Something in Swiss water?

I am starting to wonder what it is about Switzerland. In the past few months, three separate science projects jumped out at me, all Swiss and all brainy:


1. VIRTUAL BODY EXPERIMENTS:

These are described in the blog post Virtual Body Experience. The third was by Bigna Lenggenhager:

"Swiss scientist Bigna Lenggenhager induced virtual body illusions in her subjects, then had them move themselves out of position, then back into positions where they thought they had previously been, but which were in fact where their "virtual" bodies had been.

Her paper “Video Ergo Sum: Manipulating Bodily Self-Consciousness” was also published in the August 24, 2007, issue of Science."

Here is a related video.


2. BLUE BRAIN PROJECT:

This is a Swiss project headed by Henry Markram, in which an artificial "brain" is being painstakingly built. Jonah Lehrer writes,

"In the basement of a university in Lausanne, Switzerland sit four black boxes, each about the size of a refrigerator, and filled with 2,000 IBM microchips stacked in repeating rows. Together they form the processing core of a machine that can handle 22.8 trillion operations per second. It contains no moving parts and is eerily silent. When the computer is turned on, the only thing you can hear is the continuous sigh of the massive air conditioner. This is Blue Brain."

So far the project has managed to accurately simulate a single cortical column from a two-week old rat brain, only... but is still an amazing achievement. Here are media links.


3. PHYSIOTHERAPY THINKING:

A systematic review in press for Manual Therapy:

Paradigm shift in manual therapy? Evidence for a central nervous system component in the response to passive cervical joint mobilisation

Annina Schmid, Florian Brunner, Anthony Wright and Lucas M. Bachmannd
a Uniklinik Balgrist, Department of Physiotherapy, Forchstrasse 340, 8008 Zurich, Switzerland
b Uniklinik Balgrist, Department of Rheumatology, Forchstrasse 340, 8008 Zurich, Switzerland
c School of Physiotherapy, Curtin University of Technology, Perth, Australia
d Horten Center for patient-oriented research, University of Zurich, Switzerland
Received 28 February 2007; revised 30 November 2007; accepted 18 December 2007. Available online3 March 2008.


Abstract

Segmental neurological modulation, neural hysteresis and biomechanical effects have been proposed as mechanisms underpinning the effects of manual therapy. An increasing number of studies hypothesise activation of the central nervous system resulting in a non-segmental hypoalgesic effect with concurrent activation of other neural pathways as a potential mechanism of action. Whether this model is consistent with the current literature is unknown.

This systematic review aims to assess the consistency of evidence supporting an involvement of supraspinal systems in mediating the effects of passive cervical joint mobilisation.

We searched randomised trials in three electronic databases from inception to November 2007, without language restriction, and checked reference lists of included studies. We assessed study validity and extracted salient features in duplicate.

Fifteen studies met our inclusion criteria. The overall quality was high. We found consistency for concurrent hypoalgesia, sympathetic nervous system excitation and changes in motor function. Pooling of data suggested that joint mobilisation improved outcomes by approximately 20% relative to controls. This specific pattern suggests that descending pathways might play a key role in manual therapy induced hypoalgesia.

Our review supports the existence of an alternative neurophysiological model, in which passive joint mobilisation stimulates areas within the central nervous system.


Keywords: Treatment outcome; Cervical pain; Neck; Manipulation spinal; Joint mobilisation techniques; Physical therapy (speciality)"

Whatever the Swiss have going on there, I hope it doesn't lose any momentum, especially in view of the fact that it would appear brain consideration is making it all the way into Swiss PT culture, and out into the world of manual therapy. (Big smile)

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.

What's in a Name

I stumbled upon a blog this week that has engulfed me. It is the science based medicine blog. It's authors include some of the various skeptic circles including Harriet Hall and Steven Novella among others. These are so many great conversations on this blog. But, I wanted to explore the name Science based medicine.

What is the difference between this and Evidence Based Medicine? Well, I believe little if you look at Sackett's discussion of what he meant by Evidence Based Medicine. EBM describes the use of research, clinical experience, and patient preference in clinical decision making.

All too often, however, EBM takes on an Evidence Only Medicine (as described by Nicholas Lucas) characteristic. This is where no decisions can be made without outcome based research to back it up. Of course this is a very narrow view and is impractical in the clinic.

I believe Sackett's ideas are better described by the term Science Based Medicine. This implies a decision making process consistent with the scientific method. Doesn't that sound more consistent with Sackett's aims?