♪ [THEME MUSIC] ♪
>> CAN YOU BELIEVE THAT
DOCTORS WHO ARE ORTHOPEDICS AND
SURGEONS DO NOT WANT TO DO
SURGERY?
IT IS A CRIMINAL OFFENSE.
IT IS A SHANDA.
BUT I HAVE ASSEMBLED WITH THE
HELP OF THE INFAMOUS ROCK
POSITANO, THIS GROUP OF THREE
HEALTH CARE PROFESSIONALS ARE
GOING TO TALK ABOUT THE NEW
PARADIGM OF HEALTH CARE,
NONSURGICAL ORTHOPEDICS.
MY FRIEND, DR. ROCK POSITANO,
WHO IS THE HEAD OF NONSURGICAL
FOOT AND ANKLE AT THE HOSPITAL
FOR SPECIAL SURGERY.
I CANNOT BELIEVE THIS MAN IS THE
CHAIRMAN EMERITUS OF SPORTS
MEDICINE, BRIAN HALPERN, AT THE
HOSPITAL FOR SPECIAL SURGERY,
AND DOUG SECKENDORF,
FROM MANHATTAN SPINE CARE.
SURGEONS, THAT IS YOUR BUSINESS,
HOW DO YOU TAKE CARE OF
PATIENTS WITHOUT SURGERY?
>> BECAUSE WE ARE NOT SURGEONS.
WE ARE NONOPERATING DOCS WHO
TAKE CARE OF 90% OF ALL
MUSCULOSKELETAL PROBLEMS.
BECAUSE 90% DON'T NEED AN
OPERATION.
10% NEED AN OPERATION.
>> HOW DO PEOPLE FIND OUT
ABOUT IT?
I KNOW FIRSTHAND BECAUSE MY WIFE
HAPPENED TO SEE ROCK, AND I KNEW
ROCK BECAUSE OF MY INVOLVEMENT
WITH THE COLLEGE OF PODIATRIC
MEDICINE.
WHAT ARE WE DOING TODAY TO OMIT
DOING SURGERY AND HOW ARE THE
THREE OF YOU WORKING IN THAT
INVOLVEMENT?
>> THIS ENVIRONMENT HAS BEEN
THERE FOREVER IN
MUSCULOSKELETAL CARE.
BACK PAIN, ANKLE AND FOOT PAIN,
ARTHRITIS, SHOULDER PAIN --
MOST OF THAT DOES
NOT NEED OPERATION.
MAYBE SOME INJECTIONS, SOME
REHAB, AND IN THE INSTANCE IT
DOES NEED OPERATION, THESE
PROFESSIONALS ARE SO GOOD THEY
WILL DIRECT YOU TO THE BEST
PERSON FOR THAT SPECIFIC
OPERATION.
>> LET'S TALK ABOUT PRP --
PLASMA.
WHAT IS THIS?
WHEN DO YOU RECOMMEND SOMEONE
WITH REGARD TO PRP?
>> WHAT WE TRY TO DO IS USE THE
MORE STANDARD, CONVENTIONAL WAYS
OF GETTING A PERSON BETTER.
DIFFERENT TYPES OF
REHABILITATION WHETHER IT IS
PHYSICAL THERAPY, ULTRASOUND, ET
CETERA.
WHEN WE FIND THAT THE PERSON IS
NOT DOING WELL, WE SAY THERE IS
ONE OTHER EFFECTIVE
ALTERNATIVE PROVIDED THAT IT IS
DONE BY SOMEONE WHO HAS A
TREMENDOUS AMOUNT OF EXPERIENCE,
INTEGRITY, AND KNOWLEDGE.
AT THAT POINT, WE WILL REFER
THEM TO DR. HALPERN AND WILL ASK
HIM TO DO A CONSULTATION TO SEE
FIRST IF THE PATIENT FITS THE
MODEL THAT HE HAS WORKED OUT,
WHERE A PERSON WILL DO VERY,
VERY WELL IF THEY DO A PRP
VERSUS SOMEONE WHO IS NOT A GOOD
CANDIDATE.
>> WE DON'T WANT TO DO
INSIDE BASEBALL.
