Dispatches from OO

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There is a therapy . . . which has proven efficacious . . . in improving joint function . . . . But you are not likely to hear about it from your orthopaedist.”By Sanford Rose

Dolors & Sense

By Sanford Rose

Shoulder prosthesis: pretty, but was it necessary?
Shoulder prosthesis: pretty, but was it necessary?

Sanford Rose

KISSIMMEE Florida—(Weekly Hubris)—7/28/2014—Dispatches from OO? Remember that I live at the junction of Laminectomy Lane and Arthroplasty Avenue in a town that might be called Orthopaedists’ Oasis.

What’s that? You may remember the place as Quackery Corner. Yes, that name serves as well.

It’s a place in Central Florida where old folks live and spend the better part of their days in the waiting rooms of orthopaedic surgeons. It is really Any Town, Florida.

Now, I have nothing against orthopaedic surgeons (well, not much).

I don’t resent the fact that they are America’s highest-paid medical specialists. (In 2012, 20 percent of orthopaedists reported earning over $500,000 a year.)

I don’t resent the fact that they are men (mostly) of usually less than transcendent intellect.

But I do resent (just a tad) that they are responsible for many of the most unnecessary surgeries performed in the US each year.

This includes principally knee surgeries. (Even the American Academy of Orthopaedic Surgeons chides its members for the alacrity with which they rush into operations for the repair of meniscal tears.)

But there are other surgeries that may also be a mite more preventable than your run-of-the-mill orthopaedist will readily acknowledge.

Go to an orthopaedist with pain in the knee, back, hip, or shoulder, and the first thing he’ll say, if the patient is aged: “You’ve got arthritis.”

Safe diagnosis, that! Most oldsters suffer from osteoarthritis (wear-and-tear arthritis) in the major joints.

Arthritis is the erosion of the cartilage separating one bone from another in those joints, and in its advanced state can lead to bone rubbing against bone, which is exquisitely painful.

What causes it? Sometimes trauma and “overuse.” More often, especially in the lower body, obesity and “underuse.”

What is the remedy? At times, arthroplasty, which is the replacement of the natural joint with an artificial one, or prosthesis, for which we need orthopaedic surgeons.

At other times, a program of weight loss and exercise, for which we don’t need them.

Weight loss self-evidently reduces the loads on joints; exercise strengthens the muscles around these joints and also helps lubricate them, ferrying key nutrients from the synovial capsule to the joint space and disposing of wastes from that space.

But there is no money in talking to patients about weight loss and exercise.

The typical orthopaedic surgeon will at first prescribe a round of corticosteroids for pain reduction, because that is what the insurance companies now demand.

And when that doesn’t help, which is usually the case, it is time for the knife.

Interestingly, there is a therapy involving the injection, not of steroids, but of hyaluronic acid, which has proven efficacious in the relief of pain as well as in improving joint function for up to six months (it can be repeated), both in the knees and the shoulder.

But you’re not likely to hear about it from your orthopaedist.

I wonder why.

Sanford Rose, of New Jersey and Florida, served as Associate Editor of Fortune Magazine from 1968 till 1972; Vice President of Chase Manhattan Bank in 1972; Senior Editor of Fortune between 1972 and 1979; and Associate Editor, Financial Editor and Senior Columnist of American Banker newspaper between 1979 and 1991. From 1991 till 2001, Rose worked as a consultant in the banking industry and a professional ghost writer in the field of finance. He has also taught as an adjunct professor of banking at Columbia University and an adjunct instructor of economics at New York University. He states that he left gainful employment in 2001 to concentrate on gain-less investing. (A lifelong photo-phobe, Rose also claims that the head shot accompanying his Weekly Hubris columns is not his own, but belongs, instead, to a skilled woodworker residing in South Carolina.)


  • Ted Balk

    Two click of the mouse brought me to a peer reviewed meta-study in the Annals of Internal Medicine [] of use of hyaluronic acid with the following:
    “Conclusion: In patients with knee osteoarthritis, viscosupplementation is associated with a small and clinically irrelevant benefit and an increased risk for serious adverse events.”
    Other easily found peer reviewed studies cite the efficacy of long term therapy using injections of corticosteroids.
    If you wish to refute these well documented studies, please do your readers the courtesy of citing the basis for your conclusions. Without substantiating data, your proselytizing for a treatment not supported by the medical profession seems irresponsible, and potentially harmful.

  • S. Rose

    Your research is sloppy and shoddy. Viscosupplementation for osteoarthritis of the knee is accepted by the profession and is Medicare-approved. It doesn’t help everyone but helps enough so that Medicare, which is notoriously conservative, has, as noted, sanctioned it.
    By contrast, corticosteroids cause demonstrable long-term harm, leading in many cases to avascular necrosis.
    It has been impossible for me to cite all the relevant studies because I’ve read so many.
    In addition, I have spoken to a number of clinicians and scholars.
    Readers of my postings trust my scholarship, as would anyone who was not actuated by tendentious motivations.

    • Ted Balk

      Sanford, the only other commenters on your pages in this space have been relatives of you. I am a reader of your postings, as well as many other postings. I do not accept un-cited opinion as fact. My “research” was not research, it was an example of how easy it is to find citations that refute your opinions. That is opinions, not scholarship. Scholarship is backed up by references to sources so that fact-checking is possible to discern between opinion and researched fact.
      I have stated this concern with relation to your “medical” opinions in the past. I accept your ideas expressed in your past historical posts. Others have commented – on Facebook, which you find populated by people below your intellectual notice – negatively, and quite humorously, with regard to your health advice.
      May I suggest that it is not I who is “actuated by tendentious motivations” in this case, but you.
      You have severed your relationship with Weekly Hubris due to perceived slights that you have fabricated out of whole cloth. You have sent vilely insulting messages to the Publishing Editor. You have contacted other contributors attempting to poison them against this publication. Would you care to elucidate further on the tendentious motivation for these actions?

  • S. Rose

    It is of course fruitless to get into further wranglings, particularly with regard to personal matters, which are so easily misrepresented. On the substantive issues, I have never received any criticism of my medical or health postings, although I am sure one can be resurrected, ex post. I encountered some sub-voce grumblings from one or two who were obviously unacquainted with the latest research on vitamin supplements. But there was nothing explicit.
    I think it is best to quit this matter with some decorum and dignity. I have been a contributor to this magazine for probably nearly four years. People of intellect and standing have at times seen fit to applaud my writings. I leave with much sadness and wish the best to all who continue.