"It is difficult to get a man to understand something when his salary depends on not understanding it." Upton Sinclair

I really enjoy the above quote because there is so much truth to it. I was especially reminded of the quote after reading this article about the efficacy of spinal surgery in today's Wall Street Journal. 

According to the article (and based upon research published in the New England Journal of Medicine) a popular surgery designed to repair fractured bones in the spine was found to deliver no detectable benefit when compared with a placebo procedure.

This is not an inconsequential finding because an estimated 100,000 people had the surgery last year at an estimated cost of between $2,000-$5,000.

Not surprisingly, members of the Society of Interventional Radiology (whose members perform the surgery), have taken issue with the study. According to one doctor who performs the technique the study must be wrong because "We take a patient who's been lying in bed in a hospital, bedridden, you do the procedure and they're home the next day."

The response mirrors almost identically the response to a 1994 study in the New Journal of Medicine chronicling the ineffectiveness of MRI's for spinal injury (documented in the book, How We Decide, Pp. 160-165) as well as a 2002 study in the New England Journal of Medicine documenting the ineffectiveness of arthroscopic surgery. (This case is highlighted in the book, Predictably Irrational.)

In both cases, doctors who had performing surgeries simply could not believe the procedures they had been conducting for years — often at great expense — were no more effective than placebo procedures. In response, they either attacked the methodology of the study or highlighted cases of individual patients who benefited from the surgery.

It is not that the doctors are unintelligent, uncaring or greedy; rather when confronted with information that contradicts what they think they know it is easier to avoid the truth — by either questioning the study or offering antidotes — than it is to unlearn. (This is especially so when their salaries are highly dependent upon said procedure.)

But my advice is this: If the doctors won't unlearn then it is incumbent upon you to unlearn. Next time you need an MRI (for a spinal injury); arthroscopic surgery for your knee; or have a fractured bone in your spine, get a second and, if necessary, a third opinion before proceeding!