Dear Panos
Well said. Regards Kevin
----- Original Message -----
From: Panos Barlas <[log in to unmask]>
To: <[log in to unmask]>; <[log in to unmask]>
Sent: Monday, October 23, 2000 5:18 PM
Subject: Re: The reverse side of EPA
> Dear Kevin,
>
> I hope you are just sharing Kam's address and not his Jordie accent! I
> thought there for a minute that Kam was teasing me!!
>
> Your position is not disimilar to mine. I do agree that collaboration
> between clinicians and researchers is crucial, nevertheless 'real life'
> shows that we (researchers) are banished to the never-never land of the
> clinically inept. I don't for a minute advocate that clinical practice
> should rid itself from 'I know-it-works' elements, I rather encourage to
put
> such elements to the test. Since the only test I know is research I have
to
> remain true to this. Slowly but steadily, the gap between academia and
> clinic is starting to be bridged and we find more and more clinicians
> agreeable to collaboration, something that not so long ago was much rarer.
>
> Research not unlike any other element of one's profession is a specialism
> not that disimilar to manual therapy or cardiovascular rehab. It just so
> happens that research sometimes causes unease by asking difficult
questions.
> The 'no evidence, no practice' argument is not valid, we would have a lot
of
> redundancies in the healthcare professions. Nevertheless, open mindedness
> and reflection should be the guide. Witness to this process is the move
away
> from antiquated practices such as some forms of electrotherapy (eg.
> Ultraviolet radiation) and incorporation of newer, perhaps more effective
> ones (eg. Back schools). It would not be just research that changed that
it
> is also clinical observation: if it does not work don't use it. But then
> again shouldn't one think 'if it does not work did I do it right'?
>
> My efforts do focus in bringing about change which involves abolition of
the
> fear for research, not the researcher as it currently happens. Once this
is
> achieved, the only ones to lose will be those outside this fruitful
> collaboration.
>
> Lets dream together, some day we may see this happen. Not unlike your
> metaphor of love afairs, these two may end up marrying one another
(research
> and practice).
>
> in a non-alcoholic stupor
>
> Panos
>
> -----Original Message-----
> From: Kam-wah Mak <[log in to unmask]>
> To: [log in to unmask] <[log in to unmask]>; [log in to unmask]
> <[log in to unmask]>
> Date: Monday, October 23, 2000 1:04 PM
> Subject: The reverse side of EPA
>
>
> >Dear Panos
> >
> >I agree completely with your sentiment, but have one reservation. The 'I
> >know it works' argument is a little annoying, however we must not loose
it
> >altogether otherwise we may banish the intuitive / clinical experience
> part,
> >out of our discussions.
> >
> >I have said this before but generally, when it comes to research
clinicians
> >tend to know the questions that need to be answered, but have poor
research
> >skills. Unfortunately the reverse is true of those with the research
> skills;
> >probably because each is equally, a very demanding area of work.
> >
> >The consequence of this is often that clinician led research answers
> burning
> >questions (when it is not simply an exercise to pass a higher
> >qualification), poorly and research led initiatives answer well, less
> >meaningful topics. If EBM is considered the only way clinical therapists
> can
> >operate, we will loose a highly significant part of our practice. Science
> >must always lag behind practice, ie our observations, giving meaning and
> >insight into our empirical findings.
> >
> >Look at the way the medical community now views manipulation and
> >acupuncture. The position has almost completely turned on its head in 10
> >short years. I am personally as worried about the robotic 'there is no
> >evidence for this, so we shall not use it' (definately not suggesting you
> >are saying this), as opposed to the 'I know it works and therefore refuse
> to
> >think'
> >
> >Of course the answer is an equal alliance between researchers and
> >clinicians. The clinician asks the questions and runs the trial, the
> >researcher chooses the methodology and runs the analysis.
