Doctor’s Rx For a Stiff Knee: A Prescription For 90 Percocet Pills
Evidence Shows Arthroscopic Surgery for Arthritis Knee Pain Doesn't Help
Patients Attempt to 'Walk Off' Pain With Wearable Therapy
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My doctor’s order of 90 generic Percocet exceeded the number my insurer would approve, he said. I left a short time later with a bottle containing a smaller number.\u003c/p>\n\u003cp>When I got home and opened the package to take a pill, I discovered that there were 42 inside.\u003c/p>\n\u003cp>Talk about using a shotgun to kill a mosquito. I was stiff and sore after the orthopedist fished out a couple of loose pieces of bone and cartilage from my left knee. But on a pain scale of 0 to 10, I was a 4, tops. I probably could have gotten by with a much less potent drug than a painkiller like \u003ca href=\"https://www.webmd.com/pain-management/guide/narcotic-pain-medications#1\" target=\"_blank\" rel=\"noopener\">Percocet\u003c/a>, which contains a combination of the opioid oxycodone and the pain reliever acetaminophen, the active ingredient found in over-the-counter Tylenol.\u003c/p>\n\u003caside class=\"pullquote alignright\">As public health officials grapple with how to slow the growing opioid epidemic — which claims 91 lives each day, according to federal statistics — the over-prescription of narcotics after even minor surgery is coming under new scrutiny.\u003c/aside>\n\u003cp>When I went in for my follow-up appointment a week after surgery, I asked my orthopedist about those 90 pills.\u003c/p>\n\u003cp>“If you had real surgery like a knee replacement you wouldn’t think it was so many,” he said, adding that the electronic prescribing system set the default at 90. So when he types in a prescription for Percocet, that’s the quantity the system orders.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Such standard orders can be overridden, but that’s an extra step for a busy physician and takes time.\u003c/p>\n\u003cp>As public health officials grapple with how to slow the growing opioid epidemic — which \u003ca href=\"https://www.cdc.gov/drugoverdose/epidemic/\" target=\"_blank\" rel=\"noopener\">claims 91 lives each day\u003c/a>, according to federal statistics — the over-prescription of narcotics after even minor surgery is coming under new scrutiny.\u003c/p>\n\u003cp>While patients are today often given opioids to manage post-operative pain, a large supply of pills may open the door to opioid misuse, either by the patients themselves or others in the family or community who get access to the leftovers.\u003c/p>\n\u003cp>Post-surgical prescriptions for 45, 60 or 90 pills are “incredibly common,” said Dr. Chad Brummett, an anesthesiologist and pain physician at the University of Michigan Medical School.\u003c/p>\n\u003cp>Last year, the Centers for Disease Control and Prevention released a \u003ca href=\"https://www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-a.pdf\" target=\"_blank\" rel=\"noopener\">general guideline\u003c/a> saying that clinicians who prescribe opioids to treat acute pain should use the lowest effective dose and limit the duration to no longer than seven days.\u003c/p>\n\u003cp>[contextly_sidebar id=\"IKKSKEYlRZSZtDmHEy3bAWPqrZ5UtBdX\"]But more detailed guidance is necessary, clinicians say.\u003c/p>\n\u003cp>“There really aren’t clear guidelines, especially for surgery and dentistry,” Dr. Brummett said. “It’s often based on what their chief resident taught them along the way, or an event in their career that made them prescribe a certain amount.” Or, as in my case, an automated program that makes prescribing more pills simpler than prescribing fewer.\u003c/p>\n\u003cp>To determine the extent to which surgery may lead to longer-term opioid use, Brummett and his colleagues examined the insurance claims of 36,177 adults who had surgery in 2013 or 2014 for which they received an opioid prescription. None of the patients had prescriptions for opioids during the prior year.\u003c/p>\n\u003cp>The study, published online in \u003ca href=\"https://jamanetwork.com/journals/jamasurgery/article-abstract/2618383\" target=\"_blank\" rel=\"noopener\">JAMA Surgery\u003c/a> in June, found that three to six months after surgery, roughly 6 percent of patients were still using opioids, having filled at least one new prescription for the drug. The figures were similar whether they had major or minor surgery. By comparison, the rate of opioid use for a control group that did not have surgery was just 0.4 percent.\u003c/p>\n\u003cp>Some insurers and state regulators have increasingly stepped in to limit opioid prescriptions. Insurers routinely monitor doctors’ prescribing patterns and limit the quantity of pills or the dosage of opioid prescriptions, said Dania Palanker, an assistant research professor at Georgetown University’s Center on Health Insurance Reforms who \u003ca href=\"http://chirblog.org/responding-opioid-crisis-insurers-balance-stepped-monitoring-restrictions-need-appropriate-pain-treatment/\" target=\"_blank\" rel=\"noopener\">co-authored a study\u003c/a> on insurers’ response to the opioid crisis.\u003c/p>\n\u003cp>At least two dozen states have passed laws or rules in just the past few years aimed at \u003ca href=\"http://www.painmed.org/advocacy/state-updates/\" target=\"_blank\" rel=\"noopener\">regulating the use of opioids\u003c/a>.