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Is Evidence Based Practice Making Us Stupid?

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  • Is Evidence Based Practice Making Us Stupid?

    I’ve been reading and writing a number of things lately, and, predictably, none of these things has reached the level of coherency in the writing that I require before I put it out there.

    Having read Brain Rules recently I knew I couldn’t multitask like this (part of rule #4) and expect to get much done, but I’m of the opinion that flooding yourself with information in this manner will help you make connections between seemingly unrelated ideas that you wouldn’t ordinarily see. At least, this is how it works for me.

    I was pointed toward an article in the current issue of Atlantic Monthly titled Is Google Making Us Stupid? by Nicholas Carr that I’ve gone on to read very carefully. As does often happen, it came along at precisely the right moment and I want to use it to build various aspects of this thread. You can find it here.

    Let’s begin with this:

    Carr cites a change in Nietzsche’s writing that can be traced directly to his acquisition of a typewriter in 1882. His prose became tighter, almost as if he were writing telegraphs instead of essays. When his friends pointed this out he said, “You are right, our writing equipment takes part in the forming of our thoughts.”

    Please consider this, read the article when you’ve the time and see if you can guess where I’m going next.

    More soon.
    Barrett L. Dorko

  • #2
    Hey Barrett, is that Brain Rules book worth buying?
    Ole Reidar Johansen, Musculoskeletal Physiotherapist
    "And if you gaze for long into an abyss, the abyss gazes also into you." - Nietzsche

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    • #3
      Ole,

      No, not really.

      See how I got your buddy Nietzsche into the first post?
      Barrett L. Dorko

      Comment


      • #4
        Have you seen this Barrett? I found it here.
        Argh.
        Last edited by Diane; 08-07-2008, 03:34 PM.
        Diane
        www.dermoneuromodulation.com
        SensibleSolutionsPhysiotherapy
        HumanAntiGravitySuit blog
        Neurotonics PT Teamblog
        Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
        Canadian Physiotherapy Association Pain Science Division Facebook page
        @PainPhysiosCan
        WCPT PhysiotherapyPainNetwork on Facebook
        @WCPTPTPN
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        @dfjpt
        SomaSimple on Facebook
        @somasimple

        "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

        Comment


        • #5
          Originally posted by Barrett Dorko View Post
          See how I got your buddy Nietzsche into the first post?
          Yes - I like Nietzsche.
          Ole Reidar Johansen, Musculoskeletal Physiotherapist
          "And if you gaze for long into an abyss, the abyss gazes also into you." - Nietzsche

          Comment


          • #6
            I think this post from EIM belongs here.
            EBP, Deep Models, and Scientific Reasoning
            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.

            Comment


            • #7
              Diane,

              Your references are precisely on point. An interesting list of comments accompanying the article as well.

              Carr's contention in the originally referenced Is Google...? article is that the way we now find and familiarize ourselves with information has lead to a literal change in the way we read, think and, consequently, act. If we surf the web enough - seeing snippets here and then there, and then quickly over there - we will often find ourselves unable to read any tome from cover to cover as we carefully consider the deeper implications of its message. Some regular visitors here might already be aware that this has happened to them.

              In short, the machine has changed us by virtue of the way it thinks, not the way we think.
              Barrett L. Dorko

              Comment


              • #8
                The medium is the message???

                Marshall McLuhan I believe
                Last edited by Mary C; 08-07-2008, 09:50 PM. Reason: add source
                Guess learning is a lifestyle, not a passtime.
                Those people who think they know everything are a great annoyance to those of us who do. ~ Isaac Asimov

                Comment


                • #9
                  Television is also a culprit in encouraging a short attention span. Lots of information thrown at you a few seconds at a time; constant scene-changing. At least with the net and hard copy newspapers we have a choice: we can linger and contemplate, but kids are not likely to do that, anyway.

                  So if we don't take time to connect the dots properly, we become ambulant dictionaries perhaps, with little or no ability to understand anything other than on a superficial level, and that is dependent on how the modality serves it up to us.

