DEAR DR. ROACH: I read a lot about research for cancer and HIV, and nothing about money spent for help with arthritis. That one strikes almost everybody, with age. Is some research in progress for inventing a substance that can be sprayed on joints afflicted with a loss of cartilage to make them slippery? How much money is provided for arthritis compared with other diseases? — E.M.

ANSWER: Funding for research in a particular disease is decided by a large number of factors — everything from the public health burden of a disease to the effectiveness of the lobby by a particular group of supporters. An interesting paper looking at National Institutes of Health research was done a few years ago, showing that, adjusted for the amount of disability attributable to a particular condition, there are two conditions— HIV and breast cancer — that have much higher funding than others. I don’t mean to suggest that breast cancer or HIV have “too much” funding. I would like to see a major increase in research funding overall.

The basic scientific understanding gained from researching these important conditions is applicable to many different illnesses. However, there are other diseases that have much less funding given the amount of disability they cause in the population. Arthritis gets relatively little funding compared with HIV and cancer. Interestingly, the two conditions that get the least amount of funding considering the amount of suffering caused by them are depression and COPD. While I might wish for more overall funding for research, it does seem from this paper and others that the distribution of funding isn’t as equitable as possible.

Despite a relative lack of funding, there is still much research being done on improving the cartilage lining the joints, one major site of damage in osteoarthritis. Stem cells are one possibility. Unfortunately, a spray-on substance hasn’t quite been worked out yet.

DEAR DR. ROACH: I’m in the middle of a dispute between my neurosurgeon and cardiologist, and would appreciate your opinion. I’m a 70-year-old male with extensive cardiac issues, including a heart attack, stent, ablation and A fib. I have a pacemaker/defibrillator implanted in my chest. I recently was diagnosed with a herniated disc, and the neurologist wants to perform surgery. He insists that I stop taking my daily 81-mg aspirin seven days before surgery. My cardiologist absolutely refuses to allow this, and states that stopping the aspirin could be life-threatening. The neurosurgeon will not operate unless the aspirin is stopped. Neither doctor will budge. Am I doomed to a life of back pain, or is there some alternative? — R.G.J.

ANSWER: I’m sorry, but I can’t override either your cardiologist or your neurosurgeon. Both are doing their best to make sure you are safe, from their respective points of view.

When surgery is absolutely indicated, we sometimes use heparin (or one of its newer cousins) by injection for the week before surgery. It wears off much more quickly than aspirin does. So, by stopping it right before surgery, you are only without an anticoagulant for the few hours during the surgery, and you restart the aspirin as soon as the neurosurgeon allows. This plan minimizes bleeding risk during surgery and also clotting risk in the days before surgery.

If your back is bad enough to be worth both of these risks, then I would ask both your cardiologist and your neurosurgeon whether they would consider this plan.

The booklet on back problems gives an outline of the causes of and treatments for the more-common back maladies. Readers can order a copy by writing: Dr. Roach — No. 303, 628 Virginia Dr., Orlando, FL 32803. Enclose a check or money order for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.