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How To Avoid Knee Replacement

How to Avoid Knee Replacement

Pamela A. Popper, President

Wellness Forum Health

According to the American College of Rheumatology (ACR), about 790,000 total knee replacements and over 450,000 hip replacements are performed every year in the U.S. This number is expected to increase due to our aging population. The ACR states that total joint replacement is one of the safest and most reliable treatments in medicine.[1] But are these replacements really necessary? Maybe not.

According to a presentation delivered at the annual meeting of the Radiological Society of North America, muscle strength in the leg is a major factor in determining if a knee replacement will be necessary.

Two muscle groups – the quadriceps and hamstrings – act as counter forces that facilitate a wide range of motion while protecting the knee joint. Exercises that strengthen these muscles and maintain the balance between them can prevent the progression of osteoarthritis that results in the need for knee replacement in over 50% of patients.[2]

The cost of a knee replacement in the U.S. ranges from $30,000 to $50,000,[3] and the procedure is a major revenue source for orthopedic practices and medical institutions. Diet change, exercise, and weight loss are low-cost and better interventions and can usually prevent joint replacement, but there is no economic incentive to recommend these. Instead, the diagnosis of osteoarthritis is usually the beginning of monitoring the progression of the condition until joint replacement is the only option.

There are many reasons to recommend diet and lifestyle improvement to prevent the need for knee replacement. A study including 100 older patients who were eligible for knee replacement surgery showed that over a 2-year period, all of them improved including those who only were given non-surgical interventions such as exercise, dietary advice, and pain medication. While the patients who had the surgery fared better initially, they had four times as many complications such as infections, blood clots, or knee stiffness that were severe enough that another surgery requiring anesthesia was required.[4] Complications are more common and more serious than many people realize – one in every 100-200 patients who has a knee replacement dies within 90 days of the procedure.[5] And as many as one third of those who undergo the procedure continue to experience pain.[6]

There are situations in which knee replacement is the right thing to do, or the only viable option. However, in many cases, other options are both safer and better. There are many causes of knee pain. Being overweight and obese is probably the most common, and lifestyle change leading to weight loss not only relieves knee pain, but addresses many other health issues too. In some cases, the knee is not tracking properly, due to muscle imbalances or injuries. When this is the case, a replacement knee does not help because the new knee will also not track properly. Strategies such as yoga and physical therapy with a competent PT are the best options in these cases.

The bottom line: Joint replacement can be avoided in most cases by eating well, exercising, and maintaining a healthy weight.

[1] https://rheumatology.org/patients/joint-replacement-surgery

[2] Ed Sussman. Stronger Quads May Lower Risk for Knee Replacement Surgery. MEDPAGE Today Nov 29 2023 https://www.medpagetoday.com/meetingcoverage/rsna/107579?xid=nl_mpt_DHE_2023-11-29&eun=g1881756d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Evening%202023-11-29&utm_term=NL_Daily_DHE_dual-gmail-definition

[3] https://www.healthpartners.com/blog/cost-of-a-knee-replacement-surgery/

[4] Skou ST, Roos EM, Laursen MB et al. “Total knee replacement and non-surgical treatment of knee osteoarthritis: 2-year outcome from two parallel randomized controlled trials.” Osteoarthritis and Cartilage 2018 Sept;26(9):1170-1180

[5] Katz JN, “Parachutes and Preferences – A Trial of Knee Replacement.” NEJM 2015 Oct;373:1668-1669

[6] Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P. “What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients.” BMJ 2012 Feb 22;2(1):e000435.

American Children and Adolescents Are Dehydrated

American Children and Adolescents Are Dehydrated

Pamela A. Popper, President

Wellness Forum Health


According to a recent study, American children and teens do not consume enough water, which affects both their physical and mental health status. Harvard researchers analyzed data from 4,134 children and adolescents between ages 6 and 19 participating in the National Health and Nutrition Examination Survey (NHANES). About half the  children were not taking in enough fluids of any type. Dehydration was 76.0% higher in boys than girls, and 34.0% higher in blacks than whites. Almost 25.0% of the kids reported drinking no water at all.

The bad news is that so many children are dehydrated. The good news is that this could be an easier problem to solve than many diet-related issues with children, since there is likely to be less controversy and argument about getting kids to drink more water. Here are a few ways in which kids could be helped to do better with minimal expense and disruption at school. 

First, all children could be given water bottles at school. This would cost a small amount of money, but if budgets are so tight that schools cannot spend $1.00 per child to make sure water intake is adequate, perhaps the PTA could step in to help.

