Rachelle Buchbinder

Rachelle Buchbinder is an Australian NHMRC Practitioner Fellow. She has been the Director of the Monash Department of Clinical Epidemiology since its inception in 2001 and a Professor in the Monash University Department of Epidemiology and Preventive Medicine since 2007. She is a rheumatologist and clinical epidemiologist who combines clinical practice with research in a wide range of multidisciplinary projects relating to arthritis and musculoskeletal conditions.

She is the Joint Coordinating Editor of the Cochrane Musculoskeletal Group and chairs the Australian Rheumatology Association Database (ARAD) Management Committee. In 2011 she developed a new online systematic review and meta-analysis course for postgraduate students.

Rachelle has expertise in evaluating mass media campaigns, having assessed the effectiveness of the Victorian 'Back Pain: Don't Take It Lying Down' public health awareness campaign of the late 1990s (featuring Merv Hughes and 'Con the Fruiterer'), a strategy that many countries have since replicated. Yet some of her most groundbreaking work has involved challenging the value of treatments, such as vertebroplasty for acute osteoporotic spinal fractures, which have been used in routine clinical care before their proper evaluation.

"We recently completed a trial on the effectiveness of vertebroplasty that has attracted a lot of international attention," Rachelle explains.

"This treatment for spinal fractures involves injecting bone cement into people's vertebrae. Even though doctors have been using this procedure around the world for the last ten years, our findings show that it's no better than a placebo or a sham procedure and therefore the risks outweigh any benefits."

How could such a treatment, costing hundreds of dollars per procedure, remain undisputed for so long?

"There are several reasons. Firstly, the onus of proof of effectiveness, safety and cost-effectiveness is not as stringent for surgical and other procedures as it is for new drugs. Secondly, high-quality randomised placebo-controlled trials are not yet the norm in procedural specialties and methodological issues that can affect the validity of study results seem to be less well understood."

Will governments continue to subsidise this costly treatment with no proven value?

"At this point in time [August 2011], it is still subsidised by the Federal Government, but other jurisdictions have either withdrawn reimbursement or placed strict criteria on use."

Additionally, Rachelle is collaborating with Deakin University's Professor Richard Osborne in developing a new tool to measure a person's health literacy, their ability to find, understand and use health information to make good decisions about their health.

"We know that people with poorer health literacy have poorer health outcomes. The new tool will help us to identify where people need help. Do they have a doctor or other health professional that they can trust? Are they able to ask questions and know what questions to ask? Do they need help understanding written information?"

"Having a better understanding of a person's health literacy will enable us to better tailor our management and may reduce inequality in both receipt of health care and health outcomes."

She is also collaborating with Professor Osborne and others to develop a better understanding of the overall burden of back pain from a sufferer's perspective.

"The burden of chronic back pain on both the individual and society is enormous. For example it is known to be a significant cause of work disability and lost productivity. However governments apportion less priority and resources to the problem compared with other chronic conditions. Furthermore little work has been done in addressing what are significant burdens on the individual with chronic back pain such as not feeling believed, not trusting health professionals, wasting time and money on unproven treatments, and worrying about the future."

As a result, they are developing another new tool, the Back Pain Quest (or BP-Quest), which aims to capture the overall burden of back pain from the individual's perspective.

"This new questionnaire will enable us to understand the various burdens of back pain better - and thus, we will be better able to address them."