Orthopedics research now asks, 'Does it work?' rather than just, 'How is procedure performed?'

Article Abstract:

A brief report is presented from a meeting of the American Academy of Orthopaedic Surgeons (surgeons who operate on bone and joint, and surrounding structures) held in Anaheim, California, during which the topic of outcomes research was discussed. The feeling among many orthopedists (indeed, among specialists in many areas of medicine) is that it is time for the profession to focus more on evaluating the effectiveness of its remedies, and less on the development of sophisticated methods of diagnosis and treatment. Orthopedics is characterized by a variety of expensive elective procedures and by extreme variability throughout the country in the procedures performed. Procedures for which there is extensive disagreement concerning treatment approaches (total knee or total hip replacement) increased considerably in frequency and cost between 1986 and 1988, while the cost and number of hip fracture repairs (an essentially standard procedure) have not risen more than would be expected based on the increase in the patient population that needs this procedure. The scientific literature in orthopedics lacks outcome measures, and many research articles do not even describe the diagnostic criteria used. Additional weak points are poor statistical analysis, inadequate use of control groups, and lack of research into the causes of diseases. One review of the literature carried out by an orthopedic journal classified 24 of 28 articles on one topic as ''poor''. Most articles in the field focus on objective clinical measurements, omitting mention of patients' health and satisfaction. In many diseases, however (such as arthritis), ''subjective'' factors such as motivation and social support significantly affect the treatment outcome. Some orthopedists' groups have taken it upon themselves to improve their profession: in Maine, nine groups have been formed with the express purpose of reducing the surgery rates of colleagues whose rates lie too far above the state average. (Consumer Summary produced by Reliance Medical Information, Inc.)

Practice, Public opinion, Orthopedic surgery, Orthopedics

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Government extinguishes marijuana access, advocates smell politics

Article Abstract:

The US Public Health Service (PHS) has decided to revoke its approval of 28 applications to use marijuana under a compassionate-use program, but its critics claim the agency has political, not medical, motivations. James Mason, who heads the PHS, said the government would be condoning marijuana use, and the head of the Drug Enforcement Agency issued a report claiming there is no accepted medical use for marijuana. Many AIDS patients have requested marijuana, because it may cause weight gain by stimulating the appetite. There are few studies on the risks or benefits of marijuana therapy, although a US government study found no adverse effects of marijuana use. But a survey of 1,035 oncologists found that 44% of those responding had already suggested marijuana use to their cancer patients, and 48% would prescribe it if it were legal.

Health aspects, Laws, regulations and rules, Cannabis, Medical marijuana, Hamamelidae, United States. Public Health Service

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