Mandating a fixed threshold will also have the perverse effect of lessening incentives to increase productivity in health care and get lower prices from insurers, physicians and hospitals.

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One question I raised with Prof Jacobson was whether, using their methodology, you could say what the rates would have been if there were a threshold - if low doses had no effect.

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But Harvard orthopedic surgeon George Theodore, who helped conduct the Dornier study, claims that the failed studies are flawed because they used low-energy shock-wave pulses that were below the threshold needed to have a heel-healing effect, unlike the successful FDA studies that used higher energies.

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