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Futile non-surgical options

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of PainScience.com: a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

A Dr. Glaucomflecken bit (1-min video), “Ortho Guy” talking to “Insurance Guy” and getting told that his patient can’t get coverage for surgery because he hasn’t tried alternative medicine first:

INSURANCE GUY — Come on ortho, let’s try some futile non-surgical options for a while.

ORTHO GUY — No!

INSURANCE GUY — Well, your patient has to fail something before I can approve a treatment that works.

*chef’s kiss*

(And a gold star for his highly specific “ulti” reference. That is, Ultimate, the disc sport, which I played for 25 years, until 2023. Apparently Dr. G has flicked a disc or two in his time.)

Anyway, back to the point: Dr. G is doubling up on his punching up, simultaneously satirizing two behemoths that get in the way of good care:

  1. the wide array of “futile non surgical options,” many of which are either blatant quackery or at least Pseudo-Quackery in Physical Therapy,

  2. and the American medical insurance industry, which likes to pay for those cheaper options.

It’s a popular idea that insurers are so parsimonious that they would never pay for alt-med treatments if they didn’t work, but alas, no, that’s definitely not how that happens. See Insurance Is Not Evidence.

Not that orthopedic surgery doesn’t have plenty to answer for as well. Sigh.

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