This book was written by a veteran journalist Cathryn J Ramin who happened to have persistent low back pain for decades. Following years of multiple failed interventions she decided to investigate and reveal the corruption surrounding the medical management of the multi-billion dollar back pain industry in the USA.

I thoroughly enjoyed reading this book but sadly it made me more cynical. I still respect RCTs published in peer reviewed journals, however I now appreciate that some are corrupt where many individuals are “paid off”, which makes me sad.

The author exposes fraudulent treatments such as surgeries, spinal injections, Opioids, chiropractic care and physical therapy …yes you heard it, PT!

Just to be fair the book does state the positive aspects of each approach, explaining that there are good and not so good surgeons, chiropractors and PTs. The author describes how “cookie cutter” PT clinics that passively treat patients with modalities and various manual therapies are a waste of time! In the end, she endorses rehab clinics that focus on aggressive strengthening and conditioning exercises that focus on reducing patient fears.

OxyContin has annual sales of over $35 billion! How? The book Crooked by CJ Ramin, explains in detail the conspiracy behind the opioid industry that continues to this day. The studies seem to deliberately fail to report on the true addiction and death rates related to these drugs. They ignore the fact that four out of five heroin users report that their opioid use began with medically prescribed drugs.


In 1986 a paper was published in the journal Pain concluding that opioids could be safely and effectively prescribed …with relatively little risk of adverse effects. It was stated that just 1% of the patients who were treated had become addicted.

This paper was used by the pharmaceutical industry to promote to MDs the prescription of opioids. It was not until recently that the paper originally published in 1986 was denounced as incorrect and not a real “study”, however to date, that paper has been cited in 635 other studies.


OxyContin marketers paid MDs $3000 at lavish dinners called continuing education seminars for supporting their cause. In fact, some State medical boards made it clear that MDs must prescribe opioids for their patients with chronic musculoskeletal pain or risk losing their license.


In their propaganda, the industry marketed to MDs that opioid therapy for chronic pain was no different from providing insulin to a diabetic.

It has taken two decades for the Cochrane collaboration to find no significant benefit for opioids over NSAIDs or over-the counter Aleve.

Finally, now the American Academy of Neurology states that the risks of opioids in the treatment of musculoskeletal chronic pain patients far outweigh the benefits.


Reference: Els C et al Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017 Oct 30;10:CD012509.
*Dowell D1, Haegerich TM1, Chou R1. CDC Guideline for Prescribing Opioids for Chronic Pain–United States, 2016. JAMA. 2016 Apr 19;315(15):1624-45.


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