Stabbed in the Back: Confronting Back Pain in an Overtreated Society

Stabbed in the Back: Confronting Back Pain in an Overtreated Society

by Nortin M. Hadler, M.D. Hadler
     
 

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Nortin Hadler knows backaches. For more than three decades as a physician and medical researcher, he has studied the experience of low back pain in people who are otherwise healthy. Hadler terms the low back pain that everyone suffers at one time or another "regional back pain." In this book, he addresses the history and treatment of the ailment with the healthy… See more details below

Overview

Nortin Hadler knows backaches. For more than three decades as a physician and medical researcher, he has studied the experience of low back pain in people who are otherwise healthy. Hadler terms the low back pain that everyone suffers at one time or another "regional back pain." In this book, he addresses the history and treatment of the ailment with the healthy skepticism that has become his trademark, taking the "Hadlerian" approach to backaches and the backache treatment industry in order to separate the helpful from the hype.

Basing his critique on an analysis of the most current medical literature as well as his clinical experience, Hadler argues that regional back pain is overly medicalized by doctors, surgeons, and alternative therapists who purvey various treatment regimens. Furthermore, he observes, the design of workers' compensation, disability insurance, and other "health" schemes actually thwarts getting well. For the past half century, says Hadler, back pain and back pain-related disability have exacted a huge toll, in terms of pain, suffering, and financial cost. Stabbed in the Back addresses this issue at multiple levels: as a human predicament, a profound social problem, a medical question, and a vexing public-policy challenge. Ultimately, Hadler's insights illustrate how the state of the science can and should inform the art and practice of medicine as well as public policy. Stabbed in the Back will arm any reader with the insights necessary to make informed decisions when confronting the next episode of low back pain.

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Editorial Reviews

Publishers Weekly
Nobody's going to like Hadler's prescription for backache—neither patients, doctors nor the government. But here it is from the UNC professor and health-care reformist author (Worried Sick: A Prescription for Health in an Overtreated America): get over it. “The fact is that you may be best off if you do not tell anyone about your regional backache and try to get on with it,” he declares. Hadler argues that no theory on what causes regional back pain “has stood up to scientific testing,” and the myriad of treatments do more to sustain “an enormous treatment enterprise” than ease the pain. Hadler presents an impressive survey of what doctors, chiropractors and surgeons now offer for back pain—and of the history and rationale for government disability programs. His conclusion is scornful. “Predicaments of life” such as back pain are not “injuries,” Hadler insists. “[H]eadache, heartburn, sleeplessness, altered bowel habits, and many regional musculoskeletal disorders... do not respond to treatment as diseases because they are not diseases.” That's what you call a bitter pill— but one that should trigger a much needed debate among health-care reformers. 5 illus. (Nov. 15)
Library Journal
Hadler (medicine & microbiology/immunology, Univ. of North Carolina, Chapel Hill) holds that back treatments are the "poster child" for "the most irrational health-care system on the planet." As in his previous Worried Sick: A Prescription for Health in an Overtreated America, Hadler relentlessly probes the effectiveness of common medical treatments and finds them wanting. Although he touches on such conditions as carpal-tunnel syndrome and fibromyalgia, he focuses on back pain that has no detectable physical cause. While some soldier on with aspirin or acetaminophen and eventually improve, others seek out specialists who may recommend a range of treatments that, collectively, consume $30 billion per year. As Hadler points out, very few of these treatments are effective in the long run. In addition to the costs and risks of futile treatments, Hadler argues that the psychological toll of being labeled "sick" means that many patients are unable to return to their normal lives, particularly when they fall into the bureaucratic morass of Workmen's Compensation. VERDICT Though often challenging in its technical language, this compelling book is well worth the effort for students of medicine, public health, and health-care policy and, of course, for those contemplating back surgery.—Kathy Arsenault, St. Petersburg, FL
From the Publisher
Relentlessly probes the effectiveness of common medical treatments and finds them wanting. . . . [A] compelling book.--Library Journal

The next step [in health care reform] is the one Hadler is already confronting: how to really bring down costs as we move forward.--Progressive Pulse Blog

The volume is well organized, giving a good historical and clinical overview of back pain and of what Hadler terms 'the backache industry.'--Choice

"In this thought-provoking book, Hadler analyzes the evidentiary basis of the diagnosis and treatment of back pain with a fresh, no-nonsense razor.--JAMA

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Product Details

ISBN-13:
9780807898543
Publisher:
The University of North Carolina Press
Publication date:
11/15/2009
Sold by:
Barnes & Noble
Format:
NOOK Book
Pages:
224
File size:
1 MB

What People are saying about this

From the Publisher
In clear and compelling language, Nortin Hadler explains the dilemma of back pain and all the ways that patients can be misled. This book is a must read for those suffering as well as for the rest of our society, so we can better remedy ailments with fewer drugs, fewer surgeries, and greater wisdom.--Jerome Groopman, M.D., Recanati Professor, Harvard Medical School, author of How Doctors Think

Dr. Hadler brings a fresh epistemology to the entity described as back pain. His gift with words and his scientific knowledge provide a freshness that allows each of us confronting back pain and its insidious nature to rethink our current and future needs. This brilliant work will stand as his best work for decades to come.--James N. Weinstein, D.O., M.S., professor and chair of orthopedic surgery at Dartmouth College, Medical School; director of The Dartmouth Institute for Health Policy and Clinical Practice

Nortin Hadler exposes the overmanagement of a sometimes-contrived disease with a compelling body of scientific investigation.--Mehmet Oz, M.D., New York Presbyterian Hospital, College of Physicians and Surgeons, Columbia University

Abu Ali Sina, 'Avicenna,' was an unsurpassed eleventh-century Persian clinician, teacher, polymath, 'philosophe,' and prolific writer of scientific papers, treatises, and textbooks. Nortin Hadler is the twenty-first-century Avicenna.--Assad Meymandi, M.D., Ph.D., DLFAPA, University of North Carolina School of Medicine

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