NYTimes: The Evidence Gap. The Pain May Be Real, but the Scan is Deceiving

Gina Kolata has an interesting piece in the NYTimes right now, looking at the gap in evidence between use of scanning technology like MRIs and CAT scans to track down causes of pain, the discovery of a problem, and whether or not fixing the problem found via scan fixes the actual problem.

This hits home for me, because several years ago I went through a long series of scans to see what in the world was possibly causing the severe pain in my right arm. The MRI eventually discovered a disc bulge very high up in my c-spine, at an area that would have significant risks attached to surgery. Thankfully, my primary care physician, anesthesiologist and neurologist held a joint meeting with me and took the time to explain not only how to read MRIs, but the number of people who have something "wrong" with them without that "wrongness" being the cause of their pain.

In my case, terror about the risks associated with surgery high on my spinal column evaporated, and I was left with a different diagnosis and management routine for the disease.

But many people aren't so lucky, and go through unnecessary surgery because they have a pain, a scan shows a deviation, therefore the deviation must be linked to the pain. They have surgery, expecting to feel fine after your typical recovery period, and instead, no dice. (And if someone is unlucky enough to have some kind of pain condition that likes to spread when nerves are injured, things could be made even worse.)

Because of this, it's nice to see people - reporters and medical folks alike - are actually taking a look at the prevalence of "abnormal" scan results. Results that, in the end, are not so abnormal after all. However, it would have been nice to see whether or not doctors who realize that disc bulges or torn meniscus's aren't necessarily related to the pain you're feeling treat the pain, rather than the absence of a fixable issue. Knowing you have arthritis and that's the cause of your pain issues means very little if you're not getting pain relief.

Moving away from a concept of a single norm for the body is good - but hopefully as we make that transition, people recognize that simply because there is not a fixable cause to pain, doesn't mean the pain itself cannot be successfully treated.
-Kelly Hills

The Week in Review

1. Sex bias in control of cancer pain. Women get less meds, more pain. Sounds like a Raw Deal.

2. AAAS comments on human subject protection training.

3. Gardasil requirement for immigrants stirs backlash.

4. Paxil suit settled by Glaxo for $40M.

5. Inspire Pharmaceuticals reaches deal with SEC in investigation related to clinical trial of experimental dry-eye treatment.

6. Chinese parents file tainted milk lawsuit.

7. Personalized medicine: new predictive tool can help determine treatment for breast cancer patients (identifies those most at risk of relapse, potentially avoiding chemo).

8. Doctors urge the FDA to ban OTC cough and cold medicines for children until they are found safe and effective. Not safe and effective? Perhaps we should resort to that cherry-flavored placebo elixir reported on in these very pages a few weeks back, eh?

9. Impact of expanded newborn screening in the US.

10. "Friendly" bacteria protect against Type 1 diabetes. Ah, friendly, protective bacteria. Such a nice change from those drug-resistant ne'er-do-wells.

11. Secrets revealed! Penicillin bug genome unraveled.

12. Scientists find gene pathway that triggers the spread of melanoma.

13. Researchers find yet another new source of multipotent stem cells—in the walls of blood vessels.

14. How best to schedule downtime for ERMs (Electronic Medical Record Systems) . *Is* there any good time for the records to be unavailable?

15. No more excuses! Health clubs gear programs for those with ailments.

16. Faster genetic test for flu virus approved in the US.

17. Genentech warns about PML (progressive multifocal leukoencephalopathy—a rare brain infection) death in a patient taking Raptiva for psoriasis.

18. European drug makers urge regulators to impose price controls. I know, this sounds counterintuitive, but you'll see, it's not (seriously).

19. NIH announces funding for new epigenomics initiative.

20. FDA grants 510(k) clearance to I-Flow for topical wound dressing that controls oxygen and moisture. I'd like to see this thing. How does it manage all that? I'm thinking of robo-bandage here.

AND in the category of "Weird News":

21. Tainted candy from China found in US: White Rabbit Creamy Candy. Yes, that's the actual name of the candy. Is it me, or does it sound oddly sinister? Or perhaps I read "Alice in Wonderland" one too many times as a kid. Darn, now I have Jefferson Airplane's song "Go Ask Alice" stuck in my head.

22. If bioterrorists strike, letter carriers might deliver antibiotics. Neither rain, nor snow, nor anthrax spore . . . Wait a minute, weren't these the guys who were targeted with the anthrax in the first place?

23. Experts call for warning labels on energy drinks. Apparently, these things are so chock full o' caffeine that they deliver quite a blast, and people aren't really aware of just how much caffeine they're loading up with. Gives me the shakes just thinking about it.

[Thank you to Lisa von Biela, JD candidate, 2009, UMN, Editor of the BioBlurb, from which this content is taken and edited. BioBlurb is a weekly electronic publication of the American Bar Association's Committee on Biotechnology, Section of Science & Technology Law. Archived issues of the BioBlurb, as well as further information about the Committee on Biotechnology, are available here.]