Ethics in Medicine

Another Popular Back Procedure found to be ineffective

Kristen Sparrow • August 24, 2009

The Mayo clinic has found that using medical cement to fix cracks in the brittle vertebrae of elderly people is no better than placebo. The reason that this article is of interest to me is that it fits in the category of things that make sense from a Western Medicine point of view, and so are enthusiastically performed even though there is no evidence for efficacy. Or as my blog post of 4.2.09 was titled, “Believing in Treatments that Don’t Work.” Given the rigorous standards for acupuncture research, the use of sham needles, sham placement or even (ridiculously) trying to control for the practitioner interaction, it is nice to see the Mayo clinic applying the same rigor to a “logical,” popular, western medical procedure.
They go on to say at the end of article that the “miraculous” recoveries seen could be due to the anesthesia, placebo, or the fractures healed on their own. The anesthesia in this case was local anesthesia, so it is possible that the needling helped.
I am the first to admit that there are mysteries in the healing process and that placebo can play a large roll in any therapy, including acupuncture. But Western Medical procedures should be treated with the same level of skepticism as acupuncture is, if not more, since they are often more dangerous and almost always much more expensive. A quick search to determine how much the back cement treatment costs shows that it it runs $526-558 for the first level and then $236 for each level after that. That doesn’t include the anesthesia or recovery room fees etc… In addition, particularly with the drama of surgical procedures the placebo effect has the potential to be quite powerful indeed.

Cement for backs ineffective from San Francisco Chronicle,
Stephanie Nano, Associated Press
Thursday, August 6, 2009
A common treatment that uses medical cement to fix cracks in the spinal bones of elderly people worked no better than a sham treatment, the first rigorous studies of the popular procedure reveal.
Pain and disability were virtually the same up to six months later, whether patients had a real treatment or a fake one.
Tens of thousands of Americans each year are treated with bone cement, especially older women with osteoporosis, some of them stooped and unable to stand up straight. The treatment is so widely believed to work that the researchers had a hard time getting patients to take part when it was explained that half of them would not get the real thing…
“All of us who do the procedure have seen apparently miraculous cures,” said Dr. David F. Kallmes, a radiologist at the Mayo Clinic who led one of the studies. But he said there were also “miraculous cures” among those who got the fake treatments.
Bone cement has long been approved for many medical uses, but this particular use had not been tested.
The findings, published in today’s New England Journal of Medicine, mean patients and doctors need to review the options together, wrote Dr. James N. Weinstein of Dartmouth Medical School in an accompanying editorial. “When best evidence suggests a tossup between treatment options and no benefit, informed patient choice is essential,” he said.
The researchers do not know why people felt better, but suggest it could be due to the anesthesia, the placebo effect or that the fractures healed on their own over time.