\u003c/p>\n\u003cp>In my state of New York, Gov. Andrew Cuomo \u003ca href=\"https://www.governor.ny.gov/news/governor-cuomo-signs-legislation-combat-heroin-and-opioid-crisis\" target=\"_blank\" rel=\"noopener\">last year signed\u003c/a> legislation that \u003ca href=\"https://www.health.ny.gov/professionals/narcotic/laws_and_regulations/docs/combat_heroin_legislation_faq.pdf\" target=\"_blank\" rel=\"noopener\">reduced the initial opioid prescription\u003c/a> limit for acute pain from 30 days to no more than a seven-day supply.\u003c/p>\n\u003cp>As my experience demonstrated, however, a seven-day limit (those 42 pills in my case) can still result in patients receiving many more pills than they need. (For those who find themselves in a similar situation with excess pills, \u003ca href=\"https://khn.org/news/how-and-where-to-dump-your-leftover-drugs-responsibly/\" target=\"_blank\" rel=\"noopener\">here is the safe and proper way\u003c/a> to dispose of them.)\u003c/p>\n\u003cp>Still, some caregivers and patients worry that all this focus on overprescribing may scare physicians away from prescribing opioids at all, even when they’re appropriate.\u003c/p>\n\u003cp>“That’s my concern, that people are so afraid of things and taking it to such an extreme that patient care suffers,” said Dr. Edward Michna, an anesthesiologist and pain management physician at Brigham and Women’s Hospital in Boston who is on the board of the American Pain Society, a research and education group for pain management professionals. Michna has been a paid consultant to numerous pharmaceutical companies, some of which manufacture narcotics.\u003c/p>\n\u003cp>But other doctors say that one of the reasons doctors call in orders for lots of pills is their convenience.\u003c/p>\n\u003cp>“When you land on the front lines, you hear, ‘I like to write for 30 or 60 pills because that way they won’t call in the middle of the night’ ” for a refill, said Dr. Martin Makary, a professor of surgery and health policy at Johns Hopkins School of Medicine.\u003c/p>\n\u003cp>Makary is spearheading a consortium of Hopkins clinicians and patients that provides \u003ca href=\"https://www.solvethecrisis.org/best-practices\" target=\"_blank\" rel=\"noopener\">specific guidelines\u003c/a> for post-surgical opioid use. The program, part of a larger effort to identify areas of overtreatment in health care, also identifies outlier prescribers nationwide to encourage them to change their prescribing habits.\u003c/p>\n\u003cp>The Hopkins group doesn’t have an opioid recommendation for my surgery. The closest procedure on their website is arthroscopic surgery to partially remove a torn piece of cartilage in the knee called the meniscus. The post-surgical opioid recommendation following that surgery: 12 tablets.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Please visit \u003ca href=\"https://khn.org/columnists/\" target=\"_blank\" rel=\"noopener\">khn.org/columnists\u003c/a> to send comments or ideas for future topics for the Insuring Your Health column.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Following minor surgery, KHN’s consumer columnist sees how easily doctors offer pain pills, fueling epidemic of opioid addiction.","status":"publish","parent":0,"modified":1512069043,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":1141},"headData":{"title":"Doctor’s Rx For a Stiff Knee: A Prescription For 90 Percocet Pills | KQED","description":"Following minor surgery, KHN’s consumer columnist sees how easily doctors offer pain pills, fueling epidemic of opioid addiction.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Doctor’s Rx For a Stiff Knee: A Prescription For 90 Percocet Pills","datePublished":"2017-11-30T08:01:36.000Z","dateModified":"2017-11-30T19:10:43.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"437388 https://ww2.kqed.org/futureofyou/?p=437388","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/11/30/doctors-rx-for-a-stiff-knee-a-prescription-for-90-percocet-pills/","disqusTitle":"Doctor’s Rx For a Stiff Knee: A Prescription For 90 Percocet Pills","nprByline":"Michelle Andrews\u003c/br>Kaiser Health News","path":"/futureofyou/437388/doctors-rx-for-a-stiff-knee-a-prescription-for-90-percocet-pills","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>I recently hobbled to the drugstore to pick up painkillers after minor outpatient knee surgery, only to discover that the pharmacist hadn’t yet filled the prescription. My doctor’s order of 90 generic Percocet exceeded the number my insurer would approve, he said. I left a short time later with a bottle containing a smaller number.\u003c/p>\n\u003cp>When I got home and opened the package to take a pill, I discovered that there were 42 inside.\u003c/p>\n\u003cp>Talk about using a shotgun to kill a mosquito. I was stiff and sore after the orthopedist fished out a couple of loose pieces of bone and cartilage from my left knee. But on a pain scale of 0 to 10, I was a 4, tops. I probably could have gotten by with a much less potent drug than a painkiller like \u003ca href=\"https://www.webmd.com/pain-management/guide/narcotic-pain-medications#1\" target=\"_blank\" rel=\"noopener\">Percocet\u003c/a>, which contains a combination of the opioid oxycodone and the pain reliever acetaminophen, the active ingredient found in over-the-counter Tylenol.