BMJ  2008;336:1452 (28 June), doi:10.1136/bmj.39619.499583.3A

Letters

Prolapsed intervertebral disc

What if back surgery was a drug?

The first 150 words of the full text of this article appear below.

I find it fascinating that surgical treatments and medical treatments are evaluated very differently in the literature and by ethics committees.1 Let’s say you told a human research ethics committee (HREC) that you expected only a short to medium term reduction in radicular pain with no real improvement in disability or axial back pain for a drug treatment. You go on to say that treatment had a 70% chance of entrenching the axial back pain as permanent, a 5% chance of worsening the pain, 1% risk of permanent neurological damage, with lesser chances of major vessel damage or paraplegia, I wonder how many HRECs would approve it ? If you then presented a literature search that relied mainly on a 30 year old study with major design flaws and a couple of meta-analyses of poor data you could reasonably expect to be sent packing. By way of comparison, in Australia . . . [Full text of this article]

Michael Vagg, interventional pain physician

1 VMO Pain Management Unit, Barwon Health, Geelong, VIC 3220, Australia

mickvagg@yahoo.com.au


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