Stabbed in the Back

September 21, 2009
Nobody's going to like Hadler's prescription for backache—neither patients, doctors nor the government. But here it is from the UNC professor and health-care reformist author (Worried Sick: A Prescription for Health in an Overtreated America
): get over it. “The fact is that you may be best off if you do not tell anyone about your regional backache and try to get on with it,” he declares. Hadler argues that no theory on what causes regional back pain “has stood up to scientific testing,” and the myriad of treatments do more to sustain “an enormous treatment enterprise” than ease the pain. Hadler presents an impressive survey of what doctors, chiropractors and surgeons now offer for back pain—and of the history and rationale for government disability programs. His conclusion is scornful. “Predicaments of life” such as back pain are not “injuries,” Hadler insists. “eadache, heartburn, sleeplessness, altered bowel habits, and many regional musculoskeletal disorders... do not respond to treatment as diseases because they are not diseases.” That's what you call a bitter pill— but one that should trigger a much needed debate among health-care reformers. 5 illus.

August 15, 2009
Hadler (medicine & microbiology/immunology, Univ. of North Carolina, Chapel Hill) holds that back treatments are the "poster child" for "the most irrational health-care system on the planet." As in his previous "Worried Sick: A Prescription for Health in an Overtreated America", Hadler relentlessly probes the effectiveness of common medical treatments and finds them wanting. Although he touches on such conditions as carpal-tunnel syndrome and fibromyalgia, he focuses on back pain that has no detectable physical cause. While some soldier on with aspirin or acetaminophen and eventually improve, others seek out specialists who may recommend a range of treatments that, collectively, consume $30 billion per year. As Hadler points out, very few of these treatments are effective in the long run. In addition to the costs and risks of futile treatments, Hadler argues that the psychological toll of being labeled "sick" means that many patients are unable to return to their normal lives, particularly when they fall into the bureaucratic morass of Workmen's Compensation. VERDICT Though often challenging in its technical language, this compelling book is well worth the effort for students of medicine, public health, and health-care policy and, of course, for those contemplating back surgery.Kathy Arsenault, St. Petersburg, FL

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