> >
> >I know the vein in which you responded to this intially and I
> wholeheartedly
> >agree. It is almost childlike to say ' what you do sucks, try and be as
> good
> >as me' which is the inference in what some people have said.
> >
> >Discovering skills is like a holiday love affair, complete enrapture,
> >followed by discovery and flaws and a falling out with complete denial. I
> >would say this has been peoples attitudes on the list regarding
> >electrotherapy from and undergrad level to I would guess about 4 years
post
> >grad. We should try and move to a more maturer love, ie I can see your
> >faults my beloved 'ping', but I still respect you. There are times when
you
> >can still light my candle and perhaps I haven't learnt all your hidden
> >depths yet.
> >
> >Incredible, a rambling response with zero alchol in me, must be going
> senile
> >
> >Regards Kevin Reese PT UK
> >
> >----- Original Message -----
> >From: Kam-Wah Mak <[log in to unmask]>
> >To: <[log in to unmask]>
> >Cc: <[log in to unmask]>
> >Sent: 20 October 2000 13:42
> >Subject: (Fwd) The reverse side of EPA
> >
> >
> >> Hi fellow manual-therapy list member,
> >>
> >> No doubt if you are member of the physio, epa and / or evidence
> >> based health - Mailbase lists. That there were heated exchanges of
> >> views on evidence based practice on epa.
> >>
> >> Now that Panos kindly throws down an interesting challenge (see
> >> message below) to manual therapists such as ourselves. It would
> >> be nice to initiate some exchanges of ideas amongst ourselves
> >> and see what we all do clinically and whether it can stand up to the
> >> scrutiny of EBP.
> >>
> >> Over to you all.
> >>
> >> Kam
> >> manual-therapy list owner
> >>
> >> ------- Forwarded Message Follows -------
> >> Date sent: Thu, 19 Oct 2000 16:38:35 +0100
> >> Subject: The reverse side of EPA
> >> From: "Panos Barlas" <[log in to unmask]>
> >> To: <[log in to unmask]>
> >> Copies to: <[log in to unmask]>
> >> Send reply to: [log in to unmask]
> >>
> >> Dear colleagues,
> >>
> >> In response to Goh's message and in view of what has been said in
> >> the past
> >> three days or so, can we now reverse the
> >> argument and examine the evidence that justify the use of 'guru-
> >> isms' such
> >> as McKenzie, Maitland, Cyriax, Mulligan, Butler etc?
> >> And this time lets keep it where it belongs: the level of academic
> >> discourse
> >> not passionate belief and fanatic opinion.
> >>
> >> I propose the following set of rules in an effort to keep some
civility:
> >>
> >> - No names to be mentioned other as a reference (to previous messages
or
> >> published papers). in other words, lets try and keep the response
> >> impersonal, such that there is no issue of offence
> >>
> >> - No unjustified claims ('I know it works, I don't need a paper to tell
> me
> >> so' and the like- and that includes books)
> >>
> >> - Please do provide origins and rational for the concepts mentioned
> above,
> >> and try to juxtapose these to modern thought of disease progression,
> >> physiology and disease
> >> management
> >>
> >> - When mentioning efficacy (it works) lets put that into context: there
> >are
> >> published evidence of some quality (RCT- SysReview), the
> >> patient does not suffer recurrence, the disease is managed by this
> >approach
> >> with minimum utilization of expensive resources, the outcome is
> measurable
> >> with a validated tool etc. The same goes when one argues that it
doesn't
> >> work.
> >>
> >> Anyone who breaks this rules will be awarded 'Bruce-points' in
return!!!
> >>
> >> I hope this is a starting point, please do add your suggestions on how
> >this
> >> can still maintain some reason behind it and not end-up as a pissing
> >> contest. But don't forget the question, by focusing on the rules.
