This Week

[bernard]

Bas,

I understand your point of view and I see Diane as a perfectionist that goes deeper in the model. She makes a downscaling of the model and of course the model at human size becomes better.

But... Biologists have many simplified models at molecular size and an upscaling makes a wrong model.

[John W]

The problem is when the greed aspect driven by a reimbursement system that rewards reductionist approaches, i.e. throw everything available at the patient and see what sticks, is done all in the name of good intentions. We know, however, that good intentions are easily swayed by self-interest.

I've met that surgeon who put the disc in this young man, who is now my train-wreck patient. He's not evil or even a hack. He's actually a fairly respected, somewhat young spinal orthopedist here in town. He's done some good work.

I sincerely believe he thought he could help this guy, and likely came up with several rationalizations for skipping rehabilitation with this particular patient. Interestingly, he happens to be in an orthopedic group that has their own in-house PT. As has been my experience with such groups, they are not exactly on the cutting edge of PT practice, and are even less likely to think outside of the biomedical box. At least we reductionist PTs in the private practice realm have some incentive to think more broadly, if for no other reason than to distinguish ourselves from the physician-owned automatons.

It's a semblance of a free-market system- a poor one that doesn't work very well as my patient with his dislodged plastic disc can attest.

[bernard]

John,

An Health system is ever reductionist when is it confronted to productivity.
Health has a cost: It may be assumed. Medical technology maintains a cost/care that is out of proportion in many cases. Patients are now becoming ill with our assistance/intervention.

[Jason Silvernail]

Nari-
I actually wrote a "white paper" about the difficulties in reconciling the German and American systems and the issues we have in the Military Health System with some patients who get care on the German side and some on the American side.
Next week, I'll reproduce a portion of that here if anyone is interested. I'm no fan of the "system" here in Germany, that's for sure.

[Barrett Dorko]

While I have no problems at all with the way this thread has wound, I think it would be best if we took the discussion about last week's workshop to Alien Abduction where a number of provocative comments written in '07 can be found.

[John W]

I tried to reply over 36 hours ago, but we were hit with a massive ice storm and the power has just been restored. Here's how I responded to Bernard:

Bernard,
You're broad frame of reference and ability to summarize complex issues is admirable, particularly given that you're first language is not English.

I don't think health care has to continue down this road, however. My assessment is that, as in other industries where free-market principles are allowed to provide intrinsic control over "greedy reductionism" masking as good intentions, a re-structuring of health care delivery that is based on results/outcomes for specific conditions would force providers to adopt more scientifically "mechanistic" theories. Adopting such theories allows for a more accurate and practical approach to treating chronic conditions- the bulk of modern medical care, which should result in better outcomes/results and therefore better value for patients.

The biomedical reductionist trap that we're mired in is perpetuated by a non-incentivizing system. Scientific entrepreneurs are not drawn into health care for this reason. Only the very adventurous thinkers and iconoclastically inclined (as are many here at SS) have the extraordinary capabilities and motivation to forge through the biomechanistic muck.

These efforts, while admirable and personally edifying for me, are up against such huge contrary forces that I'm doubtful we'll see anything come to fruition without a significant change in health care policy.

I'm not of the opinion that President-elect Obama is a free-marketer when it comes to health care (nor is President Bush), so I'm not hopeful that much will change in health care delivery until we're forced to by our Medicare system reaching a financial crisis, which is imminent. Unfortunately, financial crises frequently result in "shoot from the hip" legislation that lacks vision and forethought.

Just look at the mess Congress has made of the banking and auto industry bail-outs.

[Diane]

I found something in a book yesterday that echoed Barrett's post #37, re civitas and communitas. It would seem there are similar things in each individual (which doesn't surprise me...).

The book is The Mindful Brain (2007), author Daniel Seigel. You can listen to a BrainSciencePodcast interview Ginger Campbell did with him, episode 44.