WE WANT TO EXPLAIN WHAT THE
PLASMA PROGRAM IS AND HOW
IT IS BEING USED TODAY.
>> IT HAS BEEN AROUND FOR ABOUT
15 YEARS.
ORIGINALLY, IT WAS DONE ON
RACEHORSES AND ANIMALS, 
TO GET RACEHORSES BACK INTO
THE ENVIRONMENT BY INJECTING
PLASMA.
TAKE YOUR BLOOD, SPIN IT DOWN,
CONCENTRATE YOUR OWN PLATELETS,
INJECT THEM BACK INTO YOURSELF,
USE YOUR OWN BODY TO REBOOT THE
HEALING PROCESS.
>> IS THIS A TWO-STEP
PROCEDURE?
YOU TAKE THE PLATELETS AND THEN
YOU INJECT THEM OR ARE THEY DONE
AT THE SAME TIME?
>> SIMULTANEOUSLY, YOUR BLOOD
DOES NOT LEAVE THE ROOM AND YOU
DO NOT LEAVE THE ROOM.
TAKES LESS THAN AN HOUR.
>> WHAT IS THE RECOVERY ON
THE PLATELETS?
>> THAT IS A GREAT QUESTION.
THAT POINTS TO WHAT ROCK IS
TALKING ABOUT, PEOPLE INJECTING
PRP WHO DO NOT KNOW THE
PROTOCOLS.
THE RECOVERY IS DIFFERENT IF I
INJECT MY TENNIS ELBOW THAN
ARTHRITIC KNEE.
THAT WILL DEPEND ON HOW THEY
RETURN TO THEIR LIFESTYLE AS
QUICKLY AS POSSIBLE BY UTILIZING
THEIR OWN SYSTEM.
>> WE WERE TALKING IN THE
GREEN ROOM ABOUT PRP AND STEM
CELL.
THAT CERTAIN PEOPLE ARE
RECOMMENDING IT OR DOING THE
PROCEDURE WHO REALLY DO NOT HAVE
THE APPROPRIATE TRAINING.
WHEN I DID A GOOGLE SEARCH ON
BRIAN, I SAW PRP.
THERE'VE BEEN ARTICLES WRITTEN
ABOUT YOUR STUDIES.
BUT THERE ARE OTHER PEOPLE TODAY
WITH PEOPLE DOING SHOTS AND
INJECTIONS WITHOUT APPROPRIATE
PROFESSIONAL CARE.
>> PEOPLE ARE OPENING UP SHOPS
ALL OVER THE PLACE TO HAVE NO
RIGHT OR BUSINESS DOING PRP
BECAUSE THEY CAN MAKE A PROFIT.
THEY DON'T KNOW WHAT THEY ARE
DOING.
IT SHOULD BE AN MD OR DO,
PEOPLE WHO ARE NOT THAT REALLY
SHOULD NOT BE DOING IT BUT THEY
ARE.
YOU WANT PEOPLE WHO HAVE DONE
THE RESEARCH SO THEY CAN APPLY
THE RESEARCH TO EACH INDIVIDUAL
PERSON DEPENDING ON THE PROBLEM,
BUT YOU ARE RIGHT, IT IS A WILD
WEST WITH PRP.
IT IS NOT REIMBURSED, WHICH IS
INSANE.
EVERYBODY IS JUMPING ON THE
BANDWAGON DOING IT FOR
EVERYTHING.
PRP IS USED FOR HAIR LOSS, PRP
FACIALS, PRP FOR THIS AND THAT.
>> BUT IT DID NOT HELP ROCK.
>> ROCK LOOKS GREAT NO MATTER
WHAT YOU DO.
[LAUGHTER]
>> IT IS A LITTLE BIT HARDER IN
SPINE BECAUSE WE CANNOT LOOK
AT THE SPINE AND SAY YOU HAVE A
TORN TENDON LIKE YOU CAN IN THE
ELBOW, IDENTIFY IT ON THE MRI
AND SAY, WE ARE GOING TO INJECT
PLATELETS IN THIS AREA.
