Nortin Hadler, UNC physician and author, has a new book  out this week on lower back pain and its treatment in our overtreated society. Hadler is a well-known critic of the estimated 1/3 of medical care costs we spend on treatments that are ineffective or even harmful. The fact that treatment of lower back pain – both surgery and otherwise – fits into this shady realm isn’t exactly a mystery. Even the New York Times has a one-page overview  of the lack of evidence that much of any treatment works for adult lower back pain. Hadler goes beyond this simple fact though to argue that not only are we wasting billions of dollars but that we in many cases are harming ourselves with the treatments we seek. Finally, the way our entire health system is designed when, for example, payment is by procedure or test, contributes to the problem.
The idea that your doctor may not be prescribing the best treatment for you isn’t one that wins any polls in the national health reform debate. However, if we are to honestly confront the enormous costs of our health system we must confront the very issues that we don’t want to talk about – some of the many treatments we see as the pinnacle of technological medicine are the very ones that are not only bankrupting us but causing many more health problems than they solve. At this point, I believe we are extremely likely to get some version of national health reform through Congress. The next step is the one Hadler is already confronting: How to really bring down costs as we move forward.