Intended for healthcare professionals

Observations Medicine and the Media

Antibiotics for back pain: hope or hype?

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3122 (Published 14 May 2013) Cite this as: BMJ 2013;346:f3122

Re: Antibiotics for back pain: hope or hype?

Nice comment piece Margaret. Watching the whole thing unfold reminded me of the tension that we face as researchers, between the pursuit of 'impact' and the pursuit of 'truth'. It requires a steely resolve to not be seduced by the prospect of CV-enhancing spin. I have written previously on this at bodyinmind.org and will paste the relevant bit here:

“Put yourself in the shoes of a scientist. Remember that a scientific path is all about discovery, innovation and rigour – it is about truth and possibility. One might say that people don’t choose science, it chooses them. Now imagine that your chance of getting support to do your science is about 20%. Your chance of getting a salary to concentrate solely on your science is about 8%. And you know that unless you show in the next 5 years that you have made an impact, served the field and served science, with documented evidence (you can’t talk your way into this club), you are out. These are immense pressures – pressures that will lead researchers to maximise impact, for example strategically presenting their findings.”

In my research group, a very high value is placed on 'precision and honesty'. I make this an explicit thing because I think we are all at risk of sliding the slippery slope of spin - not just in how we promote or 'release' a finding, but how we write the article itself and present it at conferences.

And the cost of not remaining 'precise and honest' can be profound. Take the perspective of someone with back pain reading their local paper for example - the hype would have around this antibiotic study clearly reignited dwindling hope of a ‘magic bullet’. I have already received a dozen phone calls asking if I am trained to do antibiotic therapy and I can almost hear the hope on the other end of the line and cringe as I suffocate it in the wet blanket of truth. There is clearly a wider cost of spinning for impact here: the ripple effect of potentially false hope across the millions of people who are suffering and do not understand why.

I believe that chronic back pain is a multifactorial problem. I believe that persistent pain is associated with changes in sensitivity throughout the nociceptive neuraxis, and with multiple system dysfunction. I believe that persistent pain is evidence that the brain still concludes that a body part needs protecting and working out why this is the case can be very very difficult. I believe the evidence in support of my position is very compelling. It is difficult for people in pain to accept this position because it implies that the journey to recovery will necessarily be a long and difficult one, rather than a short and easy one.

This is not the first study to claim a simple cure for back pain – a recent example is that of an RCT of injecting blue dye into the disc, which had better outcomes than the antibiotic study, and was accompanied by an editorial raising the possibility that is was a ‘cure’1, but it didn’t get anything close to the hype that the antibiotic paper did (perhaps including ‘Nobel’ in the media release was the key). We must remember that patients probably don’t hear the qualifying statements that put the idea of ‘cure’ into context – they just have a new reason to hang on to an outdated model of their chronic pain.

Our water-cooler conversations (now done over email!) tell me that there are serious lessons to be learned here. I think it is a telling reminder of the challenge we all face in negotiating the route between impact and truth, of the potential perils of spin and the need for precision and honesty. I know my own negotiations of this route have at times been clumsy.

I wonder how far any of us are from this kind of mistake – a lazy media release, and eager PR manager, an impending promotion. I reflect on the anguish I imagine the authors are feeling right now and the damage this has done to their reputations and I can hear the whispering in my own heart – ‘Careful! That could have been you'.

1 http://www.painjournalonline.com/article/S0304-3959(10)00061-8/abstract and see a blog post on it by Neil O’Connell here: http://www.bodyinmind.org/chronic-back-pain-when-research-comes-out-of-t...

Competing interests: In this comment I blatantly plug my research group's website, bodyinmind.org. I do not make money out of it, but it clearly improves my impact and profile and increases the likelihood of grant success on the grounds of recognition alone.

17 May 2013
G Lorimer Moseley
Clinical Scientist
University of South Australia
North Terrace, Adelaide, 5000, Australia