THE SPINE IS MUCH TOO
SCHIZOPHRENIC WHERE WE DO NOT
ALWAYS KNOW EXACTLY.
>> WHAT TYPES OF PROCEDURES
ARE YOU DOING SINCE YOU CANNOT
USE THE PRP OR STEM CELL?
>> WE ARE STILL STUCK WITH
TRYING IT IN AREAS WHERE WE
BELIEVE JOINTS MIGHT BE THE
CULPRIT, THE JOINTS IN THE
LUMBAR SPINE OR NECK, OR JUST
GOING BACK TO EPIDURAL STEROID
INJECTIONS AND USING CORTISONE
TO DECREASE INFLAMMATION.
THE IDEA THAT WE CAN TAKE A
DEGENERATIVE DISC OR ARTHRITIC
FACET JOINTS INTRODUCING
PLATELETS --
>> YOU BRING UP AN
INTERESTING POINT.
I REMEMBER A NUMBER OF YEARS
AGO, I THINK THAT EVERYBODY HAS
A DISLOCATED L4, L5 -- THAT WAS
SOMETHING I HAD.
I REMEMBER GOING TO A DIFFERENT
HOSPITAL AND THE
ANESTHESIOLOGIST WHO DID THE
EPIDURAL STEROID, I COULD NOT
WALK BEFORE, AND FORTUNATELY HE
DID IT THROUGH A FLUOROSCOPY,
BUT MANY PEOPLE CONSIDER TAKING
SHOTS MORE OFTEN THAN THEY
SHOULD.
WHAT ARE YOU RECOMMENDING
IN TODAY'S WORLD ABOUT SHOTS
AND OTHER PROCEDURES?
>> AT THE HOSPITAL FOR SPECIAL
SURGERY --
WHICH BY THE WAY, WE ARE ALL
PRIVILEGED TO BE A PART OF THIS
INSTITUTION.
IN MANY RESPECTS, WE ARE VERY
FORTUNATE TO BE A PART OF THE
COMMUNITY.
WHEN YOU ARE A PART OF THAT
COMMUNITY, YOU ARE ALSO EXPOSED
TO THE BEST THERE IS.
WE HAVE A GROUP THAT DOES
ULTRASOUND GUIDED INJECTIONS
WHICH MEANS IN THE OLD DAYS, YOU
WOULD SAY TO A PERSON, WHERE
DOES IT HURT YOU, AND THEY SAY
HERE, AND YOU WOULD TAKE A
NEEDLE, STICK IT IN, AND
HOPEFULLY HIT THE RIGHT SPOT.
THE THING ABOUT
ULTRASOUND-GUIDED INJECTIONS
WHEN IT DEALS WITH A FOOT -- IT
IS SUCH A -- AREA WITH TENDONS
LIGAMENTS, MUSCLES --
I ONCE TOLD A PATIENT, GIVING AN
INJECTION SHOULD NOT BE LIKE
GOING TO DISNEYLAND, YOU SHOULD
KNOW EXACTLY WHERE IT IS GOING.
THE ULTRASOUND GUIDED TECHNOLOGY
HAS DONE WONDERFUL THINGS FOR
HELPING PATIENTS' OUTCOMES TO BE
FANTASTIC.
IN THAT RESPECT, THAT TYPE OF
TECHNOLOGY REALLY IS ONE OF THE
MAJOR ADVANTAGES GOING BACK TO
WHAT BRIAN SAID THAT MAKES
NONSURGICAL MUSCULOSKELETAL CARE
SO EFFECTIVE.
>> BUT THE MAINSTAY IS --
>> THE MAINSTAY IS WHAT DOUG
DOES, PUTTING HIS HANDS ON A
PATIENT TO MAKE SURE THEY DO
BETTER.
HIS PATIENTS GET BETTER.
ROCK DOES THE SAME THING LOOKING
AT ANKLE AND FOOT, AND MYSELF AS
WELL.
INJECTIONS ARE DOWN THE LINE AND
VERY HELPFUL WHEN WE USE THEM.
