Editor’s Letter: Two Steps Forward

Change is rarely easy or straightforward. That’s especially true in the US healthcare system, which—despite vast numbers of people who lack access to the care they want, need, and deserve—has been stubbornly resistant to reform.

Amputees are all too familiar with that phenomenon. In this issue we examine a couple of new wrinkles in the amputee care model that promise to improve overall patient outcomes over time. One of them, osseointegration (OI), is pictured on our cover and explored in the feature that begins on page 22.

Recently approved by the FDA for a limited segment of lower-limb amputees, OI opens the door to socket-free prosthetics. Only a few hundred Americans have received this treatment, and only a few thousand have received it worldwide, but the early results are extremely encouraging. Liberated from socket-related difficulties, OI patients generally report better mobility, reduced discomfort, and a higher overall quality of life than their socket-wearing counterparts.

OI involves some sacrifices, along with a degree of risk; it’s not the right solution for everyone. Even so, amputees seem more eager to embrace this change than the healthcare system that serves them. Insurers, policy makers, and care providers are proceeding very cautiously, pumping the brakes on the transition to OI even as demand for the procedure gains momentum. Learn more about the present and future of OI in “Opting for Osseointegration.”

The other trend we examine this month is the emergence of prosthetic devices that are sold directly to consumers, bypassing the standard delivery channel administered by insurers and clinicians. Marketed to amputees who can’t find satisfaction under the established model, direct-to-consumer devices promise to reduce prices, eliminate procedural hurdles, and give consumers a higher degree of personal empowerment. But they also challenge the traditional relationship between amputees and prosthetists, for better or worse. And, if you believe in the law of unintended consequences, it’s possible direct-to-consumer products could cause disruptions that undermine the strengths of the status quo, negating some or all of the benefits the new model is meant to deliver.

We don’t profess to have the answers. But we do want you, our readers, to consider the right questions and be equipped with good information if and when you decide to give the direct-to-consumer market a shot. The feature is titled “The Gate Crashers,” and you’ll find it on page 14.

One thing that never changes is the appeal of a feel-good story. And if “The Bowhunters’ Gifts” doesn’t give you the warm-’n’-fuzzies, better get yourself to the emergency room STAT—your heart must have stopped. Turn to page 28 to start reading that kind-hearted chronicle, and enjoy the rest of the September-October issue.

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