Bandages made from dried placentas

It’s true! Tissue banks pay hospitals to collect placentas and ship them to laboratories where they’re made into paper-thin “skin substitutes” to cover stubborn wounds. Such bandages may help certain types of wounds to heal, but often they’re not needed. That’s because they’re moneymakers. One square inch of skin substitutes costs $5,948 on average. Medicare pays for them. What’s more, because the government categorizes them like donated organs, the manufacturers don’t have to prove that the bandages work.  

More than 100 new skin substitute products have come to market since 2023, and their prices have ballooned. Medicare will reimburse any price that a company sets for brand-new skin substitutes, even if it is far above the market average. Some companies offer doctors a “bulk discount” of up to 45 percent. Taking advantage of the discount, some doctors then collect a Medicare reimbursement for the full price of the product, pocketing the difference. The higher the price, the larger the doctors’ cut.

Here’s how it works: For the first six months of a new product’s life, Medicare will set the reimbursement rate at whatever price a company chooses. After that, Medicare adjusts the reimbursement to reflect the actual price paid by doctors after any discounts. To circumvent the price drop, some companies simply roll out new products. Example: In April 2023, Medicare began reimbursing $6,497 for every square inch of a bandage called Zenith, sold by Legacy Medical Consultants. After six months, the reimbursement fell to $2,746, after which Legacy introduced a new “dual layer” bandage called Impax, reimbursed by Medicare for $6,490.

Private insurance companies rarely pay for skin substitutes, but Medicare routinely covers them. Spending on skin substitutes exceeded $10 billion in 2024. In fact, Medicare now spends more on the bandages than on ambulance rides, anesthesia, or CT scans. For one patient in Nevada, Medicare spent $14 million on skin substitutes over the course of a year.

The Trump administration announced that it would delay a Biden-era plan to restrict Medicare’s coverage of skin substitutes, saying that it was reviewing its policies until at least 2026. It turns out that President Trump’s super PAC had received a $2 million donation from a leading bandage seller. I guess DOGE isn’t looking at that.

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Low dose radiation for aches and pains

In Germany, physicians have been using low dose radiation (LDRT) to treat inflammatory diseases of the joints, such as osteoarthritis, plantar fasciitis, bursitis, and tendonitis. They’ve been doing this for decades and have treated more than 20 thousand patients with this therapy.  I’d never heard of it until recently, when I watched a video of an interview with Dr. Sanjay Mehta, a radiation oncologist with over 20 years of experience at St. Joseph’s Medical Center in Houston, Texas. He’s an impressive guy. According to him, the U.S. is way behind Europe in using this low dose radiation to treat inflammatory diseases.

The therapy has a similar anti-inflammatory effect as you’d get from a cortisone shot, but it lasts longer. Dr. Mehta has found that if the pain is not reduced to zero, it’s at least 60 to 80 percent better than it was pre-treatment. Unlike a cortisone shot, it’s totally non-invasive. Depending on the condition, a typical treatment might include Monday, Wednesday, and Friday treatments for two weeks. Depending on the situation, the treatment might be repeated. It’s not a cure-all. For example, you still might need a knee replacement. But Dr. Mehta has found that many of his patients get immediate relief from pain.

One in seven people in this country are afflicted with such ailments, including me, at times, with osteoarthritis, bursitis, and plantar fasciitis. For many people, non-steroidal anti-inflammatory drugs (NSAIDs) cease to become effective and can have side effects such as gastrointestinal bleeds.

In the medical journals I investigated, one, the International Journal of Molecular Science states, “LDRT has been shown to be a cost-effective, noninvasive treatment with minimal side effects.” The Journal of Radiation Oncology says, “Currently, there are strong data to suggest a benefit of LDRT in plantar fasciitis, with about 80% efficacy in pain reduction. Additionally, there are data to suggest benefits in other musculoskeletal disorders, such as trochanteric bursitis, medial and lateral epicondylitis, tendinopathies of various joints, Dupuytren contracture, Ledderhose disease, heterotopic ossification, and other disorders.” (I checked out Ledderhose disease: lumps in the arches of the feet.)

