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Both negligence and overuse to blame in deadly meningitis outbreak

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This week, pharmacist Barry Cadden was sentenced to nine years in prison for manufacturing steroid injections tainted with fungal meningitis. Cadden was co-owner and head pharmacist of the New England Compounding Center, which failed to ensure the purity of the drugs and ignored safety concerns, leading to hundreds of cases of meningitis nationwide and more than 60 deaths.

However, perhaps there’s a bit more blame to go around. Patients were infected when they received steroid injections for back pain, a procedure the The New York Times news item about Cadden’s sentencing described as “routine.” Treating back pain is difficult, because there is a plethora of treatment options and no universally effective treatment. But the evidence to support steroid injections for back pain just isn’t there.

The evidence to support steroid injections for back pain just isn’t there.

This conclusion isn’t new. A Cochrane meta-analysis published almost ten years ago found “no strong evidence for or against any type of injection therapy” for low-back pain. Since the Cochrane review was published, several randomized trials have found no long-term benefits of steroid injections compared to placebos. Given the financial cost and risk of side effects, most experts recommend these injections only as a last resort.

Many patients imagine that unnecessary or useless treatments can’t hurt, but the risk of harm is always present, whether or not a treatment is effective or needed.

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