Book review: Stabbed in the Back

Title: Stabbed in the Back. Confronting Back Pain in an Overtreated Society (2009)

Author: Nortin M Hadler

Publisher: University of North Carolina Press

Nortin Hadler has written widely on the problems with modern medicine (overtreatment, overdiagnosis, medicalization) but he is also someone who is doing something about it, and his ideas on healthcare reform are novel, well informed, feasible and reasonable. For these though, you should read Worried Sick: A Prescription for Health in an Overtreated America. This book covers back pain; from historical, cultural, physical, social, occupational and psychological perspectives.

He builds a strong case. From statements like: 

“the imaging studies of the spine in patients who have acute (or chronic) regional low back pain are irrelevant at best and misleading all to often”

he argues against medicalizing a ‘normal’ human condition like back pain. He goes on to cover the diagnostic and treatment failures that persist, always exploring the underlying reasons. For example, the complexities of patient-doctor interactions and the distorted incentives of compensation programs.

Dr Hadler does not restrict himself to covering the treatment alternatives; he provides us with behind-the-scenes information about the development of guidelines, the backlash against them, actions by interest groups (pharmaceutical companies, craft groups), and the conflicts of interests that pervade this area of medicine.

He understands the problems with modern medicine, and how “The reflex is to do something, and the more dramatic that something is … the more it is accepted by peers and held in awe by the laity”. In the final chapter, he offers solutions, and comments on some solutions proposed by others.

This book can be easily understood by non-medics, so it provides useful information for doctors as well as patients. It is well written (sober, clear, and well referenced) and the subject matter (to me, anyway) is fascinating. The authors asks: “How many patients would consent to surgery for regional low back pain if they had read Chapter 6 of this book?”. Not many, would be my guess. There is a need to educate doctors and the public about the realities around spine surgery, and this book does just that.