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Archive for April 1, 2019

Placebo – Vertebroplasty

vertebroplasty copy

The white blobs you see are hardened plastic within a vertebrae of the spine.

Placebo was always a dirty word to me. I’m a physician. I don’t lie to my patients. I’m a scientist. Show me what works and what I can feel and touch. God? Once a upon a time nurses administered norsal for pain. (normal saline) And there was the 2-week Harvard study in which they gave patients sugar pills. After the study a woman demanded more pills. (she said they had helped her)

Then, there are industry myths perpetuated for money. Vertebroplasty and kyphoplasty are billed for $10,000 or more –

“Insurers generally cover the treatments. Medicare pays about $2,400 to $3,000 for vertebroplasty, and $6,500 to $10,000 for kyphoplasty, depending on where the procedure is performed.” NYT 1/24/2019

To be sure I have done it (vertebroplasty/kyphoplasty) – both methods. The results in my hands were mixed. We tend to forget failure and to remember our success. Particularly, I remember an elderly woman who literally rose from her wheelchair to give me a big bear hug. Hey, it works?

No one knows how the procedure gains its success. There is no real science behind it. Injecting a balloon will not lift up a compression fractured vertebral body. A chemical reaction? The heat of the cement setting? No definite science except that the money pours into the coffers of all parties – physician, hospital, supplier (manufacturing company).

The procedure was in my armamentarium of treatment options. More often than not I forgot it was and didn’t do the procedure but a handful of times. We have all had our suspicions. Some chose to make money while others abandoned the procedure. By the time I retired, radiologists were doing them frequently. (Baby, needs new shoes, or daddy needs a new Porsche.)

In summary, the procedure will still be done widely. Money. The companies will push and tout the procedure. Money. And the placebo effect will allow patient testimonials continue with true earnest belief.

….gimme those sugar pills, they worked. … at least they cost pennies not $thousands. I post this on April Fools. Who’s the fool?