Copyright ©2009 NPR. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

MELISSA BLOCK, host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Melissa Block.

MADELEINE BRAND, host:

And I'm Madeleine Brand.

People get all sorts of treatment and surgery right now that doesn't necessarily work, but private insurance or Medicare still pays for it. Whether that should be the case is a key question, as Congress considers a health care overhaul.

Two studies published today in "The New England Journal of Medicine" illustrate the difficulty in answering that question. The studies evaluate a popular procedure for fractured vertebrae.

NPR's Joanne Silberner explains.

JOANNE SILBERNER: Radiologist David Kallmes of the Mayo Clinic was one of the first people to do this procedure in the U.S. 15 years ago. It seemed like a miracle. By shoring up broken vertebrae with cement, he was able to offer pain relief to people with one or two cracked vertebrae from osteoporosis. The procedure was easy and it caught on like wildfire. But after a while, he and others decided it needed to be rigorously tested.

Dr. DAVID KALLMES (Radiologist, Mayo Clinic): This procedure is done in 75,000 people a year. Over 10 years, it's up, you know, three-fourths of a million patients are going to get this procedure, we should know for sure that it works.

SILBERNER: In Kallmes' study, 68 people got the procedure.

Dr. KALLMES: And what that entails is giving them sedation by vein, putting Novocain under their skin and on their bone, and then introducing a medium-size needle and injecting this medical cement.

SILBERNER: The 63 people in the placebo group had the same procedure without cement. The patients rated their pain before and after.

Dr. KALLMES: I wasn't completely shocked when I saw the data, but I, frankly, was surprised that the results in both groups were so similar.

SILBERNER: Both groups had less pain after the procedure.

A second study from Australia of 78 people who got both the sham no-cement procedure and the one with cement also showed no significant advantage.

The head of the North American Spine Society says the broken vertebrae studies show that both the placebo and cement procedures work.

But to James Weinstein, an orthopedic surgeon who directs the Dartmouth Institute for Health Policy and Clinical Practice, "The New England Journal of Medicine" information said only one thing…

Dr. JAMES WEINSTEIN (Director, Dartmouth Institute for Health Policy and Clinical Practice): What it said to me is that, essentially, this is a treatment with no effect and probably shouldn't be done anymore.

SILBERNER: Weinstein is a proponent of comparative effectiveness, of comparing various treatments to see what works best. Questions have been raised about many procedures in the area of back pain. There's surgery for slipped discs. With that one, long after such surgeries had become common practice, it was determined that the surgery has only a slight advantage over rest and rehabilitation. And spinal fusion remains controversial.

Dr. WEINSTEIN: We do need to today have these kinds of studies done before we implement these strategies in clinical practice. And where we can't do them, because of funding or support or for whatever reason, maybe we ought to think twice about introducing them into the common marketplace.

SILBERNER: President Obama has set aside $1 billion to do comparative effectiveness studies. A good idea, but it's going to take some discipline to make use of the results, says Sean Tunis, director of the nonprofit Center for Medical Technology Policy. He says insurers will have a hard time disallowing procedures that the medical community thinks work.

Dr. SEAN TUNIS (Director, Center for Medical Technology Policy): And what you've gotten into is what everybody, you know, is uncomfortable with, which is that either a payer or some bureaucrat is saying, no, you can't have this intervention that your doctor is proposing.

SILBERNER: Basically, rationing. His solution: pay for new procedures before comparative effectiveness studies are done, but only if the outcomes of each one are put into a database for long-term analysis.

As for David Kallmes, he's going to continue to do injections for cracked vertebrae so he can see if it's the Novocain or something else that's responsible for the improvement.

Joanne Silberner, NPR News.

BRAND: And you can follow the latest health news and what's going on in the health care overhaul debate on our health blog. It's at the new npr.org.

Copyright © 2009 NPR. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to NPR. This transcript is provided for personal, noncommercial use only, pursuant to our Terms of Use. Any other use requires NPR's prior permission. Visit our permissions page for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR's programming is the audio.

Comments

 

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.