An active, 71-year old man who declined joint replacement in favor of stem-cell treatment is quoted in a recent New York Times article as saying, “They’re really quick to try to give you fake joints and make a bunch of money off you.” But the NYT article goes on to suggest that making money may be the main objective of some of the many hundreds of clinics that have sprung up around the US to offer cell-based injections to people with aging or damaged joints who want relief without surgery.
The article points out that the FDA has “taken an industry-friendly approach toward companies using unproven cell cocktails” and that the scant scientific evidence about these treatments, which include injections of platelet-rich plasma, is inconclusive.
For OrthoBuzz readers who want to dive more deeply into the scientific underpinnings (or lack thereof) related to cell therapies for joint problems, please peruse the following JBJS and JBJS Reviews articles, which have been made openly available for a limited period of time:
- Intra-articular Cellular Therapy for Osteoarthritis and Focal Cartilage Defects of the Knee
- Nomenclature Inconsistency and Selective Outcome Reporting Hinder Understanding of Stem Cell Therapy for the Knee
- International Expert Consensus on a Cell Therapy Communication Tool: DOSES
- Stem Cell Therapy for Knee Pain–What Exactly Are We Injecting, and Why?
- A Call for Standardization in Cell Therapy Studies
- A Comprehensive Review of Stem-cell Therapy
The main message running through all these articles is this: Effective clinical assessment and safe, optimized use of cell-based therapies demands greater attention to study methods; standards for cell harvesting, processing, and delivery; and standardized reporting of clinical and structural outcomes.
A page-1 article in the February 18, 2015 New York Times caught our eye. It focused on patient “suffering” caused by the often frustrating, inconvenient, and noncommunicative way health care is delivered. Thomas H. Lee, MD, chief medical officer of the patient-satisfaction consultancy Press Ganey, was quoted as saying, “Every patient visit is a high-stakes interaction…And all you have to do is be the kind of physician your patient is hoping you will be.”
However, according to several online comments about the article from clinicians, alleviating this type of patient suffering may not be as simple as Dr. Lee suggests. Here’s a sampling:
MainerMD from Cleveland, OH:
To think that listening and communication will solve all of our problems cited here is horribly naive. Take 4 AM labs, for example. Doctors don’t order 4 AM labs to irritate patients. We do it because labs take time to run…What are we supposed to do? Let the patient sleep in, draw the labs at 8 AM, and then get called out of surgical cases or office visits to interpret the results and make a plan? …Wait until the end of the day to make plans, thereby delaying discharges and lengthening hospital stays? …The point is that these systems are complex, and things which irritate patients are not just the result of a lack of effort or personal shortcomings of doctors or nurses.
Rosy from Newtown, PA:
The bottom line is that we need to spend more time with patients, which is increasingly impossible.
Dr. DR from Texas:
Yes, feedback is great, and I think doctors can learn a lot from some of this data. But we also have to note that patients’ priorities (especially in a post-care survey) are not always in line with the best, evidence-based medical care.
Leo F. Flanagan from Stamford, CT:
It is time training in mindfulness, positive psychology, and hardiness is integrated into medical education. Caregivers who are trained to be resilient will not only be more attentive to patients, they will provide better clinical care.
Gary, an ER physician from Essexville, MI:
Inconvenience does not equate to the stroke or trauma patient’s suffering.
Dr. Abraham Solomon from Fort Myers, FL:
The patient is not his/her disease. The patient is a person with a medical problem. The whole person needs to be considered in solving the problem.
Rick, an ER physician from Pennsylvania:
Using patient surveys creates artificial and arbitrary measures that distract from the real questions of who gets better with the fewest complications, errors and inefficiencies. My highest ratings as an ER doc was when I gave everybody narcotics liberally, and ordered every fancy expensive test I could, “just to be sure” and to convince the patient I was “thorough” and I “cared.”
Regardless of one’s perspective, measuring patient satisfaction with the delivery of medical care is here for the midterm, at least. It would behoove us to consider the patient point of view as we balance how to interpret and respond to these measures.
The migration of traditional print businesses into online enterprises has created long-term demands on editorial functions, technology partnerships, and organizational cultures. From major technology firms like Google, Apple, and Facebook to enduring publishing brands like the New York Times, these demands have led to very public struggles over the past months.
This month, JBJS launches redesigned and upgraded Web sites, soon to be followed by a unified tablet app for iOS and Android that will include all JBJS journals (JBJS, JBJS Case Connector, JBJS Essential Surgical Techniques, and JBJS Reviews). Because of this and trends in user preferences, technology is front and center for us.
For scientific, medical, and scholarly publishers, online and digital products have been an increasing focus for more than two decades. But some change comes slowly, especially in the realm of organizational culture. During the print era, once an article was published, the cultural habit was to move on to the next set of articles. This approach allowed for batch work consistently oriented toward what was next.
No longer. With our Twitter feed now topping 10,000 followers, the moment an article is published, entirely new workflows begin– social media, archiving, editorial selections for new products and online marketing, and so forth. These activities change our culture, and require new technologies and new skills.
We also now have to rework our archives on a regular basis. This year, JBJS celebrates its 125th anniversary. While building our new sites, we had to migrate 125 years of articles into new formats, new designs, and new technology infrastructures – a major task that was far more difficult and intricate than moving a dozen shelves of bound volumes from one room to another.
We are busy transforming JBJS into a leading organization for the modern information economy – from our core journals to our online education offerings. While the challenges are real and the changes significant, we love the work, and our talents are sharpened every day.
I hope you enjoy our new Web sites, our new tablet app, and our efforts to bring you the best orthopaedic information in formats you can use.