Watch Your Back!

Over the past twenty years, treatment of back pain has become ever more expensive and intensive. Use of MRI scans, narcotic painkillers, injections, and invasive spine surgery have all grown by several hundred percent. In some areas of medicine, newer treatments have improved quality and duration of life, but as back pain is treated more aggressively, annual surveys of people with back pain report steadily worse impairments. In Watch Your Back!, Richard A. Deyo, MD, proposes an approach to managing back pain, which most adults in the United States experience at some point, that empowers the individual and leads more directly to effective care. Though it may seem counterintuitive, fewer medical interventions may produce better results. Expecting a probe, a pill, or a procedure to cure back pain is usually unrealistic, yet entire industries promote the notion that someone else will "fix" you. Watch Your Back! exposes these flaws in the current approach to back pain, along with the profit motives and conflicts of interest behind many of them. The book dramatizes the problems with stories of prominent individuals who encountered high-tech pitfalls, then found low-tech solutions suited to their lifestyles and the nature of their back pain. Watch Your Back! will be useful not only for people with back pain but also for doctors and policy makers. Our health care system has a growing interest in reducing waste, overuse, and unnecessary care. There’s a consensus that health care is too expensive and that we get too little for the money. Back pain exemplifies a problem for which we can simultaneously improve quality of care and reduce costs.

[Starred Review] Deyo (Oregon Health and Science Univ.Hope or Hype) methodically looks at the most frequently used methods of diagnosis and treatment and finds the evidence often lacking, negative, or distorted. With no stake in any particular treatment, the author cites numerous research studies, quotes experts he has interviewed, and provides anecdotes about sufferers, including President John F. Kennedy and Chair of Medicine at Harvard Medical School Jerome Groopman. The author's consistent message is that there is no magic bullet, that more isn't always better, and that patients should be informed partners in any decision. VERDICT Concise, clearly written, and evidence based, Deyo's work would be invaluable to those facing the onset of back pain and the dizzying range of treatment choices, as well as to practitioners and policy makers.

Richard A. Deyo, MD, is Professor of Family Medicine, Professor of Internal Medicine, and Professor of Public Health and Preventive Medicine, Oregon Health and Science University. Winner of the Wiltse Lifetime Achievement Award given by the International Society for the Study of the Lumbar Spine, he is coauthor of Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises.