Dealing with BLATANT Chiro misinformation 101

[Pooka1]

Goldfinch is a zen master at this! 1,000 kudos and I genuflect in Goldfinch's general direction.

http://www.fixscoliosis.com/forum/threads/178-Measurements

It is one Emily Litella moment after the next on there. They should have a sticky where they can post "Nevermind" posts.

It's like they are in a parallel universe, blind to what is really happening on the scientific front of scoliosis, imagining patently absurd scenarios, reinventing wheels, etc. etc.

[mamamax]

It's a productive discussion. Goldfinch - good teacher :-)

Most of us have at least something to learn?

[Pooka1]

Why should they rely on a random poster to edify them on basic facts about how surgeons work? Why don't they know this and why are they speculating wildly and wrongly?

They clearly assume surgeons are idiots and that they know better.

They really need an Emily Litella icon over there.

[LindaRacine]

Everyone knows you can't really diagnose the problem without a hair analysis. Duh!:rolleyes:

[Pooka1]

Everyone knows you can't really diagnose the problem without a hair analysis. Duh!:rolleyes:

Excellent point!

I suspect chiros play, "Find the subluxation" like the rest of us play Twister. :)

[mamamax]

Why should they rely on a random poster to edify them on basic facts about how surgeons work? Why don't they know this and why are they speculating wildly and wrongly?

They clearly assume surgeons are idiots and that they know better.

They really need an Emily Litella icon over there.

If I could answer such questions, I could probably solve a host of the world's problems .. just like Al Gore ;-)

I'm guessing - some folks have no idea how surgeons work unless they work with them - like so many of us do. When they need to know - it's nice when someone like Goldfinch comes along and gently offers more knowledge.

I don't think - they think - that surgeons are idiots. I really don't. Maybe sometimes, one can be so passionate about a thing - that other things get ignored. Ya know what I mean?

[mamamax]

Everyone knows you can't really diagnose the problem without a hair analysis. Duh!:rolleyes:

Nuh -uh .. the only truly valuable diagnostic tool is - a cat scan (attached) :D

[LindaRacine]

I don't think - they think - that surgeons are idiots.


I think all they care about is misleading the public.

[mamamax]

I think all they care about is misleading the public.

While Clear is not my current method of choice - I do think the men in question here, care about helping people vs misleading the public. Looking forward to that published study about to come out. Someday - all information will come together and we'll all have the answers we've been waiting for. Till then, it's like everybody holds some small piece of the puzzle. That's all I know - ain't much huh?

[LindaRacine]

While Clear is not my current method of choice - I do think the men in question here, care about helping people vs misleading the public. Looking forward to that published study about to come out. Someday - all information will come together and we'll all have the answers we've been waiting for. Till then, it's like everybody holds some small piece of the puzzle. That's all I know - ain't much huh?
We'll have to agree to disagree on this one.

[Pooka1]

Here's what I think is going on.

Just as for the case of subluxations, Clear chiro wants to carve out a niche within the scoliosis field apart from the (huge) expertise that surgeons have.

But rather than rely on an imaginary entity like subluxations (no two chiros can point to the same spot on a radiograph where the "subluxation" is located) they seem to be playing the "diagnostic study" card.

How are they playing this card?

By ignorantly misrepresenting the huge range of issues surgeons consider and lying that they only consider Cobb angle ("Cobb's angle" for one of those guys).

By ignorantly thinking that speaking with patients gets you the full story on what surgeons consider in a case.

By lying about the range of scientific diagnostic approaches surgeons in fact use in the hopes of carving out another pseudoscientific niche in the field of scoliosis similar to subluxation and to inlcude modified handheld power tools.

By staying deliberately ignorant of many things so they can reinvent wheels like they were the first to think of it.

[Pooka1]

The bottom line problem is that Clear thinks they are actually competing with orthopedic surgeons on the science. They refute that themselves through their approach.

[Pooka1]

I'm guessing - some folks have no idea how surgeons work unless they work with them - like so many of us do.

Then why are they ignorantly throwing surgeons under the bus? Shouldn't they, if they are professionals in the medical field like they claim to be, NOT do that?

In short, shouldn't they know what the hell they are talking about before writing another ignorant publication?

The evidence-based chiros are the only hope for that field. What little I have read seems very competent. It does not appear that Clear is on the evidence-based bandwagon.

[Pooka1]

Stitzel (chiro) writes:


I'm not saying that any orthos in the US are performing surgery based solely on Cobb angle

How would he know one way one way or the other what surgeons do or don't do? I have been tangentially related to two fusions, one for each of my kids and I am very sure the surgeon shared with me only what I needed to know which wouldn't fill a thimble compared to the actual expertise he brought to those two cases. And even with that small amount of knowledge I have, as a parent who helped two daughters, I know far more than a chiro knows about surgery.


(and for all the NSF readers....I was intentionally using the term "Cobb's angle" to reinforce that it is simply one man's interpretation of how scoliosis should be measured).

So what? Lateral angels aren't going to measure themselves. It just comes off as yet another point of ignorance from a purveyor of an alternative treatment. My advice is stick with accepted terminology if you don't want to be ignored out of hand. And it is no coincidence that you can publish "Cobb's angle" in a chiro publication; Try publishing that in a medical journal.


I'm suggesting that some orthos may be making the initial recommendation for surgery solely based off Cobb angle.

How would he know what surgeons do and don't do? This is beyond absurd. Chiro is not a surgical specialty.


I am not trying to suggest that anybody is acting in an unprofessional or unethical manner.

He is suggesting that chiros can make surgical decisions on firmer ground than surgeons. Maybe they use (imaginary) subluxations.


I am not trying to suggest that anybody is acting in an unprofessional or unethical manner.

He is second guessing them on THEIR field (surgery) which is not his field by a MILE. If chiro is going to have a seat at the big table of scoliosis, they need to understand where their training ends and where the training of orthopedic surgeons starts.

[Pooka1]

A chiro writes:


I'm suggesting that some orthos may be making the initial recommendation for surgery solely based off Cobb angle.

What's the evidence that starting the detailed analysis with Cobb angle is not good to do? What should surgeons be starting the analysis with if not lateral angle? What training does a chiro have to answer that? (None)

Questioning mainstream science from a non-evidence-based position is a common tactic from people who are blatantly pushing counterfactual material in other areas of science and medicine. If chiros want to be taken seriously then need to NOT use a tactic that is so closely associated with nonsense and concentrate on gathering evidence for their position instead. It's a "Look at the Wookie" approach when evidence for their own position is lacking.

[mamamax]

Stitzel (chiro) writes:



How would he know one way one way or the other what surgeons do or don't do? I have been tangentially related to two fusions, one for each of my kids and I am very sure the surgeon shared with me only what I needed to know which wouldn't fill a thimble compared to the actual expertise he brought to those two cases. And even with that small amount of knowledge I have, as a parent who helped two daughters, I know far more than a chiro knows about surgery.



So what? Lateral angels aren't going to measure themselves. It just comes off as yet another point of ignorance from a purveyor of an alternative treatment. My advice is stick with accepted terminology if you don't want to be ignored out of hand. And it is no coincidence that you can publish "Cobb's angle" in a chiro publication; Try publishing that in a medical journal.



How would he know what surgeons do and don't do? This is beyond absurd. Chiro is not a surgical specialty.



He is suggesting that chiros can make surgical decisions on firmer ground than surgeons. Maybe they use (imaginary) subluxations.



He is second guessing them on THEIR field (surgery) which is not his field by a MILE. If chiro is going to have a seat at the big table of scoliosis, they need to understand where their training ends and where the training of orthopedic surgeons starts.

NSF was mentioned because - eh hem - some seem concerned with putting this particular man under an electron microscope.

I went back over this thread today with morning coffee.

I find a good conversation between two people (Dr. Stizel and Goldfinch who is a surgical nurse at a very large hospital in the UK); one that at the end of the day, finds some enlightening concepts exchanged.

I think maybe - we make too much of this?

That's all I know :-)

[Pooka1]

Is it seemly or unseemly for a person not trained in surgery to suggests surgeons may not be taking the right approach to making surgical decisions?

[mamamax]

Is it seemly or unseemly for a person not trained in surgery to suggests surgeons may not be taking the right approach to making surgical decisions?

I think that ...

If we all restricted our conversations to only things we were truly knowledgeable about - we would have very few conversations - and learn very little :-)

I see the conversation between Stitzel and Goldfinch (or the chiropractor and the surgical nurse) as both a good exchange, and learning experience - along with good form within forum.

[Pooka1]

I think that ...

If we all restricted our conversations to only things we were truly knowledgeable about - we would have very few conversations - and learn very little :-)



Back and forth between lay people on fora is not on the table.

The central question on the table is should people ignorant of how surgical decisions are made be PUBLISHING that in a blind leading the blind leading the naked fashion and maligning surgeons?

[mamamax]

Back and forth between lay people on fora is not on the table.

The central question on the table is should people ignorant of how surgical decisions are made be PUBLISHING that in a blind leading the blind leading the naked fashion and maligning surgeons?

Well, that narrows down the question :-)

Strictly in regards to publishing: I would generally speaking, say no. However, I do not see a forum conversation as publishing. I see a forum conversation as just that - a forum conversation.

[Pooka1]

However, I do not see a forum conversation as publishing.

Nobody said it was. But we can have a forum conversation about what a person is publishing in a chiro journal to other chiros, yes? It's a metadiscussion on that.

[hdugger]

I'm not certain I have a problem with someone outside a field publicly (or, even, publishly) criticizing the methodology of a field. All it would require was good knowledge of what you were criticizing. If they have this knowledge, then it's OK to publish. If they don't, then it's not.

So, in this case, if they'd talked to lots of doctors about how the doctors make their decision to operate, then they have every right to examine that decision-making process.

I do have to say, as a complete outsider, that is does seem as if the decision to operate on immature scoliosis patients coincides 100% with a cobb angle cutoff (although the actual cutoff varies between doctors). I don't know if the additional considered factors just happen to coincide exactly with the angle, or if the angle alone is considered. But it *appears* that any curve that passes a certain agreed-upon angle is always operated on.

[Pooka1]

I do have to say, as a complete outsider, that is does seem as if the decision to operate on immature scoliosis patients coincides 100% with a cobb angle cutoff (although the actual cutoff varies between doctors). I don't know if the additional considered factors just happen to coincide exactly with the angle, or if the angle alone is considered. But it *appears* that any curve that passes a certain agreed-upon angle is always operated on.

But it's been established that they use more than that. Proven progression is one important factor. If Pam wasn't having pain, with documented non-progression of her ~50* for about two decades, I highly doubt she could find a surgeon who would operate. But I don't know that. Also, the surgical decision on my one daughter was made before she reached the trigger angle. That decision rested on the documented progression rate and the time to surgery. Indeed she was well into the surgical window on the day of surgery. Both these cases show that surgeons are using much more than Cobb angle to make surgical decisions. Further I suggest not just these two cases but EVERY case is evaluated for far more than Cobb angle. Goldfinch mentions some of these other criteria.

What is the evidence that the surgeons are doing anything in a non-optimal manner?

What training do chiros have to weigh in on surgical criteria?

What can chiros credibly add to the discussion on optimizing surgical decisions criteria given they have no training in surgery?

[Pooka1]

So, in this case, if they'd talked to lots of doctors about how the doctors make their decision to operate, then they have every right to examine that decision-making process.


They didn't do that nor did they claim to have done that.

[hdugger]

Surgical decisions on adults are multi-faceted. My son's doctor is holding off on operating on a possibly over 60 degree curve. But, on children, if you reach a certain cobb angle before you are skeletally mature, you are going to be operated on 100% of the time by any knowledgeable doctor.

To disprove this, you'd have to show a case in an immature and still-growing patient with a well-regarded doctor (or, at least, someone who was widely assumed to know what they were doing), where the doctor decided against operating on a growing child with a cobb angle over the cutoff (let's say 60 degrees, to be safe) because of other measurements. Not because of some additional risk to the child, but because the other measurement gave them information which they somehow regarded as more important in indicating progression than the cobb angle.

[Pooka1]

But, on children, if you reach a certain cobb angle before you are skeletally mature, you are going to be operated on 100% of the time by any knowledgeable doctor.

That is simply not true. Surgeons tend to hold off on definitive surgery when the child has a lot of growth remaining.

But i cases where little or no growth remains, then that surgical decision is driven by evidence in hand that virtually all of those kids will be worse off absent fusion. So where is there room for a chiro to criticize using Cobb angle if that is true?

[hdugger]

But i cases where little or no growth remains, then that surgical decision is driven by evidence in hand that virtually all of those kids will be worse off absent fusion. So where is there room for a chiro to criticize using Cobb angle if that is true?

I'm not arguing that doctors are wrong. I'd be very wary of a doctor who didn't want to stop the curve progression in a growing child once it reached 60 degrees (exception for younger children noted). I'm just saying that it is the Cobb angle, and not some other measurement, that drives that decision. At least, I haven't heard of a case where they decided not to operate because they thought some other measurement was more important than an over-60-degree angle.

My concern about this reliance on Cobb angles (although I have nothing better to offer) is that they certainly do seem to be fluid! My son's angle is just all over the map, even with the same doctor looking at the same xray (a reading which varied by 12 degrees with one of my doctors). For children on the cusp, they could have surgery or not have surgery, presumably, because of the time of day at which they got their xray. That's an awfully big decision to make based on such a fluid measure. Again, I don't have anything better to offer, but it is worrisome.

[Pooka1]

My concern about this reliance on Cobb angles (although I have nothing better to offer) is that they certainly do seem to be fluid! My son's angle is just all over the map, even with the same doctor looking at the same xray (a reading which varied by 12 degrees with one of my doctors). For children on the cusp, they could have surgery or not have surgery, presumably, because of the time of day at which they got their xray. That's an awfully big decision to make based on such a fluid measure. Again, I don't have anything better to offer, but it is worrisome.

I doubt a surgical decision ever rests on something like that. In kids who are mostly grown it seems to be driven at least by Cobb angle and documented progression rate. If the data are "noisy" in a certain case, if the data bounce around, have periods of quasi-stability, aren't unidirectional, etc., I suspect the decision to fuse would be put off until the data are clear one way or the other. But I don't know that.

There remains no evidence that any surgical decision has been precipitous. So any second guessing of the decision approach, especially from camps with no surgical training, should be very circumspect in my opinion.