Readers are advised this article includes an offensive and outdated disability term in a quote from the film.

Poor Things is a spectacular film that has garnered critical praise, scooped up awards and has 11 Oscar nominations. That might be the problem. Audiences become absorbed in another world, so much so our usual frames of reference disappear.

There has been much discussion about the film’s feminist potential (or betrayal). What’s not being talked about in mainstream reviews is disability. This seems strange when two of the film’s main characters are disabled.

Set in a fantasy version of Victorian London, unorthodox Dr Godwin Baxter (William Dafoe) finds the just-dead body of a heavily pregnant woman in the Thames River. In keeping with his menagerie of hybrid animals, Godwin removes the unborn baby’s brain and puts it into the skull of its mother, who becomes Bella Baxter (Emma Stone).

Is Bella really disabled?

Stone has been praised for her ability to embody a small child who rapidly matures into a hypersexual person – one who has not had time to absorb the restrictive rules of gender or patriarchy.

But we also see a woman using her behaviour to express herself because she has complex communication barriers. We see a woman who is highly sensitive and responsive to the sensory world around her. A woman moving through and seeing the world differently – just like the fish-eye lens used in many scenes.

Women like this exist and they have historically been confined, studied and monitored like Bella. When medical student Max McCandless (Ramy Youssef) first meets Bella, he offensively exclaims “what a very pretty retard!” before being told the truth and promptly declared her future husband.

Even if Bella is not coded as disabled through her movements, speech and behaviour, her onscreen creator and guardian is. Godwin Baxter has facial differences and other impairments which require assistive technology.

So ignoring disability as a theme of the film seems determined and overt. The absurd humour for which the film is being lauded is often at Bella’s “primitive”, “monstrous” or “damaged” actions: words which aren’t usually used to describe children, but have been used to describe disabled people throughout history.

In reviews, Bella’s walk and speech are compared to characters like the Scarecrow in The Wizard of Oz, rather than a disabled woman. So why the resistance?

Freak shows and displays

Disability studies scholar Rosemarie Gardland-Thomson writes “the history of disabled people in the Western world is in part the history of being on display”.

In the 19th century, when Poor Things is set, “freak shows” featuring disabled people, Indigenous people and others with bodily differences were extremely popular.

Doctors used freak shows to find specimens – like Joseph Merrick (also known as the Elephant Man and later depicted on screen) who was used for entertainment before he was exhibited in lecture halls. In the mid-1800s, as medicine became a profession, observing the disabled body shifted from a public spectacle to a private medical gaze that labelled disability as “sick” and pathologised it.

Poor Things doesn’t just circle around these discourses of disability. Bella’s body is a medical experiment, kept locked away for the private viewing of male doctors who take notes about her every move in small pads. While there is something glorious, intimate and familiar about Bella’s discovery of her own sexual pleasure, she immediately recognises it as worth recording in the third person:

I’ve discovered something that I must share […] Bella discover happy when she want!

The film’s narrative arc ends with Bella herself training to be a doctor but one whose more visible disabilities have disappeared.

Framing charity and sexual abuse

Even the film’s title is an expression often used to describe disabled people. The charity model of disability sees disabled people as needing pity and support from others. Financial poverty is briefly shown at a far-off port in the film and Bella initially becomes a sex worker in Paris for money – but her more pressing concern is sexual pleasure.

Disabled women’s sexuality is usually seen as something that needs to be controlled. It is frequently assumed disabled women are either hypersexual or de-gendered and sexually innocent.

In the real world disabled people experience much higher rates of abuse, including sexual assault, than others. Last year’s Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability found women with disability are nearly twice as likely as women without disability to have been assaulted. Almost a third of women with disability have experienced sexual assault by the age of 15. Bella’s hypersexual curiosity appears to give her some layer of protection – but that portrayal denies the lived experience of many.

Watch but don’t ignore

Poor Things is a stunning film. But ignoring disability in the production ignores the ways in which the representation of disabled bodies play into deep and historical stereotypes about disabled people.

These representations continue to shape lives.

Louisa Smith, Senior lecturer, Deakin University; Gemma Digby, Lecturer – Health & Social Development, Deakin University, and Shane Clifton, Associate Professor of Practice, School of Health Sciences and the Centre for Disability Research and Policy, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

In an episode of ABC’s Four Corners this week, the use of spinal cord stimulators for chronic back pain was brought into question.

Spinal cord stimulators are devices implanted surgically which deliver electric impulses directly to the spinal cord. They’ve been used to treat people with chronic pain since the 1960s.

