Rapid Decline in Online Search Queries for Hip and Knee Arthroplasties Concurrent With the COVID-19 Pandemic

BackgroundIn response to the coronavirus disease 2019 (COVID-19) pandemic, US hospitals have canceled elective surgeries. This decline in total joint arthroplasty (TJA) revenue may place financial strain on hospitals. Our goal was to quantify the impact of COVID-19 on the public interest in elective TJA.MethodsThe Google Search Volume Index (GSVI) identified the terms “knee replacement,” “hip replacement,” and “orthopedic surgeon” as the most common to describe TJA. The term “elective surgery cancellation” was also analyzed. Weekly GSVI data were extracted between 04-01-2015 and 04-04-2020. Time series analysis was conducted and state GSVI values were compared with COVID-19 prevalence and unemployment claims.ResultsThe relative public interest in elective TJA has sharply declined since the WHO declaration of COVID-19 as a global pandemic. Between 03-01-2020 and 03-29-2020, the popularity of searches for “knee replacement”, “hip replacement,” and “orthopedic surgeon” dropped by 62.1%, 52.1%, and 44.3%, respectively. A concurrent spike was observed for the term “elective surgery cancellation.” California, New Hampshire, Maine, and Nevada showed a low relative rate for TJA searches, and the highest increase in unemployment claims.ConclusionThe onset of COVID-19 correlates with declining relative popularity of searches related to elective TJA. Higher volume of COVID-19 cases in certain states may correspond with lower relative search popularity, although this correlation remains unclear. These results portend the possibility of a decline in elective TJA case volume, further straining hospitals. Further research is required to inform stakeholders how best to proceed and determine any sustained effects from the current diminished relative interest in TJA.Level of EvidenceLevel III.     

Google Trends Analysis Shows Increasing Public Interest in Platelet-Rich Plasma Injections for Hip and Knee Osteoarthritis

BackgroundOsteoarthritis is a chronic musculoskeletal condition that frequently affects the hip and knee joints. Given the burden associated with surgical intervention for hip and knee osteoarthritis, patients continue to search for potential nonoperative treatments. One biologic therapy with mixed clinical and basic science evidence for treating osteoarthritis is platelet-rich plasma injections into the affected joint. We used the Google Trends tool to provide a quantitative analysis of national interest in platelet-rich plasma injections for hip and knee osteoarthritis.MethodsGoogle Trends parameters were selected to obtain search data from January 2009 to December 2019. Various combinations of “arthritis,” “osteoarthritis,” “PRP,” “platelet-rich plasma,” “knee,” and “hip” were entered into the Google Trends tool and trend analyses were performed.ResultsThree linear models were generated to display search volume trends in the United States for platelet-rich plasma and osteoarthritis, hip osteoarthritis, and knee osteoarthritis, respectively. All models showed increased Google queries as time progressed (P < .001), with R² ranging from 0.837 to 0.940. Seasonal, income-related, and geographic variations in public interest in platelet-rich plasma for osteoarthritis were noted.ConclusionOur results demonstrate a significant rise in Google queries related to platelet-rich plasma injections for osteoarthritis of the hip and knee since 2009. Surgeons treating hip and knee osteoarthritis patients can expect continued interest in platelet-rich plasma, despite inconclusive clinical and basic science data. Trends in public interest may inform patient counseling, shared decision-making, and directions for future clinical research.     

Moving Beyond Biomedicalization in the HIV Response: Implications for Community Involvement and Community Leadership Among Men Who Have Sex with Men and Transgender People

