The “Low-Cost” Innovative Technology That is Transforming the Care of Low Back Pain

June 14, 2012

Recently, Jeffrey Immelt, Chairman and CEO of General Electric and also Chairman of President Obama’s Council on Jobs and Competitiveness, spoke about health care reform at Dartmouth College in New Hampshire: “We’re investing in really neat, high-end technology, but we’re also investing in low-end, low-cost, and low-price technology.”

We don’t often find “technology” and “low-cost” in the same sentence. But his comment reminded me of two other technology-related concepts, both presented in Christiansen et al’s excellent book “The Innovative Prescription” that I’ve reviewed in other blogs.

First, the authors emphasize it is diagnostic technologies that enable the determination of a precise diagnosis and are the key to improving health care.  They offer that it was a series of diagnostic technologies that transformed the care and lowered the cost of managing infection. The diagnosis for fever at one time was “consumption” and even immorality. But that all changed with the invention of the microscope that enabled the discovery of microbes in 1676 that over the next 200 years, with further technologies, were progressively profiled by their virulence and then antibiotic sensitivity. This growing diagnostic precision gradually identified treatments with greater and greater specificity to each organism. These diagnostic technologies enabled the cost of treating infection to drop from more than 50% of our entire health care budget to 14%, including shifting the care for most infections from higher-priced physicians to physician extenders.

Secondly, Christiansen’s definition of a precise diagnosis is one that identifies a standardized, predictably effective treatment that addresses the cause rather than just the symptom. This definition sheds considerable light on the care of back and neck pain (my clinical and research interest) that has been plagued by a widespread fixation on making a precise anatomic diagnosis in most cases. Ironically, even our most precise anatomic diagnosis, that of a herniated disc (HD) causing sciatica, neural deficits, and confirmed with an appropriate MRI finding, still falls short of Christiansen’s definition of precision since even this clearest of anatomic diagnoses fails to identify a standardized, predictably effective treatment. Indeed, the treatment is most often determined by patients’ selection of their health care provider who might prescribe rest, manipulation, exercise, injections, or even surgery.

These two points and Immelt’s reference to the existence of low-cost, low-price technologies provide important background for one such low-cost diagnostic technology and innovation that is transforming how back and neck pain patients are evaluated, diagnosed, and treated. Instead of being one of those high-tech, high cost breakthroughs, it is instead a low-cost clinical diagnostic technology or methodology targeting patients with back or neck pain.  This innovative examination makes a very informative mechanical diagnosis that characterizes the underlying pain source sufficiently enough to nicely fulfill Christiansen’s definition by revealing standardized treatments that effectively and predictably address the actual cause, without needing to know its anatomic identity.  Most treatments tend to be “one-size-fits-all” by addressing just the non-specific symptom.

Abundant evidence supports that this clinical diagnostic technology truly satisfies Christiansen’s definition of a precision diagnosis. Why waste so much money on MRIs looking for an anatomic diagnosis that can only be confidently found in less than 10% of low back and neck pain patients, and then is still insufficient to identify a predictably effective treatment?  Alternatively, a precise mechanical diagnosis can be made in 70-90% of acute low back and neck pain patients for which there are predictably effective treatments that address and rapidly reverse the very mechanical characteristics of the underlying cause as determined by these reliable mechanical assessment methods?

You may read more about this diagnostic clinical innovation in other blog postings here, on my website, as well as in my two books.  Published studies include numerous inter-examiner reliability data coupled with cohort and RCT investigations that validate the effectiveness of these methods in improving outcomes.

I’d love to hear from you.  Please be sure to click on “Like” if this was useful to you, or “Leave a Reply”.

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