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How Much Is That Stress Fracture Worth?

About $1.3 million!

That’s how much in grant money a Physical Therapy professor from The University of Delaware was awarded to study the prevention of these stress fractures. Irene Davis, PT, PhD, the director of the university’s Running Injury Laboratory and director of research for Drayer Physical Therapy was awarded the grants from the NIH and the Dept. of Defense.

Stress fractures are a real cost and challenge to the military. Its not uncommon for a soldier that suffers a stress fracture to be off-line for 6 months or more. Considering the enormous cost of training soldiers and the high frequency of stress fracture occurrence, I’d say the DOD is getting a real deal on this!

The study is really quite interesting, incorporating biofeedback and gait re-training to reduce impact forces during running at levels much greater than what a cushioning sneaker could provide. Remember, just because we all learn how to run does not imply we all know how to run correctly.

Stay tuned for more on this topic, I have a feeling that this could be one of those studies where I walk into work at the Army clinic one day and I’m met with a biofeedback device that I have no idea what to do with!

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Bye Bye, Free Samples

“Doctors who are shutting the door to sales reps are cutting themselves off from a lot of valuable information,” said Scott Lassman, senior assistant general counsel for the Pharmaceutical Research and Manufacturers of America, a trade association. “Sales reps can explain when it’s right to use a drug, when it’s not right to use the drug, which patients might benefit and which patients it might not work for.”
This was the quote that caught my eye in today’s NY Times article about the growing trend for physicians to stop giving free samples. In reading the above statement, I really feel like a doctor would be nuts to not talk to a sales rep.
But what is a sales rep, really? I’m sure some are very educated, but for the most part, these are people from diverse backgrounds, some college education, a science vocabulary and a huge marketing budget. Their job is to get a doctor to use their product. There are walking conflicts of interest.
I would feel a whole lot better if my DOCTOR didn’t have a need to learn from a sales rep, and could instead go learn for himself from government guidelines, peer reviewed journals, and continuing education formats.
Afterall, isn’t it the doctor’s job to know “when it’s right to use a drug, when it’s not right to use the drug, which patients might benefit and which patients it might not work for”?????
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Sticker Shock

The above is a Graham Watson Photo.
A friend of mine recently suffered the most dreaded of all cycling injuries: the broken collarbone. Everything about this broken bone was ho-hum. It was not a severe fracture and the care to fix the bone was minimal: a sling, rest, some pain meds. However, the entire experience was valuable as a look into costs related to an Emergency Room visit.
As my friend was unlucky enough to not have health insurance, each bill received was painful, and we talked about it openly. For the most part, I can see the services as fair. Here is what was provided and charged for…give or take a few bucks:
1. Emergency Department Bill: $1050
2. Radioloist: $45
3. Follow-up Ortho visit: $125
4. Radiology: $400
5. ER Physician: $500

HOLD ON! Did you see that last charge? Per my friend, the total time spent in the presence of this ER doc was less than 10 minutes. Why so much? The extent of his intervention was to declare this injury non-emergent, refer to another care provider, and order a sling and pain meds. In other words…not much. In another context, why is his bill so much higher than a surgical consult? (Oh by the way, we’re leaving the fact that the ortho tried to talk my friend into an unnecessary procedure.)

For someone who has insurance, this bill would carry less weight. They will be apt to overlook the high cost and just shake their head as the insurance company pays the bill and passes the cost on to small business employers. Which is where this whole story turns ironic. My friend owns his own small business and cannot afford the absurdly high prices. Now, he’s being over-charged for medical care that is the root cause behind why he cannot afford insurance!
Here is another thought: Doing the math concerning his total bill (~$2000) we can easily see that even in light of a significant injury, the total outlay for medical care is still less than if he had paid $400 dollars for health insurance monthly for the past 16 month in which he sought no medical care, and would have still had a $500 deductible for an ER visit (~$6900).

Unsustainable economics for everyone.

Everyone except the insurance company and ER doc!

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Free, Open Information

As an avid fan a peer reviewed journals, I get very excited when a journal does not charge a fee for its content. A new medical journal has recently been introduced, Open Medicine, from Canada. Its authors are the martyr type, having recently been fired from another open source journal over issues of editorial freedom. I wish them well in this new endeavor.

The Directory of Open Access Journals provides a very comprehensive listing of open journals, not just from the medical field, but from a variety of scientific disciplines. Of course, you can always conduct your search queries in the Pub Med Central engine, where all results are going to be free public domain.
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I'm Officially Sensitive!

As some of you may know, I recently was involved as a tester in a research study at USC. As testers, we were required to perform repeated muscle tests on subjects quadriceps using 4 different types of tests. I was reviewing the final manuscript and found the following paragraph:


“The sensitivity of both the isometric and dynamic manual muscle tests found in the current study was much lower than would be desired for an adequate screening test. This finding was also most likely contributable to the overwhelming tendency of tester two to find no difference in strength, on both the isometric and dynamic tests, when one was detected by the Biodex dynamometer. When analyzed separately, the sensitivity of manual muscle testing as determined by tester one (Se range of 56% to 100%) was much greater than that determined by tester two (Se range of 11% to 33.3%). This means that tester one was much more likely than tester two to correctly identify those individuals with quadriceps weakness. “

I was tester one.

This is good, as I performed the data collection in fear that I would be proved to be a poor muscle tester.

To be fair, I also had a high level of false positives, finding a difference when one was not detectable on a machine. Maybe I’m more sensitive than the machine???

In all seriousness, part of my training was unique in that I had a couple of instructors who placed a large emphasis on developing expertise in palpation skills. I was guided and praised often in this area and I am proud of my ability to feel different movements with a high degree of sensitivity. I was very lucky to have teachers so focused on palpation skills.

I wonder what the other professions or even other schools do to improve a student’s ability to sense movement.

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What Are You Looking For?

Perhaps you may have noticed, perhaps not, but for the past several weeks, a new functionality has been added to this blog. I created my own custom search engine using Google Custom Search. The premise behind my search is that I attempted to combine a mix of high quality consumer and professional information sources into one comprehensive rehabilitation search.

I browsed through many sites and it is a work in progress. My hope is that when you search for something like, “back pain, “the results you get will be from high quality, evidence-supported web sites. Google has been steadily improving their medical search as well, but the search results are still targeted to a wide audience.

Run your own test search. Pick a condition like, “TMJ,” and search Google Regular and my search and compare the results. I would love any feedback or site suggestions you might have on this. Enjoy!

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Who are the Experts in Musculoskeletal Care?

This interesting article published in Military Medicine, a smallish peer-reviewed journal asked just that question. The investigators administered a standardized examination that assesses knowledge in managing musculoskeletal conditions to uniformed Physical Therapists. They then compared the results to other healthcare providers. The results:

  1. Orthopedic Surgeons
  2. Physical Therapists
  3. Everyone else.

Everyone else consisted of: medical students, physician interns and residents, active duty military physicians, and all physician specialists except for orthopedists.

As as side note, Physical Therapists who were not trained in the Army system or had not attended their specialized training did not as well as those therapists who had.

The lack of musculoskeletal education for generalized physicians is well documented. This study tells us a couple things: Not all healthcare providers are the same. The Army is very proud of its program.

As a first hand observer of this issue: I concur.