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    Medical Research Fails to Meet Patients' Needs


    Capt. Matthew Garber and fellow physical therapists ran into this situation themselves. Garber treats patients for osteoarthritis of the knee and other disorders at the Brooke Army Medical Center in San Antonio, Texas, where he also directs one of the Army's two training programs for physical therapists.

    "There are millions of people who are affected by this disorder. Too many people think the only answers are surgery and drugs. We knew from our clinical experience that we could help people without either of those," but the research literature held little proof, Garber says. "We found that from 1966 to 1993, there were only 15 controlled trials that looked at nonsurgical and nonpharmaceutical interventions for osteoarthritis of the knee. Some of those found that exercise was good, but there were no studies that looked at manual [physical] therapy. We sought to obtain the evidence for ourselves."

    Garber and colleagues did their own study of 83 patients with osteoarthritis of the knee. Half received ultrasound at a lower-than-usual level, and half received physical therapy, involving exercises done in the clinic and at home. Both groups were seen twice a week for a month.

    After a year, only 5% of patients in the physical therapy group required knee replacement surgery, compared with 20% in the ultrasound group -- a finding that confirmed the value of manual therapy, Garber says.

    "The allocation of research funds is really a complex matter," says Cary Gross, MD, an assistant professor at Yale University School of Medicine. Gross has studied how the National Institutes of Health spends its research dollars. "Unless you have a topic that is scientifically sexy" or results in a lot of deaths or costs to society, it's hard to get funding, he says.

    He notes, for example, that funding for pancreatic cancer, a disease with a low survival rate, lags behind that for AIDS, which has seen tremendous advances in treatment. "Which comes first, the research productivity or the money? One could make the argument that progress follows money," Gross says.

    But government funding is only half the equation: About 60% of research money comes from private sources, usually pharmaceutical companies.

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