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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