The Nesting-Egg Problem: Why Comparative Effectiveness Research Is Trickier Than It Looks (Essays‪)‬

A sixty-five-year-old woman goes to her doctor with excruciating lower back pain. When she first felt it, she assumed that she had merely pulled a muscle and that the pain would go away, but a month has passed with no relief. The diagnosis is straightforward: an MRI shows a hairline fracture in her spine due to osteoporosis. But choosing the right treatment will be anything but straightforward. One option is to keep doing what she has been doing: using over-the-counter pain relievers as needed until, ideally, the fracture heals. Another option is vertebroplasty, an injection of acrylic medical cement into the fracture. Until recently, vertebroplasty was the obvious choice. A few small trials had found it superior to conservative treatment. A consensus statement signed by several medical groups endorsed the procedure, and Medicare and private health insurers paid for it. But last summer, that certainty evaporated. Two trials involving about two hundred patients, published in the August 6th issue of the New England Journal of Medicine, found that vertebroplasty--which costs $2,500 or more, plus $1,000 to $2,000 for an MRI scan--was no better than a sham injection for relieving back pain from spinal fractures.