\u003c/p>\n\u003caside class=\"pullquote alignright\">As public health officials grapple with how to slow the growing opioid epidemic — which claims 91 lives each day, according to federal statistics — the over-prescription of narcotics after even minor surgery is coming under new scrutiny.\u003c/aside>\n\u003cp>When I went in for my follow-up appointment a week after surgery, I asked my orthopedist about those 90 pills.\u003c/p>\n\u003cp>“If you had real surgery like a knee replacement you wouldn’t think it was so many,” he said, adding that the electronic prescribing system set the default at 90. So when he types in a prescription for Percocet, that’s the quantity the system orders.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Such standard orders can be overridden, but that’s an extra step for a busy physician and takes time.\u003c/p>\n\u003cp>As public health officials grapple with how to slow the growing opioid epidemic — which \u003ca href=\"https://www.cdc.gov/drugoverdose/epidemic/\" target=\"_blank\" rel=\"noopener\">claims 91 lives each day\u003c/a>, according to federal statistics — the over-prescription of narcotics after even minor surgery is coming under new scrutiny.\u003c/p>\n\u003cp>While patients are today often given opioids to manage post-operative pain, a large supply of pills may open the door to opioid misuse, either by the patients themselves or others in the family or community who get access to the leftovers.\u003c/p>\n\u003cp>Post-surgical prescriptions for 45, 60 or 90 pills are “incredibly common,” said Dr. Chad Brummett, an anesthesiologist and pain physician at the University of Michigan Medical School.\u003c/p>\n\u003cp>Last year, the Centers for Disease Control and Prevention released a \u003ca href=\"https://www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-a.pdf\" target=\"_blank\" rel=\"noopener\">general guideline\u003c/a> saying that clinicians who prescribe opioids to treat acute pain should use the lowest effective dose and limit the duration to no longer than seven days.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But more detailed guidance is necessary, clinicians say.\u003c/p>\n\u003cp>“There really aren’t clear guidelines, especially for surgery and dentistry,” Dr. Brummett said. “It’s often based on what their chief resident taught them along the way, or an event in their career that made them prescribe a certain amount.” Or, as in my case, an automated program that makes prescribing more pills simpler than prescribing fewer.\u003c/p>\n\u003cp>To determine the extent to which surgery may lead to longer-term opioid use, Brummett and his colleagues examined the insurance claims of 36,177 adults who had surgery in 2013 or 2014 for which they received an opioid prescription. None of the patients had prescriptions for opioids during the prior year.\u003c/p>\n\u003cp>The study, published online in \u003ca href=\"https://jamanetwork.com/journals/jamasurgery/article-abstract/2618383\" target=\"_blank\" rel=\"noopener\">JAMA Surgery\u003c/a> in June, found that three to six months after surgery, roughly 6 percent of patients were still using opioids, having filled at least one new prescription for the drug. The figures were similar whether they had major or minor surgery. By comparison, the rate of opioid use for a control group that did not have surgery was just 0.4 percent.\u003c/p>\n\u003cp>Some insurers and state regulators have increasingly stepped in to limit opioid prescriptions. Insurers routinely monitor doctors’ prescribing patterns and limit the quantity of pills or the dosage of opioid prescriptions, said Dania Palanker, an assistant research professor at Georgetown University’s Center on Health Insurance Reforms who \u003ca href=\"http://chirblog.org/responding-opioid-crisis-insurers-balance-stepped-monitoring-restrictions-need-appropriate-pain-treatment/\" target=\"_blank\" rel=\"noopener\">co-authored a study\u003c/a> on insurers’ response to the opioid crisis.\u003c/p>\n\u003cp>At least two dozen states have passed laws or rules in just the past few years aimed at \u003ca href=\"http://www.painmed.org/advocacy/state-updates/\" target=\"_blank\" rel=\"noopener\">regulating the use of opioids\u003c/a>.\u003c/p>\n\u003cp>In my state of New York, Gov. Andrew Cuomo \u003ca href=\"https://www.governor.ny.gov/news/governor-cuomo-signs-legislation-combat-heroin-and-opioid-crisis\" target=\"_blank\" rel=\"noopener\">last year signed\u003c/a> legislation that \u003ca href=\"https://www.health.ny.gov/professionals/narcotic/laws_and_regulations/docs/combat_heroin_legislation_faq.pdf\" target=\"_blank\" rel=\"noopener\">reduced the initial opioid prescription\u003c/a> limit for acute pain from 30 days to no more than a seven-day supply.\u003c/p>\n\u003cp>As my experience demonstrated, however, a seven-day limit (those 42 pills in my case) can still result in patients receiving many more pills than they need. (For those who find themselves in a similar situation with excess pills, \u003ca href=\"https://khn.org/news/how-and-where-to-dump-your-leftover-drugs-responsibly/\" target=\"_blank\" rel=\"noopener\">here is the safe and proper way\u003c/a> to dispose of them.)\u003c/p>\n\u003cp>Still, some caregivers and patients worry that all this focus on overprescribing may scare physicians away from prescribing opioids at all, even when they’re appropriate.