-or-not-the-evidence-is-mixed-at-best

my kids have been taught to floss, but arent told to do so. they are told to brush their teeth though.

yes, agree. but it depends on the study. im sure many of these studies have limited statistical power. but not all. it does not appear, on initial glance, that the vertebroplasty study or the knee meta-analysis lacked statistical power.

and fyi, all the patients that i have hugged are doing quite well, not on opioids. then again...


if we could add financial ramifications for not performing the study/injection/surgery, then we and the patients would be so much better off, imo.

as you know, i believe that $$$ and the pursuit of Benjamins is what has ruined health care - physicians, nurses, hospitals, insurances, etc.
Yes the recent flossing study was implied in my comments...
I feel the issue we have in this country is that we don't have the studies and statistical power to confirm common sense procedures or in this case oral care hygiene. In the setting of a failing Medicare system the push is now MJ and anything else to reduce costs( I am referring to another recent Medicare MJ biased study on cost savings).
 

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i disagree with the conclusions of that article on MJ with regards to cost savings. if i remember correctly, there is no control for other causes of decreased spending, such as restrictions on opioid prescribing and changes such as PMP, a huge technical flaw.

Hoya, IPM is only a part of chronic pain management. you might find focusing more on functional rehabilitation and multidisciplinary treatment more to your liking than IPM. i agree that the perspective is that IPM is exclusively focused on financial reimbursement, but a high percentage of medicine as a whole is likewise.


or, become an epidemiologist/public health expert and get involved in creating laws guiding IPM, amongst other fields.
 
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Disciple

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Of course not. But let's not throw out the baby with the bath water. The procedure may have some utility, just not as a treatment "to relieve back pain from worn out discs."

My problem with articles like this is they fail to concede to the layperson audience the limitations in the data upon which these judgments are made.
That's their MO, and how they push their agenda.
 
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I was the chief at a large pain program. I was in PP for less than one year. I wouldnt call them growing pains so much as gaining experience. I once was very committed to and interested in IPM, now, as you can see, I think its a scam. I find your researching my old posts a little creepy. Im sure you and many others disagree with my point of view, but despite what you want to believe it is a very well educated point of view based on my real world experience. I think 10% of injections that are done are actually legit. I think the field has spun out of control and is a result of capitalism. The public is catching on, but dont worry keep writing scripts and booking fluoro time as long as it pays the bills right!!
My first year out in practice was with a group that was on the fringe in terms of legitimacy. They did a lot of pills and injections. Many of the procedures were of questionable utility, and they overutilized MAC. Being there made me want to vomit. So I left.

I've been in a non-narcotic practice for 5+ years now and the experience has been the polar opposite. I don't have it in me to practice in a dishonest way. I counsel patients away from injections when I don't think they'll help. It's a very satisfying environment. You can find all kinds of ways to scam the system in medicine, that's not unique to IPM. It's too bad things didn't work out for you.

I'd appreciate it though if you wouldn't generalize to the entire field when you use the word "scam". You can tell us you thought your own practice was a scam, and that you are suspicious of others for which you have good reason (notes, personal contacts). But it's a bit insulting to the rest of us who aren't sociopaths.
 

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I'm sorry they put the article about vertebroplasty in there because it was a lousy article, and because the practice of a whole field changed after a single flawed article with a small N.
That is not true of the other examples discussed in the article.
A timely article from the AAFP had this to say about that...

"In 2010, the AAOS strongly recommended against vertebroplasty in neurologically intact patients with VCFs.22 Two randomized controlled trials comparing vertebroplasty with a sham procedure in patients with acute or chronic VCF found no benefit in pain reduction, function, or quality of life.32,33 In contrast, a 2013 meta-analysis of six randomized controlled trials (including those that found no benefits) found that vertebroplasty provided better pain relief, functionality, and quality of life compared with conservative care at 12 weeks, six months, and 12 months.35"