Their design has changed significantly over time. Early models required an external generator and invasive surgery to implant them. Current devices are fully implantable, rechargeable and can deliver a variety of electrical signals.

However, despite their long history, rigorous experimental research to test the effectiveness of spinal cord stimulators has only been conducted this century. The findings don’t support their use for treating chronic pain. In fact, data points to a significant risk of harm.

What does the evidence say?

One of the first studies used to support the effectiveness of spinal cord stimulators was published in 2005. This study looked at patients who didn’t get relief from initial spinal surgery and compared implantation of a spinal cord stimulator to a repeat of the spinal surgery.

Although it found spinal cord stimulation was the more effective intervention for chronic back pain, the fact this study compared the device to something that had already failed once is an obvious limitation.

Later studies provided more useful evidence. They compared spinal cord stimulation to non-surgical treatments or placebo devices (for example, deactivated spinal cord stimulators).

A 2023 Cochrane review of the published comparative studies found nearly all studies were restricted to short-term outcomes (weeks). And while some studies appeared to show better pain relief with active spinal cord stimulation, the benefits were small, and the evidence was uncertain.

Only one high-quality study compared spinal cord stimulation to placebo up to six months, and it showed no benefit. The review concluded the data doesn’t support the use of spinal cord stimulation for people with back pain.

What about the harms?

The experimental studies often had small numbers of participants, making any estimate of the harms of spinal cord stimulation difficult. So we need to look to other sources.

A review of adverse events reported to Australia’s Therapeutic Goods Administration found the harms can be serious. Of the 520 events reported between 2012 and 2019, 79% were considered “severe” and 13% were “life threatening”.

We don’t know exactly how many spinal cord stimulators were implanted during this period, however this surgery is done reasonably widely in Australia, particularly in the private and workers compensation sectors. In 2023, health insurance data showed more than 1,300 spinal cord stimulator procedures were carried out around the country.

In the review, around half the reported harms were due to a malfunction of the device itself (for example, fracture of the electrical lead, or the lead moved to the wrong spot in the body). The other half involved declines in people’s health such as unexplained increased pain, infection, and tears in the lining around the spinal cord.

More than 80% of the harms required at least one surgery to correct the problem. The same study reported four out of every ten spinal cord stimulators implanted were being removed.

High costs

The cost here is considerable, with the devices alone costing tens of thousands of dollars. Adding associated hospital and medical costs, the total cost for a single procedure averages more than $A50,000. With many patients undergoing multiple repeat procedures, it’s not unusual for costs to be measured in hundreds of thousands of dollars.

Rebates from Medicare, private health funds and other insurance schemes may go towards this total, along with out-of-pocket contributions.

Insurers are uncertain of the effectiveness of spinal cord stimulators, but because their implantation is listed on the Medicare Benefits Schedule and the devices are approved for reimbursement by the government, insurers are forced to fund their use.

Industry influence

If the evidence suggests no sustained benefit over placebo, the harms are significant and the cost is high, why are spinal cord stimulators being used so commonly in Australia? In New Zealand, for example, the devices are rarely used.

Doctors who implant spinal cord stimulators in Australia are well remunerated and funding arrangements are different in New Zealand. But the main reason behind the lack of use in New Zealand is because pain specialists there are not convinced of their effectiveness.

In Australia and elsewhere, the use of spinal cord stimulators is heavily promoted by the pain specialists who implant them, and the device manufacturers, often in unison. The tactics used by the spinal cord stimulator device industry to protect profits have been compared to tactics used by the tobacco industry.

A 2023 paper describes these tactics which include flooding the scientific literature with industry-funded research, undermining unfavourable independent research, and attacking the credibility of those who raise concerns about the devices.

It’s not all bad news

Many who suffer from chronic pain may feel disillusioned after watching the Four Corners report. But it’s not all bad news. Australia happens to be home to some of the world’s top back pain researchers who are working on safe, effective therapies.

New approaches such as sensorimotor retraining, which includes reassurance and encouragement to increase patients’ activity levels, cognitive functional therapy, which targets unhelpful pain-related thinking and behaviour, and old approaches such as exercise, have recently shown benefits in robust clinical research.

If we were to remove funding for expensive, harmful and ineffective treatments, more funding could be directed towards effective ones.

Ian Harris, Professor of Orthopaedic Surgery, UNSW Sydney; Adrian C Traeger, Research Fellow, Institute for Musculoskeletal Health, University of Sydney, and Caitlin Jones, Postdoctoral Research Associate in Musculoskeletal Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.