I think both - Rege and Sandy - are right in their messages of 28 Jan.
Indeed, the 30+ years of clinical practice are quite enough to form a
thinking professional's attitude (at least 'positive' or 'negative') to a
therapeutic agent. The question is whether this attitude has mainly been
underpinned by strong scientifically-correct evidences that are obtained -
NB! - in a finite amount of definite patients (not in the mankind), or by
the professional's individual perceiving and conclusions originated from
his/her previous life experience and his/her personal God-knows-what
including, of course, strong scientifically-correct evidences he/she is
aware of.
On the other hand, yes, Sandy, we must strengthen the foundations of what we
claim. However we must simultaneously remember that evidences of this
strengthening have their limits obligatorily (the conditions of the clinical
trials; subjective, human factors; etc). And we must not expand our results
and impressions to the level of incontestable/common truth. We should rather
speak to ourselves:
'Under these conditions, for this given patient, this modality seems to be
TO SOME EXTENT effective. For the moment. Maybe it will demonstrate its
efficacy during a definite follow-up period as well. At least I sincerely
hope for this. And will do my best to prolong this period. Or, at least, do
not worsen the situation by my further interventions improving - in my
opinion - the results obtained'.
We should remember that everything is relative, and any evidences are only
providing us with a certain probability that the given influence will result
in a certain clinical effect. Especially when we know definitely that we do
not know everything definitely.
I think it is better to bear in mind that there is such the law of
dialectics as 'the unity and the fighting of opposites' (sorry, I am not
sure of correctness of my translating its name to English). I mean mainly
that any thing contains simultaneously different, even opposite components.
E.g. - an atom which consists of a positively-charged nucleus and
negatively-charged electrons. These components differ significantly
(polarly) but attract each other (literally). Moreover if we'll remove one
of these opposite components from the atom, it will disappear as such, i.e.
as a unity. Most likely, other things/phenomena exist in the nature
similarly. Then we'll never gather either ALL the evidences that a
therapeutic agent is certainly worth to use in appropriate patients, or that
we deal with the clear placebo-effect. What is even worse, I am afraid we
are unable, in principle, to find out whether the given clinical effect is
due to a physical influence of the agent, or it takes place because of
participation of other factors (in particular psychological ones). To make
such conclusion we must exclude all participants of the process except for
the one of interest. As far as I know, this is impossible even under
experimental conditions. At least at present.
As to ultrasound, I think it is both biophysically and therapeutically
effective and cannot be ineffective in our patients due to, even though, it
elicits mechanical oscillations of living tissues and cells that are
accompanied, at least, with irritation of receptors as well as with
transformation of a part of the agent's initial energy into heat. Further
reflex responses are quite obvious to appear, and a launch of appropriate
physiological processes including those having some therapeutic significance
is not too surprising as well.
Sorry for so long [and boring? and incorrect???] thoughts. Let's think
together. Maybe this will allow avoiding many regrettable mistakes.
Rege, Sandy and other colleagues: thanks indeed for the messages generating
brain training.
Stanislav Korobov, PhD
Senior Scientist
Physician-Biophysicist
Category I Physician-Physiotherapist
PO Box 7, Odessa, 65089, UKRAINE
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