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The Best Medicine 4 pages: | 1 | 2 | 3 | 4 |

Photo of Dr. David Janda M.D.Dr. David Janda, M.D., an orthopedic surgeon based in Ann Arbor, Michigan, directs the Institute for Preventative Sports Medicine—the only health care cost containment organization of its kind in North Americawhich he founded in 1989. Janda's original and independent research has been published in prestigious journals such as the Journal of the American Medical Association and widely lauded by his colleagues. Janda's findings have revealed simply ways to reduce millions of recreational injuries each year, thereby saving our nation billions of dollars in health care costs. The political implications of Janda's work have made him the target of slander, fraud and law suits. Janda writes about his experiences in his recent book, "The Awakening of a Surgeon." FRONTIERS talked to Janda about his research and his struggle to let his findings be heard.
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How many injuries are there per year in the U.S?
All causes of injury, motor vehicle, sports and recreation, unintentional firearms injuriesnot murder or suicideif you add all of those up, we have 62 million injuries in our country, and we spend over $150 billion in health care costs. Now, let's just look at student athletes ages 5 to 22. We have 12 million student athletes getting injured every year in our country, and the vast majority of those injuries are completely preventable. We could reduce close to 70% of recreational and sports injuries.

Which sports are the most dangerous?
The sport that comes up on the top is basketball. Close to 600,000 people a year head to the emergency room because of basketball related injuries. Most often, they're playing on a surface that's pot-holed and their ankle flips. So, one thing we have to look at is the playing surfaces, which are extremely important.

We've also done a lot of work in softball and baseball. Forty million folks in our country participate in organized softball leaguesnot including pick-up games. Another 15 million folks from the little T-ballers all the way up to the senior baseball folks play each year.

What actually started me on this road was a very simple observation I made at the University of Michigan in the emergency room. We were seeing a huge number of folks coming in at night during the summer with softball and baseball injuries. Over 70% of those injuries were due to sliding into that stationary base, that fixed immovable object. Folks think of the base as a little white pillow. It's more like an iceberg; it's bolted to a metal post sunk into the ground in the concrete. A person's ankle will break before the base will disassemble.

Everybody in sports medicine kept focusing on the next operation to treat these people. Well, we already have ten good operations to repair the torn ligament in the knee from the sliding injury. Why in the world don't we just prevent this injury to begin with?

Where did the aversion to preventative medicine come from?

I give a presentation called the "Politics of Prevention," which describes the barriers to implementing many of these preventive interventions. The first barrier is how Americans think about prevention. We are all focused on being reactive. The disease develops, and then you treat it.


If you anticipate injuries and try to prevent them, they're significantly diminished in severity- if they occur at all.

What we've tried to do through the Institute for Preventative Sports Medicine is sound a wake-up call. After September 11th, I got a lot of phone calls from people who said, "You need to get that book to people in government." And I asked why. And they said, "We all wait for the planes to hit the building and then we decide to do something about it."

I try to show folks that if you anticipate injuries and try to prevent them, they're significantly diminished in severityif they occur at all. Our studies on bases were unique because they broke the paradigm of reactive thinking. They break the paradigm of how HMOs and insurance companies want us to think becauselet's face itif we prevent injuries, we actually cost the insurance companies money. If an injury occurs, they just pass the cost on to the public.

The second barrier to entry is energy. It's a lot easier to go through life and let the world shape you rather than try to shape the world around you. To do that, you have to have a lot of energy. The HMOs, insurance companies, the sporting goods equipment companies, they'd rather have people focusing on being reactive rather than proactive. So, you have to be able to take a lot of no's, and able to bounce back off of those no's.
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