Science-Based Medicine blog

[Diane]

SBM blog has been up for a year. I've referred to it many times and have chased down many of its links, borrowed certain ideas from it like "tooth fairy science" (thank you Harriet Hall :thumbs_up).

Today's post is by Steven Novella, a sum-up of Year 1, A Year of Science-Based Medicine. In it he makes this statement:

"I coined the term science-based medicine because I wanted our blog to be about what we are for, not what we are against. We advocate for a univsersal science-based standard of care in medicine. The term is also a play on evidence-based medicine, which almost gets it right but fails to properly consider prior plausibility in its evaluations."

I think we could paraphrase this slightly and it would fit Somasimple perfectly. This site is about what we are for, although it's also what we are against and why. As a PT site it has to be relentlessly explicit, because the whole profession has been way too confusing/confused all along and is in danger of getting worse instead of better if left entirely on its own.

I particularly like the second part. I think I'll use that as a quote in my signature line. :thumbs_up

[EricM]

Mark Crislip has blogged about treatment of chronic pain in AARP and Alternative Medicine on SBM today. It's an interesting article. He's complimentary to physical therapy but takes an outcomes-only approach to evidence and seems to misunderstand placebo.

[Jason Silvernail]

He's complimentary to physical therapy but takes an outcomes-only approach to evidence and seems to misunderstand placebo.

Great summary, Eric. I've dealt a lot with the outcomes-only mentality, and I find myself losing patience for these arguments when they present themselves. There's more of this in our future, so I probably need to have a healthier attitude about it. It just strikes me as so intellectually lazy, that it's hard.

[Diane]

Here is a new thread by Steven Novella on placebo: The rise of placebo medicine.

It lays out the issues carefully. The main gist seems to be about how reframing placebo would lead to bad science. The CAM studies such as the acupuncture study that showed that fake acupuncture was just as good as real, therefore "acupuncture works", are pointed out as examples. There seems to be intense disquiet as always. A comment by "twaza"(4th one in) says:

"There is another issue that is seldom noticed in these discussions. Science-based medicine has paid little attention to understanding the components of the placebo effect, and provides little guidance on how evidence-based practitioners can exploit these effects in their practice. Until it does this, CAMsters will have a competitive advantage."

Exacto, IMO.

[Adiemusfree]

I'm not so sure that I can agree with this part of your quote, Diane 'Science-based medicine has paid little attention to understanding the components of the placebo effect, and provides little guidance on how evidence-based practitioners can exploit these effects in their practice'

There is a LOT of research being undertaken with regard to placebo and meaning response - see Dan Moerman, Benedetti and Colloca et al. At least in terms of pain management, we are beginning to understand so much more about the whole thing that I think we're being much wiser about it than previously.
I take a module on placebo in the postgrad papers I teach, and this module always raises so much discussion - about ethics, about assumptions (eg if the person responds to placebo then their pain 'must' be imaginary or psychological!), about what to do if you've carried out a treatment in good faith, had good results - but then find out the RCT's demonstrate little or no effect discernable from placebo.

Certain aspects of 'meaning response' can and are clearly identified: empathy, taking time to listen, generating a positive expectancy, patient beliefs, the cultural context of the health interaction, but without a doubt: there is much more to learn.

For good reading on placebo - apart from Dan Moerman's 'Meaning response' approach, it's worthwhile looking at anything written by Benedetti and Colloca, their work is empirical science carried out to clearly identify some of the biological mechanisms for responses to placebo. Current thinking seems to be that the body uses biological systems to achieve the result but the interaction between the health care provider and patient beliefs/learning/culture etc influence the activation of these systems.

[Diane]

Bronnie, I would urge you to go and say so on the blog. The person who made the comment was 'twaza'. I'm sure they'd be interested.

[Diane]

Neck Manipulation: Risk vs. Benefit

New blogpost up on neck manipulation by Sam Homola, Neck Manipulation: Risk vs. Benefit.

Progress... progress....

[Diane]

Acupuncture

Check out the latest blogpost, Oriental Medicine or Medical Orientalism?, by Ben Kavoussi, on ScienceBased Medicine. :clap2: