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Screen Shot 2017-11-16 at 14.41.40I saved the money for the NHS because I live in the UK, but I would have saved the money for whoever was footing my health bills in any country. If I lived somewhere where I paid my own medical bills I would have saved the money myself.


I was proud of this because rising costs are making the NHS and similar organizations around the world unsustainable. You might think I saved the money by running for a charity, but I ran the full 26 miles (42 kilometers) for myself. So how did I do it? The answer takes us back to three years ago when I twisted my knee playing volleyball. It swelled up so much that it hurt to walk and I couldn’t bend it past 90 degrees. I waited weeks and it didn’t heal, so I got a scan, and they found pretty serious bone and cartilage damage. (I had an old injury in the same knee from my college days—that’s another story.) The hospital doctors recommended a kind of knee surgery called arthroscopy. About 40,000 of these are done in the UK and a million in the US are done each year. At a cost of £1681 in the UK and $5000 in the US, this means that £67,000,000 in the UK and 5 billion dollars in the US are spent each year on knee arthroscopies. That doesn’t include the costs of treating side effects.

I was tempted to get surgery because I could see the damage to my knee. However I was just writing my book about self-healing and thought it would be hypocritical for me to get surgery. I asked my general practitioner if there were other options and he referred me to a physiotherapist.

The physiotherapist gave me some simple exercises (like one leg squats), which I did 3 or 4 times per week. Slowly my knee started to heal, and eventually I started running again. I ran more and more each month. Then six months ago I gathered the courage to sign up for a full marathon. On October 22nd I completed it without stopping in just under four hours. My legs and body were very stiff for a few days, but my knee was okay.

1*Kkq3NLrwuZ2FdFqtpm9WBgClearly, I was offered the option of surgery too quickly (doctors are not supposed to offer knee surgery too quickly, and many don’t). Curious, I did a little digging to see what the evidence said. A systematic review of randomized trials suggests that knee surgery is no better than simpler, cheaper, and safer options like exercise or physiotherapy. Surgery can also have serious side effects. Four in 1000 people who have the surgery experience deep venous thrombosis (basically a blood clot that blocks circulation), which can in exceptional cases lead to deadly complications such as pulmonary embolism (blockage of an artery). Surgery also carries the risk of infections. This means that tens of millions of pounds and dollars, and a lot of unnecessary suffering could be saved if we opted for less invasive, safer options like physiotherapy.

Since the evidence says it’s no better than physiotherapy, why would anyone demand surgery? One reason is laziness—some people don’t like exercise. But if people were clearly explained that physiotherapy was as good with fewer risks, I know some people who would be happy to get off their butts and try physio. Another reason is that we live in a culture of ‘too much medicine’ where we tend to (wrongly) believe that new fancy treatments are better than old ones when in fact old treatments are better than new ones about half the time. I’ve also spoken to people who say that since the problem with their knee is mechanical, they need a mechanical solution like surgery. That’s not quite right. At a basic level, the exercises strengthen the muscles around the knee, which stabilize the joint and allow you to function better, so physio is a mechanical solution. Physiotherapy can also work via other more complex mechanisms that reduce how much pain you feel.

A final objection is that people complain that they have to wait weeks to see a physiotherapist, especially in publicly funded healthcare settings like the UK. I agree this is frustrating. But if we reduced the number of knee arthroscopies by just 10%, we could pay for about 150,000 additional physiotherapist appointments in the UK and over 6,000,000 in the US each year. This would reduce physio waiting times.

This doesn’t mean you should never have surgery. I myself would consider it if nothing simpler and safer worked. But evidence suggests that most of us are probably better off going for the less invasive options before going under the knife.

Choosing a less invasive and cheaper treatment helped me last a full 26 miles. If more people choose these types of treatments, maybe the NHS (or your healthcare provider) can go the distance too.

Written with input from Liz Morris @Lmo_Ox and Mackenzie Fong

This newsletter was first published by on 21 November 2017: