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John -- please answer the question!

Posted by Ed Davis, DPM on 11/13/04 at 10:21 (163820)

John:
This is now the 4th time in 3 days I pose the SAME question to you which you have failed to answer each time. My question is how do David Lowy of the Sonorex Treatment Center in Vancouver, BC, Sunny Jacob of Pain-Free treatment center in Ontario and the various Sonorex users obtain an extremely high success rate in the cure of intractable plantar fasciitis if you maintain that only high energy ESWT works?
Ed

Re: John -- please answer the question!

vince on 11/13/04 at 15:35 (163846)

Are there any studies that have followed these patients for 4-5 or more years and if so is there a significant number of patients still acceptably symptom free? I personaly, would not accept an in-house survey as credible.

Re: John -- please answer the question!

Dr. Z on 11/13/04 at 17:10 (163857)

Ed,
Please show me where John ever stated that High energy is better then low energy. My understanding of John comments were that High energy is FDA approved for pf and low energy isn't therefore until Low energy manfactors aim for FDA approval there should be no insurance approval for low energy treatments. There shouldn't hold you or anyone back from charging reasonable fees for your low energy treatments.

Re: John -- please answer the question!

vince on 11/13/04 at 17:52 (163863)

It's obvious why Dr. Davis is suddenly posting all these ads for low energy- He owns one-he told us he did in a previos post and he get paid by the patient 3 times for treating each foot instead of once if he used FDA APPROVED HIGH ENERGY. I wonder if he set up a closet in his office as an outpatient surgery center and bills for the technical fee also.

Re: John -- please answer the question!

Dr. Z on 11/13/04 at 19:19 (163867)

Be nice!!! Dr. ED does own a sonocur low energy three treatment device. Usually the total cost is for three treatments. So that one fee for three treatments The problem I have is that in my area( Northeast) there are doctors billing three times for three low energy treatments at a rate of $2000 per treatment. This is one of the reason why there is lost of insurance coverage

Re: John -- please answer the question!

john on 11/14/04 at 10:43 (163883)

Dr Davis,

I answered your question. Please show me the published results from David Lowy showing that he tested low energy ESWT against placebo. Until you show me the results, your statements about his success are suspect. As I have said many times, treating pain is subject to a high level of placebo effects.

You cite the cumulative experience with ESWT as evidence that it works, the same was said for arthroscopic knee surgery, a procedure that had been performed since the 1970s. In 2002, after careful study, if was determined that arthoroscopic knee surgery was not better than pacebbo. The experience of thousands of cured patients was not enough because the patients likely benefited from the treatment effect. You can read more at the following link:
http://www.mindbodyhealth.com/kneesurgery.htm

The point here is that the placebo effect is real and that the experience from others using low energy ESWT could be the placebo effect. We need carefully designed studies!

Re: John -- please answer the question!

vince on 11/14/04 at 17:39 (163902)

I am very suspicious about low energy- it didn't work for me- no FDA approval or effort to get approval for treating anything but lateral epicondylitis- Sunny Jacobs refusing to make the clinical data available- Dr Davis pushing the treatment- lots of studies that show it's not very effective and none that I can find that deals with how well it continues to work with those patients who claim that they had good results. I personaly think that it has no effect on the actual ligaments or tendons but merely causes a long time numbing of nerves in the area. High energy probably has the same effect on the nerves but I think it also starts a healing improvement in the tendons and ligaments as well so the results are better and last longer.

In addition there I heard a rumors about a company in the east that was (or still is) treating with low energy, and was billing with some code that shouldn't have been used. The rumor goes further to say that some podiatrists had to give back money to insurance companies.

I heard this from a a patient in my podiatrist office yesterday when I went with my wife. He was looking at a brochure about ESWT and we got to talking and that's when he told me that the podiatrist he had been going to stopped using the low energy because this was happening. He was at my podiatrist to see about getting his pf treatment done with FDA APPROVED HIGH ENERGY.

Re: John -- please answer the question!

vince on 11/14/04 at 17:48 (163903)

And Pauline- don't ask me any questions about who, what, when, and where. No further information will be posted- you can believe it or not- your choice. All that's important is that I know what's true or not.

Re: John -- please answer the question!

vince on 11/14/04 at 17:49 (163905)

And Pauline- don't ask me any questions about who, what, when, and where. No further information will be posted- you can believe it or not- your choice. All that's important is that I know what's true or not.

Re: John -- please answer the question!

Ed Davis. DPM on 11/14/04 at 18:54 (163911)

Vince:

So you work for Ossatron and are in their favor. I will compliment you for revealing that since it is only fair that readers know where we stand and what our biases are.