>> HOW OFTEN SHOULD THESE
INJECTIONS --
I WAS WITH A FRIEND WHO SAID HE
PLAYED A LOT OF TENNIS, AND HE
TRIED TO GET AN INJECTION IN
BOSTON AND THE DOCTORS REFUSED
TO DO IT.
SURGERY IS WONDERFUL FOR CERTAIN
CONDITIONS, BUT IT SHOULD NOT BE
USED ALL OF THE TIME AND THAT IS
A SPECIALTY THAT THE THREE OF
YOU -- HOW DO YOU MAKE THE
DETERMINATION OF WHAT TYPE OF
WORK YOU SHOULD HANDLE?
SOMEBODY COMES TO YOU IN THE
SAME MANNER THAT I MENTIONED
MY WIFE -- SHE WENT TO ONE
ORTHOPEDIST WHO SAID SHE NEEDED
BACK-SPINE SURGERY BUT IT REALLY
RELATED TO HER ANKLE.
YOU WERE ABLE TO GIVE HER
DIFFERENT PROCEDURES.
YOU HAVE NEVER GIVEN HER A SHOT.
>> YOU ARE ASKING THE ANSWER TO
WHAT IS A VERY DIFFICULT RIDDLE
TO SOLVE OFTEN.
THAT IS WHY I SPEAK TO ROCK AND
BRIAN FIVE TIMES A DAY, SIX
TIMES A DAY.
WE ARE ALWAYS COMMUNICATING.
>> YOU ARE CULTIVATING A
TEAM EFFORT.
>> CORRECT.
>> INSTEAD OF ONE PERSON
SITTING IN A VACUUM MAKING A
DETERMINATION.
>> WE HAVE BEEN SOCIALIZED
INTO THINKING I HAVE PAIN HERE,
WHERE DOES THE SHOT GO?
A LOT OF TIMES WHAT WE WILL DO
IS WE WILL TRY TO WORK TOGETHER.
SOME PEOPLE ARE IN SO MUCH PAIN
THAT THE NEXT STOP IS A
CORTISONE INJECTION SO THEY WILL
FEEL LESS PAIN.
BUT A LOT OF TIMES, PEOPLE ARE
FUNCTIONAL ENOUGH AND ONCE WE
TEACH THEM THAT THE IDEA IS
AVOIDING SOMETHING THAT IS
PROVOCATIVE.
>> THE BOTTOM LINE IS THAT
PATIENTS ARE COMING TO THE THREE
OF US BECAUSE THEY ARE A, IN
PAIN, OR B, CANNOT FUNCTION.
IT IS OUR JOB TO FIND OUT WHAT
IS THEIR PAIN GENERATOR.
IN THE SHOULDER, IF YOU INJECT
THE WRONG THING, THEY ARE NOT
GOING TO GET ANY BETTER.
>> I KNEW A GUY THAT WAS A
PSYCHIATRIST SUBSEQUENTLY
TRAINED IN PAIN MANAGEMENT.
HE USES TRIGGER POINTS --
>> WE TALK ABOUT THIS ALL OF THE
TIME.
THINGS CAUSE TRIGGER POINTS OR
TENDER POINTS.
THEY ARE THE RESULT OF THE
PROBLEM.
THEY ARE NOT THE PROBLEM.
WHERE YOU COULD SAY, OH YOU HAVE
A TENDER POINT HERE, LET ME
INJECT YOU WITH STEROID,
THAT IS MUCH SIMILAR TO REMOVING
THE LIGHT IN YOUR CAR THAT SAYS
LOW OIL.
WHERE ROCK AND BRIAN, AND I COME
INTO ACTION IS, WHAT IS CAUSING
THIS DEFICIENCY?
WHAT ARE THE RIGHT EXERCISES,
WHAT'S THE RIGHT APPROACH?
YOU SHOULD NOT NEED TO BE
GETTING STEROID AND INJECTIONS
REPETITIVELY.
>> DOESN'T IT GO BAD IF
YOU HAVE TOO MANY OF THESE
INJECTIONS?
>> YOU SHOULD NOT HAVE TOO MUCH
STEROID PERIOD BECAUSE IT
AFFECTS THE ENTIRE SYSTEM.
YOU HAVE TO BE CAREFUL WITH
THAT.
