Oh my aching back

I noted a couple of days ago that among the least intelligent features of our design is the spine. It works well enough for a while but it just isn't engineered to carry the vertical load for a whole lifespan. If you're a blasphemer, you probably think that's because it was pressed into bipedal service after having evolved as a horizontal structure in quadrupeds, but if you think that, you will be doomed to sciatica for all eternity.

Anyhow, whatever the true explanation -- evolution or a screw up in the engineering lab -- Brook Martin and a multitude, in the new JAMA, note that 26% of U.S. adults in a 2002 survey reported low back pain. In an analysis of the Medical Expenditure Panel Survey, they found that in 2005, about 15% of respondents had a medical diagnosis of a spinal problem. That's a drag, but just as big a bummer is that people with spinal problems had an average of more than $6,000 in annual medical expenditures, compared with $3,500 for people without spinal problems, after adjusting for age and sex. What is more, the average expenditure for people with spinal problems increased by almost $2,600 since 1997, which is more than the increase for people without such problems.

Biggest bummer of all -- it didn't do a damn bit of good. The prevalence of disability and functional limitations for people with spinal problems just got worse. A lot of the expenditure was on narcotics, a figure which jumped when Cox-2 inhibitors were found to be dangerous, though outpatient visits were the biggest share. Total medical spending for spinal problems in the U.S. is similar to that for arthritis, cancer and diabetes.

Since we're spending so much more on these problems, without any comcomitant improvement in symptoms or functioning, most of that increased expenditure must perforce be wasted. For those of you who have back pain, I wish I had better news, but maybe you should just try doing less about it. You might end up better off.