 |
 |
Very well said Michael. The evidence-based approach seems to have more strengths than weaknesses, though it has its detractors. Unfortunately the large cost in time and money required (not to mention the expertise) to produce robust evidence deters/prevents some disciplines and encourages others to pursue evidence gathering. Those applications/interventions that are more likely to lead to results that are commercially valuable or exploitable, unfortunately, attract the funding. An intervention (eg a manual therapy) that involves no pharmeceutical, device or other "product" that could be "proven" and then sold, is less likely to attract funding for trials. The supplier of the funding is looking for a return on that capital. Sadly, with universities needing to become more self-funding, they too will lean towards research will potentially commercial outcomes. The massively powerful and profitable pharmaceutical companies are R&D machines that produce a stream of evidence-based *proprietary* substances. They have a high pay-off for their evidence-gathering. No-one owns a patent on generic apples (excluding genetically engineered models!), so even though eating two a day *may* be more effective for a certain condition than taking two XYZ pills a day, the XYZ pill will be backed up by scientific evidence (not to mention a marketing juggernaut) and the apple, probably, will not. Doctors will therefore be recommending the pill over the apple. This may seem an absurd example, but I use it to make a point: the evidence-based approach inherently will lead to the predominance of interventions that can be commercially exploited, while other interventions, without the resouces (and potential pay-off), will languish if based solely on evidence. Having said that, love it or loath it, the evidence based approach is here to stay for some time. Insurers love it. My suggestion to practitioners in disciplines that currently lack an evidence base, is to simply accept that the health and growth of your profession may depend on building a sold evidence base. Figure out how you can help gather the resources required to conduct the trials. Universities, Ph.D. students and not-for-proft research foundations seem the best options for faciliating such trials. My 2 cents worth! Michael Spinal Sensor Technologies Australia www.spinalsensor.com ======================================== From: michael meddows <[log in to unmask]> To: Internet Mail::["[log in to unmask]" <[log in to unmask]>] Subject: RE: MUSCLE WEAKNESS? Date: 3/11/99 8:48 AM Charlotte and list members: If you had a life threatening cardiac condition, would you just trust a physician to provide the treatment that will save you just because he says "IT WORKS, I have seen it work on 40 or so cases that were a lot like yours?" Or would you read a bit about your condition, do a literature search and EVALUATE THE EVIDENCE? There are plenty of treatments in medicine that were sworn to be cures and were later shown to be harmful. An example being Geo. Washington who probably died as much from bleeding by his physician as from his illness. We are wrong to presume that we are any smarter than those who practiced trephination, bleeding, gastric freezing for ulcers, or Rx of high cholesterol with clofibrate which killed 5500 just in the US in the 70's. There are scientific papers for many interventions that physios advocate, and it is our responsibility to provide evidence, not just testimonials, for or against anything we do. Michael Meddows [log in to unmask] -----Original Message----- From: Charlotte Borch-Jacobsen [SMTP:[log in to unmask]] Sent: Thursday, March 11, 1999 1:43 AM To: [log in to unmask] Subject: Re: MUSCLE WEAKNESS? Dear Kevin, I agree 100% with you. Academics and the Health community as well as Insurance seem to forget too easily that sciences comes out of observation and empirical trials and from clinic. It is getting so bad that some MD don't want to refer patients not because what you do does not work but because there are any scientific papers!!!! Charlotte