Orthopedics & Sports Medicine

May 27, 2018

Let’s bust this myth now: Don’t expect insurers to help cut medical bills

Patients who expect their health insurer will work in their interests to contain costs by medical providers might just as well hope for assistance from leprechauns, unicorns, or the tooth fairy.

Marshall Allen, a reporter for the Pulitzer Prize-winning investigative site ProPublica, has just penned a strong myth-busting piece, cross-posted on the National Public Radio site, about health insurers, writing:

The United States spends more per person on health care than any other country does. A lot more. As a country, by many measures, we are not getting our money’s worth. Tens of millions remain uninsured. And millions are in financial peril: About 1 in 5 is currently being pursued by a collection agency over medical debt. Health care costs repeatedly top the list of consumers’ financial concerns. Experts frequently blame this on the high prices charged by doctors and hospitals. But less scrutinized is the role insurance companies — the middlemen between patients and those providers — play in boosting our health care tab. Widely perceived as fierce guardians of health care dollars, insurers, in many cases, aren’t. In fact, they often agree to pay high prices, then, one way or another, pass those high prices on to patients — all while raking in healthy profits.

May 23, 2018

Overrun by sports performance chatter? Can questions on MBI bust the bunk?

by Patrick A. Malone

If you can get your favorite sports fans peeled away from the latest broadcast pro event ─ whether it’s the basketball playoffs, hockey championship series, golf tourneys, or the heating up baseball season ─ a conversation of sorts could be sparked by dropping numbers on them. See what kind of rise you can get by telling them their data-driven obsession with improving their own athletic performance may be built on shoddy calculation.

In the “Moneyball,” statistics’ crazy world of contemporary sports and athletic fandom, that statement could be heretical. But the numbers-driven folks at the web site “528” deserve credit for digging into a popular but dubious approach employed by researchers in sports medical science: Magnitude-based inference, aka MBI. Their article’s worth a read, especially for wonks and the numerically inclined. For those who are less so, here’s a taste of what’s at stake, as 528 reported:

At first blush, the studies look reasonable enough. Low-intensity stretching seems to reduce muscle soreness. Beta-alanine supplements may boost performance in water polo players. Isokinetic strength training could improve swing kinematics in golfers. Foam rollers can reduce muscle soreness after exercise. The problem: All of these studies shared a statistical analysis method unique to sports science. And that method is severely flawed.

February 11, 2018

Winter Games and Super Bowl offer health takeaways, too

by Patrick A. Malone

The Winter Olympic Games and the Super Bowl can offer fans not just exciting sports spectacles but also important health insights and information— everything from the risks of viruses and the value of hand washing to the dangers of head blows and why Americans may be slowly changing their minds about how they feel about violent recreations.

Let’s start with what can happen when you put more than 2,000 elite athletes from 92 nations in a village setting in Pyeongchang, South Korea. It’s no surprise that contagious illnesses can break out, and in this case the noxious norovirus. More than 100 cases of the highly infectious viral illness at the Olympic site have been confirmed already, and 1,200 people — many of them security guards for the Games — have been quarantined with disease symptoms. (The South Korean military has sent in forces to assist with security, in place of the quarantined guards).

Norovirus, aka the winter vomiting disease, is a gastrointestinal bug with other symptoms including diarrhea, nausea, and stomach pain, according to the according to the CDC. Its symptoms typically start 12 to 48 hours after patients come in contact with the virus. Symptoms might also include headache and body aches. Fever is uncommon. The sickness is highly contagious, spreading when viral particles get aerosolized over large areas. Hygiene becomes key in outbreaks, as public health experts have emphasized and global cruise lines have discovered.

February 2, 2018

Gymnastics scandal offers a tragic reminder of challenges in protecting kids

by Patrick A. Malone

His basic credentials would come under fire, but they were sufficient for the “doctor” to insinuate himself into major institutions, and, worse, into the lives of hundreds of girls and young women on whom he inflicted a tragic toll. His combination of enthusiasm — he was a rah-rah kind of guy— extreme controlling conduct, and horrific “treatments” never seemed to set off the red flags they should have.

Instead, Larry Nassar — an osteopath who served as an athletics and team caregiver for USA Gymnastics and Michigan State University — got away for years with abusing adolescent females put under his sway. He purportedly provided medical services to them, many in exclusive and demanding athletic camps where young participants were cut off from their friends, family, coaches, and personal physicians. He “treated” aspiring Olympians, at all hours of the night and day, alone and without any other adults around, in their bedrooms, on their beds — not in medical offices or athletic training facilities.

He enthusiastically told his patients, many of whom excelled at their sport because of their willingness to please adults and to be coached, that he could deal with their pains and injuries with what he termed pelvic manipulations in which he digitally penetrated them in their private parts. Without medical cause or justification, he conducted repeated and invasive “exams” of girls and young women’s genitals.

January 26, 2018

Repeated, lesser head hits, and not just concussions, linked to brain harms

by Patrick A. Malone

As the science keeps getting deeper, the news keeps getting worse about the harms that can be inflicted by repeated blows to the head in sports — and in life.

