Craig,
The Americans are upset because although the treatment has been FDA
validated, the insurance companies will not in many, if not all cases,
accept claims for ESWT, apparently quoting the Buchbiner work as evidence,
and as a valid reason not to do so. But the patient group investigated in
the FDA study were the long term cases i.e. 6 months or more, and resistant
to treatment, not the short term cases. It is accepted that 85% or more of
new PF cases improve via conservative means, so this is not the patient
group the treatment is aimed at.
ESWT is deployed by a growing number of US Podiatrist in treating the long
term, chronic cases, recalcitrant to conventional treatments. And the
outcomes appear favourable. The dilemma is that HMO's and the like are
pretty much dictating doctors on what treatments they can offer their
patients. The doctors judgment is severly undermined. A patient can
therefore have PF surgery under insurance cover, but not the less damaging
ESWT, which appears to produce outcomes at least comparable to surgical
intervention. This is frustrating the hell out of a lot of doctors as well
as patients in the US, and some patients opt to travel to Canada for access
to the treatment. As the doctors can make equal money on either option I
don't think this reflects a financial bias for using the treatment, but a
heart-felt opinion that surgery can and does at times damage the patient,
and it is an unethical choice when there is a viable alternative.
This is not so much an attack on Buchbinder, although the undercurrent
seems to be that she is somehow "working for" or in collusion with the
insurance companies. I believe this is merely displaced frustration, as the
insurance companies do not seem to want to consider the evidence for
treating the chronic cases.
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