When faked surgeries work as well as the real ones

The current issue of Health Affairs has an excellent case study of the aftermath of two rigorous 2009 studies in the New England Journal of Medicine that showed that vertebroplasty – an invasive back procedure that injects bone cement into the spine to treat fractures – offered no more pain relief than “surgeries” that were faked.

Two years later, Medicare and insurance companies continue to pay for the procedures. Science is ignored, and patients apparently are being ill served. This does not bode well for health reform’s efforts to increase comparative effectiveness research to determine the best way to treat medical conditions. There is a political constituency arrayed behind every procedure – the physician, the facility where it is performed and the medical device maker who produces medical supplies. A meek effort to stop paying for vertebroplasty by a Medicare carrier in the western U.S. was squashed by medical-lobbying forces.

In 2002, 180 patients with osteoarthritis were randomly assigned to undergo either arthroscopic knee surgery or fake surgery, although neither group was aware of the parameters. The results indicated that knee surgery provided no more pain relief or added mobility than the fake surgery. Predictably, the results were attacked by those who do knee surgeries. A second set of researchers did a similar study in 2008. The results were the same. Regardless, more than 500,000 patients spent $3 billion on arthroscopic surgery for arthritic knees in 2009.

An estimated 30 percent of medical spending is considered to be of no benefit. If the U.S. payers do not react to solid evidence such as this, we have no hope of dealing with medical costs that are overtaking government and household budgets.