STEROIDS IS ONLY ONE OF THE
THINGS YOU CAN INJECT.
YOU CAN INJECT MANY DIFFERENT
THINGS.
>> SALINE.
>> THERE WAS THE STUDY OF PRP
AND STEM CELLS WITH THE
PLACEBOS .
MANY PEOPLE THOUGHT, THEY'RE
FEELING BETTER BECAUSE THEY HAD
THE SHOT.
IN REALITY, IT WAS THE PLACEBO.
IT IS THE PSYCHOLOGICAL --
>> THE PLACEBO EFFECT IS VERY
REAL.
ABSOLUTELY REAL.
IT IS NOT LIKE YOU GOT NOTHING.
THE GOOD STUDIES ARE LOOKING AT
THE PLACEBO EFFECT VERSUS THE
INTERVENTION.
THE INTERVENTION IS BETTER THAN
JUST A PLACEBO.
>> WHAT TYPE OF
INTERVENTION ARE WE DOING TODAY
IN ORTHOPEDICS, FOOT AND ANKLE,
FULL-BODY, AND SO ON?
>> THE DIAGNOSTIC CAPABILITY AND
THE INTERPROFESSIONAL
COMMUNICATION.
THE NEW PARADIGM IS, WE REALIZE
THAT ALL OF THE BODY PARTS SORT
OF TALK TO ONE ANOTHER.
WHEN BRIAN GETS A PERSON THAT
HAS A TYPICAL KNEE PAIN OR DOUG
GETS A TYPICAL BACK PAIN,
THEY WILL TAKE A LOOK AT THE
WAY THEY STAND OR WALK.
I THINK THE REALLY IMPORTANT
PART, MANY PARTS OF THAT
QUESTION, BUT I THINK PROBABLY
BRIAN AND DOUG CAN PICK UP ON
THIS, IS THAT WE REALIZE THAT
EVERYTHING IS CONNECTED.
FOR YOU TO JUST LOOK AT
SOMEONE'S KNEE WITHOUT LOOKING
AT THEIR HIP OR THEIR FOOT IS
PROBABLY NOT A VERY GOOD IDEA.
WHAT WE HAVE BEEN ABLE TO DO IS
BRING ALL OF THESE AREAS
TOGETHER AND SHOW HOW THEY
INTERCONNECT AND WORK.
I REALLY THINK THAT IS WHAT
MAKES THE PARADIGM THAT WE DO AT
THE HOSPITAL FOR SPECIAL SURGERY
SO DIFFERENT BECAUSE WE LOOK AT
THE FACT THAT EVERYTHING IS
CONNECTED.
>> SO WHAT ROCK IS SAYING
IS THAT WE ARE TREATING THE
INDIVIDUAL PERSON, NOT THEIR
INDIVIDUAL PART.
>> RIGHT.
WE ARE IN PATIENT CARE.
YOU ARE HURTING, YOU COME TO US
FOR HELP, AND WE ARE TRYING TO
FIGURE IT OUT.
BUT IT IS ALL ENCOMPASSING.
>> WHAT ABOUT ARTHRITIS?
>> THAT IS A HUGE INVESTMENT OF
MONEY RIGHT NOW BECAUSE
ARTHRITIS HAPPENS AS WE GET
OLDER HAS MANY COMPONENTS TO IT.
INFLAMMATION, OBESITY,
MALALIGHMENT.
WE ARE LEARNING MORE AND MORE
ABOUT THESE CONDITIONS THAT WE
ARE ALL GOING TO HAVE AS LONG
WE ARE ON THIS EARTH.
WE WANT TO FUNCTION BETTER,
ISOLATE OUT VARIOUS MARKERS THAT
ARE CAUSING THIS ARTHRITIS, WHAT
WE CAN DO TO AFFECT THE OUTCOME
OF THE ARTHRITIS RATHER THAN
TREATING THE PAIN, MAYBE WE
CAN CHANGE THE COURSE OF THE
ARTHRITIS.
