My mentor at Harvard/Mass General Hospital, Bert Zarins MD told me to always beware of “the triumph of technology over reason”. Skill and diligence on the part of health care providers is the most important element in quality care; and one of the problems with health care currently is money being spent on items that do not improve health. Now it appears that surgical robots may be part of that equation. A study from South Korea has shown that robotic surgery “was associated with prolonged operating time and higher hospital costs compared with laparoscopic surgery” for patients undergoing radical nephrectomy (kidney removal) for a renal mass with no benefit to the patient for that extra time spent in surgery. The adoption of new, and potentially unproven, technology is used as a marketing tool, because new technology, like new buildings, has commercial appeal to consumers. I am constantly approached by well meaning industry representatives appropriately doing their job to tell me about new technology from their company. However, it is important that I also do my job and not adopt them unless there is evidence that newer is really better. But, unfortunately, as more and more doctors are employed by hospitals, doctors have less and less say about what is offered to their patients, since hospitals often dictate how their employed doctors provide care. The physicians in South Korea are to be commended for providing important evidence that this costly technology is not better, at least in this instance.
Chelation therapy is a process of removing heavy metals such as lead and cadmium from blood as a means to prevent heart attacks. It is an old treatment that was felt to be quackery when I learned about it as a medical student at Johns Hopkins many years ago. But now there is convincing evidence that it can dramatically reduce the incidence of heart attacks without the use of toxic drugs. Cardiologist GA Lamas in Miami, originally a skeptic of the technique has performed studies showing marked reduction in heart attacks incidence with this technique – and new larger studies are underway. At a time when large percentages of patients refuse to take statin drugs for heart disease, and other pharmaceuticals, because of onerous side effects, alternative safe and effective treatments like this are becoming increasingly popular.
The secret to fighting cancers, as well as autoimmune disorders such as MS, ALS and rheumatoid arthritis, lie within each of us in our immune systems. Now this potential is being unlocked in an increasing number of patients. For cancer, the treatment involves removing immune system cells from our body, treating them to recognize the tumor, multiplying them, and then returning them to the body to seek and destroy the cancer cells. Recent articles in The Wall Street Journal and elsewhere have described how the National Cancer Institute’s Dr Steven Rosenberger Institute has treated a patient with metastatic breast cancer that had resisted all other treatments , and was expected to be fatal, who is now cancer free for more than a year after this treatment.
Recent Meta-Analysis Shows Hamstring Grafts equally as stable as patellar tendon grafts but with significantly fewer complications
The authors analyzed all prospective randomized studies comparing hamstring and patellar tendon grafts to come to the above conclusion. Here is how the authors stated their findings: “Contemporary 4-strand HT ACL reconstruction is comparable with the PT technique in terms of clinical stability and postoperative functional status across most parameters studied. The HT technique carries lower risk of postoperative complications such as anterior knee pain, kneeling discomfort, and extension deficit. Primary ACL reconstruction using the 4-strand HT technique achieves clinical results that are comparable with the PT technique with significantly less postoperative complications.”
PRESERVING THE BICEPS TENDON WHEN REPAIRING THE ROTATOR CUFF SHOWS BETTER RESULTS THAN CUTTING THE BICEPS TENDON
As the above picture shows the long head of the biceps tendon attaches directly into the shoulder joint. The rotator cuff tendons are located very nearby. While it is controversial, many surgeons will cut the biceps tendon if it has damage and then implant it into the top of the humerus or arm bone: a procedure called biceps tenodesis. The rationale is that cutting the biceps eliminates a potential pain generator after surgery. But now a new study shows that there may be a price to be paid in some by doing so.