By Elizabeth Hofheinz, M.P.H., M.Ed., August 30, 2019
“When it comes to stem cells and PRP, we wage a battle against the public’s perception of these treatments. “I wish patients wouldn’t take medical advice from their hairdresser/waitress/sports figures,” says one orthopedic surgeon. “Patients are talking to everyone about these treatments and are getting the idea that if NBA players are getting PRP treatments, then they should too. But it is up to us as a profession to help educate patients about what is really known about the efficacy of these treatments.”
Part of the problem may be somewhat optimistic usage by specialists outside of our field, says this surgeon. “It’s not uncommon in my practice to see a patient with a clear surgical indication who was told by their previous physician that it could be cured with a series of PRP injections. Often times they appear to be physicians outside of my specialty who mean well but may not always know the orthopaedic literature. I can’t comment on other physicians’ motivations because I know some patients want these injections at all costs…and perhaps they just happen to see a lot of these patients. BUT, all physicians have a responsibility to be educators and provide the evidence that is—and isn’t– available surrounding the usage of these procedures,”
“One of the bigger distractions in sports medicine practices is that patients often focus on what we do with professional athletes…everyone wants to try what worked for Kobe Bryant. But I tell them that is an n of 1, and what they should truly be basing their decision on is the result of a large prospective study where you are looking at efficacy of a specific dosage and formulary, for their particular type of orthopaedic problem. And this is our job to present that data in a fair fashion, particularly because of the appearance of conflict involved in these cash-based procedures that are rarely covered by insurance.
“Because medicine has become a consumer field we must focus on public education. If we were to poll the physicians who are performing most of these treatments, they will likely agree that the evidence is still pending but looking promising, and furthermore that the patients are asking for it.” I spend a good amount of time in my clinic talking to these patients about the current evidence (and lack of such) behind these treatments, and some still do choose to move forward with this option.
“I hear you can regrow my cartilage and make my knee younger,” is what this sports medicine surgeon hears during these requests.
“It’s time that we make a concerted effort to dampen the hype around these treatments. I am happy to see that our subspecialty societies are increasing the number of courses on biologics for orthopaedic and sports medicine surgeons, but I feel there is not enough in the way of patient and public education. Of course, in the medical field, we want to advance patient care and provide cutting edge treatments, and we want the public to support, and believe in, medical innovation. But we also know that the studies on PRP in treating orthopaedic conditions have considerable variability in the contents and dosages of PRP, and that there is a lot that needs to be better understood.”
“I believe that we as a field understand this and are adept at having discussions with patients to help them determine the treatment course that is best for them, with or without PRP. However, this hype is only getting ‘louder’…we need to focus not only on treating individual patients, but also on educating the public, so that they can ask the right questions and know the options available to them in order to make an informed decision on whether they would like to spend time and money on these types of procedures, instead of just buying into what they’ve heard on the news.”