TO: SpecialtyHealth Clients

FROM: Dr. Greenwald

DATE: September 3, 2002

SUBJECT: Technology & Pharmacology

Ladies & Gentlemen:

Two things have happened in the last week that are important and will dramatically affect how we can take care of your injured workers. Both are significant advances. One involves technology and the other pharmacology. I'm very excited about these advances and want to let you know what is going on. 

Technology - As many of you know, there is a company called Sonorex that we have been interested in for a long time. Sonorex makes a machine that is similar in function to the lithotripsy machine that is used to break up kidney stones. It is a lower strength machine that has applications for orthopaedics that are enormous. It is used to treat near bone tendonopathies, tennis elbow, golfer's elbow, chronic heel pain, anterior knee pain, chronic shoulder pain, etc. Patients with these problems are identified hopefully early, brought into the clinic and treated with a specific dose for the body part involved. The machine is actually placed on the elbow, for example, and treatment occurs over a period of about ten to fifteen minutes. This technology has been available especially in German, as well as in Europe for over ten years and in Canada for over five years. The FDA in the United States has just approved it. SpecialtyHealth is on the list to get one of the first machines. In fact, I think we'll have one of the only machines in Nevada. We're working very hard to get this machine into the clinic as soon as possible. We've got a waiting list of people who need this procedure done. You'll be hearing more about this.

Pharmacology - A drug called Remacaid is being used by rheumatologists all over the country for treatment of patients with rheumatoid arthritis. The results have been spectacular. This drug can stop rheumatoid arthritis in its tracks. Perhaps many of you know patients who have received Remacaid treatments. Physicians in Europe noted that patients who had sciatica (pain down the back of the leg associated with disk problems) were responding dramatically not only for their rheumatoid arthritis but for their sciatic pain. Physicians in Europe expanded the indications of Remacaid to the treatment of acute sciatica and the results have been fabulous. A 

patient comes into the clinic, is given an IV and the drug is slowly dripped in over a two-hour period. It's a little like a chemo therapy treatment that the patient goes through. The relief of leg pain is sudden and dramatic. I can't wait until we have a chance to provide this treatment within the clinic. If Remacaid for sciatica is half as good as I've heard it is - just half as good as I've heard it is - it will change everything in the work comp arena and will make our lives easier. We won't have to send patients for pain management for back pain and the number of back surgeries for disk disease could go down all over the country. This reminds me of when Tagamet first came out for ulcer disease. The results were so spectacular that suddenly the general surgeons were no longer doing ulcer surgery. My hope is that the same thing goes on with Remacaid and the treatment of sciatica.

If there are any questions, please let us know. Remember that Steve Atcheson is a rheumatologist and has supervised thousands of Remacaid treatments for rheumatoid arthrtitis. He will be very comfortable using this for the treatment of sciatica. It will be another unique service that we can bring to the treatment of your patients. I'm very excited to see how well this works. I'll be reporting back to you. Have a great weekend.


E. James Greenwald, M.D.