Shock Wave Applications in Medical Field

Updated: Feb 27

A Personal Prospective from One of the Lead and Renowned Researchers in the Field - Dr. Ching-Jen Wang


Dr. Ching-Jen Wang is the world-wide distinguished researcher in medical applications for extracorporeal shock waves. From 1997 to present, Dr. Wang is Professor of Orthopedic Surgery at the Chang Gung University College of Medicine and Chang Gung Memorial Hospital, Taiwan. He was the former President of the International Society for Musculoskeletal Shockwave Therapy (ISMST). During the course of his career, he has conducted more than 50 clinical and basic scientific researches in orthopedics surgery and applications of shock wave technology in musculoskeletal afflictions, and published over 160 articles related to orthopedics and shock waves. His main interests are in total joint and ligament surgeries around the knee and musculoskeletal shock wave therapies. In the shock wave field his research focuses on treating bones, cartilage ligaments, and soft tissue. Also, he perform studies on the use of stem cells in conjunction with shock waves.


In December 2017, during the SANUWAVE’s Clinical and Science Symposium from Chateau Elan, Braselton, GA, USA, Dr. Ching-Jen Wang presented some of his distinguish research. I took the opportunity to talk with him on various subjects, as part of a short interview presented below.


Dr. I. Cioanta: First of all, it is a pleasure, as always, to have a discussion with you and I am glad that you accepted to do an interview. You have a prestigious career, you are the best in the shock waves field and this is why we would like to do this interview.


Dr. C-J Wang: Thank you for the comment.


Dr. I. Cioanta: The first thing, let’s talk about you career. What do you think that made it so successful, as it is right now? What triggered the big success that you have?


Dr. C-J Wang: Well, I kept get involved with the clinical work for almost twenty years and at the beginning the introduction of a device to me triggered curiosity and uncertainty. So, I tried a clinical trial. After about three or four series of the most serious cases in the clinical trial, I found out patients to respond very favorable. That is why I tried, I think I was looking to start doing and organize clinical trials and animal experiments. That began in 1999, and the more we did it, the more people responded. People basically asked their friends to come to join and to receive the treatment, because they were feeling so good.


Dr. I. Cioanta: Yeah, it is. In a way, shock waves look like Star Trek, you know. When they go with the shock wave applicators on top of things, the patients don’t heal in two minutes, like they show in the movie, but we know very well the shock waves have a huge effect and they can do a lot of things, good things, for the patients and also for the physicians and the whole society. Of what thing you feel the most proud from your distinguish career?


Dr. C-J Wang: I am proud when in a project I happen to discover something, which has never been discovered before. For example, as it happen with the biological mechanism for shock waves, even though so far still we do not know 100%, but the data will show to a download the ingrowth of neovascularization and the tissue regeneration. These are all accumulation from previous studies and a cumulate fact now that most studies support this theory. So, it is a proven fact we seen definitely the shock waves work biologically.


Dr. I. Cioanta: And this is why you proved that. Everybody was thinking, yeah I see something is happening, but you gave the key factors for proving that. That is indeed a proud thing to do, you know. Was there any event in your life that you thought was going to be amazing but then turned completely different?


Dr. C-J Wang: For myself?


Dr. I. Cioanta: For yourself, for the practice, for whatever you’ve done in your career.


Dr. C-J Wang: I am an orthopedic surgeon. I am actually consider retiring as orthopedic surgeon. I still doing part-time practice and part-time research. Research does not have too many restrictions to do in whatever you are interested in and there are so many grants. You can do anything, as long as you are approved by the hospital. So, I am still very active in doing research, especially shock wave related and partially in clinical practice. I still perform surgeries, but usually with the help by younger surgeons.


Dr. I. Cioanta: Your physicians that you taught them how to do something like that?


Dr. C-J Wang: Yeah, my previous students. They are all grown-up right now. They are helping me out, but also they get paid by doing that.


Dr. I. Cioanta: You know, it is good to have mentors and being able to mentoring such good physicians, and you know, by doing that the more you do the more you put on the map the shock wave technology. What scientific discovery do you think it would change the course of humanity overnight, if it were to be discovered?


Dr. C-J Wang: I am a surgeon and I make a living by doing surgeries. However, I honestly I feel many surgeries are unnecessary and some are subjective and some are objective. Shock waves, for example, are objectively ready to replace many surgeries already. And that feels good, saves the money, saves the patient from the risks of such surgery, become perfused, etc., and also save them from recovery from unnecessary surgery.


Dr. I. Cioanta: That’s very interesting. How and why did you start your prestigious work in shock wave field? I mean, what triggered that? You said initially that, you know yeah you saw that is working but what convinced you to follow-up that path even more and more and more?


Dr. C-J Wang: To me is the story that I strongly believe shock waves not only work in soft tissue, but they should work in bone. And I’ve done a bone disease, AVN is one example, and saw other conditions that can be treated. And if I can avoid surgery and cure a disease, one disease only, I feel very proud of myself.


Dr. I. Cioanta: Yeah, correct. And you have done many of those not only one.


Dr. C-J Wang: Correct.


Dr. I. Cioanta: Yeah. So, in your opinion, which is the next significant step in shock wave field, the next hot topic?


Dr. C-J Wang: I think the biggest problem is the inconsistency in the bureaucratic approval. I think FDA approval is very critical. Even though it does not change the clinical patient, but because their support. That makes people to trust more the technology. One thing that I don’t like it that much is that in European Community (CE Mark), they approve so many so quickly. In contrast, United States FDA is slow and very, very impatient. In the past fifteen years (15), fifteen (15), I don’t believe any new indication has been approved.


Dr. I. Cioanta: No. The dermaPACE indication is the only one that probably will gone be approved.


Dr. C-J Wang: Yeah. That does not catch-up with the reality.


Dr. I. Cioanta: I agree. I mean, there are so many applications for shock waves.


Dr. C-J Wang: The question is - they should step into it and then talking to what is the problem. But just to not respond for fifteen (15) years. That I personally think it is wrong. Meaning, they have to consider all the causality, but it cannot just ignore the shock wave technology, that is not good.


Dr. I. Cioanta: Yeah. There are also the insurance companies and stuff like that. So, what is the most significant projects at this time for you? Is the stem cells, is still work on the bone or the soft tissue?


Dr. C-J Wang: From the previous results, my opinion is that by combining stem cells and shock waves, definitely potentiate each other nicely. And if you think is ... the new vessel formation, tissue regeneration, or overgrowth, we do not know. We should look at cartilage. It’s is first time I discovered cartilage can regrow after shock waves therapy alone. It does not need any stem cells to equally improve.


Dr. I. Cioanta: That is fantastic. Because few years ago everybody was saying that the cartilage will not regrow.


Dr. C-J Wang: I had the same opinion too, about five years ago. Now, since last year, with the results shown to me, I changed my mind. Cartilage can grow.


Dr. I. Cioanta: That’s fantastic. That’s a very good thing for a population, which is more active and active and prone to sport’s injuries.


Dr. C-J Wang: That is where our research is currently expanding.


Dr. I. Cioanta: Perfect. So, what is your opinion about the annual ISMST conference, and I do not mean their wonderful locations, where they take place?


Dr. C-J Wang: ISMST (International Society for Musculoskeletal Shockwave Therapy)! I can tell you too, my association to ISMST has been steadily decreasing. Because they are looking not for an academic per se. They are looking for the good locations, expensive hotels. I think that they are going into that direction and actually this does not accomplish anything academically or for basic research. For example, I told them to talk to each membership and act like a godfather. Overall every country’s society should have a chance to give a guideline ... and they can use that as a reference. Because so far still not a definitely guideline. That is very bad, for such a rapidly developing treatment. It should have a strictly guideline. You can only change it from time to time. Without that you can’t really accomplish anything.


Dr. I. Cioanta: So, practically what are you saying they do less important research, basic research, like you promoted for many years at this conference.


Dr. C-J Wang: There are too many talks.


Dr. I. Cioanta: Yeah. You know like you said, probably we have to develop the universal guidelines to do the treatment for this and that and that (shock wave treatment). And that is practically the purpose of such society. What is the best compliment, the most wonderful compliment that you received as a researcher?