\u003c/p>\n\u003cp>“That’s my concern, that people are so afraid of things and taking it to such an extreme that patient care suffers,” said Dr. Edward Michna, an anesthesiologist and pain management physician at Brigham and Women’s Hospital in Boston who is on the board of the American Pain Society, a research and education group for pain management professionals. Michna has been a paid consultant to numerous pharmaceutical companies, some of which manufacture narcotics.\u003c/p>\n\u003cp>But other doctors say that one of the reasons doctors call in orders for lots of pills is their convenience.\u003c/p>\n\u003cp>“When you land on the front lines, you hear, ‘I like to write for 30 or 60 pills because that way they won’t call in the middle of the night’ ” for a refill, said Dr. Martin Makary, a professor of surgery and health policy at Johns Hopkins School of Medicine.\u003c/p>\n\u003cp>Makary is spearheading a consortium of Hopkins clinicians and patients that provides \u003ca href=\"https://www.solvethecrisis.org/best-practices\" target=\"_blank\" rel=\"noopener\">specific guidelines\u003c/a> for post-surgical opioid use. The program, part of a larger effort to identify areas of overtreatment in health care, also identifies outlier prescribers nationwide to encourage them to change their prescribing habits.\u003c/p>\n\u003cp>The Hopkins group doesn’t have an opioid recommendation for my surgery. The closest procedure on their website is arthroscopic surgery to partially remove a torn piece of cartilage in the knee called the meniscus. The post-surgical opioid recommendation following that surgery: 12 tablets.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Please visit \u003ca href=\"https://khn.org/columnists/\" target=\"_blank\" rel=\"noopener\">khn.org/columnists\u003c/a> to send comments or ideas for future topics for the Insuring Your Health column.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/437388/doctors-rx-for-a-stiff-knee-a-prescription-for-90-percocet-pills","authors":["byline_futureofyou_437388"],"categories":["futureofyou_452"],"tags":["futureofyou_987","futureofyou_938","futureofyou_379","futureofyou_381"],"featImg":"futureofyou_437389","label":"futureofyou"},"futureofyou_389217":{"type":"posts","id":"futureofyou_389217","meta":{"index":"posts_1591205157","site":"futureofyou","id":"389217","score":null,"sort":[1495035702000]},"guestAuthors":[],"slug":"arthroscopic-surgery-for-knee-pain-doesnt-help","title":"Evidence Shows Arthroscopic Surgery for Arthritis Knee Pain Doesn't Help","publishDate":1495035702,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>A panel of international health experts and patients last week challenged the effectiveness of one of the most common orthopedic procedures and recommended strongly against the use of arthroscopic surgery for patients with degenerative knee problems.\u003c/p>\n\u003caside class=\"pullquote alignright\">A surgery performed more than 2 million times a year across the globe is ineffective, an expert panel said after looking at multiple studies.\u003c/aside>\n\u003cp>The guidelines, \u003ca href=\"http://www.bmj.com/content/357/bmj.j1982\" target=\"_blank\" rel=\"noopener noreferrer\">published in the journal BMJ\u003c/a>, relied on 13 studies involving nearly 1,700 patients that found the surgery did not provide lasting pain relief or improve function. Those studies compared the surgery with a variety of options, including physical therapy, exercise and even placebo surgery.\u003c/p>\n\u003cp>The experts said that fewer than 15 percent of patients felt an improvement in pain and function three months after the procedure, and that those effects disappeared after one year. In addition, the surgery exposed patients to “rare but important harms,” such as infection.\u003c/p>\n\u003cp>Casey Quinlan, 64, who had the surgery in 2003 and was on the panel issuing the guidelines, said her orthopedist told her the procedure would not only help restore mobility in her knee after a nasty ski accident but also improve her arthritis.\u003c/p>\n\u003cp>Quinlan, of Richmond, Va., said the procedure did not deliver, since her arthritis remained unchanged. “It was not what I was told to expect,” she said.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In an \u003ca href=\"http://www.healthline.com/health/knee-arthroscopy\" target=\"_blank\" rel=\"noopener noreferrer\">arthroscopic knee surgery,\u003c/a> physicians make several small incisions around the joint and insert a tiny camera that allows them to see inside the knee as well as insert small instruments to correct problems they identify. Often the surgery is performed to remove part of a damaged meniscus, a disc of cartilage that helps cushion the knee.\u003c/p>\n\u003cp>The panel said meniscal tears “are common, usually incidental findings, and unlikely to be the cause of knee pain, aching or stiffness.”\u003c/p>\n\u003cp>The panel said the surgery is performed more than 2 million times a year across the globe, and in the United States alone costs more than $3 billion annually.\u003c/p>\n\u003cp>The panel’s recommendations are counter to guidelines from a number of medical groups. Most of those organizations have recommendations against arthroscopy for patients solely with arthritis that can be seen through an X-ray. But many still promote the procedure for people with ailments such as meniscal tears, which are frequently present in arthritic patients.\u003c/p>\n\u003cp>The American Academy of Orthopaedic Surgeons does not recommend the treatment for patients with arthritis, said David S. Jevsevar, chair of the AAOS Council on Research and Quality. He said the BMJ assessment is in line with current evidence, but he also cautioned that generalizing a variety of randomized trials does not necessarily take into account the circumstances of individual patients.\u003c/p>\n\u003cp>“Guidelines don’t apply to every patient,” he said. “There’s always going to be an exception.”\u003c/p>\n\u003cp>Reed Siemieniuk, a physician in Ontario, Canada, and the lead author of the panel’s statement, said he understands the frustration some people may have about the guideline — especially those who have seen an improvement.\u003c/p>\n\u003cp>“I think what’s important is that we need to look at the strongest evidence is a randomized controlled trial,” he said. “Despite those personal experiences that say it might be doing good, the evidence suggests that it might not be doing any good.”\u003c/p>\n\u003cp>Siemieniuk said that the panel’s reading of the studies suggests, “on average, the pain relief that you’re getting is not going to be important to you at all.”\u003c/p>\n\u003cp>The BMJ assessment is the latest in a string of studies that have raised concerns about the surgery. The journal published a \u003ca href=\"http://www.bmj.com/content/350/bmj.h2747\" target=\"_blank\" rel=\"noopener noreferrer\">study in 2015\u003c/a> by researchers in Denmark showing that arthroscopic repair of the meniscus for middle-aged people was not much better than exercise in relieving pain and carried a risk of rare but debilitating side effects.\u003c/p>\n\u003cp>The surgery was questioned in 2002 after \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa013259#t=article\" target=\"_blank\" rel=\"noopener noreferrer\">researchers reported\u003c/a> in The New England Journal of Medicine that in a randomized trial of older veterans with osteoarthritis in their knees, arthroscopic surgery was no more effective in treating pain than a “placebo surgery” in which patients had incisions made but no instruments were inserted into the knee. At least three other studies in that journal since then have also found arthroscopy is \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1305189#t=article\" target=\"_blank\" rel=\"noopener noreferrer\">not better than “sham surgery”\u003c/a> or \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1301408#t=article\" target=\"_blank\" rel=\"noopener noreferrer\">physical therapy\u003c/a> in relieving arthritis pain in the knees of older adults.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\" target=\"\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"A panel of international health experts and patients recommended strongly against the use of arthroscopic surgery for degenerative knee problems. The surgery is performed more than 2 million times a year.","status":"publish","parent":0,"modified":1495727091,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":19,"wordCount":771},"headData":{"title":"Evidence Shows Arthroscopic Surgery for Arthritis Knee Pain Doesn't Help | KQED","description":"A panel of international health experts and patients recommended strongly against the use of arthroscopic surgery for degenerative knee problems. The surgery is performed more than 2 million times a year.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Evidence Shows Arthroscopic Surgery for Arthritis Knee Pain Doesn't Help","datePublished":"2017-05-17T15:41:42.000Z","dateModified":"2017-05-25T15:44:51.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"389217 https://ww2.kqed.org/futureofyou/?p=389217","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/05/17/arthroscopic-surgery-for-knee-pain-doesnt-help/","disqusTitle":"Evidence Shows Arthroscopic Surgery for Arthritis Knee Pain Doesn't Help","nprByline":"Carmen Heredia Rodriguez\u003c/br />\u003ca href=\"http://californiahealthline.org/\">California Healthline\u003c/a>","path":"/futureofyou/389217/arthroscopic-surgery-for-knee-pain-doesnt-help","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>A panel of international health experts and patients last week challenged the effectiveness of one of the most common orthopedic procedures and recommended strongly against the use of arthroscopic surgery for patients with degenerative knee problems.\u003c/p>\n\u003caside class=\"pullquote alignright\">A surgery performed more than 2 million times a year across the globe is ineffective, an expert panel said after looking at multiple studies.\u003c/aside>\n\u003cp>The guidelines, \u003ca href=\"http://www.bmj.com/content/357/bmj.j1982\" target=\"_blank\" rel=\"noopener noreferrer\">published in the journal BMJ\u003c/a>, relied on 13 studies involving nearly 1,700 patients that found the surgery did not provide lasting pain relief or improve function. Those studies compared the surgery with a variety of options, including physical therapy, exercise and even placebo surgery.\u003c/p>\n\u003cp>The experts said that fewer than 15 percent of patients felt an improvement in pain and function three months after the procedure, and that those effects disappeared after one year. In addition, the surgery exposed patients to “rare but important harms,” such as infection.\u003c/p>\n\u003cp>Casey Quinlan, 64, who had the surgery in 2003 and was on the panel issuing the guidelines, said her orthopedist told her the procedure would not only help restore mobility in her knee after a nasty ski accident but also improve her arthritis.