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Platelet-Rich Plasma

As I mentioned in a not-so-recent blog post, I’ve often marveled at the marketing successes of “integrative” medicine – a practice which generally refers to the act of blending effective treatments with ineffective or untested/equivocal ones. Only the marketing elite know how integrative medicine became associated with enlightenment. Perhaps they’re the very same people who came up with the idea that women should be excessively concerned about cellulite? Thanks a lot, guys.

But I do find a lot of integrative medicine vexing because it often starts with a grain of truth, and then usually proceeds to make wildly exaggerated claims about its efficacy.

Take this one for example: platelet-rich plasma therapy. Featured on The Doctors (right after a segment about “Hungarian mud wellness treatment” I might add). You can watch the 6 minute clip or read my shortened transcript of Dr. Stork interviewing Steve Sampson, D.O.:

Dr. Stork: Obviously at this point it isn’t scientifically proven but can help so many potential problems.

Dr. Sampson: That’s correct… Everybody at home as well as the weekend warrior…

Dr. Stork: So whether it’s tennis elbow, jumper’s knee, or plantar fasciitis this thing offers hope.

Dr. Sampson: Through this treatment we’re able to promote healing naturally without any adverse effects of cortisone… What we do is take blood from a patient’s arm, put it in a centrifuge and filter out their platelets which are rich in the body’s natural healing properties called growth factor, and then looking under ultrasound guidance (like looking at a baby) we inject the patient’s own blood platelets directly into the elbow tendon to promote healing and regenerate the tissue.

Dr. Stork: So this is still in studies in terms of being scientifically proven. So how many treatments do people need?

Dr. Sampson: With chronic injuries, between 1-3 injections spread out by 4 week intervals.

Dr. Stork: What I love about this is it’s your own platelets, there’s no foreign injection of anything else, so if this does prove to be as beneficial as it has been in your practice, this is something that a lot of people at home might get benefit from.

Dr. Sampson: … This treatment has really revolutionized the way I do patient care, maximizing the body’s inherent ability to heal itself. It’s part of a whole field in medicine, called regenerative medicine, opening the doors to stem cells and various treatments where we’re realizing that we can unlock some natural healing by increasing blood flow and oxygen. We’re kick starting healing.

Dr. Stork: Many years ago I had several injections in my knee, and I wish we had had something like this back then because then I wouldn’t have had all those other worries that we have.

This script contains some typical integrative medicine speak: natural healing, regeneration, blood flow, oxygenation, etc. The interviewer clarifies that the procedure has not been proven effective – and then goes on to say how he wishes he could have had the procedure himself, expressing concern about the known risks of standard of care therapy, without any apparent concern about the unknown risks of the new procedure.

The Plot Thickens

I was hesitant to discuss the subject of platelet-rich plasma therapy at Science Based Medicine primarily because Dr. Sampson was a resident in my graduating class. However, it troubles me that he has chosen to promote a scientifically unproven therapy without an appropriately cautious tone. His willingness to perform and charge for unvalidated procedures is ethically questionable at best and morally objectionable at worst.

I found Sampson’s website to be revealing in a number of ways. First, he states that he is conducting research on the procedure:

“Multiple studies are underway to help further refine the treatment and demonstrate its efficacy.”

This reasoning comes straight from Tom Harkin’s play book. You’ll recall that he recently admitted to creating the NCCAM to “validate” alternative medicines and he openly chastised NIH scientists who were unable to find scientific evidence for their efficacy after 10 years of rigorous testing. Nonetheless, in Harkin’s mind, they hadn’t done their job.

Second, Sampson applauds doctors who are “promoting PRP’s widespread use.” This is concerning on many levels. In an era where we are trying to reform healthcare, reduce costs, and get physicians to practice evidence-based medicine, the last thing we need is the wild promotion of unproven and expensive therapies.

Third, there is a degree of exaggeration that makes me uncomfortable. While only 3 years out of residency training, Sampson states that he has “extensive experience” in treating many different complaints. His partner appears to be no more experienced, recently graduating from medical school in the Caribbean.

And fourth, Sampson shows a deep commitment to continuing his vision for PRP, science-be-darned, by forming an institute to promote his work called “The Orthobiologic Institute.” His reasoning for forming this institute must be at least partly (if not largely) monetary. One can only guess what he’s thinking from his website:

The size of the orthobiologic market focused on the knee and hip alone exceeds $1 billion annually and is growing at the rate of 20% per year.

And so it is with a heavy heart that I must wonder if Steve Sampson is redeemable as a physician and scientist. Just three years ago he seemed like a reasonable guy. Then he moved to California.

What do you think?

Posted in: General, Surgical Procedures

Leave a Comment (21) ↓

21 thoughts on “Platelet-Rich Plasma

  1. Nigel says:

    California -rebuked. *snap*

  2. Dr Benway says:

    What has happened to the practice of medicine? Why can’t state boards stop doctors from promoting unproven therapies – aka lying to the public?

    Liars use ambiguous statement to retain plausible deniability when cornered, e.g., “it’s not proven to work, but here’s how you can benefit from it.”

    The quacks have taught the public through sheer repetition that “not scientifically proven” is a mere formality.

  3. David Gorski says:

    I was hesitant to discuss the subject of platelet-rich plasma therapy at Science Based Medicine primarily because Dr. Sampson was a resident in my graduating class. However, it troubles me that he has chosen to promote a scientifically unproven therapy without an appropriately cautious tone. His willingness to perform and charge for unvalidated procedures is ethically questionable at best and morally objectionable at worst.

    No, that he was in your residency class is exactly why you should call him out for his promotion of unproven therapies. The correct order is to do the clinical trials first before promoting it as a cure-all for chronic wounds and other problems. You do the research first to see if it actually works, and then start offering it. Above all, you don’t go on The Doctors to promote it with such glowing words backed by such thin-to-nonexistent evidence.

  4. med humanities says:

    While Dr. Sampson’s style and claims might be a bit “out there,” if you look at the medical literature, you’ll find that it is not thin on the ground; the research has been done and is ongoing; and PRP has been found to be useful in many conditions. It is NOT a cureall.

    I have no personal interest, financial or otherwise, in PRP, I just want to set the record straight.

  5. the bug guy says:

    Okay, thinking back to my injured rotator cuff. One cortisone injection and several weeks of exercises for a full recovery. What’s my motivation to add more shots to the process? Especially one that feels so damn weird as one going into the shoulder joint? Not painful, just very creepy.

  6. Todd W. says:

    @the bug guy

    What’s my motivation to add more shots to the process?

    Oooh! I know! I know! To avoid…teh toxinz!!!one!!1

  7. Versus says:

    @ Dr. Benway:

    “What has happened to the practice of medicine? Why can’t state boards stop doctors from promoting unproven therapies – aka lying to the public?”

    State Boards CAN stop doctors if they know about it, but someone must turn them in. I suggest those of you who are concerned file a complaint with the California medical board. If you don’t have “standing” to do this (e.g., if California limits complainants to state residents or to patients of the offending doctor) you can at least write a letter of concern to the Board and they can likely order an investigation. It just depends on each state’s laws in determnining how to proceed. I thought MDs had an ethical (perhaps legal, I don’t know) duty to report this sort of thing.
    My state allows anyone to file a complaint against a licensed health care provider, and I have.

  8. Joe says:

    Val wrote “But I do find a lot of integrative medicine vexing because it often starts with a grain of truth, and then usually proceeds to make wildly exaggerated claims about its efficacy.”

    I wish I could remember where I first read that; but the “grain of truth” idea changed my approach. I can’t say that I have become more effective; but I understand deluded ideas better.

  9. Zetetic says:

    Does this run afoul with FDA guidelines for the use of blood products?

  10. Dr Benway says:

    Through this treatment we’re able to promote healing naturally without any adverse effects of cortisone…

    The word “natural” has no scientific meaning. It’s a marketing term aka a bullshit term. For bullshitters. Doctors are supposed to do better.

    Just FYI.

    …the research has been done and is ongoing; and PRP has been found to be useful in many conditions. It is NOT a cureall.

    Experimental therapies should be restricted to registered trials so everyone can learn about their risks and benefits prior to widespread use. Going on TV to promote the use of an experimental therapy apart from a registered trial is not ethical.

    A couple of years ago, I’d have shrugged and said, “whatever floats your boat.” But then the quacks got busy with kids. That’s when I woke up. Quackery on kids who can’t consent is just fucking, fucking, fucking, hugely evil.

    Any quackery that becomes popular enough gets used on kids.

  11. nitpicking says:

    What could be more natural than cortisol, a hormone each of us is producing right now? Why is growth factor, a different hormone, more natural or automatically safer?

  12. khan says:

    “Multiple studies are underway to help further refine the treatment and demonstrate its efficacy.”

    A statement such as this should be an automatic signal that something is not to be taken seriously.

  13. TsuDhoNimh says:

    With chronic injuries, between 1-3 injections spread out by 4 week intervals.

    That’s 1-3 months of therapy. I assume the PRP post-procedure therapy also includes rest, massage, and heat. He says, “Patients are encouraged to participate in physical therapy following the injection which enhances recovery. ” (and what if they had a dummy injection? huh? )

    accelerate healing of tendon injuries and osteoarthritis naturally without subjecting the patient to significant risk Until he’s done the studies, how do we know what the risk is? How can he claim it’s insignificant?

    During this time, the patient receives either local anesthetic (injected) or conscious sedation (via IV), as determined beforehand by the physician and patient. And this is risk-free? Natural? Somehow better than cortisone?

    Dr. Sampson is currently leading a clinical study on the effects of PRP Therapy and osteoarthritis pain. It doesn’t show up on http://clinicaltrials.gov … has he filed the right paperwork or is he winging it?

