Observations

FDA Consumer, March-April, 2004 by Ray Formanek, Jr.

Our knees and hips are among the body's hardest working joints. They allow us to twist, turn, dance, jump, stand, walk, run, climb stairs, swing a golf club, kick a soccer ball, or even hit a home run. All that wear and tear can take a toll, and osteoarthritis can result, even among younger people.

About 500,000 hip and knee replacements are done annually in the United States, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Successful replacements of knees and hips have helped keep people mobile, comfortable, and independent.

Researchers are studying the types of patients most likely to benefit from hip and knee replacement surgery. In addition, new technologies and materials involving prosthetic devices for hip and knee replacement and advances in surgical techniques are being developed.

Questions remain, however, concerning which prosthetic designs and materials and which surgical techniques and rehabilitation approaches yield the best long-term outcomes. The National Institute on Aging and NIAMS are among the federal agencies looking for answers. For more on hip and knee replacement and the FDA's role, see our cover story titled "Joint Replacement: An Inside Look," beginning on page 12.

Stub your toe or hit your thumb with a hammer and the resulting sensation that races through your nervous system to your brain to alert you to possible injury is called acute pain. Chronic pain is different. The pain signals continue for days, weeks, months, and even years.

Headaches, low-back pain, arthritis-related pain, and pain related to damage to the nervous system itself are among the most common causes of chronic pain, according to the National Institute of Neurological Disorders and Stroke.

Clinical studies have found that people with chronic pain sometimes have lower-than-normal levels of the body's own pain relievers called endorphins in their spinal fluid. Researchers are working to develop new painkillers and also are studying the effects of stress on chronic pain. For more on chronic pain, see our feature story titled "Managing Chronic Pain," on page 22.

No doubt about it--Americans want to look good. Nearly 7 million of us had some type of cosmetic procedure--surgical or non-surgical--done in 2002, according to the American Society of Plastic Surgeons. The vast majority, 5 million, chose the non-surgical option, rather than going the nip-and-tuck route to smooth wrinkles or to lift age-related sags. Find the latest on so-called vanity drugs in our feature titled "Science Meets Beauty: Using Medicine to Improve Appearances," on page 30.

We also take a look at the 2003-2004 flu season, the FDA's ban of the dietary supplement ephedra, and the agency's crackdown on illegal products.

Ray Formanek Jr.

Editor