BMJ blogger Richard Lehman’s weekly review of medical journals is worth a weekly visit.
This week he comments on a New England Journal of Medicine article, “Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis.” He writes:
“To my mind, the words meniscal tear conjure up Monday morning at the surgery, with young men hobbling in to report crunching and swelling of their knee after a hard game of football on Saturday afternoon. The METEOR trial, however, was not interested in young amateur sportsmen: the mean age of the participants was 58 years, and 58% were female. Now at that age, about half of the knees you put through an MRI scanner will show meniscal tears of some sort, and in people with knee pain due to osteoarthritis, a judgment has to be made whether to interfere with the cartilage. If there is a financial gain to be made by interference, then you can expect arthroscopic trimming to follow swiftly. The alternative is physiotherapy, which was employed as a sophisticated-sounding package in the trial: participants were randomised to this or a prespecified range of arthroscopic procedures. A very worthy effort: undoubtedly there are far too many arthroscopic knee procedures carried out in the USA; and this trial showed similar outcomes in the two groups at 6 months. But it is a devil of a trial to generalize from. Of 14,430 patients assessed, 12,008 did not meet the trial criteria, and only 351 underwent randomization. Of these, 30% of the physio group had crossed over to surgery during the six months. So the intention-to-treat analysis does not really carry much weight, and I suspect orthopaedic surgeons will carry on doing whatever pays for the best and fastest car.”
On another, weightier topic, he writes:
“Orlistat, which interferes with fat absorption in the bowel, is the only drug treatment for obesity available in the UK and many other countries. The subtitle of the editorial which accompanies this article says that it is still a useful option for some obese patients, though that is not my experience. All it did is make me fart for England is one patient comment I remember; and since pétomania has not yet been adopted as an Olympic sport, this somewhat narrows its clinical usefulness. It mayor may notsometimes cause liver inflammation too.”
Petomania – in case you haven’t used it in Scrabble – is the art of musical farting, or the performance art of breaking wind for comedy, music or other “art” forms.
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