The treatment is covered by Medicare and private insurance. Nevertheless, good luck in finding someone near you who uses this treatment. Dr. Mehta says that most doctors have negative reactions to the treatment because it’s taking away their specialty. Using Google, I did find a hospital in the Bay Area that uses the technique.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

AI may be writing docs' reports

Do you ever look at the “patient visit” notes that are available on your patient portal—the internet site that displays information about your visits with the medical establishment? Sometimes I do. As I learned from alert reader George—who sent me an article written by a doctor—those notes may be created by AI. A busy doctor may not take the time to review the notes and correct them.

Here’s a (rather extreme) story the doctor recounts about one AI-generated report: A patient came in for a routine visit, which consisted of a recitation of aches and pains and a review of recent blood work and other regular tests. AI created a report stating that the patient was on dialysis; that he had a congenital defect affecting his kidneys; that he had recently been septic; and that he was unable to drive because of cataracts. None of this was true. Had the doctor signed this and had it gone into the patient’s chart, the ramifications could be serious. For example, if the patient applies for anything such as life insurance, his application would be denied.

The AI “time saver” may actually take more time for those conscientious doctors who must dig through the notes looking for mistakes. Furthermore, some of these reports, he writes, can run to five or six pages of “gobbledy gook with important data scattered all over the place.”

In my case, I looked up my “patient visit” notes of a pre-op appointment prior to getting steroid injections to treat a pinched nerve in my spine (which didn’t work). The report says that I complain of “low back and right leg pain. Pain is described as spasms/cramps." I never said I had low back pain and never said the pain is spasms or cramps (I had neither). I recognize that this is small potatoes, but to me it illustrates: 1) that the physician’s assistant wasn’t paying attention and wrote down other people’s complaints; or 2) that the report was generated by AI. Incidentally, I’ve found that these visit notes often begin by saying that I’m “pleasant.” I think they do this so you won’t complain.

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Your big toe

I’ve recently seen a few articles about feet, especially the big toe. Is that a new thing?  Dr. Courtney Conley, who specializes in foot and gait mechanics, says that “Toe weakness is the single biggest predictor of falls when we get older.” Really?! Apparently, gripping the floor with your toe flexors is crucial in maintaining balance. (The flexor muscles are those you use to curl your toes down.) One study assessed the feet of 312 men and women aged 60 to 90, looking for bunions and other toe deformities. In 12 months, 107 people had fallen. The fallers showed significantly less strength in their toes and were more likely to have bunions and other deformities.

In addition to balance, we use toe muscles for propulsion when walking. If toe strength is compromised, everything up the chain is more vulnerable—ankle, knee, hip, and spine. Lack of toe flexor strength is implicated in bunions (hallux valgus) and lesser toe deformities, such as hammer toe (raised toe knuckle).

The big toe gets special attention. Your big toe initiates propulsion when we walk. Lack of big-toe extension (pointing the toe up) can cause gait dysfunction and can even be a limiting factor in getting up off the floor unassisted as we age. One expert says that, when pointing your big toe up, the angle should be about 50 degrees (photo). 

You can determine your toe dexterity by trying to lift your big toe while keeping your other toes flat on the ground and vice versa. Being able to move your toes independently, even a small amount, is a sign of healthy feet. One physical therapist says your toes can be agile enough to play the piano. Right.

You can do exercises to strengthen your toes, such as, while sitting, placing all five toes of one foot on a folded towel, then pressing your toes down (don’t grip) and raising your heel.

I have bunions and one hammer toe, but I’m not a faller! I tried a series of toe exercises. They’re probably worth doing, but they’re a drag to do. As to the photo: impressive! I can’t even come close.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.