Spinal Fusion for Chronic Low Back Pain: A ‘Magic Bullet’ or Wishful Thinking?
Conflicts of interest through consulting ties and other relationship with device manufactures aside, doctors have now started becoming investors in spinal implant manufacture and distribution. As of Oct 2012, there were at least 20 states in U.S. with multiple active physician owned distributorships (PODs) which supply devices to hospital, with California alone having 40 such distributorships31. This has sparked fears that this would provide extra financial incentive for surgeons to recommend spinal fusion.
Despite the absence of good evidence to support the efficacy of spinal fusion for chronic low back pain, the rates of spinal fusion has rocketed in recent decades. This has raised concerns about conflicts of interest and unethical behaviour among healthcare providers. Accusations of kickbacks to spine surgeons from the medical devices industry have made headlines in major newspapers in the US in recent years. Another area of concern is the involvement of spine surgeons in the manufacture and distribution of spinal implants and this has created pernicious conflicts of interest leading to an increase in spinal fusions and bias in the doctors’ decision making process.
Allegations of financial conflicts of interest and the fact that there isn’t sufficient scientific evidence to support the use of spinal fusion as a modality of treatment for chronic low back pain, should make us reconsider our indications for spinal fusion. The decision to do spinal fusion in the absence of clear indications may have future medico-legal implications and the conflicts of interest involved may run afoul of existing legislations in some countries.
Nine additional physicians join 15 others charged in an illegal 15-year spine surgery bribery scheme at Pacific Hospital in Long Beach, Calif.
Here are five things to know:
1. The nine additional physicians charged are accused of being involved in more than $40 million in illegal kickbacks. The total scheme totaled $950 million in surgeries performed at the hospital after physicians referred thousands of patients to Pacific Hospital in return for bribes.
2. Orthopedic surgeon Danie Capen, MD, agreed to plead guilty to a conspiracy charge involving illegal kickbacks after submitting $142 million in claims and receiving nearly $56 million in kickbacks.
3. Timothy Hunt, MD, agreed to plead guilty to the conspiracy charge. He referred hundreds of patients to Pacific Hospital for spine surgery. Additionally, former Pacific Hospital CFO of physician management George Hammer agreed to plead guilty to tax charges for falsely classifying illegal kickbacks in the hospital’s corporate tax filings.
4. Chiropractor Lauren Papa agreed to plea guilty to the conspiracy charge. She referred hundreds of patients to a neurosurgeon at Pacific Hospital. Orthopedic surgeon Tiffany Rogers, MD, was also listed in the indictment. It is unclear if she agreed to plead guilty.
5. Brian Carrico and two companies he partially owns were charged in connection to the kickback scheme and are accused of being responsible for $80 million in claims. Mr. Carrico and the companies allegedly received $56 million for referring patients to Pacific Hospital.