Wednesday, July 13, 2016

Transparency of Medical Research

In my practice I see many shoulder injuries.  Patients often come in with shoulder pain, and a rotator cuff tear is diagnosed.  I am not a surgeon, so I typically advise conservative treatment for these patients, to start, unless they are a young athlete with an acute injury, as I have seen many people return to full function without the need for surgery.  I recommend strengthening exercises, steroid injections, PRP injections, and osteopathic manipulations, depending on the medical history and the clinical symptoms.  Most patients vastly improve with these modalities alone.  I do, however, have some patients that end up requiring surgical intervention.

I decided it would be a good idea for me to calculate the "net treatment benefit" of conservative treatment and surgery, for rotator cuff tears.  I wanted to know the Treatment Score for each modality.  This way I could actually inform my patients of the success of conservative treatment versus surgical intervention, so as to give my patients the best possible chance for a full recovery, in the shortest amount of time.

I went to PubMed to look up studies on surgery versus conservative treatment for rotator cuff tears.  I actually found 2 studies on just this!  I went to the first study, which is titled, "Surgery or conservative treatment for rotator cuff tear:  a meta-analysis."  I was able to pull up the abstract, and saw that the conclusion was that conservative treatment was, in fact, just as good as surgery.  I wanted to know more:  how was the study done, what exactly was the difference in outcomes between the two treatment modalities, what is the actual percent improvement in each treatment?  I really was excited to enter these numbers into the STAR blocks.  I then tried to pull up the full text in order to fully understand the study, and was not able to.  I would be billed if I wanted to read the rest of the study!  My search was then over.  I cannot actually quantify the net treatment benefit of surgery or of conservative treatment for my patients.  I cannot go back and tell my patients that I have clear evidence that one way to treat their rotator cuff tear is better than another way.

This is a big problem with medicine these days.  Neither physicians, nor patients, can easily access all good studies, and determine what the best treatment is.  Studies need to be made public so that physicians and patients, alike, can determine the best possible treatment for every disease and injury out there.  Research needs to be transparent for full understanding.  If we can quantify and compare every treatment for every disease, then we would be able to more effectively eradicate and fix injuries and diseases that affect us every day.

Here at Treatment Scores, I am aiming to consolidate this information into an unbiased, and freely accessible source of information so that we can truly move forward in the healing and health of the world.

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