An ad with famous athletes and their new knee brace. A company marketing the “first ever” joint replacement made for women. A surge of online influencers proposing peptides as the cure-all treatment. Increasingly, patients who would once walk in looking for a diagnosis now walk in looking for a specific treatment. Three surgeons told Becker’s the phenomenon is accelerating faster than the evidence base behind it.
“Every week we get at least five or so patients asking about peptides,” said Sanjay Konakondla, MD, a clinical associate professor at New York City-based NYU Grossman School of Medicine. He said the requests generally fall into three buckets: preventive strategies, preoperative optimization and postoperative healing or scar prevention. Some patients arrive already using peptides such as BPC-157 and ask whether to continue them through surgery.
Marketing directly to patients
The physicians described two distinct categories of products driving these conversations and said the distinction matters for how they respond. The first is treatments that are simply ahead of the evidence. They are not necessarily dangerous but lack substantial clinical evidence. The second is products pushed by companies with no real innovation behind them, sold on branding alone.
Joseph Bosco, MD, vice chair of clinical affairs in orthopedics at New York City-based NYU Langone Health and a joint replacement and sports medicine surgeon, traced both categories back to an increase in direct-to-consumer marketing.
“They read that Tiger Woods went to Germany to get a blood treatment,” Dr. Bosco said, adding that people skilled in “the new media are savvy about retweeting these things and really making a niche for themselves.”
He described the landscape as a spectrum. He said compounds such as peptides “may not be totally available but have been shown to be relatively safe,” while something like anabolic steroids is effective but carries safety risk, and human growth hormone is effective and relatively safe but expensive.
Dr. Konakondla placed spine-specific orthobiologics and peptides in the unproven-but-not-necessarily-fraudulent category. He said the clinical data for treatments such as platelet-rich plasma and BPC-157 in the human spine specifically is limited, even though there is some positive animal data.
“We’re in the ‘it probably doesn’t hurt’ phase versus an absolute treatment recommendation in the perioperative phase,” he said, calling it a good candidate for randomized study “with genuine equipoise.”
Dr. Bosco said part of why the evidence gap exists comes down to incentives: Manufacturers often need only FDA clearance showing a product is not inferior or harmful, not that it is actually superior. “Why would a company pay a lot of money [to run a superiority trial] if it’s doing well financially?” he said. “Plus, those studies are very difficult to do.”
Farzin Kabaei, MD, an orthopedic surgeon at Los Angeles-based Docs Health, put the bad-actor category in sharper terms, pointing to companies that market expensive products directly to patients and incentivize surgeons to sell them.
“It’s a pure pyramid scheme scam where they recruit doctors to be part of this scheme, and ultimately the patient loses money,” he said, noting that patients who do not realize a product’s branding is marketing rather than new technology can end up paying thousands more out of pocket for a procedure Medicare would otherwise cover.
Dr. Kabaei also pointed to the incentive structure on the physician side of the equation. He said struggling private practice surgeons can be recruited by device or biologics companies with consulting fees in exchange for recommending a product to patients.
“You can’t blame a young surgeon for signing up for that because he needs to pay his bills,” he said. “This whole thing with [declining] reimbursements affects everything downhill.”
Dr. Bosco added that part of a physician’s job is keeping up with new treatments without carelessly pursuing every new product.
“You want to offer the newest and latest procedures, but you want to make sure that they’re proven,” he said. “You don’t want to be the first. You also don’t want to be last.”
A road map for conversations
All three surgeons described a similar approach in the exam room.
“I ask them where they heard about the treatment, what they know about it, and get to the reason why they’re asking for it,” Dr. Bosco said, noting that physicians have no ethical obligation to provide a treatment they disagree with, but that an outright refusal can send a patient elsewhere.
Dr. Kabaei described taking a patient out of an unproven injection marketed online as a cure for knee arthritis and said he feels the instinct to simply shut the idea down is a mistake.
“You cannot outright say it’s a scam. Don’t go for it, because you’re taking away the hope they had,” he said. Instead, he tells patients he is aware of the treatment, that early research exists, but that it is not ready and the risks are too high to use the patient “as a guinea pig.”
He said he often asks patients to send him the information they have found and considers that part of what makes the conversation useful rather than adversarial.
“It gives you an opening to create a relationship with the patient, to build trust,” Dr. Kabaei said.
Dr. Konakondla sees patient engagement as a positive rather than a nuisance to manage.
“I try not to open with just the ‘no’ because it can be dismissive,” he said. “We need patients to have an avenue to explore what they’re learning.”
The physician’s role has not changed
All three surgeons framed the shift as a test of physician ethics rather than a genuinely new problem.
“The primacy of patient interest” means recommending what’s best for the patient, not “what can earn you the most money,” Dr. Bosco said. He tied that to board certification, arguing it is what allows a patient to trust that a surgeon is acting in their interest even amid heavy outside marketing.
Dr. Kabaei said the responsibility for staying on top of research should always be on physicians.
“I don’t think we’re going to do away with scams and false information out there,” he said. “It’s our job to just be ahead of it and be prepared for it.”
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