                  Nari

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                  • #10
                    I had thought that it was either a) the length of time since I was in school, or b) the fact I'm getting older, that was responsible for the noticeable decline in my attention span. I'm not sure I'm relieved to learn of this other contributer, but it does make sense. I rarely read any more than about 3/4 of any post on the first run through. I also find it increasingly difficult to compose these posts. I'd like to be more thoughtful and thorough but am too frequently distracted by something else to take the time to accomplish even this small a task. You've no idea how many pots of rice I've burned on the stove in the last year! As much as I'd like a remedy, I'm not so sure I'd follow through with anything.
                    Some regular visitors here might already be aware that this has happened to them.
                    You got me.
                    Eric Matheson, PT

                    Comment


                    • #11
                      I haven't noticed any change in the depth to which I can sink into a topic, and I feel my ability to write has actually improved...mostly by writing lots....
                      But there has been one effect I've noticed, which I don't know is a bad thing or a good thing yet, which indicates to me how deep into my brain the internet has sunk and how it has taken over pathways: it is in dreaming. I rarely dream about my physicality anymore - i.e., walking down a street, encountering other people in my dreams in an ordinary physical way the way one does in waking life. Instead it's like I watch dreams on a screen, and can change them by opening a new window, or shut them off if I don't like them.
                      Diane
                      www.dermoneuromodulation.com
                      SensibleSolutionsPhysiotherapy
                      HumanAntiGravitySuit blog
                      Neurotonics PT Teamblog
                      Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                      Canadian Physiotherapy Association Pain Science Division Facebook page
                      @PainPhysiosCan
                      WCPT PhysiotherapyPainNetwork on Facebook
                      @WCPTPTPN
                      Neuroscience and Pain Science for Manual PTs Facebook page

                      @dfjpt
                      SomaSimple on Facebook
                      @somasimple

                      "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

                      Comment


                      • #12
                        Well, you guys are already way ahead of where I thought we’d be at this point. Jason saw that this is yet another run at the weaknesses inherent to the current notions surrounding evidence based thinking as it has evolved in our profession, and he’s exactly right about that. I’d recommend looking at the link he provided. This thread might even be linked to that eventually.

                        Steven Novella, a neurologist, recently wrote a bit about his own problems with EBM on his blog, Neurologica. Here he writes at length in response to what he refers to as a “crank” who is wildly critical of his skeptical view:

                        The goal of EBM, ironically, is to focus on evidence for efficacy - not mechanism of action. In fact…that is my primary criticism of EBM, that it does not adequately consider mechanism of action when dealing with highly improbable therapies.
                        So, as you can see, those of us who have been speaking critically of this specific aspect of EBM thinking have a powerful ally.
                        Barrett L. Dorko

                        Comment


                        • #13
                          Well I'll tell you one thing. Surfing the net and writing quick discussion board posts DOES NOT prepare you for the writing portion of the GRE. I know. Twice. :embarasse
                          "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

                          Comment


                          • #14
                            Jason's link is certainly relevant.
                            The problem with EBP (which is well recognised by those who are wary of its consequences) is the risk that a patient has to 'fit' into a certain objective category and therefore the therapist will perform this technique.
                            Many patients do fit into categories such as the CPR for manips, but what about individual differences? Take them away and you have recipe-induced thinking which tends to make us technically correct but not much else. And as we know, that is not how therapy should be.

                            Eric, I do the same thing; some posts I skip altogether and return a day or so later when my brain is in an academic mood. Maybe that is laziness, and/or only a remote interest in the thread especially when a link is a zillion pages long.

                            What I find myself doing is going to Barrett's threads/posts first; and I think this is because I can understand them immediately, and they then assist in delving into other posts, sometimes. No offence intended to those who usually write almost dopamine-inducing posts.

                            Nari

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                            • #15
                              I wonder, is it EBM itself that makes us stupid, or does it just distract us?

                              Perhaps a closer analogy would be, "Does abstract-only reading make us stupid?"
                              Last edited by Luke Rickards; 09-07-2008, 11:01 AM.
                              Luke Rickards
                              Osteopath

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