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Cause's Confusion

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  • #31
    Ready, set...

    The link to the book review by Patricia Churchland (see post #17) has garnered a response by Pinker. See John Wilkin's Evolving Thoughts blog for more.
    "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

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    • #32
      Here's a podcast/article about neuroscience and the law. I'll look for the content in the new season of Law & Order.
      "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

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      • #33
        Last Wednesday's episode (of Law and Order) was the first I remember the series using fMRI in the courtroom. I feel confident that it won't be the last time we see it.
        "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

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        • #34
          This Philosopher's Zone podcast could have found a place in any number of threads but this one is still interesting to me. Consider spending some of your time learning more about the time you're spending.
          "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

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          • #35
            [YT]62daicHQ9as[/YT]
            "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

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            • #36
              Jon,

              Great tune and directly to the point of this wonderful thread; one of my favorites.

              In case anyone's wondering, emphasizing origin as opposed to cause hasn't gotten any easier.
              Barrett L. Dorko

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              • #37
                From the folks at The Science Network: Neurolaw and Neuropolitics
                "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

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                • #38
                  Reading through this thread I can't help but think that actually lots of the things that patients come to us for DO have causes!
                  And that even though no doubt the pain/injury is part of a large, global, holistic, multi-factorial neuromatrix system we can and should identify the causative parts of this that we are able to.

                  Identifying causative and provoking/allieviating factors helps to give the patient more insight and therefore more control of their health.

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                  • #39
                    Jono,

                    I always tell therapists that looking for the cause (as it has been defined here) is a perfectly human thing to do, but that the search will probably be both fruitless and unnecessarily time-consuming.

                    Please convince me otherwise with a specific example.
                    Barrett L. Dorko

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                    • #40
                      Okay i'll take the bait!

                      Smoking causes lung disease/cancer. There are other factors involved such as genetics and environmental influences but if you have a patient with COPD it is important to ask them if they smoke. Then you should explain to them that this is a cause and help them to quit.

                      From a PT perspective lots of things are "causes" for pain. Some people use their bodies poorly (biomechanically, posturally), some people have bad workstation set-ups, some people are stressed, some people are overtraining.... my last patient ran 4kms wearing jandals and now has plantar fasciitis, my next patient just did a cycle race and now is complaining about tight suboccipital m/s.... i see causes everywhere!

                      I do understand the bias of our brains towards seeing patterns in randomness- but it doesn't logically follow that EVERYTHING is random and there aren't causes anywhere!

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                      • #41
                        Jono-
                        Well, this need to see causes is common, but unfortunately it is also counterproductive.
                        Let's see to your examples and find out why.

                        For COPD - does smoking cause this? Meaning, does smoking exist in such a way that COPD always follows? Well, of course not - and lucky for all the smokers out there. This is at least a contributing factor that we can establish through a plausible and basic science mechanism, and therefore might be worthy of approaching. But it's certainly not a "cause".

                        For your runner and cyclist examples - certainly there are people who have done those things and not had pain or "tightness" - what do we tell those people? Certainly there are people who have those same "problems" yet have not done the activity that supposedly "caused" these problems in your patients. What do you tell them?

                        In short, we have now spent some time and energy trying to determine a cause for these problems. This time has done no further work toward helping us address the origin of the patients complaint or assist the patient in any meaningful way. Other than that, its really a good idea. (just a joke there)

                        I think addressing contributing factors makes sense. For those with mechanical pain, prolonged postures and positions are a good example. But calling them a "cause" is probably leading us down a path that won't lead to any useful care.
                        Jason Silvernail DPT, DSc, FAAOMPT
                        Board-Certified in Orthopedic Physical Therapy
                        Fellowship-Trained in Orthopedic Manual Therapy

                        Certified Strength and Conditioning Specialist


                        The views expressed in this entry are those of the author alone and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.

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                        • #42
                          Jono,

                          I sense that you're talking about something to blame, not for the cause. Finding something, or, better yet, someone to blame is perfectly human, but it's not productive.

                          Forgive me, but I don't think you're getting the concept of origin (or cause) here.

                          One more thing. It's 2008. Do we really have to tell people that smoking isn't healthy? Isn't that kind of patronizing?
                          Barrett L. Dorko

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                          • #43
                            Along with the smoking thing, what about carbohydrates 'causing' diabetes, red meat 'causing' bowel cancer, poor posture 'causing' spinal pain; all these things may contribute along with many other factors to ill health, but living is a risk factor anyway.

                            People look for a cause, certainly. It is logical that a bad car crash will cause some degree of injury. But if someone with no history of trauma presents with debilitating pain in one or two parts of the body and he has been cleared of morbid pathology, searching for a cause is not useful. Primarily because we don't treat anatomy, we treat processes.

                            Jono, I can understand your stance; some years ago i would have argued that everything has a cause and it should be searched for.
                            But I've worked out, as Jason has stated, it is counter-productive. It doesn't change anything and the patient tends to become over-medicalised.

                            Nari

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                            • #44
                              Wow! I'm honestly kind of suprised by those responses!

                              I agree with Nari's point that it certainly isn't always possible to know the cause, and i agree that sometimes knowing a 'cause' doesn't actually change your management of the patient.

                              I know that health isn't a linear, cause/effect process and i do understand that simplistic "X causes Y" type formula's lead to frustration and aren't particularly helpful.
                              If you got 1000 people to run 5kms wearing jandals some would be injured and some would feel fantastic- there is a great deal of variability in any normal population.

                              I don't disagree with any of this!

                              BUT the guy i saw this morning didn't have any fasciitis until he ran wearing jandals and since then he has had fasciitis. If i didn't probe around to find out this cause- i might have done the best treatment in the world but he may have just kept on aggravating the problem and i wouldn't have been able to have help him. Seeing as i did ask him for a bit more detail I can suggest that he walks his dog in running shoes not jandals and hopefully he'll have a much better/quicker/cheaper outcome. Asking him about the circumstances around his injury gave me a possibe clue to helping him.

                              I would think of finding 'blame' as being a judgemental way of approaching things... looking for 'causes' is different in my opinion.

                              Barrett- Sorry if i came across as being patronizing re: the smoking thing. I was just using it as an example.

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                              • #45
                                The spectrum of "causes" becomes obviously non-functional when you look at something like chiropractic. First of all, "subluxations" cause all things that can ever go wrong with anyone (justifies treatment by manipulating the spine for "wellness" care).

                                On the other hand, chiropractors claim they never "cause" stroke in patients, because "cause" cannot be "proven" definitively (excuses treatment by manipulating the spine for "wellness" care).

                                Not even a well-oiled trombone could slide up and down the cause spectrum faster from one "cause" for everything, to "can't prove cause," faster than chiro.

                                Slick eh?
                                Diane
                                www.dermoneuromodulation.com
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                                "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                                “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                                “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                                "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                                "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

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