Dr. ZuckermanPosted by Fed Up Also on 3/02/05 at 19:55 (170329)
OK, I am going to ask a couple of questions regarding ESWT:
The FDA, during tests reported a mean percent of improvement of 56.2% during tests of the Dornier EPOS Ultra ESWT on January 15, 2002. Your website indicates that a 'Study shows that 90% of patients suffering with heel spur pain are completely satisfied with the results'.
1. What study shows a 90% satifaction rate?
A. Were they satisfied with procedure?
B. Were they satisfied with results?
C. What is time frame? Immediately? 3 Months? 6 months? 12 months?
2. Has the method of application changed since 2002?
A. If so, what has changed and where is data supporting the change?
3. Dr. Jonathan Cluett, M.D, Chief resident of orthopaedic surgery at a hospital in Washington, D.C. reports, 'If the shock wave treatments are helpful, the difference is small. The reports in the literature are quite variable, but even in studies that show a good effect of ESWT, it probably helps only 5-40% of patients. Therefore, a significant number of patients will still have pain after shock wave treatments. **Why the difference in opinions regarding this treatment?
4. The Physician and Sports Medicine Journal reports Nov 04, reports, 'Two recent important studies have cast doubt on the efficacy of ESWT.' and 'The efficacy of ESWT for the treatment of plantar fasciitis remains controversial. Initial studies showed promising results, and a recent meta-analysis supported its use. However, most of these studies are flawed, and some were funded by ESWT manufacturers, making their conclusions difficult to generalize. Currently, no standardized treatment protocol is used, and devices and patient populations vary widely among the studies.' QUESTION:**Who are potential patients to believe, a Dr claiming 90% satifaction, an Orthopedic Surgeon claiming it help 5-40% of patients, a journal, or the AMA?
**FURTHER QUESTIONS TO FOLLOW**
Re: ESWTDr. David S. Wander on 3/04/05 at 14:53 (170451)
I am not responding to your comments regarding Dr. Z's website, but I will respond to a study performed at Mass. General Hospital in Boston regarding ESWT and the Dornier machine. This study is often misquoted as patients reporting a 90% success rate. In actuality, the study reported an overall REDUCTION of pain of 92% for the entire study group at the end of one year. I believe the study group involved approximately 40-45 patients. Prior to the study the patients were asked to rate their pain on a scale of 1-10 (10 being the most pain) and the average pre-treatment score was a '7'. At the end of one year the same patients were asked to rate their pain and the average score was a 0.64 (or something like that) for an overall decrease in pain of 92% of the total study group over a one year period. This is not the same as a 92% success rate. Some of my details of the study might be a little inaccurate, but I think that my point is clear. In this particular study, there was an overall reduction of pain of 92% of the total study group at the end of one year, not a 92% success rate.
Hopefully this will give you some information on where that 90%+ number often appears. I do understand your concerns regarding the efficacy of ESWT. The majority of my patients respond to conservative care without the need for costly prescription orthoses (though these often are beneficial) and without the need for surgery or ESWT. However, if a patient has failed conservative therapy, I do believe that ESWT is an excellent alternative to surgical intervention, since surgical damage can be irreversible and unsuccessful. The disadvantages of ESWT are that it is not a guarantee to recovery and it is usually not covered by insurance plans and can be costly. The advantages of ESWT is that it may provide a percentage of the population pain relief without the need for surgery.
I do believe that more unbiased,double blind studies need to be performed to test the efficacy of ESWT. And I do feel that many doctors across the country have over-utilized ESWT with poor results. I personally know Dr. Z and do believe that he truly believes in ESWT and performs the procedure when he truly believes it is indicated.
Re: ESWTRalph on 3/04/05 at 17:02 (170466)
Thank you Dr. Wander for your interpretation. This number sure has been thrown around hasn't it. Some of the earlier posts really give this number a going over almost to the point of arguements. It must have been one hot topic.
If what you say is true, why don't all doctors who are providing ESWT just stick to the reality of this study and the 90% figure as it is actually stated.
I haven't look at Dr. Z's site, but if he or any doctor in their advertising misquotes isn't this being dishonest with the public?
I thought doctors police each other. If you find figures being misquoted by other doctors do you ask them to stop or change their advertising statements concerning ESWT and the 90% cure rate or just let it slide?
Re: ESWTDr. David S. Wander on 3/04/05 at 19:19 (170475)
It is difficult for me to explain why other doctors say or do things that I may not agree with. I may be naive, but I truly believe that many doctors quote the '90+%' number based on erroneous information they have seen or heard, without every actually reading the studies, therefore they are simply repeating inaccurate information.
As I previously stated I personally know Dr. Z and have never found him to attempt to mislead anyone regarding ESWT.
Although it sounds ideal, I simply don't have the time to 'police' every claim made by doctors that I don't agree with. As a past president of the Philadelphia County Podiatric Medical Society, I was involved with policing obvious false claims such as doctors advertising 'board certification' from unapproved boards, making inaccurate statements about procedures that don't exist (such as 'laser' bunion surgery which does not exist), etc. Unfortunately, every profession has it's bad apples that will attempt to mislead the public for financial gain. That it why it is important to be an educated consumer, do your homework and ask your doctor the right questions.
As stated twice before, I don't think it's Dr. Z's intention to mislead anyone and know that although he does a lot of ESWT he has strict criteria prior to scheduling a patient for ESWT. If you have a question regarding any statistics on his website, the best person to ask would be Dr. Z himself. I'm sure he'll give you a straight-forward answer.
Re: ESWTRalph on 3/05/05 at 10:03 (170502)
I saw Dr.Z's ESWT group website for the first time today. There sure are a lot of participating doctors in your group Dr.Z. and your site looks nice. Your members appear to be concentrated in Eastern States. Is this also the case for United's Group or are their members in different parts of the U.S.
I have to admit after reading some of the posts about United and your group I thought of the God Father movie thats why I wondered if both of you service the same areas.
In light of what Dr. Wander has explained about the 90%+ figure what does
the 94% good to excellent represent on your website?
Re: ESWTDr. David S. Wander on 3/05/05 at 12:37 (170509)
The website you're referring to is not 'my' website. The website belongs to Excellence Shock Wave Therapy. If you have a question regarding any comments on their site, you should email them and I'm sure they will answer your questions. I am a provider that uses the equipment supplied by Excellence Shock Wave Therapy and receive referrals from them for patients in my geographic area that are interested in ESWT. I have no ownership of the company.
Re: ESWTRalph on 3/06/05 at 08:22 (170560)
I thought I had read that Dr. Z owned the Excellence Shock Wave Therapy Group so my post was really directed to him. Maybe he will respond although he has been absent from the board lately.
Re: ESWTDR. Z on 3/06/05 at 10:11 (170563)
I am on vacation but just took a look at this post today. The 94% figure is from the people that were followed up from the one year after the ending of the FDA study. This is a Roles Maudsey scoring. The 92% is the Average VAS reporting one year after the FDA study started. The FDA study stopped at 12 weeks. All of these numbers are from printed literture from respected journal ( Foot and Ankle International)
Re: ESWTRalph on 3/06/05 at 11:46 (170569)
I don't know anything about Roles Maudsey scoring or VAS so I'm afraid I'm still in the dark. A more simple answer would do it for me. Does the 94% figure and the 92% that Dr. Wander explained come from the same study?
Re: ESWTDr. Z on 3/07/05 at 21:54 (170667)
It comes from the study published by Dr. Zingas and group.It was published in Foot and Ankle International. It is the Dornier Epos FDA study and a follow up of patients after the 12 week unblinding. I am sure you can find it online.