Hi Dieter,

>You wrote: "Buchbinder's NEJM literature review could be tainted by her
desire to support her original negative study.  I would have liked to see a
non- biased author perform a literature review. What we have are pro-ESWT
authors producing positive literature and anti-ESWT authors producing
negative literature."

Everyone is biased one way or the other.  Non-biased people do not exist.
Bias does exist in literature reviews as some authors omit articles which do
not prove their point.  Systematic reviews address this by systematically
reviewing the literature so that you cannot leave any trial out.  If you
want to call Buchbinder biased, point out a randomized, double-blind,
placebo-controlled trial that she purposively left out.  Don't call her
biased because of the results of her previous research, that's just petty.

>Dieter also said: "Finally, there is a growing body of evidence that ESWT
is indicated as a treatment of last resort... Buchbinder seems to ignore the
length of symptoms as she included in her review all articles, regardless of
duration of symptoms of the study participants."

Buchbinder only reviewed RCTs and pointed out that none of them provide any
evidence to support ESWT for any duration of symptoms except for a small
sample of 45 runners.  If people don't like the patient samples of these
trials set up a trial with the sample it should be tested on.  For now, if
your patient fits the decription of the sample in these trials, you should
be wary about using ESWT for them as it may be a waste of time and money.

Sorry, cannot comment on the very recent Ogden article at this stage as I
don't have a full-text copy of it yet.

>Dieter later wrote: "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."

Where's the evidence that ESWT has outcomes comparable to surgery.  I do not
know of any RCTs on surgical procedures for plantar fasciitis, let alone
six.

Finally, I don't understand why clinicians are only prescribing treatments
that the insurance company will cover.  Shouldn't the clinicians be
examining the evidence themselves and then deciding whether the treatments
are effective.  Not deciding purely whether insurance covers it?  Jeff makes
a good point regarding orthoses.  Should clinicians stop prescribing
orthoses just because insurance doesn't cover it?

Cheers,

Joel.

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