Following up on earlier discussions of radiofrequency denervation, I asked my wife’s doctor about the July 2017 JAMA report on randomized control trials which found no pain benefit compared to exercise when measured three months out.
Two immediate reactions from the doctor (1) this is inconsistent with my 15 years of clinical experience and (2) the studies were probably funded by insurance companies, who will use it as an excuse not to cover the procedure.
I thought you might find this amusing.
Reminds me of stent surgeons when presented with studies showing no meaningful differences from sham surgery in most contexts. OTOH, even a placebo effect can be good, so long as there’s no meaningful risk (compare inserting a stent).
There actually was some insurance funding, but also funding from non-insurance sources. I’d bet denervation is lot cheaper for insurance companies than surgery, which seems the main medical alternative.
The Comparison With the Literature section includes that other studies “showed evidence of low to moderate quality for associations of facet joint radiofrequency with small positive effects on pain and functional status compared with placebo or steroid injections”, which is hardly a ringing endorsement of the procedure. I can’t see any meaningful flaws in the methodology or conclusions of the JAMA paper (“no clinically important improvement in chronic low back pain compared with a standardized exercise program alone”).
I actually had a discussion with some attendings and fellows regarding that study and it was funny the variation of responses and mental gymnastics they went through to explain why it wasn’t a good study. My attendings who are more academic based and salaried agreed and try to put the focus on treatments in line with biopsychosoial model. The ones who were predominantly private practice will hold onto the patho-anatomic model until its pried from their dead hands. I don’t mean to be cynical but the implication is clear on why they feel that way and how vehemently they will defend their practice , recently I read Oregon won’t pay for any epidural steroid injections for lumbar radiculopathy. For lots of interventionalists cutting off bread and butter procedures like that could cut their earning significantly.
Upton Sinclair could have had the definitive line on motivated reasoning, “It is difficult to get a man to understand something, when his salary depends upon his not understanding it!”
It may not even be consciously cynical or mercenary by those in private practice. They may well believe.