On page 207 he writes,

"Coherence and cohesion are very different. To get a feeling for this difference, imagine this mathematical idea: A cohesive state is created as a set of equations that rigidly defines the in- and out-group status of any variable that it is assessing (Thagard, 2002). Here the circle drawn to define boundaries of the set is clear and distinct: you are either in or out, identity defined, certainty established.

In contrast, coherence can be imaged as an equation that embeds the variables under consideration into the numerical sequences of the equation itself. As each new variable is encountered, it actually alters the equation and changes the shape of the "self" that defines the in- and the out-group membership characteristics. The shape of the boundaries is continually emerging. Here we see that coherence embeds flexibility at its core."

I see Somasimple as a coherent communitas, whereas I see the profession itself needing to be more of a cohesive civitas.

[Jon Newman]

John you may be interested in reading the answers to the question posed on Edge.org

Can science help solve the economic crisis?

[Barrett Dorko]

Ten days and counting

In the first post of this thread I described the class in St. Augustine as “a group that could potentially send my words around the world.” Today it seems I may have overstated that, or perhaps I should have emphasized the word “potentially.”

I know what time of year it is and my life contains as much busyness as anyone else’s, but I don’t think that sharing information or looking for more has ever been far from my thoughts. This week was no exception.

Now I find that the threads concerning my trip to St. Augustine (this one and Alien Abduction) are nearly on life support despite the presence of a few provocative issues and some remarkable posts from the usual suspects.

Perhaps I’m being premature in my assessment and will have to change my tune eventually, but I’m beginning to see this “continuation of the course” here on the pages of Soma Simple as pretty much a flop.

My question: What more can we do to generate interest in an actual discussion about the patient in pain with the group in St. Augustine?

That is, aside from wait.

[John W]

Barrett,
I have an idea, but only you know if it's feasible.

If Stanley was present during your presentation, perhaps you could ask him to to provide a brief comment on his impressions of the information you presented. The profession desperately needs leaders of his stature within OMPT to address the neurobiological revolution.

Up to this point, other than the EIM/Regis U. group, none from the "old guard" of OMPT have even acknowledged the profound impact that this information will (or at least should) have on the way we practice.

Maybe he would respond to a personal email request, and then allow you to post his comments here. I think the other members of your audience may be waiting for the "green light" from their leader.

[Jon Newman]

I'll play a little of the six degrees of physical therapy substitution game with the Edge link I provided earlier. Given that pain in general and chronic pain specifically can be viewed as the output of a complex system:

(From the link)

When economists physical therapists and other scientists study a complex system they begin by asking about what assumptions have been used previously in understanding it, and how well they have done compared to data. So if we approach the crisis in this way, we have to begin by asking about the principles and assumptions that have been used to construct and justify the complex financial instruments popular treatments whose use contributed to the present instability. We want to know how these theoretical ideas have been tested, and whether or not the present crisis is evidence that the ideas that the financial treatment system have been built on may need to be improved.

The neoclassical biomedical paradigm based on these ideas has had some undisputed successes. At the same time, it appears to have led to the adoption of practices and recommendations, which are at least partly at the root of the present crisis.

Nor do these new ideas necessarily invalidate the successes of neoclassical economics the biomedical approach. The conclusion we draw from this is that much more work has to be done. The good news is that both the successful aspects of the neoclassical biomedical paradigm and the newer ideas based on complex systems offer much scope for development of economics as a science. What is needed is an open-minded development of economic pain theory (or analgesia theory really), as in any area of science, based on the development of detailed models, through which the applicability of different principles and hypothesis can be compared with real world data.

There is more of course but I'll let others play if they desire.

[Diane]

Keep going Jon!

(BTW you missed changing one repetition of the word "economics" in the last quote box.)(I would recommend changing it to "human primate social grooming," but you might want to choose something else.)

[Jon Newman]

I'll just leave it. I was trying to come up with substitutes and couldn't decide on biomedicine, physical therapy, biomechanics, etc. As long as I get the idea across.

[Jon Newman]

Picture time

Chasm? What chasm?

[Diane]

Here's a version without redeye. :angel: