Platelet-Rich Plasma

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?

(And here’s a more evidence-based take on platelet-rich plasma for problems like plantar fasciitis.)

Posted in: Surgical Procedures

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