Back and knee surgery questions.

How much of the $2.5 trillion we spend on health care goes down the drain for tests and treatments that don't help, run up the bill and may even cause harm? A recent article in Forbes addresses the issue of unnecessary tests, treatments and even surgeries. Here are two excerpts from the article about back pain and surgery, and arthroscopic knee surgery. Read the full article here

"Former computer programmer Laura Held, 52, spent years suffering from herniated discs in her upper spine that sent waves of pain shooting down her arms. So in 2006 she underwent a newly invented operation that replaced three of her worn-down discs with artificial ones, even though her insurance wouldn't pay the $10,000 cost.

But the relief was temporary and the complications long-lasting, she says. The operation paralyzed her left vocal cord, making speaking and swallowing difficult for months. Her voice is still noticeably raspy. The neck pain returned after a year. Held has already generated $100,000 in bills and now faces the prospect of another operation to fix the problems caused by the first one. "She bought a bill of goods," says University of California, Irvine spine surgeon Charles Rosen.

Spending on back and neck pain treatments, including prescription narcotics, increased 65% (after inflation) between 1997 and 2005 to $86 billion, a 2008 Journal of the American Medical Association study found. Yet the study found no evidence all the spending was making people feel better.

Back surgery is getting ever more complicated and expensive. One controversial operation that has surged in popularity is spinal fusion, in which two or more vertebrae are fused together to alleviate pain blamed on degenerated discs. It costs around $50,000. Two controlled trials, one in England and one in Norway, found it was hardly better for plain lower back pain than a good rehab program combining exercise and cognitive therapy. The surgery comes with more complications than the exercise.

33.3 million Americans report back and neck pain.
$86 billion Total spending on back and neck pain treatments.
65% Rise in spending since 1997 (inflation adjusted).
20.7% Percent of back patients with limitations in physical function in 1997.
24.7% Percent of back patients with limitations in physical function in 2005.

Source: Journal of the American Medical Association, Feb. 13, 2008.

One common way to treat arthritis of the knee has been to shave off loose pieces of cartilage through arthroscopic surgery. Two rigorous trials show that this $5,000 procedure doesn't help. In 2002 researchers at the va Medical Center in Houston showed that the real operation was no better than a fake (placebo) operation for arthritic knees. But some surgeons refused to accept the verdict, even as Medicare stopped covering the procedure for arthritis alone. (It is widely used for sports injuries.) They argued that the veterans study reflected a narrow demographic and that patients with locking or other "mechanical" symptoms could still benefit. Doctors performed 956,000 knee arthroscopies in 2006, up from 629,000 in 1996. How many are done in arthritis sufferers is unknown.

Orthopedic surgeon Robert Litchfield of the University of Western Ontario in Canada thought his trial, comparing arthroscopy to treatment with painkillers and physical therapy in 176 arthritis patients, would disprove the earlier one. But after two years those who got operations were no better, including those with mechanical symptoms, according to the results reported last year in the New England Journal of Medicine.

A murky situation is patients with some arthritis and with tears in the meniscus, the knee's shock absorber. Most arthritis patients have the tears, whether they are in pain or not. "This is one of the most frequently performed procedures in medicine, and we don't know whether it works," says Brigham & Women's Hospital rheumatologist Jeffrey Katz, who is leading another trial to resolve the matter."

$5,000 Cost of knee arthroscopy.
956,000 Number of knee arthroscopies performed in 2006.
629,000 Number of knee arthroscopies performed in 1996.

Surgery is invasive, expensive, and not always effective. Why not try other available options, including yoga before surgery or drugs? Most people do not know that yoga can be effective, and most are not told there are ways to manage their condition, and even improve it, without the risks of surgery.

Here is a link to an abcnews piece about doctors prescribing yoga, even in hospitals, for everything to ADHD to brain tumors.