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Stabbed in the Back: Confronting Back Pain in an Overtreated Society 1st Edition

3.9 out of 5 stars 14 customer reviews
ISBN-13: 978-0807833483
ISBN-10: 0807833487
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Editorial Reviews

From Publishers Weekly

Nobody's going to like Hadler's prescription for backache—neither patients, doctors nor the government. But here it is from the UNC professor and health-care reformist author (Worried Sick: A Prescription for Health in an Overtreated America): get over it. The fact is that you may be best off if you do not tell anyone about your regional backache and try to get on with it, he declares. Hadler argues that no theory on what causes regional back pain has stood up to scientific testing, and the myriad of treatments do more to sustain an enormous treatment enterprise than ease the pain. Hadler presents an impressive survey of what doctors, chiropractors and surgeons now offer for back pain—and of the history and rationale for government disability programs. His conclusion is scornful. Predicaments of life such as back pain are not injuries, Hadler insists. [H]eadache, heartburn, sleeplessness, altered bowel habits, and many regional musculoskeletal disorders... do not respond to treatment as diseases because they are not diseases. That's what you call a bitter pill— but one that should trigger a much needed debate among health-care reformers. 5 illus. (Nov. 15)
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A bitter pill--but one that should trigger a much needed debate among health-care reformers.--Publishers Weekly

The next step [in health care reform] is the one Hadler is already confronting: how to really bring down costs as we move forward.--Progressive Pulse Blog

The volume is well organized, giving a good historical and clinical overview of back pain and of what Hadler terms 'the backache industry.'--Choice

"In this thought-provoking book, Hadler analyzes the evidentiary basis of the diagnosis and treatment of back pain with a fresh, no-nonsense razor.--JAMA

Relentlessly probes the effectiveness of common medical treatments and finds them wanting. . . . [A] compelling book.--Library Journal


Product Details

  • Hardcover: 224 pages
  • Publisher: The University of North Carolina Press; 1 edition (November 15, 2009)
  • Language: English
  • ISBN-10: 0807833487
  • ISBN-13: 978-0807833483
  • Product Dimensions: 6.4 x 0.8 x 9.4 inches
  • Shipping Weight: 1 pounds (View shipping rates and policies)
  • Average Customer Review: 3.9 out of 5 stars  See all reviews (14 customer reviews)
  • Amazon Best Sellers Rank: #289,473 in Books (See Top 100 in Books)

More About the Author


Nortin M. Hadler, MD

Dr. Hadler is a graduate of Yale College and The Harvard Medical School. He trained at the Massachusetts General Hospital, the National Institutes of Health, and the Clinical Research Centre in London. He was certified a Diplomate of the American Boards of Internal Medicine, Rheumatology, Allergy & Immunology, and Geriatrics. He joined the faculty of the University of North Carolina in 1973, was promoted to Professor in 1985 and transitioned to Emeritus Professor of Medicine and Microbiology/Immunology in 2015. He served as Attending Rheumatologist at the UNC Hospitals till 2015. In recognition of his clinical activities, he was elevated to Mastership in both the American College of Physicians and the American College of Rheumatology.

The molecular biology of hyaluran and the immunobiology of peptidoglycans were the focus of his early investigative career. Because of the contributions of his laboratory, he was selected as an Established Investigator of the American Heart Association and elected to membership in the American Society for Clinical Investigation. The focus on basic biology was superseded by what he initially termed "industrial rheumatology." Over 200 papers and 12 books bear witness to his analyses of "the illness of work Incapacity" including the sociopolitical constraints imposed by various nations faced with the challenges of applying disability and compensation insurance schemes to predicaments such as back pain and arm pain in the workplace as well as for a more global illness narrative such as is labeled "fibromyalgia." He is widely regarded for his critical assessment of the limitations of certainty regarding medical and surgical management of the regional musculoskeletal disorders. The third edition of his monograph, Occupational Musculoskeletal Disorders, was published by Lippincott Williams & Wilkins in 2005 and provides a ready resource as to his thinking on the regional musculoskeletal disorders. In recognition of this work he was elected to the National Academy of Social Insurance and is a Fellow of the American College of Occupational and Environmental Medicine.

Fifteen years ago he turned his critical razor to much that is considered contemporary medicine at its finest. Assaults on medicalization and overtreatment have appeared in many editorials and commentaries, and in 6 monographs: McGill-Queens University Press published The Last Well Person. How to stay well despite the health-care system in 2004 (paperback 2007). UNC Press published Worried Sick. A prescription for health in an overtreated America (2008, paperback 2012), Stabbed in the Back. Confronting back pain in an overtreated society (2009), Rethinking Aging. Growing old and living well in an overtreated society (2011), Citizen Patient. Reforming health care for the sake of the patient, not the system (2013) and By the Bedside of the Patient. Lessons for the twenty-first-century physician (2016). Les Presses de l'Université Laval published the French translations: Le Dernier des Bien Portants (2008), Malades d'inquiétude (2010), Poignardé dans le dos (2011 and won Prix Prescrire in 2012), Repenser le vieillissement (2013) and Citoyen et Patient (2014).

