Abstract
Every so often I receive emails from patients containing a link to an article by a news outlet regarding some treatment of spinal disorders. An informed and engaged patient is a good partner and I usually perceive a close interaction with their spine specialist of choice as a sign of trust and patient satisfaction. So I politely thank them and comment on their matter.
However, almost every single 1 of those shared articles have 1 thing in common: They report on the ineffectiveness or even harm of specific spinal treatments. The author usually quotes some recent study, often published peer reviewed, which concluded that a widespread and established treatment is not providing any benefit to patients. Usually the journalist quotes an „expert professor” „that this treatment should have been ended years ago”. The conclusion of these articles is always similar: „These treatments are administered to millions of patients by doctors in the country or even around the world only for the financial gain by the doctors.
The repetitiveness of this pattern is concerning and raises several questions:
Why do peer reviewed articles with negative conclusions find their way into the media easier? Is „a story about established predictable success and positive outcomes less interesting?” Probably so and journalists’ need for landing a scoop and uncovering a medical „scandal” is understandable. However, the essence of clinical research in medicine evolves from questioning current concepts and the quest for improvement. From a scientific perspective, a paper finding flaws / room for improvement in treatment is the whole idea of research and genuinely positive as such. Nevertheless, the public media discussion draws a mostly negative conclusion and assumes some “ethically questionable” motivation on the doctor’s side.
Most commonly, the financial reimbursement for a treatment is seen as the main motivation for treating a patient in a specific way. Interestingly this is a global phenomenon, regardless of the health care environment, whether doctors work on salaries or are self-employed and in virtually all reimbursement patterns around the globe. So regardless of the system the doctors work in, the assumption that treatment decisions depend on individual reimbursement only is a conclusion falling far short of reality and is deeply flawed in the vast majority of cases. Admittingly, black sheep colleagues are all too present in spine care and we all know our examples.
On a side note and depending on society and circumstances, the fact that medical professionals are reimbursed for their work is still debated in a way unknown for other professionals. At least from a European perspective and certainly in the patient-doctor context, medical bills are debated differently than eg, legal fees charged when consulting a lawyer (topic for another editorial, I presume…).
Another interesting point when looking into this type of media articles is that usually the scientific argumentations in the discussion part of the covered scientific paper is not laid out. The methodology, a key scientific basis for drawing conclusion etc. is usually only mentioned on the side, if at all. While professional scientific discussions and authors conclusions frequently summon “more research needed”, that point is not reflected in what makes it to the public.
Scientifically solid and relevant clinical research papers are not only evaluated in the process of peer review publishing, often they are part of the scientific basis for clinical guidelines and practice recommendations by multiple groups of medical associations and bodies around the world. That aspect is 1 of the great values of structured, multiprofessional guidelines. But in the context of this editorial looking at media articles about spinal treatments, the important aspect that clinical guidelines reflect on the science behind a recommendation and are regularly updated as the science evolves, is usually omitted.
Thirdly, public media articles often follow a specific cause. Lobbyism and bias easily find a way into journalistic work, consciously or not. The ongoing discussion about “too much surgery” and “too many interventions” for spinal disorders is a very present example how stakeholders’ arguments can shape general public media discussions. Scientific discussions about these arguments usually follow a much different road.
So in conclusion, I call for a more thorough and holistic approach by medical journalists when covering clinical research findings in spine care. Progress comes by questioning the established and new findings should be presented to the public within a positive context. The simple conclusion “doctors around the world have been deliberately treating you badly for moneys sake” is falling way short.