published 02/21/09
Super-duper ultrasound
ESWT is high tech, expensive, and the science is a confusing mess. A new study declares that it works … but guess who paid for the study?
The ESWT Saga Continues
A new study overconfidently declares victory, calling extracorporeal shock-wave therapy “safe and effective” for plantar fasciitis
by Paul Ingraham, Vancouver, Canada MOREclose
Credentials and qualifications
I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.
For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.
Credentials and qualifications
I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.
For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.
This article is an update to an earlier one, Dueling Studies! New research contradicts earlier research on the effects of extracorporeal shock-wave therapy for plantar fasciitis.
Never trust a scientific study when the title sounds overconfident.
“Radial extracorporeal shock wave therapy (ESWT) is safe and effective in the treatment of chronic recalcitrant plantar fasciitis,” declares a German researcher group in the American Journal of Sports Medicine.
It’s the “is” in that title that worries me — “is safe and effective” is just a bit too positive. For sure? Really? No rational person could possibly disagree? The science of aches and pains is rotten with curve balls and gotchas, and every researcher in the field should know it. Most scientific studies are contradicted by another dozen studies. This situation is no different.
“Is.” Ha! My foot.
This post does not attempt to draw any conclusions from this new research. I’m writing about it just because I’m interested in the way the story of ESWT research is going. This new paper is an interesting new plot twist.
Quick review of the ESWT controversy
The controversy has been going on for some time now. To quickly recap, ESWT uses strong sound waves — yes, you heard that correctly, sound waves — to “stimulate healing” in tissues, and its effect on plantar fasciitis (foot pain) has been studied a fair bit lately … without conclusive results. (See Dueling Studies! for a review of evidence so far.) Although approved in the US by the Food and Drug Administration (FDA) for treatment of plantar heel spurs and plantar fasciitis. It’s still not clear what that approval is based on, science-wise. And knowing the truth particularly matters because the therapy is an expensive alternative to cheaper therapies that also have a lot going for them — i.e. simple stretching, which is a much less controversial evidence-based therapy for stubborn plantar fasciitis.
A major conflict of interest
This new German study comes from the same (or similar) group of researchers that also published one of the other most positive-sounding studies about ESWT … so it’s not too surprising to see them coming out with another one.
At first glance, their experiment certainly appears to be well-conceived and executed. There’s nothing obviously fishy about what they did, and the results may be compelling. I am just not sure. There’s a lot of ways that research can look good and still be wrong.
What I do know is that this research group was entirely funded by Electro Medical Systems, manufacturers of ESWT devices, and that some of the authors are actually on that company’s payroll, both salaried employees and consultants. Hmmm. And they published a paper whose title is about as conservative and modest as a drag queen. It’s just not a confidence-inspiring combination.
How should a scientific paper be titled?
Typically a scientific paper about an experiment will have a nice dry and boring title like this:
“A certain type of experiment comparing yada to yada with etc. and jargon jargon jargon.”
That’s it. Neutral, descriptive, technical, “this is what we did” … not “we win, the controversy is over, neener neener neener,” which is pretty much how the Germans’ title comes off. And they are on the payroll of a company that makes the blasted equipment that they were studying. Uh huh. I’m sorry, but I have to take their results with a ten-pound grain of salt.
This research group was entirely funded by Electro Medical Systems … manufacturers of ESWT devices!
Perspective
Historically, science funded by people with a financial interest in the results has often been unreliable. But it’s not a total deal-breaker. It’s not reasonable to expect science to always and only be done by peopple who are completely objective — it’s not even possible, let alone practical.
And so, even with the conflict of interest, this research is still a worthwhile addition to the body of evidence. It wasn’t irresponsible of the American Journal of Sports Medicine to publish it — they are in the business of publishing whatever evidence might bear upon the discussion, and this does, and the conflict of interest is clearly stated. Journal readers aren’t generally fools — we can make up our own minds about the quality of the evidence. And, in this case, there is no way we are going to become fans of ESWT until more objective researchers have also given a thumbs up!
And the effectiveness of ESWT is largely a moot point, in my mind. Sure, I’d like to know one way or the other — but there’s definitely a risk of caring much too much about ESWT, because there are highly effective, much cheaper (like free), and more comfortable treatments for plantar fasciitis! ESWT is only a “worth a shot” option for a few plantar fasciitis patients who have already tried everything else and still haven’t gotten relief. For those people, it would be worth knowing if there was an evidence-based option. For 98% of plantar fasciitis patients, cheaper and more certain methods are good enough.
To close, a quick plug for my plantar fasciitis tutorial: this site is partially funded by sales of an extremely detailed tutorial about plantar fasciitis, with a lot more information like this. Detailed, conversational, well-researched — just try to find anyone else on the internet writing about plantar fasciitis like this! For chronic plantar fasciitis victims, it’s the best $20 you’ll ever spend. Read the first few sections of the plantar fasciitis tutorial for free.