Two opinions on evidence-based medicine in orthopedics

[Pooka1]

http://www.jbjs.org/article.aspx?articleid=327865

And

http://www.jbjs.org/article.aspx?articleid=327866

The second one explains very well why the bracing literature is an unsalvageable train wreck but also that nobody has shown bracing can't work under the right circumstances.

I also see a problem with identifying cases of equipoise. For bracing, there should be a very loud, clear case of it across the board based on the literature. Yet we hear some loose comments from surgeons that bracing is more proven than it is. These comments, by definition, can only have come from personal experience which is known to be fatally flawed. If it wasn't then we would never need high-quality controlled studies. Surgeons need to stop undermining their own profession in this way. Evidence is the gold standard for this or anything real. Faith and hope are not relevant.

[LindaRacine]

Hi Sharon...

I think that doctors may feel it's unethical to withhold bracing treatment just because there is no absolute proof that it works. It may also be unethical to put a child in a brace when there's no absolute proof that it works. But, of the two options, one is more lethal than the other. Until we have absolute proof one way or the other, I don't think we can all just sit around and do nothing.

Since there's no modality that is absolutely proven to treat smaller curves (25-35 degrees) in growing children, I'm guessing the specialists who are still bracing, think they have to take a shot at doing something, if there's at least a significant possibility that it will help (especially if the kid has a high ScoliScore). I'm sure there are lots of examples in medicine, of treatments that are offered, even if there's no guarantee that the treatment will work.

Some day, I would love to set up a debate between some of the top pediatric scoliosis specialists, to hear how they feel about the issue.

Regards,
Linda

[Pooka1]

Some day, I would love to set up a debate between some of the top pediatric scoliosis specialists, to hear how they feel about the issue.

Rather than hearing how they feel about it, I'd like to ask them what evidence they have supporting their approach. Because there is no high quality evidence, it's going to be either personal experience which of course is entirely uncontrolled and uncontrollable or a misunderstanding of the literature. Bracing is arguably too drastic a treatment to go forward with that.

Scoliscore, as you mention, might represent a more ethical way forward with bracing.