\u003c/p>\n\u003cp>Quinlan, of Richmond, Va., said the procedure did not deliver, since her arthritis remained unchanged. “It was not what I was told to expect,” she said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In an \u003ca href=\"http://www.healthline.com/health/knee-arthroscopy\" target=\"_blank\" rel=\"noopener noreferrer\">arthroscopic knee surgery,\u003c/a> physicians make several small incisions around the joint and insert a tiny camera that allows them to see inside the knee as well as insert small instruments to correct problems they identify. Often the surgery is performed to remove part of a damaged meniscus, a disc of cartilage that helps cushion the knee.\u003c/p>\n\u003cp>The panel said meniscal tears “are common, usually incidental findings, and unlikely to be the cause of knee pain, aching or stiffness.”\u003c/p>\n\u003cp>The panel said the surgery is performed more than 2 million times a year across the globe, and in the United States alone costs more than $3 billion annually.\u003c/p>\n\u003cp>The panel’s recommendations are counter to guidelines from a number of medical groups. Most of those organizations have recommendations against arthroscopy for patients solely with arthritis that can be seen through an X-ray. But many still promote the procedure for people with ailments such as meniscal tears, which are frequently present in arthritic patients.\u003c/p>\n\u003cp>The American Academy of Orthopaedic Surgeons does not recommend the treatment for patients with arthritis, said David S. Jevsevar, chair of the AAOS Council on Research and Quality. He said the BMJ assessment is in line with current evidence, but he also cautioned that generalizing a variety of randomized trials does not necessarily take into account the circumstances of individual patients.\u003c/p>\n\u003cp>“Guidelines don’t apply to every patient,” he said. “There’s always going to be an exception.”\u003c/p>\n\u003cp>Reed Siemieniuk, a physician in Ontario, Canada, and the lead author of the panel’s statement, said he understands the frustration some people may have about the guideline — especially those who have seen an improvement.\u003c/p>\n\u003cp>“I think what’s important is that we need to look at the strongest evidence is a randomized controlled trial,” he said. “Despite those personal experiences that say it might be doing good, the evidence suggests that it might not be doing any good.”\u003c/p>\n\u003cp>Siemieniuk said that the panel’s reading of the studies suggests, “on average, the pain relief that you’re getting is not going to be important to you at all.”\u003c/p>\n\u003cp>The BMJ assessment is the latest in a string of studies that have raised concerns about the surgery. The journal published a \u003ca href=\"http://www.bmj.com/content/350/bmj.h2747\" target=\"_blank\" rel=\"noopener noreferrer\">study in 2015\u003c/a> by researchers in Denmark showing that arthroscopic repair of the meniscus for middle-aged people was not much better than exercise in relieving pain and carried a risk of rare but debilitating side effects.\u003c/p>\n\u003cp>The surgery was questioned in 2002 after \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa013259#t=article\" target=\"_blank\" rel=\"noopener noreferrer\">researchers reported\u003c/a> in The New England Journal of Medicine that in a randomized trial of older veterans with osteoarthritis in their knees, arthroscopic surgery was no more effective in treating pain than a “placebo surgery” in which patients had incisions made but no instruments were inserted into the knee. At least three other studies in that journal since then have also found arthroscopy is \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1305189#t=article\" target=\"_blank\" rel=\"noopener noreferrer\">not better than “sham surgery”\u003c/a> or \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1301408#t=article\" target=\"_blank\" rel=\"noopener noreferrer\">physical therapy\u003c/a> in relieving arthritis pain in the knees of older adults.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a>, an editorially independent program of the \u003ca href=\"http://kff.org/\" target=\"\">Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/389217/arthroscopic-surgery-for-knee-pain-doesnt-help","authors":["byline_futureofyou_389217"],"categories":["futureofyou_1062"],"tags":["futureofyou_1271","futureofyou_1275","futureofyou_987"],"featImg":"futureofyou_392116","label":"futureofyou"},"futureofyou_183979":{"type":"posts","id":"futureofyou_183979","meta":{"index":"posts_1591205157","site":"futureofyou","id":"183979","score":null,"sort":[1469049072000]},"guestAuthors":[],"slug":"patients-attempt-walk-off-pain-wearable-therapy","title":"Patients Attempt to 'Walk Off' Pain With Wearable Therapy","publishDate":1469049072,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>Typically, when people suffer from back or knee pain, they reach for the anti-inflammatories or the pain meds.\u003c/p>\n\u003cp>But one company has come up with a shoe it thinks can be just as effective.\u003c/p>\n\u003cp>\u003ca href=\"https://www.apostherapy.com/\" target=\"_blank\">AposTherapy's\u003c/a> space-age-looking footwear is designed to reduce knee, hip and back pain by realigning the way patients walk.\u003c/p>\n\u003cp>The shoes get good reviews from one location in the U.S. currently prescribing them, Mt. Sinai Hospital in Manhattan. But the $5,000 out-of-pocket price tag and only minimal evidence that the shoe works has raised concerns among some doctors.