Abstract
The use of platelet rich plasma (PRP) as a novel treatment is discussed in the context of a qualitative research study comprising 38 interviews with sports medicine practitioners and other stakeholders working within the English Premier League during the 2013–16 seasons. Analysis of the data produced several overarching themes: conservatism versus experimentalism in medical attitudes; therapy perspectives divergence; conflicting versions of appropriate evidence; subcultures; community beliefs/practices; and negotiation of medical decision-making. The contested evidence base for the efficacy of PRP is presented in the context of a broader professional shift towards evidence based medicine within sports medicine. Many of the participants while accepting this shift are still committed to casuistic practices where clinical judgment is flexible and does not recognize a context-free hierarchy of evidentiary standards to ethically justifiable practice. We also discuss a tendency in the data collected to consider the use of deceptive, placebo-like, practices among the clinician participants that challenge dominant understandings of informed consent in medical ethics. We conclude that the complex relation between evidence and ethics requires greater critical scrutiny for this emerging specialism within the medical community.
Highlights
Innovative or novel treatments have traditionally been part of sports medicine, where athletes, coaches, and trainers have sought to find a competitive edge over their competitors for performance enhancement, injury prevention, or therapy and return to play
The use of platelet rich plasma (PRP) as a novel treatment is discussed in the context of a qualitative research study comprising 38 interviews with sports medicine practitioners and other stakeholders working within the English Premier League during the 2013–16 seasons
We focus here on the apparent problem of a lack of robust evidence base for these novel treatments, while critically evaluating the rationales offered for their continued use
Summary
Innovative or novel treatments have traditionally been part of sports medicine, where athletes, coaches, and trainers have sought to find a competitive edge over their competitors for performance enhancement, injury prevention, or therapy and return to play. The rise and significance of EBM has been the subject of philosophical and sociological analysis and it is useful to summarise key aspects of this here as it constitutes the backdrop for current debates about different forms of ‘evidence’ in medical science and medical practice These issues appear, arguably in an extreme form, in sports medicine (understood in a broad sense to include sports physiotherapy). It might be thought that the development of EBM is a linear one: a trend toward ever increasing reliance by clinicians on research driven decisions While this may be the perception of some sectors of sports medicine, it is not the case for the evidence based medicine movement itself. What will be interesting to mark in the following discussion is the commitment, informed or otherwise, that sports medicine practitioners have to which version of EBM, and how this influences treatment decisions in the elite football world of the English Premier League
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