ABSTRACT
Background: Despite a lack of evidence, a number of "regenerative" therapies have become popularized treatments for erectile dysfunction (ED). Platelet-rich plasma (PRP) injections and shockwave therapy have received significant attention through direct-to-consumer marketing and are advertised as viable alternatives to guideline-backed therapies. Additionally, focused low-intensity shock wave therapy (LiSWT) has become conflated with acoustic or radial wave therapy (rWT), although their mechanism of wave generation and tissue penetration is distinct. GAINSWave, a marketing platform for acoustic wave therapy, has also pervaded the marketplace. We aim to evaluate the relative impact of direct-to-consumer marketing of shockwave therapy and PRP by analyzing the quantity of Google internet search queries for selected regenerative and guideline-backed non-regenerative therapies for ED. Methods: National Google Search trends in the United States (www.google.com/trends) were analyzed to characterize interest in different forms of therapy for ED. Search trends for PRP, LiSWT (and various iterations), intracavernosal injections (ICI), intraurethral injections (IU), vacuum erectile device (VED), and GAINSWave were analyzed. Monthly search data were compiled over multiple years, ending at 2/28/2020, just before the COVID-19 pandemic and state of emergency in the United States. Macro-level changes in public interest were quantified using yearly averages. Results: Patterns in Google Search interest in PRP and LiSWT increased respectively by 3-fold and 275-fold over the decade, representing a larger share of Google Searches by 2020. Trends in Google Search interest in selected types of shockwave therapy for ED also show that queries for GAINSWave commanded public interest, increasing by 219-fold from 2016 to 2020. Conclusions: Regenerative therapies for ED have produced interest surpassing other adjunct guideline-backed therapies, despite receiving the designation of "experimental" or "investigational" therapies. The establishment of GAINSWave also constitutes an inflection point for the whole shockwave market: searches for shockwave therapy increased by 782% between 2016 and 2020. Direct-to-consumer marketing of PRP and shockwave therapy has upturned the customary role of physicians in counseling patients about evidence-based therapies for ED. This increase in public interest in GAINSWave emphasizes its success as a marketing platform. The urological community should consider strategies to address misinformation, such as search-engine optimization, social media, and educational outreach.
ABSTRACT
Viruses that infect bacteria, bacteriophages (phages), are well-studied across a wide range of environments and among diverse scientific fields. Nevertheless, current methods in phage research are lacking, in part due to limitations in culturability and the lack of a universal gene marker. Here, we demonstrate that droplet digital PCR (ddPCR) can be used as a repeatable and sensitive method to study bacteria-phage dynamics both in vitro and in vivo. Using fluorescent probes designed for the bacterial plant pathogen, Pseudomonas syringae, and two phages that prey upon it, we illustrate the use of ddPCR to enumerate phages, track bacteria and phage densities over time both in media co-culture and during infection of a tomato plant, compare phage time-to-lysis, and explore phage-phage competition. Overall, the ddPCR approach closley mirrors results from more traditional counts of plaque forming units (PFUs) but offers a much faster, lower waste, and more high-throughput way of studying these interactions. As such, we suggest that ddPCR will be a valuable new tool in bacteriophage research.
