{"id":988,"date":"2021-03-28T09:38:16","date_gmt":"2021-03-28T13:38:16","guid":{"rendered":"https:\/\/myuprightlife.com\/?p=988"},"modified":"2021-03-28T09:38:20","modified_gmt":"2021-03-28T13:38:20","slug":"book-review-stabbed-in-the-back-confronting-back-pain-in-an-overtreated-society-by-nortin-m-hadler","status":"publish","type":"post","link":"https:\/\/myuprightlife.com\/index.php\/2021\/03\/28\/book-review-stabbed-in-the-back-confronting-back-pain-in-an-overtreated-society-by-nortin-m-hadler\/","title":{"rendered":"Book Review: Stabbed in the Back: Confronting Back Pain in an Overtreated Society by Nortin M. Hadler"},"content":{"rendered":"\n

Until I read Stabbed in the Back: Confronting Back Pain in an Overtreated Society<\/a><\/em>, I didn\u2019t realize that it was possible to write a book about back pain that was thoughtful and full of interesting tidbits, and yet had nothing useful to say to patients.<\/p>\n\n\n\n

The premise behind the book was promising: An experienced medical researcher exposes the scandalous shortcomings of the back pain treatment industry, and offers a path forward.<\/p>\n\n\n\n

It was also referenced in Crooked<\/a><\/em>, a book which I found tremendously useful, if not faultless.<\/p>\n\n\n\n

I put it on my list.<\/p>\n\n\n\n

Who Can Resist a Canny Curmudgeon?<\/h2>\n\n\n\n

Dr. Hadler was trained as a rheumatologist, and worked in both a hospital and a research lab at the University of North Carolina, Chapel Hill. He specialized in microbiology and immunology, until he turned his attention to the mess at the intersection of politics, sociology, and medicine.<\/p>\n\n\n\n

Since the mid-2000s, he\u2019s published eight books on overtreatment and reform. This is a remarkable output, especially since he continued researching and seeing his patients all the while. He has since started tiptoeing toward retirement. In 2015, he transitioned to Emeritus Professor of Medicine and Microbiology\/Immunology.<\/p>\n\n\n\n

As an author, Hadler has his adherents. It\u2019s easy to see why. His tone is intellectual, yet gruff. He\u2019s not afraid to ruffle feathers, break a few eggs, rock the boat, or engage in other feisty metaphors. Who can resist a canny curmudgeon?<\/p>\n\n\n\n

Hadler is happy to adopt this persona. In the introduction, he writes, \u201cNo reader will find all of the chapters that follow resting easily within his or her preconceptions. Many will find some of the information presented here to be counterintuitive, some of it infuriating.\u201d<\/p>\n\n\n\n

I was all set to have the status quo overturned. I wanted<\/em> to nod along with him, and scribble notes all over the margins that said THIS!!!<\/em> But when Hadler started outlining his most basic assumptions, I found myself scribbling other things.<\/p>\n\n\n\n

Back Pain as an Object Lesson<\/h2>\n\n\n\n

Why, exactly, did a rheumatologist decide to write a book on back pain?<\/p>\n\n\n\n

A glance through Hadler\u2019s academic publication history shows he has never restricted himself to rheumatology. He\u2019s written papers on conditions like lupus, gout, fibromyalgia, and arm pain. He\u2019s currently on the editorial board of the journal Spine<\/em>, and he\u2019s published several papers on diagnosing and treating back pain.<\/p>\n\n\n\n

Yet, once I started reading Stabbed in the Back<\/em>, I noticed that Hadler was barely interested in back pain, let alone the patients who suffer from it. He refers to back pain as an object lesson, and that is a good signifier of his perspective.<\/p>\n\n\n\n

The key point, to Hadler, is that back pain treatment reflects systematic flaws in the medical system. He will happily change the subject and discuss other conditions if they better illustrate those flaws. The number of lines devoted to arm pain, PTSD, whiplash, and fibromyalgia was higher than I expected.<\/p>\n\n\n\n

Dr. Hadler is a voracious researcher and powerful intellectual, and these qualities are responsible for the best parts of the book. Stabbed in the Back<\/em> is a wealth of odd historical trivia.<\/p>\n\n\n\n

For example, did you know that the ancient Egyptian physician Imhotep mentioned a sprained vertebra in a medical text? Or that, according to the Code of Hammurabi, incompetent surgeons would have their hands cut off?<\/p>\n\n\n\n

These tidbits were fascinating. If I didn\u2019t have back pain, and was merely looking for an interesting book on the subject, I would have been satisfied. <\/p>\n\n\n\n