IN THE RHEUMATISM WORLD, THERE
ARE ALREADY DISEASE MODIFYING
DRUGS THAT LITERALLY CHANGE THE
COURSE OF THE RHEUMATOLOGICAL
DISEASE.
IF YOU HAVE A DEBILITATING
RHEUMATOID ARTHRITIS, AND YOU
HAVE YOUR JOINTS BEING WASTED
AWAY, YOU TAKE THESE DRUGS
CALLED BIOLOGICS, THEY HAVE
RISK FACTORS, BUT THEY CAN
CHANGE THE COURSE OF THAT
DISEASE.
WE ARE NOW TRYING TO APPLY THE
SAME SCIENCE TO OSTEOARTHRITIS.
ALL OF THE WEAR AND TEAR.
THE KNEE AND SPINE ARTHRITIS,
THE ANKLE AND FOOT ARTHRITIS.
IN ROCK'S CASE, THEY CAN UNLOAD
THAT JOINT AND MAKE IT NOT WEAR
AS QUICKLY AND THAT'S
APPROPRIATE.
IN DOUG'S CASE, 
THE RIGHT POSTURE, THE RIGHT
PROGRAM, HOW YOU SIT, HOW YOU
STAND, WORKS ON THE FLEXIBILITY.
THAT IMPACTS IT.
>> HOW MANY INSTITUTIONS ARE
TRAINING THE NEXT GENERATION TO
UNDERSTAND THIS?
YOU GO TO SCHOOL, YOU COMPLETE
YOUR RESIDENCY, YOU ARE AN
ORTHOPEDIC SURGEON.
THE SURGEON'S JOB IS TO CUT.
HOW DO YOU TRAIN THE NEXT
GENERATION OF YOUNG PHYSICIANS
WHO WILL GET INVOLVED INTO THE
SPECIALTY TO LEARN WHAT THE
THREE OF YOU ARE DOING AS
OPPOSED TO THE TRADITIONAL
MEDICINE WE HAVE HAD IN THE
PAST?
>> IT GOES WITH THE INDIVIDUAL
SPECIALTIES.
YOU WILL STILL TRAIN THE
ORTHOPEDIC SURGEON TOWARD THE
SURGICAL PIECE.
IN THE PRIMARY SPORTS MEDICINE,
WE START AS PRIMARY CARE
DOCTORS, ER DOCS, PODIATRISTS,
AND THEN WE GET SPECIALTY
TRAINING IN SPORTS AND
MUSCULOSKELETAL CARE,
AND THEN WE APPLY THE
ENTIRE CONTINUUM TO THE PATIENT.
WE HAVE THE BACKGROUND OF ALL OF
THE OTHER THINGS.
WE JUST APPLY THE
MUSCULOSKELETAL.
>> ARE THERE RESIDENCY
PROGRAMS TODAY IN NONSURGICAL?
>> THERE ARE FELLOWSHIPS IN
NONSURGICAL SPORTS MEDICINE.
I WAS THE FIRST FELLOW IN THIS
COUNTRY TO BE A NONOPERATIVE
FELLOW IN 1983.
NOW, THERE ARE APPROXIMATELY 200
FELLOWSHIPS FOR PRIMARY CARE
SPORTS MEDICINE.
IN THE COUNTRY, WE HAVE A
MEMBERSHIP OF PRIMARY CARE
SPORTS MEDICINE DOCTORS THAT
SURPASSES 4000 DOCTORS.
>> YOU STILL NEED THE PHILOSOPHY
OF THE INDIVIDUAL SURGEON
HOWEVER TO ELEVATE HIMSELF OR
HERSELF TO SAY, HOLD ON A
MINUTE.
AND NOT OPERATE JUST BECAUSE AN
MRI LOOKS A CERTAIN WAY OR A
SYMPTOM LOOKS A CERTAIN WAY.
IT TAKES A CERTAIN TYPE OF
PERSON.
WE ARE NOT TRAINING SURGEONS TO
NOT OPERATE.
>> BUT IF I LISTEN TO THE
SITUATION, HSS STANDS FOR
HOSPITAL FOR SPECIAL SURGERY.
>> CORRECT.
>> YOU ARE NONSURGICAL.
>> RIGHT.
