Category: Orthopedic surgery

Tiger Woods’ career ended after he bulked up

April 10, 2015- By Steven E. Greer, MD

Ten years ago, Tiger Woods hit one of the most memorable shots in golf when he chipped in a birdie on the 16th hole at Augusta in the Read more »

Atul Gawande’s surgical checklist fails in real world study

March 15, 2014- By Steven E. Greer, MD

In 2009, Atul Gawande, MD, MPH and his large international team published in the New England Journal of Medicine (NEJM) an observational study that showed a significant reduction of death and “complications” after non-cardiac surgery. The World Health Organization (WHO) created the checklist used in the NEJM paper. After this non-randomized, non-controlled, observational study was published, entire nations adopted the surgical checklist system.

Now, in 2014, a population study drawing from Ontario surgical patient data, published in the NEJM, showed no significant benefit from the widespread adoption of the same WHO surgical safety checklist that Dr. Gawande popularized. This study was also observational, but it was stronger than the 2009 Gawande study in that it included the entire population within a region.

What went wrong? Read more »

MRIs are overused and lead to unnecessary surgery for sports injuries

Interviewed by Steven Greer, MD

A recent New York Times article concluded that MRI’s are overused when diagnosing sports injuries and lead to unnecessary surgeries. One sports surgeon, and skeptic of MRI’s, scanned 31 healthy baseball pitchers and found “abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent.” The article went on the explain the financial incentives to the fee-for-service system that pays for the MRI’s and procedures. In many cases, doctors own the MRI’s and receive even greater profit.

Related to this, the New England Journal of Medicine published a landmark study in 2008 by lead author Robert Litchfield, MD, from Ontario. The paper concluded that routine knee arthroscopy was of no benefit for osteoarthritis.

 

Tiger Woods’ knee surgery, rehab, and JNJ

June 26, 2008

Tiger Woods is in the news for yet another scandal. This time, The New York Times has published a report linking him to a Canadian sports medicine doctor who administers banned substances to athletes in order to speed their recovery from surgery. According to the story, Mr. Woods’ sports agents at IMG referred him to this doctor after his knee was recovering too slowly from surgery in 2008.

To be fair to Mr. Woods, the article does not say that he took HGH or steroids, but rather a platelet derived growth factor, Actovegin, to help with ligament and tendon healing. Giving this product a drug name makes it seem more sinister than it actually is. Actovegin is simply bovine platelet-rich fluid made from centrifuged blood. The theory is to collect the growth factors known to speed healing found in platelets. Small centrifuge machines made for the operating room that spin the patient’s own blood are available in the U.S. now and sold by Johnson and Johnson as the Symphony device. Regranex is an actual drug containing Platelet Derived Growth Factor (PDGF), also sold by JNJ.

The HCC interviewed knee surgeon, Sharon Hame, MD, of UCLA, to discuss Tiger Woods specific type of knee surgery and his prospects for a full recovery and ability to beat Jack Nicklaus’ record of 18 majors.


New Therapies to treat acute spinal cord injury

Interviewed by Steven Greer, MD

W. Dalton Dietrich, Ph.D., Scientific Director of the Miami Project to Cure Paralysis discusses two therapies to treat acute spinal cord injury (SCI). First, he discusses the trial recently allowed to proceed by the FDA, funded by company Geron, to use stem cells to treat SCI. It will be the first human trial of its kind in the U.S. In the second part of the interview, he discusses the pioneering work from Miami that uses hypothermia to treat acute SCI.

 

The general surgery shortage crisis

General surgeons and other primary care varieties of surgery are training fewer doctors as the salaries decrease and the hassle factor increases. This is creating a critical shortage of trauma and emergency care in rural areas, as well as a decrease in quality of surgical care everywhere. To address this, Senator Orin Hatch (R-Utah) asked Dr. Frank Opelka of the American College of Surgeons why there is a shortage of people entering the field and how it can be remedied.

AHRQ report: Best evidence for rotator cuff tear repair

Produced and interviewed by Steven Greer, MD

August 1, 2010

CurrentMedicine.TV, in conjunction with the AHRQ, has created a video summary of the AHRQ report about the comparative effectiveness research on the various ways to surgically repair torn rotator cuffs and to rehabilitate the injuries. Is surgery more effective than physical therapy alone? Which forms of PT are best?

Karen Siegel, physical therapist within AHRQ, discusses the report.

 

Marcia Crosse, PhD: The GAO report on the 510K process

Marcia Crosse, PhD, Director at the Government accountability Office GAO discuss their report on urgent changes needed in the way medical devices are approved using the lax 510K pathway. The implications to the medical device industry, particularly orthopedics and spine, are significant. Most ortho devices are approved via the 510K.

Produced and interviewed by Steven Greer, MD

Current guidelines and methods for treating knee and head injuries in NCAA athletes

September 14, 2010

Lee Kaplan, MD, Chief of Sports Medicine at The University of Miami Health System and team doctor for the Miami Hurricanes football team discusses the state-of-the-art methods for surgically repairing torn knee meniscus injuries and for repairing torn ACL’s.

Clifton Page, MD, internists for the Miami Hurricanes football team, discusses the new guidelines for handling the return to play for athletes who have suffered a concussion, testing for sickle cell, and for monitoring heat exhaustion. (See Op-Ed How to Eliminate Head Injury in Football)

David Wofsy, MD: Guidelines for industry funding of medical societies

Dr. Wofsy discusses the recent article in JAMA, which he co-authored, on the handling of industry payments to medical societies. A similar paper a few years ago caused significant changes in the way academic medical centers handled industry payments.

The IOM recently published a similar report.

Senator Grassley and others have also been targeting corruption in medicine. All of these factors make it likely that industry-funded research, academic publications, and medical meetings will continue to undergo major transformations.

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