There was an excellent article in Forbes this month called "Dangerous Devices". The article primarily focuses on the folly of stents for heart disease. Newer medicated stents are actually causing heart attacks. Also mentioned in the article are some devices used to treat low back pain. "Now some doctors are flagging the potential dangers of new implantable gadgets to treat back pain, prevent stroke and soothe severe heartburn. Some doctors decry J&J's new metal disc, known as the Charite, which has been implanted in the spines of several thousand patients. It was approved by regulators after a trial involving only 304 patients--and only 36% of them fared well enough to get off narcotic painkillers."

This replacement disc surgery was approved recently, and I am bombarded with advertisements for it at my office--suprising since only 1/3 improve enough to get off narcotics! They also discussed spinal fusions: "Each year half a million people in the U.S. undergo spinal-fusion surgery, says research firm Frost & Sullivan. They get cages, screws and rods implanted in the spine, despite studies that show fusion is not very effective for lower back pain." Why are these devices successful despite a lack of evidence of efficacy? "Medtronic in July agreed to pay $40 million in fines to settle civil allegations that its spinal-devices unit paid kickbacks to doctors in the form of sham consulting agreements, shady royalty pacts and lavish trips; though the company paid up, it denies any wrongdoing." "UC, Irvine's Charles Rosen argues that scores of spine surgeons 'have basically become marketing men for these companies and earn huge consulting fees.'"

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