Dr. C-J Wang: I think the one that struck me the most is recently I was told that in Taiwan when patients come to see the visiting office or the hospital, the one question that they always ask – “Do you have a shock wave treatment? If you do shock wave treatments, I will make the appointment, if you don’t, I go somewhere else”.


Dr. I. Cioanta: Where they have something.


Dr. C-J Wang: That is right. Yeah. The shock waves have become very popular. The public accept that as a fact. The shock waves are very effective and have very good results. Even though they (patients) pay out-of-pocket, the patients’ acceptance is very, very high. I have very rarely a patient review (change) the appointment, just because of money.


Dr. I. Cioanta: That’s fantastic. When people don’t look at the money, just to be sure that they receive the right treatment and especially the shock waves. In your relationship with persons, how do you evaluate a person’s personality? What are your criteria to look for that?


Dr. C-J Wang: My criteria is very simple. I think for anybody I know, I observed them for a short period of time, and then I can make a comment. The most important is the consistency. If a guy is consistent, no matter how smart or stupid, doesn’t matter. People coming and see these things developing, they want everything, and do nothing.


Dr. I. Cioanta: That’s the easiest way in life.


Dr. C-J Wang: Yeah. People who make their mind, even they have multiple choices, but still can choose in between 1, 2, 3, through 9. In this way they can basically focus in that area. Nobody could do everything, it’s impossible.


Dr. I. Cioanta: I agree.


Dr. C-J Wang: So when you are focused in one area, he/she is more concentrated, he/she is more dedicated to it, and have more achievements per se.


Dr. I. Cioanta: Yeah. So you follow your idea and just choose the right topic. What near future predictions do you have for the medical field?


Dr. C-J Wang: I think the breakthrough is the shock wave technology. If you can eliminate or prevent arthritis, isn’t that be a very big contribution to the society, to the whole society.


Dr. I. Cioanta: Do you think that the shock waves can also have a role in a preventive way?


Dr. C-J Wang: Yes, absolutely. If you have the arthritis, the concept in the mind is a booster. You can still do a little bit of stimulant in a while, otherwise the tissue regeneration does not last forever. So, every six-months or every four-months you should give a little bit of a treatment, stimulation.


Dr. I. Cioanta: That means that the technology should get into the family physician hands?


Dr. C-J Wang: That’s correct.


Dr. I. Cioanta: What is something that most people do not know about you, as a person?


Dr. C-J Wang: I am very conservative and I am more internal, rather than external. I participate in sport activity, but not as aggressive I should.


Dr. I. Cioanta: OK. Well, being conservative is very good, you know.


Dr. C-J Wang: I also focus pretty much. If I want to do something, for example, whether this month I want to complete this particular project, I think I try to strive to finish it up before I go to the next project. That is my personal habit.


Dr. I. Cioanta: Ah, OK. What are you most grateful for in your life?


Dr. C-J Wang: To be a doctor, to be a clinician, whereas an academic physician and that is what I like to do, and I think I achieved some level of satisfaction. I don’t want to be a strictly academia, I want to be an academic clinician and to create a practice with some percentage into research. How much research might be in it, can change from time to time.


Dr. I. Cioanta: Yeah. And also is the family, which is coming into the equation too. So, if you can master one skill you do not have right now, what would it be?


Dr. C-J Wang: Be a GOD. Ha, ha! Hmmm, what kind of skill I do not have right now? I don’t know.


Dr. I. Cioanta: You don’t know? Maybe, you mastered all of them. The most important thing is that you mastered the important things.


Dr. C-J Wang: Maybe, if I may start my medical career right now, I may or may not choose the orthopedic. I may choose something more academic.


Dr. I. Cioanta: Well, thank you very much. It is a pleasure all the time, and I hope we can continue the dialogue in the future.


Dr. C-J Wang: You’re welcomed. It’s my pleasure too.


Keywords: wound care, diabetic foot ulcers, DFU, shockwave therapy, amputation prevention, dermaPACE, chronic wounds, SANUWAVE, PACE Technology, Dr. Ching-Jen Wang, interview

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