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 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 America—which
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 injuries—not
murder or suicide—if
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 leagues—not
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.
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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 severity—if
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
because—let's
face it—if
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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