Is That Surgery You’re Thinking About Even Necessary?  

Four different surgeons told Jared Lichtin he needed back surgery. But he'd met other patients at his physical therapy appointments who regretted getting back surgery and felt they were even worse off.

Mr. Lichtin thought it might better to avoid any sort of operation. He resisted surgeons’ pushing the procedure, believing they were doing what they’d been taught to do: “sell” him on surgery.

“If you walk into a Burger King, they’re going to sell you a burger. You walk into a hospital, and they’re going to sell you something. They’re financially incentivized,” he said. “It’s a system that’s been corrupted through insurance, through government, through greed.

“You have to make your own decisions. If you don’t, someone else is going to make them for you.”

Elective surgeries like Mr. Lichtin’s may not be necessary in many cases—a line that’s been frequently blurred. Physician training and even research can be confusing. Often, the science supporting alternative treatments never makes it into clinical practices, and doctors continue with protocols that should be used as a last resort after other therapies have been tried.

You can live without organs such as your gallbladder and appendix, which doctors often suggest be removed. Likewise, some studies show that having vertebrae fused together lowers pain, that stents can lower the risk of cardiac disease, and that stomach-shrinking surgeries can treat obesity. In some cases, such promises come true. But not always.

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Somewhere along the way, operations reserved for specific scenarios drifted into standard practice despite the reality that they often aren’t the best option. Patients are rarely offered evidence that contradicts advice to undergo surgery. What surgeons may not tell you—and may not know—is that many elective surgeries don’t produce universally positive results, or that other approaches can be just as effective—often without adverse effects.

The other top reason given in the survey was that they believed patients wanted the procedure anyway. However, the study pointed to research showing doctors can be mistaken about what kind and extent of care patients really desire, and when physicians advocate for more, then patients get the impression the procedure is actually necessary.

Its findings classified more than 1 million Medicare tests and procedures from 2016 to 2018 as being “overuse,” meaning they weren’t necessary. Among the services pinpointed were hysterectomy for benign disease and coronary stents for stable heart disease.

A year later, the Lown Institute released another report using Medicare claims data showing that more than 100,000 older Americans received unnecessary and potentially harmful procedures during the lockdowns between March and December 2020.

The analysis showed some of the most well-regarded U.S. hospitals had rates of coronary stent overuse above the national average. These four had rates at least double the national overuse average: Cleveland Clinic (44 percent), Houston Methodist Hospital (44 percent), Mt. Sinai (42 percent), and Barnes Jewish Hospital (42 percent).

“We’ve known for over a decade that we shouldn’t be putting so many stents into patients with stable coronary disease, but we do it anyway,” Dr. Saini said. “As a cardiologist, it’s frustrating to see this behavior continue at such high levels, especially during the pandemic.”

One patient of his had a heart catheterization recently to check the status of three stents he’d previously gotten in preparation for a recent spine operation.

“He’s been following our program for three years. The cardiologist was surprised, maybe disappointed, that his disease actually looked better,” Dr. Backs said. “There’s no doubt in my mind we’ve kept people from [having surgery]. The best way to have a good outcome from an elective surgery is to not ever have the surgery in the first place.”

An acute injury or pressure to the spine can cause it to crush or crack. Traditional treatments for osteoporotic vertebral compression fractures include bed rest, pain medication, braces, and physical therapy.

Since the late 1990s, however, vertebroplasty—which uses an acrylic bone cement inserted with radiologic guidance—has become the preferred treatment—at least for painful vertebral fractures that don’t respond to conservative treatment.

“In some cases, we almost completely eliminate a woman’s ability to make estrogen and progesterone, which is a pretty horrendous state because every cell in every system in the body depends on these sex hormones. I like to call them flex hormones because they have flexible functions; they’re not just about sex,” Dr. Dunston said.

The reality, Dr. Dunston said, is that women desperate to fix problems caused by hormonal imbalances often recover from hysterectomy with new hormonal imbalances. Hormone production is altered because the uterus supplies half of the blood flow to the ovaries, which are vital to hormone production.

Patients now come to her new practice, which is focused on prevention and natural healing, desperate for help to recover from this surgery.

“Surgical treatment of non-specific back pain where no pathoanatomical diagnosis has been established is bound to fail. Therefore the outcome of spinal fusion in these patients can be no better than nonsurgical treatment,” the article stated.

Spinal fusion is one of several types of back surgery. It involves using metal implants to permanently connect two or more bones in the spine. Back surgery is often better at resolving nerve pain that shoots down the leg and can cause numbness, than it is at alleviating back pain, according to Mayo Clinic.

“I was adjusted some 250-odd times in 2016, and by October of that year, I was 100 percent better. I knew if I put my head down and found the right people my body would heal,” he said. “You have to be aggressive.”

But that’s how he ultimately found the solution, which required him to step away from his job and life to prioritize healing—something not everyone is willing to do, he acknowledged.

“I feel like a lot of people are lazy, and they’re impatient, and they just accept whatever is told to them. These people don’t look at the rest of their life. You’re probably going to live 80, 90 years,” he said. “You’re either spending money on your illness or your wellness.”