As the world enjoys the promise of biomedical advances against HIV, numerous challenges remain. Some of these are connected to politics, others are connected to resource constraints. Other barriers are linked to the need to ensure that the concepts used to think about HIV remain current. Terms such as “MSM” (men who have sex with men) and “community” require critical interrogation at a moment when their political origins seem forgotten. Likewise, struggles between groups most affected by HIV and scientists and policymakers (an enduring feature of the epidemic) remain a key aspect of the response. The dangers of co-option and distraction remain real. In this context, it is vital to promote community ownership, political commitment, solidarity, and respect for differences, not as competing values, but as part of the ultimate solution to HIV.Anyone who has worked internationally on the HIV epidemic knows the importance of politics,1 and how the way in which the issues are framed influences the ability to address them effectively.2 It is of vital importance, therefore, to think critically about how best to describe the global HIV epidemic and the challenges it poses. It is also imperative that we think critically about the need for a major switch from the discourse of 3 to 4 years ago—from an earlier vision of “doom and gloom”—to a more optimistic outlook.It is also important to recall the lessons of history in relation to global health and development. We cannot help but remember the misplaced optimism in relation to the Declaration on Health for All by the Year 2000, adopted at the International Conference on Primary Health Care held in Alma-Ata, USSR, in 1978,3 and the World Declaration on Education for All that emerged from the 1990 World Conference on Education for All in Jomtien, Thailand.4 The world is still far away from both health for all and education for all.What then are we to make of the targets regularly announced by UNAIDS, such as “Getting to Zero” by 2015,5 “90-90-90” by 2020,6 and “the end of AIDS” by 2030?7 What are we to make of the promises of biomedical advances and the prospects of “an AIDS-free generation” we heard about at the 2012 Washington AIDS Conference8 and the 2014 Melbourne AIDS Conference,9 which is a promise that seems to provide the foundation for such optimistic target-setting? Increasingly, as we listen to these slogans, we cannot help but wonder if the time has not come for a little more realism as the world struggles to develop meaningful strategies to address the epidemic in the midst of its fourth decade.The grim reality is that in many contexts, rates of new infection among gay and other men who have sex with men (MSM), among transgender people, and among numerous other socially excluded groups, are not on a steady decline toward zero, but instead, these rates are rising rapidly.10,11 The same is true for the notion of zero discrimination. Particularly, in parts of Africa, in Russia, and in India, as well as in Central Asia, there is evidence of increasing hostility toward sexual and gender minorities and people living with HIV. This hostility is sometimes fueled by claims of the “unnaturalness” and “foreignness” of the behavior and is often encouraged by politicians and religious leaders.12,13 In some cases, a new wave of repressive laws amounts to nothing less than state-sponsored discrimination and should be understood as such.As for the notion of zero AIDS-related deaths, it is true there have been remarkable advances for those who have access to the most up-to-date medications and good quality health care. However, many people still lack complete access to these or are in receipt of outdated regimens with debilitating side effects. In addition, relatively few rich countries have followed the lead of the United Kingdom in making access to antiretroviral therapy nondependent on migration status. UNAIDS itself currently estimates that no fewer than 22 million people currently lack access to the treatment drugs they need, which is nearly twice as many as those who currently have access to treatment.14Therefore, even the most general overview of the global HIV epidemic in 2015 suggests that almost none of the various slogans and targets devised to inspire the global response come close to providing an accurate picture of the challenges that confront us. Instead of being provided with a realistic portrayal of the current situation, we are invited to enter into an Alice in Wonderland world in which most everything is the opposite of what it claims to be. Because of this, there is an urgent need to think critically and more realistically about the current status of the epidemic, and to seriously consider: where are we now, what have we learned, and what needs to be done?This is obviously a large and collective undertaking that must involve wide participation by researchers, policymakers, advocates, and others, and it is a task that goes far beyond the scope of 1 short article. However, it is a task that has to begin somewhere, and our goal is to make a modest contribution by focusing on the important challenges for community involvement and community leadership in responding to the epidemic in the 2 key populations we have worked with extensively since the earliest years of the epidemic: gay, bisexual, and other MSM; and transgender persons.In thinking about the challenges facing these communities, we focused on 3 different but related sets of issues: (1) the continuing importance of context (time and place really do matter when it comes to responding to HIV), (2) the limits of present terminologies and understandings (the social world is changing faster than the available terminology), and (3) the need to rethink the idea of “community” in certain respects, and to rediscover instead a challenging new politics of HIV.If we fail to address these important social and political concerns, no biomedical advances, no matter how remarkable, and no policy or program objectives, no matter how inspirational, can ever succeed in bringing about an end to AIDS, whether for these populations or any others.     

Using a Google Web Search Analysis to Assess the Utility of ChatGPT in Total Joint Arthroplasty

BackgroundRapid technological advancements have laid the foundations for the use of artificial intelligence in medicine. The promise of machine learning (ML) lies in its potential ability to improve treatment decision making, predict adverse outcomes, and streamline the management of perioperative healthcare. In an increasing consumer-focused health care model, unprecedented access to information may extend to patients using ChatGPT to gain insight into medical questions. The main objective of our study was to replicate a patient’s internet search in order to assess the appropriateness of ChatGPT, a novel machine learning tool released in 2022 that provides dialogue responses to queries, in comparison to Google Web Search, the most widely used search engine in the United States today, as a resource for patients for online health information. For the 2 different search engines, we compared i) the most frequently asked questions (FAQs) associated with total knee arthroplasty (TKA) and total hip arthroplasty (THA) by question type and topic; ii) the answers to the most frequently asked questions; as well as iii) the FAQs yielding a numerical response.MethodsA Google web search was performed with the following search terms: “total knee replacement” and “total hip replacement.” These terms were individually entered and the first 10 FAQs were extracted along with the source of the associated website for each question. The following statements were inputted into ChatGPT: 1) “Perform a google search with the search term ‘total knee replacement’ and record the 10 most FAQs related to the search term” as well as 2) “Perform a google search with the search term ‘total hip replacement’ and record the 10 most FAQs related to the search term.” A Google web search was repeated with the same search terms to identify the first 10 FAQs that included a numerical response for both “total knee replacement” and “total hip replacement.” These questions were then inputted into ChatGPT and the questions and answers were recorded.ResultsThere were 5 of 20 (25%) questions that were similar when performing a Google web search and a search of ChatGPT for all search terms. Of the 20 questions asked for the Google Web Search, 13 of 20 were provided by commercial websites. For ChatGPT, 15 of 20 (75%) questions were answered by government websites, with the most frequent one being PubMed. In terms of numerical questions, 11 of 20 (55%) of the most FAQs provided different responses between a Google web search and ChatGPT.ConclusionA comparison of the FAQs by a Google web search with attempted replication by ChatGPT revealed heterogenous questions and responses for open and discrete questions. ChatGPT should remain a trending use as a potential resource to patients that needs further corroboration until its ability to provide credible information is verified and concordant with the goals of the physician and the patient alike.