  14. TsuDhoNimh says:

    I also looked at his “Platelet rich plasma injection grafts for musculoskeletal injuries: a review” from his website.

    Much blather, and no real analysis. Cherry-picking studies and handwaving.

    If this stuff WORKED, I know some orthopedic surgeons and sports docs who would have mentioned it … they would love to cut down on surgery, minimize risk, etc.

  15. TsuDhoNimh says:

    This article is much more cautious:

    Platelet Rich Plasma: Myth or Reality? ; Hom-Lay Wang and Gustavo Avila University of Michigan, USA
    Eur J Dent. 2007 October; 1(4): 192–194
    http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2609914&tool=pmcentrez

    Currently there is a paucity of critical scientific data regarding the beneficial effects of platelet rich plasma in clinical procedures. There have been animal and human studies both purporting and refuting its adjunctive positive effect. In theory, PRP has many beneficial effects such as autologous supply of growth factors and improved wound healing. In addition it is relatively inexpensive and readily available. However, from the current available literature it is clear that there is great variability in study design, clinical and radiographic parameters that were measured, and clinical outcome. Many studies claiming a positive beneficial effect suffer from a poor study design. Many have no controls or a limited sample size. In general, conclusions advocating for an adjunctive effect are not supported by the study design. Therefore, the use of this material cannot be supported at present, and further controlled, prospective clinical trials are urgently needed.

  16. knidsrok says:

    If this stuff WORKED, I know some orthopedic surgeons and sports docs who would have mentioned it … they would love to cut down on surgery, minimize risk, etc.

    Well, actually, there are quite a few orthopedic surgeons and sports docs using it on high-profile patients. Dr. Neal Attrache, for one, treated Takashi Saito of the LA Dodgers with PRP, and most likely did the same during the rehab following the ACL/MCL repair he performed on Tom brady. Troy Polamalu and Hines Ward of the Pittsburgh Steelers were both treated with PRP by their team’s doctors.

    Now, I’m hardly an expert, but it seems to me that there is more than just a “grain” of truth to PRP. Obviously, Sampson is a quack and is pitching his new platelet rich snake-oil to make a buck, is the jury really already in on PRP? Can it already be written off, or is it just a case of it receiving undue, premature hype?

  17. qetzal says:

    FWIW, there are a lot of published randomized controlled trials on PRP listed in PubMed (I got 151 hits). They cover a lot of different applications, and some do report positive results.

    However, I could only find one on the use of PRP for tendon healing: Silva & Sampio (2009), Anatomic ACL reconstruction: does the platelet-rich plasma accelerate tendon healing? They found no benefit. Here’s the abstract:

    Recently, the use of hamstring tendons in anterior cruciate ligament repair has been increasing. However, tendon-to-bone healing occurs slowly, which can be a problem to an early return to sport activities. The use of growth factors from platelets seems to improve tissue healing. We enrolled 40 patients in a prospective study that were submitted to an anatomic reconstruction of the anterior cruciate ligament. Patients were sequentially enrolled into four groups: group A without platelet-rich plasma (PRP); group B with PRP in femoral tunnels at the end of surgery; group C with PRP in femoral tunnels at the end of surgery and intra-articular at 2- and 4 weeks after surgery; group D with PRP activated with thrombin in the femoral tunnels. All patients underwent magnetic resonance imaging of the knee 3 months after surgery to evaluate the signal intensity of the fibrous interzone (FIZ) in the femoral tunnels. We did not find any difference among the groups when comparing the signal intensity of the FIZ on magnetic resonance imaging.

  18. drlevy1224 says:

    I’d like to know why Dr Jones hasn’t done her homework on this- but I guess that’s to be expected from someone who is not board certified and doesn’t practice clinically. Since when is it unethical to promote alternatives to surgery? In order to make any progress in medicine we have to open our minds to new ways to treat old problems. Has she read the research published by Allan Mishra or investigated the ongoing multi-center FDA study that Sampson is involved in? Sounds like someone is using another person’s success to leverage their blog and spark controversy.

  19. Dr Benway says:

    Hi drlevy,

    How ’bout we let the on-going study finish and then, if the stuff works, we us it.

    I hear Val Jones has smelly feet and bad breath. Oh, and she’s mean to puppies. But I give her points for not over stating the data.

  20. Joe says:

    drlevy1224 on 20 Sep 2009 at 4:44 pm “Has she read the research published by Allan Mishra …”

    It seems Mishra has published one, clinical, pilot study. It had 15 subjects receiving PRP and 5 receiving sham injections. After 8 weeks, 3 of the controls withdrew. “CONCLUSION: Treatment of patients with chronic elbow tendinosis with buffered platelet-rich plasma reduced pain significantly in this pilot investigation. Further evaluation of this novel treatment is warranted. …” This is hardly compelling.

    http://www.ncbi.nlm.nih.gov/pubmed/16735582?ordinalpos=14&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

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