WHAT HAPPENS IS IF YOU ARE LUCKY
ENOUGH TO COME TO A PLACE LIKE
HSS WHERE A LOT OF THE
SURGEONS ARE ENLIGHTENED
AND THEY SAY YOUR MRI LOOKS LIKE
THIS, SYMPTOMS LOOK LIKE THAT,
BUT FIRST, LET'S SEE IF THESE
DISCIPLINES CAN GET YOU BETTER
AND IF THAT DOES NOT WORK, COME
BACK AND SEE ME FOR SURGERY.
>> AND HSS IS ADOPTING THAT
MODEL.
WE NOW HAVE 15 AND WITHIN TWO
YEARS, WE WILL HAVE 20
PHYSICIANS JUST LIKE ME AT HSS.
EVEN THOUGH THEY ARE THE
HOSPITAL FOR SPECIAL SURGERY,
THEY ARE THE BEST SURGEONS IN
THE WORLD FOR ORTHOPEDICS.
>> VERY INTERESTING PHENOMENON.
I RAN INTO A GUY AND HE WAS IN A
BOOT AND CRUTCHES AND I ASKED
WHAT HAPPENED.
HE SAID I HAD A PRP.
I SAID WHERE DID YOU HAVE IT
DONE?
HE SAID IT WAS IN KANSAS.
HE SAID THE COST ELEMENT WAS
MUCH LESS EXPENSIVE SINCE IT IS
NOT COVERED BY INSURANCE.
ARE PEOPLE DOING COST-CONSCIOUS
APPROACHES TRAVELING ALL OVER
THE COUNTRY?
>> SOME ARE, AND YOU HAVE
DOCTORS THAT DO NOT KNOW WHAT
THEY ARE DOING THAT ARE
UNDERCUTTING BECAUSE THEY CAN
BRING IN THE VOLUME.
IT IS AN INSANE ENVIRONMENT
RIGHT NOW.
WE ARE TRYING TO ESTABLISH
CRITERIA FOR WHAT PLATELETS WE
SHOULD INJECT.
>> RIGHT, SO YOU ARE DOING
PROTOCOLS.
>> EXACTLY.
>> WHAT IS THE NEW
SITUATION TODAY WITH STEM CELL?
>> STEM CELL IS NOT NEW, WE HAVE
USED IT FOR CANCERS FOREVER.
THE STEM CELL APPLICATION NOW 
HAS GONE A LITTLE BIT AWRY.
THERE IS NOT A LOT OF RESEARCH
DONE ABOUT STEM CELL.
PEOPLE ARE JUST INJECTING STEM
CELLS BECAUSE THEY CAN AND THE
CONCEPT IS BY INJECTING
SOMETHING, SOMETHING WILL
HAPPEN.
WE HAVE NOT PROVED THAT YET.
STEM CELL INJECTIONS ARE AHEAD
OF THE SCIENCE.
>> WHAT ABOUT THE
PHARMACEUTICAL COMPANIES, HOW
ARE THEY GETTING INVOLVED TO
MAKE CHANGES AND ADVANCEMENTS
TODAY?
>> AS A RULE, WE REALLY DO NOT
ALIGN OURSELVES --
>> I AM NOT SAYING THAT
YOU ARE ALIGNED WITH THAT, BUT
YOU WATCH TELEVISION AND YOU
SEE MORE PHARMACEUTICAL ADS FOR
EVERY HEALTH-CARE CONDITION
INCLUDING RHEUMATOID ARTHRITIS
AND OTHER CONDITIONS.
HOW ARE THESE MEDICATIONS WHICH
ARE BEING ADVERTISED IN
MAGAZINES AND ON TELEVISION
HAVING AN EFFECT ON PATIENTS
WHEN THEY COME TO VISIT YOU?
THIS IS THE EARTH SHATTERING
DRUG THAT IS GOING TO HELP SAVE
--
>> THE RHEUMATOLOGIST AND THE
RHEUMATOID ARTHRITIC WORLD
EVALUATE THE VALUE OF THE
BIOLOGICS THAT ARE COMING OUT,
THE SIDE EFFECT PROFILE, WHO
BEST FITS THE CHARACTERIZATION
TO HELP THEM.
