Orthopedic surgeons, neurosurgeons, and chiropractors are busier than ever, if the rising national medical bill for aching backs is any indication. Out of every $11 spent on medical care in 2005, according to a new study in the Journal of the American Medical Association, $1 of it was for our backs. After adjusting for inflation, bad backs rang up $86 billion worth of medical expenses in 2005. That's a 65 percent jump from 1997. On average, expenses for an individual with a back problem added up to $2,580 more in 2005 than for someone without one. Between 1997 and 2005, the cost of pain drugs and other back-related medications almost tripled.
So much money, so little relief. The same JAMA study cites an annual federal survey of U.S. households showing that year by year, from 1997 to 2005, the percentage of those with back problems reporting limitations on their social life, on work and school activities, or on physical functioning never dropped once and only in one year stayed the same. The increase was slow but absolutely inexorable.
I'm sure there are many explanations, but two come to mind. One is that as Jerome Groopman eloquently and scarily described a few years ago in "A Knife in the Back," a classic New Yorker article, medical care doesn't do much for a painful back. About 85 percent get better on their own, he wrote, and of those that turn into chronic problems, only a small proportion of sufferers benefit from surgery or other heroic care. Translated, this means to me that we can shower surgeons and other practitioners with money in hopes of easing the pain, but they mostly can't do much.
The other factor that immediately occurred to me is the obesity trend. The more excess weight carried, the greater the load on the poor spine. Sure enough, the overweight/obesity trend tracked by the National Center for Health Statistics nicely matches the JAMA data. Dropping a few pounds might be the best treatment out there. It's sure the cheapest.
U.S. News's Avery Comarow has been editor of the America's Best Hospitals annual rankings since they first appeared in 1990. His reporting on clinical medicine, from the latest cholesterol guidelines to robotic surgery, has been driven by the question: What does this mean to patients? And that is the perspective he brings to his observations and commentaries on the increasing number of programs by hospitals and other healthcare providers to improve care and patient safety.
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