Second, children could be allowed to drink water during the school day. It is appalling to me the number of children of members of Wellness Forum Health who are forbidden to drink water during the school day, and also forbidden to use the restroom except at specified breaks like recess (I assume that the reason water drinking is prohibited is to lessen the number of times children need to use the restroom during the day). While there are many reasons to keep kids from running around the school building during the school day, stopping them from using the restroom is not one of them.

Third, water could be served with meals at school. While it would be great if water replaced milk, the milk lobby won’t let that happen anytime soon, so water in addition to milk would be a step in the right direction.

Fourth, water could replace caloric beverages like milk, soft drinks, and sports drinks in the vending machines.  Some schools have already made this change. While schools have become reliant on revenue from vending machines, this does not mean that junk foods, including caloric beverages, need to be offered for sale. 

Last but not least, coaches could encourage kids to drink more water and require water bottles at practice. While many coaches push protein and sports drinks, most coaches would agree that kids need to drink more water and that water drinking is a good habit to form.

The result of this focus on water would most likely carry over to home. Kids who become used to drinking water at school would most likely also do so at home, which might encourage parents to drink more water too.

Kenney E, Long M, Cradlock A, Gortmaker S. “Prevalence of Inadequate Hydration Among US Children and Disparities by Gender and Race/Ethnicity: National Health and Nutrition Examination Survey, 2009–2012.”  Am J Public Health. 2015 Aug;105(8):e113-118

COVID Vaccine Efficacy Data

COVID Vaccine Efficacy Data

Pamela A. Popper, President

Wellness Forum Health

According to newly disclosed government data and emails, vaccinated seniors were much more likely to get COVID than those who were unvaccinated. The report was provided by Humetrix Cloud Services, which was hired by the U.S. military to analyze vaccine data for seniors.

For the week ending July 31 2021, 73% of COVID-19 cases were people who had been vaccinated, and the infection rates were higher in those who were vaccinated earlier. The rates were two times high for people vaccinated 5-6 months prior, as compared to people vaccinated 3-4 months prior, indicating that vaccine efficacy rapidly declined. That same week, 63% of COVID-19 hospitalizations were among those fully vaccinated, with the same trend of waning efficacy over time.

Seniors who had already had COVID-19 and recovered were more likely to avoid hospitalization than the vaccinated. This is particularly important, since natural immunity was denied as a justification for exemption from COVID vaccine mandates.

The Humetrix data showed that at the time of the report, there had been 133,000 cases, 27,000 hospitalizations and 8300 intensive care admissions among the fully vaccinated since the vaccines became available. These data were shared with the CDC in August 2021.

Humetrix CEO Dr. Bettina Experton sent an email to FDA officials on September 15, 2021 that included this statement:

“Our observational study VE [vaccine efficacy] findings show a very significant decrease in VE against infection and hospitalization in the Delta phase of the pandemic for individuals vaccinated with either the Pfizer or Moderna vaccine for those 5–6 months post vaccination vs. those 3–4 months post vaccination.”

Emails show that FDA and public health officials were aware of the data:

Peter Marks MD PhD, Director of the Center for Biologics Evaluation and Research at FDA wrote “It would have been nice to know [the military] was conducting this prior to now. Also would have been nice for CDC to share the data.”

Janet Woodcock, acting FDA commissioner at the time, wrote, “This is more worrisome than the other data we have in my opinion.”

Frances Collins, then director of NIH, wrote, that the study provided “pretty compelling evidence that VE is falling 5-6 months post vaccination for both infection and hospitalization for those over 65. Even for those 4-5 months out there is a trend toward worsening VE.”

While clearly aware that there was a problem, the FDA, CDC, NIH and other agencies did not make the data public and continued to support vaccine mandates. The agencies also did not provide the data to their own committees. 

The CDC held a meeting with its vaccine advisors on August 30 2021, during which waning vaccine efficacy was discussed. The Humetrix report was not provided. Instead, CDC presented data from COVID-NET which showed that the vaccines were still 80% effective and data from Israel showing that protection against infection ranged from 39% to 84%; against hospitalization vaccine efficacy ranged from 75-95%.

The FDA held a meeting with its vaccine advisors on September 17 2021, and also did not present the Humetrix data. The FDA approved the Pfizer booster for most Americans, and the CDC agreed that most people should be boosted. The Moderna booster was added as another option, and eventually officials recommended that all Americans ages five and older be given a COVID booster.

