NIH Study Shows Arthroscopy Ineffective for Osteoarthritis

Arthroscopic surgery is a common option offered to patients with osteoarthritis who want to avoid a total knee replacement.  Each year over 650,000 Americans with osteoarthritis undergo this procedure at a cost exceeding $5,000 per knee, not including the cost of postoperative complications.  Arthroscopic surgery involves debridement, the removal of bone and cartilage fragments, and lavage, a flushing of fluid through the joint in order to cleanse it of debris.  Even though this treatment is widely employed, it has never been rigorously tested for its efficacy until now.

A study at the Houston Veterans Affairs Medical Center randomly assigned 180 volunteers to receive debridement, lavage, or placebo surgery, in which  the surgeon cut the skin but did not insert any instruments into the knee joint.  The patients were followed for two years.

At the end of the study, the patients who received placebo surgery had the least amount of pain compared to those who had the operative arthroscopic procedure.  In other words, the operation was less effective than the placebo surgery.

This study, one of the firsts of its kind, rigorously tests a commonly performed procedure, approved and reimbursed by Medicare.  We must ask the question if this procedure should continue to be used in those patients with osteoarthritis.  We strongly believe that Medicare needs to evaluate other  forms of therapy to aid those suffering from arthritis of the knee.  Studies have failed to show that drugs like Synvisc, cortisone, and anti-inflammatories such as Celebrex and Vioxx, provide long-term relief.  Prolotherapy is a proven and scientifically studied method to relieve pain and restore function in those suffering from arthritis.  Medicare desperately needs to evaluate this treatment as an alternative for knee replacement surgery.  For more information on prolotherapy, please see our Web site and video at www.prolotherapy-md.com and attend one of our free monthly educational seminars.  With over 2500 prolotherapy procedures performed, Dr. Greenberg has had a great deal of success in curing those with arthritis and chronic pain problems. 

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Plastic Tubing Material Linked to Infertility 

The Food and Drug Administration has posted a new set of warnings against a plastic compound called DEHP.  This chemical, used to soften plastic medical devices from blood bags and IV tubings, may affect testicular development and sperm production.  While we are all exposed to DEHP, sick baby boys are most at risk from exposure, as they receive intensive medical care such as continuous tube feedings, transfusions, antibiotics, and a blood oxygenation treatment known as ECMO.

Other groups at risk from DEHP exposure include prepubescent boys and pregnant women or nursing mothers who are undergoing dialysis treatments.  Medical tubing devices coated with heparin, silicon or other substances to prevent DEHP from leaching are now being recommended by the FDA.  This should help lower the risk of sperm and testicular dysfunction.

DEHP is another member of the phthalate group.  These chemicals have been linked to prostate and breast cancer and are found commonly in soft plastic bottles.  To minimize your risk of exposure to phthalates, drink from either glass or reused hard plastic bottles.  

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As the debate between high and low carbohydrate diets continues, researchers at the University of Pittsburgh Department of Medicine, Shriners Burns Institute, and the University of Texas Medical Center have wondered if thin and obese people have different metabolisms during exercise -- and have come up with an answer.

Fourteen sedentary men, evenly divided between thin and obese individuals, were analyzed during aerobic exercise sessions.  Each individual performed 60 minutes of bicycle riding at approximately 50% of his maximal breathing capacity.  Blood and respiratory samples were taken. 

The results indicated that overweight individuals derived almost 50% more of their energy from the burning of fats compared to the thin men, who burned more carbohydrates compared to their obese counterparts. 

While this is a very small study, it provides some insight in the metabolic differences between lean and obese people, and indicates that the latter who are planning exercise as part of their weight loss plan should perhaps restrict their carbohydrate intake.   Otherwise, for everyone else, the recommendation is: continue to eat those whole grains.     

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 In medical school, we were taught that the risk of breast cancer is directly correlated to a woman's lifelong estrogen exposure.  Those that did not bear children, those who had an early onset of their period, or those who entered menopause later than average were most at risk.  It only made theoretical sense that using powerful synthetic estrogens would also increase that risk.  Many prior studies have also shown this dangerous potential of synthetic HRT. However, the pharmaceutical industry counteracted by funding numerous other studies to show that HRT did not increase breast cancer.  In addition, aggressive marketing by the industry lead to an almost universal acceptance of HRT.

Now, a five-year government funded study has again turned the tables on the HRT industry -- it was halted early, as the statistics overwhelmingly showed the benefits of HRT were greatly outweighed by their risks.  The Women's Health Initiative study looked at 16,608 postmenopausal women with an average age of 64 who had not been diagnosed with heart disease.  More than half of the women took a daily dose of 0.625 milligrams of synthetic estradiol and 2.5 milligrams of progestin (synthetic progesterone), while the rest received  placebo.  After five years of follow up, the researchers found that women taking the hormone combination had 26 percent more breast cancers, 29 percent more heart attacks and deaths from heart disease, 41 percent more strokes and twice as many blood clots as women not taking hormones.  HRT did provide some benefits: Women taking it had a 37 percent lower risk of colon cancer, one-third fewer hip fractures and one quarter fewer overall fractures.  

There are many alternatives women can consider to help quench symptoms of menopause, reduce the risk of heart disease and stroke, and build bone.  Some of the many alternatives include soy isoflavones, a low fat diet high in folic acid, vitamin C, antioxidants, and phytonutrients, and maintaining your ideal body weight with regular exercise.

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Ovarian cancer is a deadly disease -- usually detected only in its late stages, where prognosis is poor.  It has no warning signs -- no pain or bleeding, and is often not detected on a routine pelvic examination.  The risk of a woman having ovarian cancer in her lifetime is approximately 1.3%.

While it was previously thought that HRT was protective against ovarian cancer, a study from the National Cancer Institute shows otherwise.  Adding to the mounting evidence against HRT, this report as published in the Journal of the American Medical Association concluded that synthetic estrogen and progestin actually increase a woman's risk of ovarian cancer.  The study, which tracked almost 45,000 women over a 20-year period, found that, on average, women who took them were one and one-half times more likely to develop ovarian cancer.  The effects of this medication seems to be cumulative, as women who took synthetic HRT for over 20 years were three times more likely to develop this lethal disease.

Over 8 million women in the United States take HRT.  It is time for a change to natural alternatives that have a superior history of safety and efficacy.  At the Magaziner Center, we have had more than 15 years experience in safely prescribing effective alternative therapies for menopause.

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