Setting the Record Straight: A Response to JAMA on Corporate Influences on Spinal Cord Stimulation

Pain Matters Podcast Network

On this episode of the Pain Matters Podcast, we turn our attention to a Viewpoint article published in JAMA on December 18, 2023 entitled “Corporate Influences on Science and Health—the Case of Spinal Cord Stimulation”. Written by the same lead author of the widely criticized Cochrane Review of Spinal Cord Stimulation (SCS) for Low Back Pain, this recent article blames all physicians who defend SCS for having corporate interests and suggests that no research in any specialty should be influenced by industry.

Hosts Shravani Durbhakula, MD, MPH, MBA, and Mustafa Broachwala, DO, sit down with Nathaniel M. Schuster, MD, from UC San Diego Health. All are authors to responses in Pain Medicine to the Cochrane Review by Traeger et al. –see Pain Matters Episode 21 and articles PMID: 37067491 & PMID: 37195450 by Durbhakula et al. This episode responds to the questionable allegations made by Traeger et al., questioning the integrity of all SCS research and the pain physicians who utilize SCS for patients. We do a fact-check on the JAMA article and take a deep dive into understanding the true nature of corporate influences on SCS.

In this episode, you'll gain insights into:

• Critiquing Corporate Influence: Dr. Schuster and our hosts examine corporate influence in pain medicine research, particularly in the context of SCS treatments for low back pain.
• False Dichotomies in SCS Research: The false dichotomy that physician-scientists who may engage with industry at any level cannot be industry-independent when speaking on the subject of SCS.
• Physician Scientist Integrity: False accusations, including that ALL physicians who responded to the Cochrane Review by Traeger et al,. were influenced by industry.
• Publishing SCS Research: The by Traeger et al. that academic journals should never publish anything with industry ties – in SCS or any field of medicine.
• Reality of SCS Funding: Understanding the intricacies of device research funding as well as the limitations of funding outside of industry (e.g., government funding) and contextualizing the paucity of placebo- or sham-controlled studies.
• Ethics in Academic Societies: Clarifying the policies surrounding conflicts of interest amongst academic societies.
• Debunking Hara et al.: Understanding the methodologic flaws of the Hara et al. study of SCS for Chronic Radicular Pain After Lumbar Spine Surgery.

Listen in as we navigate these complex waters, aiming to provide a balanced perspective on the interplay between industry funding, scientific research, and clinical practice in pain medicine.

This episode is a must-listen for anyone looking to understand the multifaceted nature of pain medicine in today's healthcare landscape.
CORRECTION (11:10-11:50): SCS for FDA requires a premarket approval (PMA). There is no need for clinical data if it is possible to prove equivalence. For external powered devices where RF is the predicate device, FDA 510k pathway is required.