THE PHARMACEUTICAL COMPANIES ARE
CONTINUING TO DO THE RESEARCH IN
THE VARIOUS BIOLOGICS.
THEY ARE BEGINNING TO ENTER THE
WORLD OF OSTEOARTHRITIS, AND HOW
DO WE AFFECT OSTEOARTHRITIS IN A
DRUG FASHION.
OR IN AN INJECTION FASHION.
>> FOR THE NOVICE WHO DOES
NOT KNOW, HOW DO THEY FIND
PEOPLE LIKE YOU AND OTHER
PHYSICIANS WHO ARE PRACTICING
DOING THIS NON-SURGICAL?
>> I THINK IT IS HARD.
WE ARE FORTUNATE.
WE USE EACH OTHER TO HAVE OUR
PATIENTS HAVE A CERTAIN TYPE OF
EXPERIENCE.
YOU ARE NOT GOING TO BE ABLE TO
OPEN UP A BOOK AND SEE AN
ADVERTISEMENT, COME SEE ROCK
POSITANO.
OUR PATIENTS COME TO US THROUGH
REFERRALS.
BUT I SAY ALL DAY LONG WITH OUR
PATIENTS, THERE ARE SO MANY
PEOPLE WHO DO NOT KNOW WHERE TO
TURN WHEN THEY HAVE A PROBLEM.
>> THAT IS THE BIGGEST QUESTION.
YOU BRING UP THE POINT ABOUT
ORTHOTICS.
PEOPLE THINK ABOUT OR THEY ARE
GOING TO THE DUANE READE AND
THEY SAY, THIS IS THE ORTHOTIC
I CAN USE.
PEOPLE HAVE A SPORTS INJURY, I
SHOULD PUT HEAT ON, NO, YOU
SHOULD PUT ICE ON.
PEOPLE ARE NOT AWARE OF WHAT
THE RIGHT PROCEDURE IS.
>> AND THEY REACH OUT TO DR.
GOOGLE.
>> AND THEN THEY LOOK AT
OTHER THINGS AND WHEN YOU PUT
NONSURGICAL, I WILL GET ONE OF
THE CLINICS AROUND THE COUNTRY
IN KANSAS CITY WHO HAS BEEN
ADVERTISING, WHO IS
PAYING FOR SPONSORED ADS ON
THIS SITUATION.
PEOPLE DO NOT KNOW WHERE TO GO.
>> THE OTHER GOOD THING IS THAT
WE ARE ALSO FORTUNATE THAT WE
HAPPEN TO BE AFFILIATED WITH
A MAJOR MEDICAL CENTER.
THE NEW YORK PRESBYTERIAN
HOSPITAL, CORNELL UNIVERSITY.
MANY OF THE INTERNISTS THERE
WILL KNOW RIGHT AWAY, WHERE DO
WE SEND SOMEONE WHO COMPLAINS
OF KNEE PAIN OR BACK PAIN
OR FOOT PAIN.
IN THAT RESPECT, THAT IS AN
IMPORTANT RESOURCE BECAUSE
IMMEDIATELY, THE PATIENT --
>> RIGHT.
YOU HAVE A GREAT TEACHING
HOSPITAL OVER THERE, HIGHLY
REGARDED.
SO BOTH OF THEM HELP.
>> THE OTHER THING IS KNOWING
WHICH PATIENTS WILL DO THE BEST
SURGICALLY.
DOUG, BRIAN, AND MYSELF WILL DO
EVERYTHING HUMANLY POSSIBLE TO
GET SOMEONE WELL.
WHEN IT COMES TIME, OK.
IT IS NOW TIME TO GO TO THE NEXT
STEP.
>> HOPEFULLY WE DO NOT GO
TO THE NEXT STEP WHEN THEY VISIT
THE THREE OF YOU.
I WOULD LIKE TO THANK MY
EXECUTIVE PRODUCER ROCK, BRIAN,
AND DOUG.
SEE YOU NEXT WEEK.
>> THANK YOU.
♪ [THEME MUSIC] ♪