I truly wish their were studies out there fro everything we do in health care, but lets face it, only a small percentage of what we practice is backed by the kind of studies we are talking about. Many jestingly mention that aspirin, due to all of its potential side effects could never make it through the FDA today. We know for a fact that, for most people, if you have a headache, taking two aspirin will make it better. Sorry but there are no double blinded studies to that effect and probably never will be. Much of what we do in healthcare is based on experiences from our personal practice and by comparing notes with hundreds of other practitioners, now thousands due to the internet. The bottom line is, studies or not, when thousands are being cured with low energy ESWT it is very hard to attribute that to placebo effect. Yes, I would love to see more studies, but experiential evidence dwarfs the numbers looked at it the studies.
Ed

Re: John -- please answer the question!

Ed Davis. DPM on 11/14/04 at 18:59 (163912)

John:

I am aware of the study but would need to read the entire study carefully before concluding that arthroscopic knee surgery is of little value as it is the standard of care in the orthopedic community.

The experiential evidence of the suceesses of low enrgy dwarf the numbers in the high energy studies. It is hihgly unlikely that David Lowy's and Sunny Jacob's treatment successes can be attributed to the placebo effect especially when one considers that they are treating not just PF but intractable PF, something that a placebo is highly unlikely to have an effect on.
Ed

Re: John -- please answer the question!

Dr. Z on 11/14/04 at 19:29 (163920)

Ed,
Where does Vince state that he works for ossatron.? If he does I would like to ask him a question.

Re: John -- please answer the question!

Ed Davis. DPM on 11/14/04 at 19:43 (163926)

David:
It was in a thread a couple pages back. He is involved in a curent shoulder study with Ossatron, but am unsure if he revealed who his actual employer was. I did not ask as I feel it is only important for readers to know what poster's biases are.
Ed

Re: John -- please answer the question!

john on 11/14/04 at 19:46 (163928)

Dr Davis,

The article was published in the New England Journal of Medicine. I expect that it was carefully reviewed prior to publication. I would be interested in your review of the article and your comments on the placebo effect.

There are plenty of studies showing low energy does not work any better than placebo on patients with intractable PF. For example, 'Extracorporeal shock wave therapy for plantar fasciitis: randomised controlled multicentre trail', Haake et. al. published in BMJ, Volume 827 12 July 2003.

Participants: 272 patients with chronic plantar fasciitis recalcitrant to conservative therapy for at least six month: 135 patients were allocated low ESWT and 135 were allocated placebo. Results: No difference in results were found. Conclusion: ESWT is ineffective in treatment of chronic plantar fasciitis.

Haake tested low energy ESWT on patients with intractable PF and found a placebo effect. Have you seen this study? There are other negative studies.

I continue to support my statements with facts, research articles, and independent web sites.

Re: John -- please answer the question!

john on 11/14/04 at 19:50 (163931)

Dr Davis,

I think that you are getting Vince mixed up with Tony.

Tony said that he operated the Ossatron machine.

Vince said that he was a patient that had a failed low energy treatment. He commented that he received a successful high energy treatment and was upset that his podiatrist did not tell him that low energy treatments were not FDA approved. Vince wants his money back from the podiatrist.

Re: John -- please answer the question!

Ed Davis. DPM on 11/14/04 at 20:02 (163932)

John:

The New England Journal of Medicine also published the highly flawed Buschbinder study in which about half of the participants hould not have even been in the study as they did not meet the 6 month minimum criterion for PF.

I have read the stduy from Haake, et al. and it is the only study of value that really contradicts the body of evidence supporting low energy ESWT. What other studies on the level of Haake do you have? It is the only one I am aware of that is properly performed to the best of my knowledge.

All of the web sites I have provided are independent. Yes, a common denominator, if they are US based is use of the Sonocur becasue the Sonocur is the only low energy machine available in the US. The only research article you have provided that credibly goes against low energy has been Haake, et. al.

You can go to http://www.ismst.com to get a long list of articles. One thing to consider is that a lot of researchers are looking at numerous tendonopathies and enthesopathies throughout the body and have long moved on past the plantar fascia as their sole interest in not in presenting a case to the FDA.
Ed

Re: John -- please answer the question!

Ed Davis, DPM on 11/15/04 at 09:11 (163957)

john:
Yes, you are correct about the mix up.
Ed

Re: John -- please answer the question!

Ed Davis,DPM on 11/16/04 at 12:24 (164063)

vince:
I use MORE high energy than low energy. Not because high is better but due to the insurance situation. I am simply relating my experiences over many years in stating that I have seen no differences in results between the two. Again, you are making an example out of your own experiences but how do you feel about the experiences of thousands of others? Shifts to high energy are being made since third parties are calling the shots. In using high energy I feel that I am compromising between patient interests and insurance company policies. Certainly, no harm is being done to the patient, just the insurance company costs which do eventually show up as higher health care costs for all.
Ed