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BackPage Online, September 2016

doi: 10.1097/01.BACK.0000493155.01014.65
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Is It Time to Curtail the Volume of Useless Spine Research?

Most published clinical research is neither practical nor useful. It is a waste of time and money. Stanford-based research expert John P.A. Ioannidis, MD, suggests it is time to start discouraging useless research.

“Many of the features that make clinical research useful can be identified”, says Ioannidis. Research should be valid, pragmatic, patient-centered, feasible, transparent, useful, clinically relevant, and appropriate.

“Many studies, even in the major general research journals, do not satisfy these features and very few studies satisfy most or all of them,” according to Ioannidis.

It is time for reform, he suggests. Altering the current research approach could easily produce more clinical research—and at massively reduced cost.


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Race to Develop New Painkillers

Analgesic medications were once regarded as the cornerstones of routine back and spine care, believed to be safe and effective in relieving pain and improving function. Careful scientific research has pretty much exploded that idea. In the wake of the opioid overtreatment and addiction epidemic, it is clear that opioids are neither effective nor safe for chronic pain. Acetaminophen appears to be largely useless in the treatment of back pain. And nonsteroidal anti-inflammatory drugs (NSAIDs) can lead to potentially lethal gastrointestinal and cardiovascular events.

So drug companies are racing to develop innovative drugs that might provide significant pain relief without dire risks. Here is an intriguing article from STAT about that race:

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Group Medical Appointments Gaining Popularity

Group medical appointments are growing in popularity—and for good reasons. A medical appointment between a single patient and a single primary care physician lasts up to 15 minutes, with a substantial proportion of that time devoted to bureaucratic tasks, such as entering patient information into the electronic medical record. Only a few precious minutes are left for face-to-face discussion about the primary reason or reasons for the medical consultation. And a variety of scientific studies show that patients have to invest up to two or three hours of work and personal time to travel to the clinic and see the doctor. By contrast, group medical consultations involve up to ten patients with similar medical issues consulting a physician for up to 90 minutes. In spine care they are particularly useful for patients seeking both information and strategies on how to cope with various spinal conditions. However, as always in organized medical care, payers rule the roost. And they sometimes won't underwrite group sessions even when they appear to be effective and cost-effective. So this is a medical trend in progress. Here is an article about group medical appointments from

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