Sunday, March 2, 2008

Engulfed: To be or not to be

In reference to What's in a Name:

Cory, you said,
"I stumbled upon a blog this week that has engulfed me. It is the science based medicine blog."

I find that site a good port in a storm. I linked it to my own blog awhile ago. It looks like an wonderfully informative effort by medical skeptics to uncover and examine pseudoscientific thinking in general and in their own profession specifically. I think the world, especially the internet world, needs all the help it can get in that regard.

Cory, you said,
"I wanted to explore the name Science based medicine. What is the difference between this and Evidence Based Medicine?"
It looks like the authors at Science-Based Medicine blog are burrowing straight into a similar topic at the moment.

Could some of the problem defining the boundary of what is and what isn't strictly "evidence-based" include issues stemming from cultural relativism?

Lynn Payer wrote a book that impressed me greatly at the time, called Medicine and Culture:
"A classic comparative study of medicine and national culture, Medicine and Culture shows us that while doctors regard themselves as servants of science, they are often prisoners of custom. The United States, England, Germany, and France have equivalent life expectancy rates, yet medical treatment differs enormously from country to country. A new foreword by the author examines the trend toward evidence-based medicine and addresses the substantial changes in medical culture since 1988, including the proliferation of alternative medicine and the changing face of medicine in the European Community since the fall of Communism."
It was from the perspective of a writer who noted that the treatment of one's medical "diagnosis" could change just by crossing a border.

All we can do, I think, from inside a designated profession, is ultimately rely on basic science to settle the arguments. About PT, we certainly have our own fires to put out, don't we? In the absence of a generally recognized theory of our work, lots of strange fluff can creep in, which may need close scrutiny on a regular basis.

If I could choose a way to conceptually unite PT globally, I think I'd pick Cott's Movement Continuum Theory, based on Hislop's pathokinesiology theory. It's stretchy enough to include movement from cellular through to social. From an article by Michael A. O'Hearn:
"Building on Hislop's pathokinesiology theory is the MCT as proposed by Cott et al.3 It was described with the purpose of being unique and central to physical therapy, as well as being broad and applicable to research and education while "subsuming" current middle-range theories. It is similar to pathokinesiology, being established on the principle that movement is essential for human life, taking place on a continuum from a cellular level to an individual's interaction with society. Physical therapy intervention can take place at one or several places along the interdependent continuum similar to Hislop's.1"

I've just finished a lengthy look at Buzsáki, learning a bit about his research on brain oscillations. Even they qualify as "movement", inherent in neurons. Seems to me that neuroscience has opened up vast new territory for PT to explore, adapt to, consolidate itself into.

Most of this post is straying off topic though, isn't it? In the end, in the clinic, when we are working with the patients, regardless of who we are, medical doctors or physiotherapists, we are people in a culture who have adopted a designation, a path that is trying to make scientific sense of the world. As an individual we can choose to just ride along, or else we can put a bit of personal thought and energy into looking at where that path is actually heading, help to steer it a bit. One of my favorite essays of all time is James Willis' The Sea Monster and the Whirlpool. In this essay Willis argues that in a profession where one finds oneself looking after others medically (and dare I say, physiotherapeutically), one must retain one's humanity, steering carefully between "Scylla", for Willis a two-headed sea monster, whose heads are Antiscience and Pseudoscience, on one side, and on the other, "Charybdis" the whirlpool of "Scientific Fundamentalism."

There, I think I've finally managed to get back on track with Sackett.

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