The United States is known for having one of the most technologically advanced healthcare systems in the world. With state-of-the-art equipment, prestigious research institutions, and high healthcare spending, it would be reasonable to expect world-leading patient outcomes. Yet in many areas, the U.S. falls short—particularly in conditions like spinal cerebrospinal fluid (CSF) leaks, where simple, research-backed treatments are frequently overlooked.
Spinal CSF leaks can result from medical procedures or occur spontaneously, leading to debilitating symptoms like head and neck pressure, dizziness, nerve pain, and cognitive impairment as well as lead to many reversable secondary conditions when the spinal leak itself is fixed, from hypothyroidism to schizophrenia to dementia. The gold standard treatment is the epidural blood patch where a patient's own blood is injected into the epidural space to seal the leak.
Despite decades of success and strong physiological logic behind the approach of an epidural blood patch, many U.S. physicians are undertrained—or not trained at all—in how to perform this procedure properly. Some recent graduates in anesthesiology are unfamiliar with basic concepts like Poiseuille’s Law, which governs flow dynamics crucial to understanding how CSF leaks behave and how to treat them.
We recently had a US-trained anesthesiologist tell us that his decision-making process in choosing the right size needle for a blood patch was simply to choose the 18g needle that came in the pack and that he thought length of the needle was approximately equivalent to back pressure as the diameter of the needle lumen so he saw no problem with choosing a needle with a much smaller lumen diameter for the needle for a blood patch despite the viscosity of blood. In layman's terms as to the laws of physics involved, this physician thought that squeezing honey through a small honey bear with a large opening in the top would be equivalent in how much force it required to squeeze the honey out versus squeezing honey in a small honey bear with a tiny opening in the top. This physician also scoffed at the issue as "just stories" raised of this concern increasing significantly with non-Western European-descent patients who tend to have a higher platelet count as we have seen complications in case studies and patient anecdotes where Black patients were more likely to have a clot created in their epidural area that caused partial paralysis until removal of the clot could occur. This physician is the person who is going to be behind patients' backs, making decisions on how epidural blood patches are approached and squeezing blood into people's epidural areas.
The core issue lies in how American healthcare is structured. Medical education and clinical priorities are shaped heavily by insurance reimbursement rates and hospital billing targets. Procedures that are well-reimbursed, such as spinal cord stimulators or nerve ablations, are emphasized in training and practice. In contrast, blood patches are inexpensive and therefore receive far less institutional attention.
This focus on profit over patient outcome has real consequences. Major academic centers in the US have openly deprioritized training in blood patching, instead steering residents toward more lucrative but less curative interventions. The result is a healthcare workforce that may be unfamiliar with or skeptical of the very treatment that could most directly resolve the patient’s condition.
In contrast, many healthcare systems outside the U.S. emphasize relational care over transactional care. In countries with fewer resources, providers learn to do more with less. They are trained to problem-solve, adapt to constraints, and partner with patients based on what is realistically accessible—not what is most profitable.
In some international systems, the patient’s own blood is one of the only tools readily available. This scarcity encourages deeper clinical understanding and greater respect for the simplicity and effectiveness of a procedure like a blood patch.
Relational healthcare systems tend to produce more thoughtful, holistic care. Patients report stronger continuity, better coordination between providers, and higher satisfaction. By contrast, patients in the U.S. often face fragmented care, rushed surgeries, and difficulty receiving help when complications arise.
Relational medicine also teaches humility. When tools are limited, communication, precision, and empathy become more essential. Doctors in these systems often engage in shared decision-making and practical problem-solving that U.S. patients rarely experience.
Another reason epidural blood patches are undervalued in the U.S. is the lack of commercial interest. Since the procedure uses the patient’s own blood and cannot be patented or sold, patches attract little attention from pharmaceutical companies or medical device manufacturers. As a result, spinal CSF leak care receives less research funding, such as in improving the epidural blood patch needle, researching the rate of accidental dural punctures occurring during blood patches, and researching the impact of nutrition on blood quality and healing during the patching process, leading to the false impression that epidural blood patches themselves are outdated or ineffective despite current articles still listing epidural blood patches as the gold standard.
This cycle creates a dangerous feedback loop. Physicians assume that if a procedure is not well-represented in medical training, it must not be important. But in this case, the absence of attention reflects market dynamics, not clinical evidence where research internationally is full of discussions on gaps in epidural blood patching knowledge, continued affirmations that epidural blood patches are still the gold standard for spinal CSF leak care, and further research challenging the idea that spinal CSF leaks are self-limiting.
To correct this imbalance, we have been working on developing international partnerships to bring basic knowledge back into the US and to then expand on this. Professionals in some countries with fewer resources but a strong relational culture often have stronger training in spinal leak treatment because their systems still prioritize foundational skills and patient-centered thinking.
These global clinicians can collaborate remotely with American providers to fill in the educational gaps left by U.S. institutions. The goal is to transfer practical skills and a more human-centered mindset to practitioners who never learned these aspects during their formal training.
In a time with changing economies and tariffs, conveying crucial foundational knowledge remotely across borders as a service stands out over the shipping of physical products to the US as part of the medical device industry, many companies within this industry are arguably doing great harm to US patients and corrupting medical education.
In a relational system, care is not about high-volume procedures or the most advanced imaging. It is about using what works, communicating with patients, and respecting the physiological mechanisms that govern the human body. In such systems, a spinal leak is not simply masked with pain control. It is understood, diagnosed, and treated at its root.
For conditions like spinal leaks, the U.S. must be willing to learn from countries that never stopped teaching core practices like blood patching. These global partners offer a model for how care can be done thoughtfully and with integrity, even in the face of limited resources.
The U.S. does not lack tools. It lacks coordination, humility, and a relational approach to care. Medical systems in other countries have preserved values that the U.S. has largely lost to industrialization and financial pressures. If American healthcare leaders hope to improve outcomes, especially in underserved areas like spinal leak treatment, they must be willing to learn from those who are doing more with less.
International partnerships are not just helpful. They are vital. They hold the key to restoring balance in a system that has become too focused on what can be billed and too distant from what truly heals.