And One Pill Makes You Small

Overcoming Fear With Facts and Faith

Crenshaw

• Publisher: Resource Publications
• Year: 2015
• eBook ISBN: 9781498225045
• Topic: Theology & Religion
• Subtopic: Religion

Americans are using more medical services every year, but as many as half of those services do nothing to improve their health. For many, the alarming rise in health care costs is stretching family budgets to the breaking point. This book challenges the notion that more medical care is always better.A clearer understanding of the health benefits--and the risks--of the most widely prescribed drugs and the most commonly performed procedures will enable you to evaluate your doctors' recommendations in a new light. For example, before you go to see your doctor, you can learn the answers to questions like: What is the exact probability that taking a statin drug will protect me from a heart attack? Does spinal surgery relieve back pain better than rehabilitation programs? Using examples from real patients, you will learn how to steer the conversation with your doctors to be sure your questions are answered and your preferences respected.Finally, if you read this book you will be reminded of the Bible's message about life on earth and life after death--and you will see a clear contrast between that message and what the world is saying.

Chapter 1

By The Sweat of Your Face

Cursed is the ground because of you; in pain you shall eat of it all the days of your life.

Genesis 3:17

I believe the first backache occurred in the Garden of Eden. When they failed to follow their maker’s instructions, God pronounced a curse on the man and the woman. He told Adam that he would have to labor and toil on a relatively unproductive ground to get food to eat. Because the human race spread out, back pain now covers the face of the whole Earth.

In my experience most cases get better in a couple of weeks without any treatment at all. In spite of that, billions of dollars are spent each year on doctor’s visits, diagnostic tests, and various remedies for neck and back pain. According to WebMD, low back pain is one of the most common reasons for visits to the doctor. In a survey, one in four adults reported having low back pain in the last three months.

Over the last decade CAT scans and MRIs have become increasingly common in the diagnosis of spinal disorders. Narcotic prescriptions, injections around the vertebra, and surgery have exploded in popularity. Most of the money spent on these supposed cures is wasted. Researchers at of the University of Washington reported in the Journal of the American Medical Association that patients did not get better results, just higher costs.

Some things haven’t changed much in the last 2000 years. The New Testament records an encounter between Jesus and a woman with persistent, unrelenting, uterine bleeding. Mark 5:25–30 says that she’d been bleeding for twelve years, and she “had suffered much under many physicians, and had spent all that she had, and was no better but rather grew worse.” Those of you with chronic, recurring back or neck pain can identify.

BMJ Clinical Evidence, a publication of the British Medical Journal, is one of my “go to” places to find the best information about the effectiveness of the most popular and common therapies. Their researchers perform systematic reviews of the clinical trials published in the English language. In their review of acute low back pain (pain present less than twelve weeks) published on their website on May 9, 2011, they say

• NSAIDs (ibuprofen family) and muscle relaxants improve symptoms, but they sometimes cause adverse effects. Trade offs are involved.

• There are no studies on the effectiveness of steroid injections in acute low back pain.

• It is not known whether spinal manipulation (chiropractic), acupuncture, back schools, behavioral therapy, massage, multidisciplinary treatment programs, lumbar supports, TENS, temperature treatments, or exercises make any difference in acute low back pain.

The medical evidence leads to the conclusion that this painful condition is usually self-limiting. That’s doctor-speak for “it gets better with no treatment.” I’m not saying it’s all in your head, but the times I have personally come down with disabling back pain were times of high stress in my life. The chapter on depression adds more to this overly simplistic and utterly unhelpful statement, so don’t close the book yet.

Chronic Low Back Pain (published 08 Oct 2010)

On the same website I discovered that about 75 percent of people in developed countries develop low back pain at some time, and their symptoms usually improve in less than two weeks. A small number of patients, however, have symptoms persisting after one year of follow-up care. The percentage of patients who describe their back pain as “chronic” has increased, from less than 5 percent in 1992 to more than 10 percent in 2006. In the highest-quality, randomized, controlled clinical trials (the “gold standard” in medical research) BMJ Clinical Evidence makes the following observations about the effectiveness of a variety of medical, physical, psychological and surgical therapies.

• NSAIDs might be more effective than placebos.

• Narcotics might improve pain and function compared to placebos, but they have well-recognized adverse effects.

• We don’t know whether antidepressants reduce pain or improve function more than placebos. Suicidal behavior might occur more often in those who use antidepressants.

• Benzodiazepines might lessen pain.

• We don’t know if steroid injections improve chronic low back pain in people without sciatica (pain running down into the leg).

• Spinal fusion is no better than intensive rehabilitation with a cognitive behavioral component. (This again raises the question of the role life’s stresses play in causing back pain. The chapter on depression sheds more light on this.)

• Acupuncture, back schools, and chiropractic manipulation may reduce pain in the short term, but their effects on function are unclear.

• Massage may lessen pain and improve function.

• We don’t know whether biofeedback, lumbar supports, traction, or TENS provide pain relief.

• We also don’t know whether electrothermal disc therapy or disc replacement lessens pain or improves function. Ditto for radio frequency destruction of the nerves.

Variations in Medical Practice

The science then, sadly, is insufficient to steer us toward a satisfactory solution to the ubiquitous problem of lower back pain. This uncertainty, no doubt, explains a curious phenomenon uncovered by the researchers at Dartmouth University. There is no “standard” way of treating back pain in the United States, or of treating many other conditions for that matter. On January 29, 2015 I went to their really good website (dartmouthatlas.org) to look afresh at the section called VARIATION IN THE CARE OF SURGICAL CONDITIONS. There they describe the problems:

“For many conditions, surgery is one of several care options, and in some instances, there are several types of surgical procedures available. Research into the effectiveness and adverse effects of a surgical procedure compared to alternatives is often incomplete. While quality has generally improved over time, outcomes can differ across hospitals and surgeons. Too often, treatment options, whether medical or surgical, are recommended without patients fully understanding the choices and participating in the decision; and these recommendations can vary markedly from one physician to the next.”

Looking specifically at spinal fusion, I uncovered some observations that are hard to explain, given the fact that fusions have not been shown—in the best studies done to date—to give people better results than less-risky, non-surgical treatment. Bear with me as I shift into nerd mode to give you some idea of the scope of the problem.

• The rate of spinal fusion operations for lumbar spinal stenosis among Medicare beneficiaries age sixty-five and over increased 67 percent between 2001 and 2011.

• The average rate among regions in the U. S. during that period was forty-one per one hundred thousand, but the rate varied wildly and dramatically across the three hundred and six hospital referral regions. Bangor, Maine Medicare patients had nine procedures per one hundred thousand while Medicare patients in Bradenton, Florida had one hundred and twenty-seven. Stated another way, if you live in Bradenton you are fourteen times more likely to receive fusion as a treatment than if you live in Bangor! Here is a break down of the five highest and five lowest use regions in the U. S.

Bradenton, FL	127.5
Grand Rapids, MI	89.9
Mason City, IA	89.2
Tyler, TX	88.5
Newport News, VA	87.4
Bronx, NY	17.5
Scranton, PA	17.1...

Table of contents

• Title Page
• Acknowledgments
• Introduction
• Chapter 1: By The Sweat of Your Face
• Chapter 2: The Stress of Not Getting What I Want
• Chapter 3: Our Days Are Numbered
• Chapter 4: Brittle Bones: a Bonanza for Big Pharma
• Chapter 5: Clean Arteries, Clean Heart
• Chapter 6: Follow The Money
• Chapter 7: The Final Battle