Dr. Quillen,
This quote from Lewis is easily applied to the "evolutionary reasoning"
articulated by Nesse and Williams in "Why We Get Sick: The New Science of
Darwinian Medicine" published in '94 and referred to by Gifford in his
newest "Topical Issues in Pain." To me, this thinking enhances the methods
of evidence based practice quite easily.
There's an essay on my web site entitled "Asking Why-Evolutionary Reasoning
and Manual Care" that explains this further and is being discussed
extensively on a couple of bulletin boards.
Go to <http://barrettdorko.com> for more.
Barrett L. Dorko, P.T.
At 10:31 AM 1/31/03 -0500, you wrote:
>Readers;
> I thank Dr. Korobov for his kind thoughts. As I read them I was
> prompted to recall the following quotation from the noted British writer
> C.S. Lewis in 1940. I have it hanging on my wall and certainly use it in
> my physical agents teaching philosophy.
>
> "The Magic is not in the medicine (or physical agent - my
> words)
> but in the patient's body -
> in the vis medicatrix naturae,
> the recuperative or self-corrective energy of nature,
> what the treatment does is to stimulate natural functions
> or to remove what hinders them."
>
> So less is probably more, when scientifically applied. Not the
> way it's done in most clinical settings today, unfortunately!
>
>
>Sandy
>
>William S. Quillen,PT,PhD,SCS,FACSM
>Associate Professor & Director
>Doctor of Physical Therapy Program
>Indiana University
>1140 W. Michigan Street, CF 120
>Indianapolis, IN 46202
>317-278-1851 FAX 317-278-1876
>www.dpt.indiana.edu
>
>
>
>
>
>
>-----Original Message-----
>From: Stanislav Korobov [mailto:[log in to unmask]]
>Sent: Friday, January 31, 2003 12:10 AM
>To: [log in to unmask]
>Subject: Re: evidence based practice
>
>
>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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