> >>
> >> Yours,
> >> Panos
> >>
> >>
> >>
> >> -----Original Message-----
> >> From: Goh Ah Cheng <[log in to unmask]>
> >> To: [log in to unmask] <[log in to unmask]>
> >> Cc: epa <[log in to unmask]>
> >> Date: Thursday, October 19, 2000 12:50 PM
> >> Subject: Re: A personal note of support
> >>
> >>
> >> >Dear David,
> >> >Thank you for your note of support. I am indeed grateful for your
> >concern.
> >> >You are right of course.... responding to such irresponsible comments
> >made
> >> >by people like Bruce takes up a lot of energy and time. If I was
> >convinced
> >> >that he was the only one who held these views, I would not have
bothered
> >to
> >> >even reply. Unfortunately, there are many people like him who think
> >> EXACTLY
> >> >the same way. Before we started to respond to his note, there was
even
> >> >someone who wrote in to support him (albeit a one liner). But I am
also
> >> >aware that there were many who felt instinctively that he was right,
> even
> >> >though they probably wouldn't say it the way he did. My (and Panos)
> >> >response was to try and speak to these people, beyond Bruce. It is
> >> >frightening how a radical idea, if remained unchallenged, can actually
> >make
> >> >sense simply because it stands unchallenged. Hence, it was something
I
> >had
> >> >to do... to try and expose the flaws in his arguments. He is a clever
> >one,
> >> >though. He reminds me of somebody else on the PHYSIO list (I can't
> >> remember
> >> >his name) who did something similar last year (on another topic
> >> altogether).
> >> >Even the words he used was similar (eg. "non sequitur "). I am not
sure
> >if
> >> >he is the same guy, but registered under a different name. I do know
> for
> >a
> >> >fact, however, that there are people who seek attention this way.
> >> >Anyway, at the end of the day, I guess we just have to laugh and make
> >light
> >> >humour of it all. After all, it is senseless to be angry at a
faceless
> >> >email address (which is essentially who he is). The sad part though
is
> >> that
> >> >a lot of these "radical" people are coming from University of
> Queensland.
> >> I
> >> >even heard that the PT school in UQ have decided to drop EPA entirely
> (or
> >> at
> >> >least de-emphasise it) from their curriculum. These are the graduates
> we
> >> >can expect if we fail in our education.
> >> >Nevertheless, I did enjoy it a bit at the end (perhaps a bit too
> much!!).
> >> >Thanks anyway, for your concern. It means a lot to me, especially at
> the
> >> >end of another exhausting day at work. Hope to catch up with you some
> >> other
> >> >time.
> >> >Regards,
> >> >Cheng
> >> >P.S. I hope you don't mind, but I am copying this to the list since I
> >> >wanted to explain my intentions.
> >> >
> >> >----- Original Message -----
> >> >From: "Anand David Pandyan" <[log in to unmask]>
> >> >To: <[log in to unmask]>
> >> >Sent: Thursday, October 19, 2000 7:42 PM
> >> >Subject: A personal note of support
> >> >
> >> >
> >> >> Dear Cheng,
> >> >>
> >> >> I do apologize for not taking part in this recent debate (there were
> >> >> some interesting self contradictions in his argument!) the time
> >> >> pressures on me were intense. However, do take a break and
> >> >> ignore the fanatic - no amount of rational explanations will work.
> >> >> Shall catch up with you again in due course.
> >> >>
> >> >> Kind regards
> >> >> David
> >> >>
> >> >> PS: Do not let guys like this run you down.
> >> >> A D Pandyan
> >> >> Centre for Rehab. Eng. Studies (CREST)
> >> >> M25 Stephenson Building
> >> >> University of Newcastle upon Tyne
> >> >> Newcastle upon Tyne NE1 7RU
> >> >> UK
> >> >> e-mail to: [log in to unmask]
> >> >> tel ++ 44 (0)191 222 5434
> >> >> fax ++ 44 (0)191 222 8600
> >> >> URL http://www.ncl.ac.uk/crest/
> >> >>
> >> >
> >>
> >>
> >>
> >>
>
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