Dr. Hadler has lectured widely, including many named lectureships and is a frequent commentator for the print and broadcast media. He has garnered multiple awards and served lengthy Visiting Professorships in England, France, Israel and Japan. In 2015 he assumed a leadership role in an initiative designed to provide rational health care as an evidence-based, cost effective, employer-sponsored, defined contribution, insurance benefit.

Customer Reviews

Top Customer Reviews

Format: Hardcover Verified Purchase
Using back pain as his subject, Nortin Hadler, M.D., presents a forceful critique of much of what is wrong with the American health-care system today and the disability bureaucracy that sustains a broken conception of illness and health. "Stabbed in the Back" is a lucid, informed and well-researched discussion of one of modern post-industrial society's greatest and costliest sources of physical and mental suffering -- regional low back pain. He excludes from the analysis unusual sources of back pain such as cancer, infection and inflammatory diseases and focuses on the run-of-the-mill suffering that causes millions of Americans every year to complain to their doctors, "I threw my back out and I don't know if I can go back to work."
Back pain is an unavoidable reality of modern life, Hadler argues. About 75 percent of cases are inherited. Disc degeneration, thought to be the primary culprit in back pain, is a normal part aging, somewhat like grey hair or balding. Modern medicine simply has not found a way to relieve back pain, despite a huge industry whose existence depends on the notion of back pain as a disorder or illness warranting a cornucopia of treatments (none of which work over the long term).
If Hadler had his way, doctors would tell back-pain patients to tough it out and go back to work. "Individuals with regional backache might fare less poorly by managing as best they can," Hadler writes, "perhaps with some lay advice, than by choosing to become patients."
He suggests pain sufferers would be best off telling their doctors, "I can't cope with this backache," rather than seeking an elusive cause and cure for their travails in a medical system that promotes illness rather than health.
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Format: Hardcover
"Stabbed in the Back is an expose of a contrived "disease" and the enormous enterprises it has spawned that conspire to its "cure" and provide fallback when a "cure" is elusive. That industry has developed a life of its own, despite a robust and compelling body of scientific investigation that points toward backache as a socially constructed ailment. The American notion of health, the American's wherewithal to cope and persevere, and the American pocketbook are paying a heavy price. An assault on the backache industry is long overdue. No reader finds all of the chapters that follow resting easily within his or her preconceptions."

The above words are from Dr. Nortin hadler's new book Stabbed in the Back: Confronting Back Pain in an Overtreated Society.

Dr. Hadler is is a professor of medicine and microbiology/immunology at University of North Carolina at Chapel Hill, author of Worried Sick: A Prescription for Health in an Overtreated America and 14 other books, and more than 200 medical papers. He is also a consultant to ABC News.

Stabbed in the Back is an overview of the history of back pain, its many diagnoses and treatments over the decades, as well as its personal, financial, and social cost. Dr. Hadler's care and concern for patients with regional back pain permeates throughout the book as he discusses the many aspects of this "contrived disease."

My favorite chapter is Chapter Six, titled "Invasion of the Spine Surgeon," where he takes on the surgical treatment for back pain showing that there is no evidence for efficacy of surgery and that most surgeons financially benefit from recommending and performing surgery. This has contributed to the high cost of treating back pain.
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Format: Hardcover
Maybe in real life, Dr. Hadler is a caring and compassionate doctor. If this is the case, it does not come through in this book. I have read some of Dr. Hadler's other work, and I do think that what he says is often important, especially since he's so often at odds with mainstream system. And I certainly agree with his belief that Americans are overtreated and that many routine tests are probably unnecessary.

However, his continual emphasis on people who "choose" (his word) to be patients is incredibly frustrating for one who has had trouble seeking relief from pain. A chapter of this book is devoted to fibromyalgia, which Dr. Hadler has another name for (I don't quite understand what he accomplishes by not calling it fibromyalgia). Basically, Dr. Hadler does not believe that fibromyalgia exists. He points out that there are not tests for it, but it's quite possible that tests will eventually be discovered. Similarly, because low back pain does not seem to have any correlation to physical problems with the back, Dr. Hadler basically says that people with pain should quit "choosing" to be patients and get back to work. As someone who has had to go to the emergency room in an ambulance because back pain literally kept me from standing up, I find this attitude dismissive and borderline offensive. I recognize that both low back pain and fibromyalgia may have psychological components, but that does not mean that sufferers can simply decide not to be patients anymore (and when Dr. Hadler suggests that people who claim they can't work actually can, I wonder if he's ever held a blue collar job involving hard physical labor - perhaps he did as a young man, but the effect of physical labor is not as debilitating for the young).
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