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生物,工程和医学的道德
SJR: 0.123

ISSN 打印: 2151-805X
ISSN 在线: 2151-8068

生物,工程和医学的道德

DOI: 10.1615/EthicsBiologyEngMed.2012004719
pages 237-251

The Medicalization of Episodic Regional Backache

Stuart Green
Department of Orthopaedic Surgery, University of California, Irvine, Medical Center, Pavilion III, 101 The City Drive South, Orange, CA 92868

ABSTRACT

Regional episodic backache, a normal human attribute, has been medicalized by numerous health care professionals−chiropractors, osteopaths, physiatrists, and orthopedic surgeons−into a disease of disputed etiology, allegedly responding favorably to whichever therapeutic option the respective practitioners promote. The enormous expenditure of resources on this self-limiting condition threatens to bankrupt our nation's health care enterprise while simultaneously creating a medication-addicted, multiinjected, and surgically invaded populace.
The problem is exacerbated by tort and workers compensation systems overstuffed with attorneys who derive their income through contingency compensation arrangements. Such lawyers must present their clients as being as impaired as possible on the day of disability determination. Many health care providers acquire substantial remuneration supporting the legal profession in this endeavor. The scheme discourages recovery and perpetuates illness behavior by the claimant, leading to overtreatment and unnecessary surgery.
The situation cries out for improvement. Breaking the link between lawyers and their champion doctors would be a first step. Disability ratings by court-appointed or randomly selected physicians would advance integrity. Ultimately, however, rigorously controlled research protocols utilizing placebo controls and sham surgeries will be required to separate bogus and often harmful interventions from truly worthwhile measures to deal with either trauma-induced or naturally occurring backaches.


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