Trust in public health officials and institutions has never been lower than it is right now, and for good reason. As more and more data are made public, this will most likely get worse. The individuals involved in this spectacular and unprecedented fraud must be punished for their roles, and their agencies need to be defunded, disbanded, and replaced with smaller entities that are more accountable to legislative bodies. Accomplishing these goals will take considerable resources and time.

In the meantime, Americans should commit to learn as much as possible about health (informed consumers know when to ignore public health directives); to contribute to litigation (the government will never punish or fix itself – it’s up to us to do this!); and more important – REFUSED TO COMPLY WITH MEDICAL TYRANNY DISGUISED AS PUBLIC HEALTH ADVISORIES AND ORDERS! Remember that agencies and officials are only as powerful as we allow them to be.

Zachary Stieber. FDA, CDC Hid Data on Spike in COVID Cases Among the Vaccinated: Documents. Epoch Times Sept 3 2023

https://www.theepochtimes.com/us/fda-cdc-hid-data-on-spike-in-covid-cases-among-the-vaccinated-documents-5483439

Visual Examination For Skin Cancer

Visual Examination for Skin Cancer

Pamela A. Popper, President

Wellness Forum Health

The only justification for cancer screening programs is that they should reduce the risk of dying of the particular cancer for which the screening test is used. Enthusiasm for cancer screening is based on the idea that if cancer is found early, when it is more treatable, the risk of death is lower.

At this time, only one screening test has been shown to deliver this result – pap tests that screen for cellular changes that can lead to cervical cancer. In every country in which pap testing has been instituted, the death rate from cervical cancer has dropped – significantly.

Many other screening tests have become “routine,” but there is no evidence that use for population screening reduces death rates. For example, colonoscopy has some value as a diagnostic tool, but not as a means for reducing death from colorectal cancer. The Canadian Task Force on Preventive Health Care removed it from the list of standard screenings several years ago.[1] A recent large randomized controlled trial showed that colonoscopy did not reduce the risk of developing colorectal cancer, death from colorectal cancer, or risk of all-cause mortality.[2] 

The data is even worse for prostate cancer screening: the chance of benefit is extremely low, while the risk of being harmed is at least 30 times higher.[3]

What about skin cancer screening? It’s summertime, and people are outside in the sun more regularly. Many doctors and the sunscreen industry promote the false idea that almost any sun exposure is a risk factor for skin cancer, and regular visual examinations are encouraged. There is no evidence that this is reducing death rates, but not only dermatologists, but also family practice docs and internists are looking for skin cancer. The US Preventive Services Task Force recommends against this practice because it has led to more diagnoses but without any change in the death rate. It is estimated that 4000 excisions are required to prevent one death from melanoma. Additionally, specialists (dermatologists) have no better track record than general practice docs in finding early-stage cancer.[4]

The belief in early detection as a means for reducing death remains high despite these data, and one company has developed a direct-to-consumer screening app with the idea that people can examine themselves and find cancer. Perhaps artificial intelligence might be better than doctors?

Well, not so much. A study presented at the European Academy of Dermatology and Venereology showed that the consumer app incorrectly classified Merkel Cell Carcinomas as low risk 17.9% of the time, and a particular type of melanoma was categorized as low risk 22.9% of the time. Nearly two-thirds of benign lesions (62.2%) were classified as high risk. This means that if widely used, most people with harmless moles and lesions would be told they had serious cancer who did not – exactly the problem with other cancer screening programs.

You might think that in response to this dismal result, the dermatologists would lose enthusiasm for this app. You would be wrong. Full speed ahead. It just needs more work and development, was the conclusion.[5]

Bottom line: Before agreeing to any cancer screening test, make sure it has been proven to reduce the risk of dying from cancer.

[1] https://canadiantaskforce.ca/guidelines/published-guidelines/colorectal-cancer/ accessed 7.31.2019

[2] Bretthauer M, Loberg M, Wieszcry P et al. “Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death.” NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2208375

[3] Turini G, Gjelsvik A, Renzulli J. “The State of Prescreening Discussions About Prostate-specific Antigen Testing Following Implementation of the 2012 United States Preventive Services Task Force Statement.” Urology 2017 Jun;104:122-130

[4] Bibbins-Domingo K, Grossman D, Curry S et al (USPSTF members). “Screening for Skin Cancer: US Preventive Services Task Force Recommendation Statement: US Preventive Services Task Force.” JAMA. 2016;316(4):429-435.

[5] Skin Cancer App Fails to Identify Rare, Aggressive Cancers. Oct 15 2021 https://www.practiceupdate.com/c/125242/2/1/?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_onc&elsca4=oncology&elsca5=newsletter&rid=MTM1MTQ0NTcxMjk3S0&lid=20844069