IN my role
as a medical reporter, I am a seasoned skeptic. If a new treatment has scant
evidence behind it, I reserve judgment. I’m all too aware of the many times
patients said they were cured and doctors said they had seen great results,
only to discover, when a proper study was done, that the treatment was useless.
But it’s
one thing to be a professional reporter and quite another to have a running
injury and be desperate for relief. Is there an unproven treatment that might
help? Give it to me, whatever it costs, even if my insurance does not pay. Mine
is a personal story that showed me why and how health care costs can easily go
out of control.
My problem began on March 12. I was halfway through a seven-mile run when suddenly my hamstring hurt so much I could not go on. After a few weeks, I was able to run again, ignoring pain that ranged from a dull ache to something sharper.
On April 7, I saw an orthopedist in my hometown in New Jersey who told me I had a pulled hamstring and prescribed physical therapy, which consisted of stretching. It did not help. My coach, Tom Fleming, said it was ridiculous to stretch a pulled hamstring, so I stopped.
After
that, as far as my coach knew, I was better. I kept running, never
telling him that my hamstring hurt because I did not want him to tell me
to stop. When I finally confessed, Tom told me to see a doctor he
trusts, Joseph Feinberg, at the Hospital for Special Surgery in New
York.Two weeks later, on July 6, I arrived for my appointment.
Dr. Feinberg said my hamstring was definitely injured. Then he said the magic letters: P.R.P. Doctors at the Hospital for Special Surgery, he said, have been trying something new, injecting patients’ own blood or, alternatively, platelet-rich plasma, or P.R.P., directly into the injured area.
Before he could begin to explain, I burst out: “Oh — do you offer it here? Can I get it?”
I knew about the treatment because I had read an article in The Times reporting that professional athletes were getting platelet-rich plasma, with many claiming it cured them. It consists of your own blood, concentrated so that it is made up mostly of platelets — tiny colorless bodies in blood that release substances that help repair tissues.
At the time I read the article, I was dubious, noting that there weren’t even semi-rigorous studies of the effects of P.R.P. Here we go again, I thought, with an expensive treatment spreading and companies selling equipment before research could even begin.
Now, of course, in Dr. Feinberg’s office, I suspended my disbelief.
Some doctors inject a person’s whole blood; others inject mostly platelets. It’s not cheap, typically costing more than $1,000. But the price varies markedly depending on the area of the body being injected, on whether the injection is done under ultrasound guidance, whether the doctors also charge for follow-up appointments, and the region of the country. The two treatments cost about the same. Some insurers pay, while others do not.
I could find no studies formally testing one treatment against the other. And the evidence in support of both treatments was mostly anecdotal, said Dr. Ronald Adler, chief of the ultrasound division in the Department of Radiology and Imaging at the Hospital for Special Surgery.
The idea of injecting blood or platelet-rich plasma into an injured tendon makes some sense. Blood contains platelets that release growth-promoting molecules that can help tissue heal.
“We think a switch gets turned on,” and the body starts to heal the injury, said Dr. Brian Halpern, a sports medicine physician at the Hospital for Special Surgery. He is the doctor there with the most experience with P.R.P., having used it for two years.
One of the most experienced doctors in the nation, Dr. Allan Mishra, an orthopedist at Menlo Medical Clinic in Menlo Park, Calif., has studied the treatment in the laboratory and found that it helps tendons heal. Others tested it in rats, and reported it sped healing of their tendons.
And Dr. Mishra and others who use the treatments say that patients often get better sooner than expected. Some who suffered for years with tendon pain finally got relief after platelet-rich plasma therapy, Dr. Mishra said. He is directing a study in which 230 patients with tennis elbow will receive either a saline injection or P.R.P., to objectively test whether the treatment works.
But none of the evidence so far is enough to sway many skeptics, especially when, as Dr. Adler explained to me, “the whole issue of why tendons heal is fairly complex and not entirely understood.” And, he added, “even surgery, which many consider a gold standard, doesn’t necessarily work.”
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