\u003c/p>\n\u003cp>\u003cstrong>How Is the Shoe Supposed to Work?\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Currently prescribed by doctors at Mount Sinai and administered by physical therapists, the sneakers are outfitted with two semi-oval pods on the bottom of each sole. These are meant to redistribute weight and strengthen weaker muscles, reducing the stress on knee, hip and back joints.\u003c/p>\n\u003cp>When patients are in pain, they often change the way they walk, says Mount Sinai physical therapist Steven Venegas. They favor one leg over the other, shorten their stride or bend their knees less to reduce the impact on joints,\u003c/p>\n\u003cp>This walking pattern means some muscles start to work less and others work more to compensate, he says.\u003c/p>\n\u003cp>The AposTherapy shoes are intended to \u003cspan style=\"font-weight: 400\">correct a person's gait and allow them to start engaging the underutilized muscles again. \u003c/span>\u003cstrong>\u003cspan style=\"font-weight: 400\">Better muscle control and stability then alleviate pressure on painful joints.\u003c/span>\u003c/strong>\u003c/p>\n\u003cp>The company got its start in Israel in 2005, expanded to the UK, and is now headquartered in New York City, the only place in the U.S. where the shoes are currently available. A handful of physical therapy practices and hospitals are trying them out. Healthfirst is the only insurer in the U.S. to cover the cost of the shoes.\u003c/p>\n\u003cp>Dr. Joseph Herrera, the chair of Mount Sinai's rehabilitation medicine department, has been recommending the shoes to his patients.\u003c/p>\n\u003cp>\"It’s actually been remarkable,\" he says, \"we’ve had great patient satisfaction.\"\u003c/p>\n\u003cp>Researchers at the hospital are actively enrolling more patients to join the 30 already participating in a clinical trial.\u003c/p>\n\u003cp>\u003cstrong>Satisfied Customer\u003c/strong>\u003c/p>\n\u003cp>One satisfied patient\u003cstrong> \u003c/strong>is 35-year-old Summer Dion, a professional hip-hop dancer with a medial meniscus tear, mild knee osteoarthritis and a stress fracture in her back.\u003c/p>\n\u003cp>After having received a cortisone shot and physical therapy, her left knee started to swell, she says, so Herrera recommended Apos. Dion says the pain in her back subsided after a week of wearing the shoes.\u003c/p>\n\u003cp>\"I feel like it’s working and I wish I could wear them longer,\" she says. \"What sucks is taking them off because then you have to put regular shoes on or you’re walking barefoot and you're not in that perfect alignment anymore.\"\u003c/p>\n\u003cp>The therapy has received a smattering of \u003ca href=\"http://www.cnbc.com/2015/04/06/apos-therapy-catches-the-eye-of-ex-pro-athletes.html\" target=\"_blank\">positive press\u003c/a> over the last few years, but not everyone is enthusiastic. Stanford \u003ca href=\"http://ortho.stanford.edu/spine/todd-alamin-profile.html\">spine surgeon Todd Alamin\u003c/a> questioned Apos' medical studies, calling them, \"relatively poor,\" with \"weak evidence.\"\u003c/p>\n\u003cp>And then there's the price. The out-of-pocket cost is $5,000, Herrera says, for those not covered by Healthfirst.\u003c/p>\n\u003cp>Apos says health care providers set the price and the cost includes a fitting with a physical therapist and multiple follow-up sessions.\u003c/p>\n\u003cp>Alamin says, \"If their shoe is worth the money, they should have better data.\"\u003c/p>\n\u003cp>\u003ca href=\"http://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-11-179\">One study\u003c/a>, published in BMC Musculoskeletal Disorders\u003cem>,\u003c/em> lasted eight weeks and involved 57 patients, including a control group. It found significant improvements in the patients who used the shoe, and no improvements in the control group.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.hindawi.com/journals/arthritis/2013/689236/#B21\" target=\"_blank\">lengthier study \u003c/a>followed 40 participants over two years, but didn't find a meaningful difference in improvement between those using the shoes and a control group.\u003c/p>\n\u003cp>Researchers expect results in the Mount Sinai trial by the end of this year.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n","blocks":[],"excerpt":"Special sneakers meant to realign the way people with knee, hip and back pain walk are now being tested at a handful of hospitals. But not everyone is on board with the concept.","status":"publish","parent":0,"modified":1475119731,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":26,"wordCount":688},"headData":{"title":"Patients Attempt to 'Walk Off' Pain With Wearable Therapy | KQED","description":"Special sneakers meant to realign the way people with knee, hip and back pain walk are now being tested at a handful of hospitals. But not everyone is on board with the concept.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Patients Attempt to 'Walk Off' Pain With Wearable Therapy","datePublished":"2016-07-20T21:11:12.000Z","dateModified":"2016-09-29T03:28:51.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"183979 http://ww2.kqed.org/futureofyou/?p=183979","disqusUrl":"https://ww2.kqed.org/futureofyou/2016/07/20/patients-attempt-walk-off-pain-wearable-therapy/","disqusTitle":"Patients Attempt to 'Walk Off' Pain With Wearable Therapy","path":"/futureofyou/183979/patients-attempt-walk-off-pain-wearable-therapy","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Typically, when people suffer from back or knee pain, they reach for the anti-inflammatories or the pain meds.