The path-breaking medical scientists at Boston University and elsewhere, who have helped to establish how concussions, notably in football, may lead to the onset of the neurodegenerative disease chronic traumatic encephalopathy or CTE, have told the Washington Post that their latest study may show that, “It’s really the hit that counts.”

January 12, 2018

Safety and injury prevention should be part of our new year exercise plans

by Patrick A. Malone

Millions of Americans may be hitting the gym as part of their new year resolve to get fitter. They also need to exercise caution and common sense to avoid injuries that could leave them in worse shape.

As the Washington Post reported, the 2018 health club crush will result in “hundreds of thousands of [exercisers] stumbling on treadmills, falling off exercise balls, getting snapped in the face by resistance bands, dropping weights on their toes and wrenching their backs by lifting too much weight.”

Further, the newspaper added:

December 31, 2017

Vegas shooting victims finding tough road to recovery from mass tragedy

by Patrick A. Malone

When illness, accidents, and natural- or man-made calamities strike, victims discover in their long slog to recovery that our health insurance system only aggravates their pain and anxiety. That’s a painful lesson that hundreds of Americans will keep struggling with in 2018, months after a madman rained gunfire from high-powered rifles down into a Las Vegas music festival crowd.

Modern Healthcare deserves credit for its follow-up of the October mayhem Nevada. It was part of what the industry publication calls an “epidemic of mass shootings,” tragedies stretching from San Bernardino, Calif., to Newton, Mass. They’re taxing hospitals’ capacities not only to provide large-scale emergency medicine but also to provide follow-up care — especially assisting survivors and their families and friends in dealing with their staggering medical expenses.

Victims in mass shootings, Modern Healthcare reported, confront a “proliferation of health plans with high deductibles and coinsurance requirements, leaving [them] exposed to many thousands of dollars in cost-sharing. Severely injured patients needing repeat surgeries may hit their out-of-pocket spending limits multiple years in a row, forcing them into bankruptcy. On top of that, even insured patients may face big balance bills if they are treated by out-of-network providers.”

December 28, 2017

Whoa, nelly: Equestrian sports found to be a top cause of adult brain trauma

by Patrick A. Malone

Get out of the crowds and traffic of the nation’s capital, and into the rolling green of Virginia and Maryland, where thrives the stately and multibillion-dollar business of breeding, raising, showing, and riding horses. That bucolic equestrian life also has a less-known health worry: Horseback riding, not a contact sport, turns out to be the top adult athletic endeavor that causes traumatic brain injuries.

Researchers in San Francisco scrutinized just under 5,000 cases, recorded between 2003 and 2012 in a federal nationwide data bank of adult sports-related trauma incidents, finding that “equestrian sports were the greatest contributors to sports-related” traumatic brain injuries, they reported in their recent article in the Journal of Neurosurgery.

As ABC-TV News noted of the researchers’ study, they found that “45.2 percent of [traumatic brain injuries] among adults were related to horseback riding, dwarfing the other causes. The second-leading cause of sports-related traumatic brain injury was falls or hits from contact sports like football and soccer, but that accounted for just 20.2 percent.”

December 22, 2017

It’s not a stretch: Avoid those over-use boo-boos, older yogis are warned

by Patrick A. Malone

For seniors who may be rushing to squeeze in a few more pretzel-twisting sessions to ease their stress from a hectic holiday season, this is a gentle reminder: Take it easy with the yoga. It can be good for you, but don’t overdo it or you may hurt yourself.

The Washington Post reported that the number of yoga devotees has climbed to an estimated 36.7 million Americans, many of whom find that stretching and posing in various styles makes them breathe and feel better, as well being more limber, focused, and relaxed. Yoga also has special appeal to older practitioners, 17 percent of them in their 50s and 21 percent 60 and older, according to a study conducted by a yoga publication.

But public health researchers from the University of Alabama Birmingham, after examining electronic data on almost 30,000 yoga-related injuries that led patients to emergency room treatment between 2001 and 2014, reported that:

November 17, 2017

Overzealous youth athletics can result in hobbled adults later

by Patrick A. Malone

Here’s another painful reminder to grownups about youngsters and sports: Moderation matters, and youthful games are supposed to fun, diverting, and character building—and most definitely should not leave today’s aspiring athletes as tomorrow’s hobbled adults.

The New York Times has reported on what a pediatric sports medicine expert has described as a “dirty little secret” of orthopedics, which is “the chance of getting arthritis within a decade of tearing a tendon or a ligament in the knee is greater than 50 percent.” And more and more youths, as they participate aggressively and frequently in sports programs, are undergoing surgeries on damaged or torn anterior cruciate ligaments, a procedure well-known as the ACL repair.

The sports medicine doc says he is gathering data for a study that will show that patients at 26 children’s hospitals he has focused on underwent 500 ACL repairs in 2005, but by 2014, more than 2,500 youths had these surgeries.