Dear Bruce
One last time then I'm off.
I do not participate in the list as I used to as discussions rarely stir me
to a response. This you have managed to do and that is why I appreciated
your post.
The point I have been making is that it is hard to make black and white
decisions regarding modalities when evidence for their efficacy is so poor
in either direction. I believe the hypothetical deductive model the RCT is
based on is philosophically and intellectually flawed, I believe the 5per
cent threshold produced for crop germination may not be so applicable to the
human condition, I believe the research to date on most physio modalities is
not good enough to say categorically it is good or bad because it does not
attract the drug money to produce a decent trial. The reasons for doubt go
on and on. Therefore I am unable to strong black and white decisions as you
can.
I am unconvinced by US but will not totally discard it because the evidence
to do this is not total. We are not at the research position in EBM to do
this yet and for that reason we must be careful.
Looking at my patients in audit 90 per agree with me that they a
significantly (clinical) better than when they came in. I use symptomology,
movement directions and function as the measures and so do they. How this
comes about I could not say for sure. I am not 100 per cent sure of any of
the modalities I use, I could be a good MT or exercise therapist, a good
conduit for placebo or counselling, I don't know and it is this element of
doubt I would encourage you to embrace.
Therefore there is so much doubt in my practice regarding evidence or
procedure, how do I square all this. Well the first thing you do is
recognise the doubt, trust what you understand, your own clinical evidence
and be happy that I am helping 90 percent of the people I see. I also
recognise that I have a life long journey to explore what I do, evolve and
modify or discard, read the papers and keep an open mind to new ideas and be
a wise skeptic. We are not at the this is rubbish and this is brilliant
stage rather the shades of grey asI tried to hint.
In your post I was curious. Do you have some knowledge I crave or have you
jumped on the EBM bandwagon of this is great and this is rubbish. When I ask
for your thought processes you say read the literature, so it looks like the
latter.
You have convinced me of one thing. If I do look forward to your responses
perhaps my downtime has become a little sad, especially when I am described
in such terms as POM (I know sufficient about its aetiology to know it is
not a nice phrase). So I will say goodbye to the list and the friends and
enemies I have made on it and Bruce I hope the passage of time mellows your
thinking.
Warm Regards Kevin
----- Original Message -----
From: Bruce- Australia <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, August 26, 2001 1:06 AM
Subject: Re: Ultrasound and Electro discussions
> Hi Kevin
>
>
>
>
> Dear Bruce
>
> You have made a number of assumptions, inferences and half statements I
need
> to have them clarified.
>
> 1 .Inference; My life is not dull, and your suggestion that it is, is
> borderline rude. Usually people resort to this when they are on the ropes.
>
>
>
>
>
>
> > I really enjoyed your last answer. Few things have made me smile so
> broadly
> > in the last month; a great start to the day.
>
> Kevin, in Australia, I would take this comment as an anaemic attempt at
> high brow sarcasm, and have met enough poms to know it would be the same
in
> England.
>
> If you didn't mean it sarcastically, then to state that my comments
> brighten up your day so, is pretty convincing in itself that nothing else
> interesting is happening in your life. Anyway, enough of this. Let's be
> nice.
>
>
>
>
>
>
>
> 2. Inference; my knowledge of electro history is shaky, No I am reasonably
> well read and my BSc Hons dissertation was on this subject. So no need for
> the revision thanks all the same.
>
>
>
>
>
>
>
> Well I am surprised that you are so open to current electro practice if
you
> are familiar with its dark history and share no concern about the
> similarities of what drove it then and now.
>
>
>
>
>
>
>
>
> 3 Assumption; I rarely use US, perhaps 5 applications a year at most, I am
> relatively unconvinced by its claims, work in the English NHS and have no
> need to take $150 dollars off anyone. It is your clinical reasoning
> processes I am interested in not the US debate.
>
>
>
>
>
>
>
> Oh ok, so why not just come onto the newsgroup and say
> "I am relatively unconvinced by its claims"
>
> The therapy decisions you make and the treatments you give are funded by
> the tax payer...someone pays for the treatment eventually, and if it is
> ineffective or unnecessary, then the opportunity cost will approach $150,
> and other patients don't get seen until later, which is contributing to
the
> unsustainability of the NHS. As usual, the public get the bum deal. And
> this is why I feel strongly about finding truth, and weeding out "machines
> that go ping" as M. Python once said.
>
>
>
>
>
>
>
>
>
>
> 4. Half Statement; Ok rice, heat and active movement in your opinion has a
> good scienfific validation. Lets have the evidence, discuss the processes,
> paper, methodology strengths and weaknesses etc. We have to determine how
> strong this validation is to understand why it is so superior the the US
> evidence.
>
>
>
>
>
> The evidence is in the literature. Why don't you go and find the peer
> reviewed consensus of opinion that refutes RICE and heat.
>
>
>
>
>
> 5. I don't understand your statement with regard to the aura stuff and
> scientific background. Science is the creation and testing of ideas not a
> restrictive dogma where one methodology is king and everything outside is
> crass. Things like RCT SSED etc are just the imperfect tools to answer the
> questions. If done in a poor or inappropriate way they have no value.
> Scientists should have enquiring minds not aggressively dismissive.
>
>
>
>
>
>
>
> Read the literature in the field of psychology and psychophysiology, and
> contact "English Skeptics".
>
>
>
>
>
>
>
>
>
> 6. Assumption. One last time I have no need to cling to US you could take
it
> out of my dept tomorrow and I wouldn't blink an eye. Therefore I do not
need
> to tell you why I cling to it. We are discussing reasoning/EBM/clinical
> effectiveness, surely this and not a who will win the anti/pro US debate.
>
>
>
>
>
> So on what scientific basis would you remove US from your dept? What
> evidence do you have to deprive the English public from receiving a
> commonly used physical therapy treatment?
>
> And as someone so passionate about EBM, I'd like to know what treatments
> you do perform.
>
>
>
>
>
>
>
> Probably your bedtime now in Oz so look forward to tomorrow
>
> Kevin
>
>
>
>
>
>
>
> Kevin, you have to find something better to do with your downtime if you
> look forward to my responses, as I have stuff to do that is better than
> getting into extended repetitive exchanges... :)
>
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