Research trends in IS etiology in 2000

[Ballet Mom]

Doctors use anecdotes all the time to help them in their practices.

[Pooka1]

Yes and that is the crux of the issue that hdugger is banging on about as far as I can tell.

Surgeons have to use gut instinct with bracing because there is no dispositive evidence. But we are talking about a very hard treatment. Your daughter and my daughter were only in night-time braces which were hard enough. None of that can compare to a 23 h/d brace for several years. And it certainly doesn't compare to a Milwaukee brace with the superstructure for MANY years (which is the slightly ironic part in these exchanges with hdugger).

She will correct me if I'm wrong but I think hdugger's position is not that surgeons don't admit there is no good evidence for bracing but that because there is a chance it might work for even a few kids, coupled with the extreme difficulty of wearing it such that it is a constant uphill battle, that the placebo effect on the parents should be preserved.

If it isn't that then I don't know why she says what she says on this subject.

[Pooka1]

I can't see either of the responses, but I suspect they disagree with me.

If you aren't going to read responses to YOUR ARGUMENT then you aren't serious FULL STOP.

Give me a break! You have raised childishness to operatic levels. This is beneath you. Far beneath you.

[Ballet Mom]

If you aren't going to read responses to YOUR ARGUMENT then you aren't serious FULL STOP.

Give me a break! You have raised childishness to operatic levels. This is beneath you. Far beneath you.

For once Pooka and I agree.

[Pooka1]

I can't see either of the responses, but I suspect they disagree with me. Someone can set me right if they don't.

As an example of the type of spun viewpoint I just never, ever, ever want to see outside of the research section is this response to a mother whose child's curve is progressing while in brace.

Well how the hell are you ever going to see it if you have it blocked??? Problem solved!!!

You are melting down in a spectacular way here. Please pull yourself together.

For what it is worth, I suspect the people who don't mention when they are blocking people are the ONLY ones who are actually blocking people. The ones who go on and on about blocking people are studying every one of those "blocked" words in my opinion.

Nobody cares who is blocking who or who isn't blocking who. That should be obvious.

Will you please gather yourself and get back to the logical posts you wrote when you first joined?

[Pooka1]

For once Pooka and I agree.

Yay!
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[Ballet Mom]

Yay!
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.....lol......

[Pooka1]

What's the spin? Well, there are a bunch.

Sponseller, an expereinced pediatric orthopedic surgeon who thinks bracing is worth a shot, stated THE EXACT SAME THING I DID.

Is he spinning the facts also?

Are you following along?

Hello??

[Pooka1]

If people want to spin the facts down in the research section, I don't really care. As far as I can tell, hardly anyone is reading down here, and, if they are, I expect them to be intelligent enough to realize that research is, well, research.

Intelligence has zip to do with this. Knowledge of the evidence case is what is on the table.

[Pooka1]

If people want to spin the facts down in the research section, I don't really care.

This is the problem in a nutshell. The research section should be the MOST protected against spin, not the least. The science of this is the only game in town and the only hope to ever get anywhere.

[Ballet Mom]

This is the problem in a nutshell. The research section should be the MOST protected against spin, not the least. The science of this is the only game in town and the only hope to ever get anywhere.

Please...there are twenty to thirty people who read the posts in the research section. I'm sure we're all able to think for ourselves.

[Pooka1]

Please...there are twenty to thirty people who read the posts in the research section. I'm sure we're all able to think for ourselves.

I agree with the folks here being able to think for themselves but I disagree that many people read this section. Maybe but I doubt it. It is stem to stern nonsense.

[Pooka1]

Well, there sure are alot of posts - 8 or 9 appear just while I'm wandering around the house, cleaning a little, mulling, and then posting again

Why can't you just participate in a serious way? You have proven you can contribute if you want to do so.

[Pooka1]

I got yer "spin," right here...

I wrote this on 19 March 2011

http://www.eorthopod.com/content/is-...osis-effective

emphasis added

Before we look at how surgeons decide to use bracing, it should be pointed out that when asked why surgeons use bracing without convincing evidence that it works, there is agreement that the chance to reduce the risk of needing surgery is worth the effort.

Is this not EXACTLY what I have been banging on about? It this not EXACTLY what I have been saying?

Sponseller and others may think it works in some cases but no competent, sane surgeon claims there is good evidence it works. And Sponseller is admitting EXACTLY that. This is medicine and science and must be that way.

That is my entire point. Bracing may work in some cases. This research is so hard that I can well imagine a (small) population out there who might avoid surgery, perhaps for life with the right brace at the right time with full compliance. But there is a huge false positive signal here (~3/4 of the braced kids) that has to be dealt with.

And when talking about making baby kids wear a hard 23 h/d brace, you can't just KNOW it, you have to SHOW it in my opinion. Sponseller claims it's still worth a try. Other surgeons disagree. When you see opinions all over the map like that it is proof the jury is still out.

also

Another quote...

Dr. Sponseller concludes by reminding us that there is some evidence that bracing can be effective. But it is unpredictable as to how much or who might benefit the most (or at all).

I suggest he is probably (mostly?) referring to the 2010 Katz et al. article here.

Is this not EXACTLY what I said about Katz et al. (2010)? That there is a small signal that is completely swamped out by the variability such that you can never predict what will happen in an individual case?

I am not clairvoyant. Scoliosis is completely outside my field but everyone, myself and these scoliosis researchers, are all dealing with the same principles of science. Science is a hard game, especially in medicine where hands are tied and you almost can't do an adequately controlled study. My hat is off to all these guys who at least try and salvage what they can. It's straight up courage to do this research in the face of that.

[Pooka1]

For some reason, the term "genetic" has come to stand, in the discussions on this forum, for invariable or fixed or not amenable to environmental intervention.

Speak for yourself.

If you'll recall, every time you stated that I told you it was a non sequitor.

I have also stated there is no correlation between the etiology and the treatment in terms of broad classes as you also just assumed. I used the example of HIV which is almost entirely not genetic but rather infectious disease and yet it defies a cure. At the other end of the spectrum we have Marfans which is entirely genetic and it can be completely treated not to mention some lethal effects can be completely obviated.

It was a specious correlation from the get go and now you are realizing why.