Comparative effectiveness: Back surgery remains popular despite poor study results

Studies have recently found that vertebroplasty - a type of back surgery in which cement is injected into the spine - isn't effective, but many patients and their doctors insist it works. The surgery "is under scrutiny after two recent studies in the New England Journal of Medicine concluded the popular treatment to ease pain from back fractures, typically caused by osteoporosis, is no more effective than a sham surgery," The Boston Globe reports. "Coming more than a decade after vertebroplasty was introduced in this country, the studies are the first to compare the treatment's effectiveness to a placebo surgery, the gold standard for medical research."

"Yet the findings are unlikely to change the practice of many specialists, who said they don't jibe with their years of experience" providing pain relief to patients. "The fallout illustrates how hard it is to find clear-cut answers about whether health care dollars are being wisely spent, a key question as Congress debates a national overhaul of the health care system. President Obama has promoted such 'comparative effectiveness research' as a way to cut costs and improve quality."

"The studies' tsunami-like aftershocks -- insurers are now reconsidering whether they will continue to pay for the treatment -- also underscore a little-known fact outside the medical community: Surgeries often become widespread before they've undergone rigorous evaluation. While prescription drugs and medical devices must be reviewed by federal regulators before they're released to the public, surgical procedures do not" (Lazar, 8/24).

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