\u003c/p>\n\u003cp>But one company has come up with a shoe it thinks can be just as effective.\u003c/p>\n\u003cp>\u003ca href=\"https://www.apostherapy.com/\" target=\"_blank\">AposTherapy's\u003c/a> space-age-looking footwear is designed to reduce knee, hip and back pain by realigning the way patients walk.\u003c/p>\n\u003cp>The shoes get good reviews from one location in the U.S. currently prescribing them, Mt. Sinai Hospital in Manhattan. But the $5,000 out-of-pocket price tag and only minimal evidence that the shoe works has raised concerns among some doctors.\u003c/p>\n\u003cp>\u003cstrong>How Is the Shoe Supposed to Work?\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Currently prescribed by doctors at Mount Sinai and administered by physical therapists, the sneakers are outfitted with two semi-oval pods on the bottom of each sole. These are meant to redistribute weight and strengthen weaker muscles, reducing the stress on knee, hip and back joints.\u003c/p>\n\u003cp>When patients are in pain, they often change the way they walk, says Mount Sinai physical therapist Steven Venegas. They favor one leg over the other, shorten their stride or bend their knees less to reduce the impact on joints,\u003c/p>\n\u003cp>This walking pattern means some muscles start to work less and others work more to compensate, he says.\u003c/p>\n\u003cp>The AposTherapy shoes are intended to \u003cspan style=\"font-weight: 400\">correct a person's gait and allow them to start engaging the underutilized muscles again. \u003c/span>\u003cstrong>\u003cspan style=\"font-weight: 400\">Better muscle control and stability then alleviate pressure on painful joints.\u003c/span>\u003c/strong>\u003c/p>\n\u003cp>The company got its start in Israel in 2005, expanded to the UK, and is now headquartered in New York City, the only place in the U.S. where the shoes are currently available. A handful of physical therapy practices and hospitals are trying them out. Healthfirst is the only insurer in the U.S. to cover the cost of the shoes.\u003c/p>\n\u003cp>Dr. Joseph Herrera, the chair of Mount Sinai's rehabilitation medicine department, has been recommending the shoes to his patients.\u003c/p>\n\u003cp>\"It’s actually been remarkable,\" he says, \"we’ve had great patient satisfaction.\"\u003c/p>\n\u003cp>Researchers at the hospital are actively enrolling more patients to join the 30 already participating in a clinical trial.\u003c/p>\n\u003cp>\u003cstrong>Satisfied Customer\u003c/strong>\u003c/p>\n\u003cp>One satisfied patient\u003cstrong> \u003c/strong>is 35-year-old Summer Dion, a professional hip-hop dancer with a medial meniscus tear, mild knee osteoarthritis and a stress fracture in her back.\u003c/p>\n\u003cp>After having received a cortisone shot and physical therapy, her left knee started to swell, she says, so Herrera recommended Apos. Dion says the pain in her back subsided after a week of wearing the shoes.\u003c/p>\n\u003cp>\"I feel like it’s working and I wish I could wear them longer,\" she says. \"What sucks is taking them off because then you have to put regular shoes on or you’re walking barefoot and you're not in that perfect alignment anymore.\"\u003c/p>\n\u003cp>The therapy has received a smattering of \u003ca href=\"http://www.cnbc.com/2015/04/06/apos-therapy-catches-the-eye-of-ex-pro-athletes.html\" target=\"_blank\">positive press\u003c/a> over the last few years, but not everyone is enthusiastic. Stanford \u003ca href=\"http://ortho.stanford.edu/spine/todd-alamin-profile.html\">spine surgeon Todd Alamin\u003c/a> questioned Apos' medical studies, calling them, \"relatively poor,\" with \"weak evidence.\"\u003c/p>\n\u003cp>And then there's the price. The out-of-pocket cost is $5,000, Herrera says, for those not covered by Healthfirst.\u003c/p>\n\u003cp>Apos says health care providers set the price and the cost includes a fitting with a physical therapist and multiple follow-up sessions.\u003c/p>\n\u003cp>Alamin says, \"If their shoe is worth the money, they should have better data.\"\u003c/p>\n\u003cp>\u003ca href=\"http://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-11-179\">One study\u003c/a>, published in BMC Musculoskeletal Disorders\u003cem>,\u003c/em> lasted eight weeks and involved 57 patients, including a control group. It found significant improvements in the patients who used the shoe, and no improvements in the control group.\u003c/p>\n\u003cp>A \u003ca href=\"http://www.hindawi.com/journals/arthritis/2013/689236/#B21\" target=\"_blank\">lengthier study \u003c/a>followed 40 participants over two years, but didn't find a meaningful difference in improvement between those using the shoes and a control group.\u003c/p>\n\u003cp>Researchers expect results in the Mount Sinai trial by the end of this year.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/183979/patients-attempt-walk-off-pain-wearable-therapy","authors":["5432"],"categories":["futureofyou_1060","futureofyou_1062"],"tags":["futureofyou_988","futureofyou_987","futureofyou_989"],"featImg":"futureofyou_184629","label":"futureofyou"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. 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