By GINA KOLATAGINA KOLATA NY Times: September 4, 2011 As Sports Medicine Surges, Hope and Hype Outpace Proven Treatments

Search for a cure Until she tore her hamstring a year and a half ago, Tina Basle ran marathons. Since then, she has been on a desperate search for a cure. It took her from doctor to doctor, cost her thousands of dollars and led her to try nearly everything sports medicine has to offer — an M.R.I. to show the extent of the injury, physical therapy that included ultrasound and laser therapy, strength training, an injection of platelet-rich plasma (or P.R.P.), a cortisone shot, another cortisone shot. M.R.I.ultrasound Finally, in February, she gave up.

Sports Medicine Medical experts say her tale of multiple futile treatments is all too familiar and points to growing problems in sports medicine, a medical subspecialty that has been experiencing explosive growth. Part of the field’s popularity, among patients and doctors alike, stems from the fact that celebrity athletes, desperate to get back to playing after an injury, have been trying unproven treatments, giving the procedures a sort of star appeal. But now researchers are questioning many of the procedures, including new ones that often have no rigorous studies to back them up. “Everyone wants to get into sports medicine,” said Dr. James Andrews, a sports medicine orthopedist in Gulf Breeze, Fla., and president- elect of the American Orthopaedic Society for Sports Medicine.

Problems The problem is that most sports injuries, including tears of the hamstring ligament like Ms. Basle’s, have no established treatments. Some remedies for certain injuries do work: putting a cast on a broken bone or operating to repair a torn Achilles tendon. But patients whose injuries have no effective treatment often do not know that medicine has nothing to offer. And many expect cures. broken bone Added to that is the effect of sports stars and their doctors. Patients “see a high-profile athlete and say, ‘I want you to do it exactly the same way their doctor did it,’ ” said Dr. Edward McDevitt, an orthopedist in Arnold, Md. The result is therapies that are unproven, possibly worthless or even harmful. There is surgery, like a popular operation that shaves the hip bone to prevent arthritis, that may not work. There are treatments, like steroid injections for injured tendons or taping a sprained ankle, that can slow the healing process. And there are fads, like one of Ms. Basle’s treatments, P.R.P., that soar in popularity while experts debate whether they help.arthritissteroid

The Economics - Information What works? The patient goes in and asks “what’s wrong” and the physician acts as his agent. Or … the patient goes in and says “I want the treatment that Tiger Woods got. If you won’t give it to me, I’ll get it elsewhere.”

The Economics - Testing Does anyone know what double blind tests are? They are the “gold standard” for testing. What are the criteria? Arrowsmith is my favorite double blind novel. Has anyone ever heard of Laetrile?