I learned that in the 1860s, public consternation about \u201cRailway Spine\u201d broke out. I learned that Franz Kafka worked for the old Bohemian equivalent of a workers\u2019 comp agency, and that Jack London went undercover to investigate life among London\u2019s poor.<\/p>\n\n\n\n

Craving Some Measure of Empathy<\/h2>\n\n\n\n

And yet, despite the intellectual rigor Hadler brought to the subject, I found myself craving some measure of empathy. Although Hadler readily reviews secondhand, historical accounts of illness and poverty, he seems unwilling to consider firsthand testimonies of present-day patients.<\/p>\n\n\n\n

We do get one glimpse of a back pain patient, the first Hadler ever treated:<\/p>\n\n\n\n

Off I went to my first rheumatology clinic, proudly displaying a name tag that read \u201cAssistant Professor of Medicine\u201d and confident I knew all that was known about rheumatoid arthritis, lupus, scleroderma, and the other systemic diseases that are the purview of the academic rheumatologist. My first patient was a well-muscled man of forty, who appeared anxious and in some discomfort.<\/span><\/em><\/p>\n\n\n\n

\u201cDoc,\u201d he said, \u201cI injured my back and I don\u2019t know if I can go to work.\u201d<\/span><\/em><\/p>\n\n\n\n

If the complaint was, \u201cMy back has been getting stiffer and stiffer since I was a teenager,\u201d I would have been able to help him with his ankylosing spondylitis. But I had no experience or body of information to draw upon to help him with any component of his complaint\u2014the pain in his back, the notion that his back was injured even though he couldn\u2019t point to a particular event or accident that had caused the injury, or the perception that he was too incapacitated as a result of his back pain to continue pursuing gainful employment. I examined him, reassured him that he had suffered no major structural catastrophe, and admitted that I knew not what else to do or say. I suggested that since he had been coping for a couple of months already, he should continue to do so, and I would see him in two weeks, prepared to offer him wiser counsel.<\/span><\/em><\/p>\n\n\n\n

That is the last we hear of this man, or any individual patient. I don\u2019t know what Dr. Hadler told the man at the next appointment, and I don\u2019t know whether his back pain ever did get better.<\/p>\n\n\n\n

For Hadler, the individual\u2019s experience seems to be an unimportant point. He\u2019s interested in studies, and statistics, and aggregate numbers. This attitude has its merits, since making health claims based on anecdotal evidence is its own sort of shortcoming.<\/p>\n\n\n\n

Still, Hadler takes a detached view of actual people who are suffering from back pain. They float somewhere in the background as a vague, depersonalized mass.<\/p>\n\n\n\n

Other than organizing the occasional survey, Hadler makes no effort to talk<\/em> to patients, or understand what their lives are like outside the clinic or the courtroom. They may as well be lab rats, for all the individual differences he notes among them.<\/p>\n\n\n\n

Were You Aware That Back Pain Doesn\u2019t Exist?<\/h2>\n\n\n\n

Hadler specifies that his book is about regional backache. Perhaps you haven\u2019t heard that specific term. Hadler coined it himself, before claiming it doesn’t exist. He goes on to say that scientists still have no idea what causes back pain.<\/p>\n\n\n\n

According to Hadler, Mixter and Barr \u201cinvented\u201d the ruptured disc in 1934. The \u201cinvention\u201d spread because labor leaders and workers comp lawyers were keen to believe in it.<\/p>\n\n\n\n

Hadler never seriously considers whether herniated discs (or any other specific spine problem) can indeed cause back pain. He seems annoyed that anyone is still trying to figure this out. In his opinion, people who look for a specific cause are chasing a chimera.<\/p>\n\n\n\n

He isn’t interested in reviewing the origins or (effective) treatment of back pain. No, the story he has to tell is about an invented disease that is allowed to live on because patients have poor coping skills, and are incentivized to act sick. Unscrupulous surgeons can make a lot of money by exploiting this weakness.<\/p>\n\n\n\n

Surgeons are indeed the targets of most of Hadler\u2019s barbs about back pain treatments, though he does take a few jabs at osteopaths and chiropractors.<\/p>\n\n\n\n

One of the strongest parts of the book was Hadler\u2019s history of surgical treatment options, which was both frightening and disconcerting. I was horrified to learn that doctors have tried to chemically dissolve, or burn away, the disc\u2019s nucleus.<\/p>\n\n\n\n

So, if surgery isn\u2019t the answer, what is? In Hadler\u2019s world, the proper prescription for backache is big ol\u2019 dose of Suck It Up and Deal.<\/p>\n\n\n\n

Some key excepts:<\/p>\n\n\n\n