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Thread: ANother case of bracing only delaying surgery

  1. #31
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    Quote Originally Posted by Pooka1 View Post
    Nobody is cavalier about fusion.

    Being realistic about fusion is often confused with promoting fusion.

    Some people equate not bracing with being pro-fusion. That would only make sense if bracing was known to avoid fusion for life. That is NOT known. Equating not bracing with fusion doesn't make any sense because there is no good evidence bracing avoids fusion for life. With the large overtreatment rate and the overt failures (some perhaps due to non-compliance) not-bracing can't possibly account for more than a small percentage of fusions. And there is no good evidence it can even account for those cases.

    Lay people can't seem to grok that something can be a standard of care AND ALSO be completely experimental. I certainly can't grok it. It makes no sense.
    I believe we are discussing about many different issues. I’ll refer to this by now:

    1) People promoting to erase braces from the face of the earth are doing the right.

    I would (or might) agree if braces only could be used without any correction and only in stiff spines and without combining with nothing else and nobody ever heard about a successfully case.
    But nothing of that is true, although probably (I’m almost sure) was used sometimes with insignificant correction, in stiff spines, without combining with other method and some people never heard about a successful case.

    As I know there is no evidence that braces don’t works!
    And braces are not guilty if unquestionable evidence about how good or bad are, seems to be ever questionable.

    The fact(?) that nobody knows any record about a successful case dying because old age, of course not imply that should not works and should not be used. I don’t want to imagine how many things used in medicine, should have never been used if this would be the criteria to be followed.

    If a right reasoning based on our (even limited) knowledge, is saying us that some product has good chances to works under certain conditions, it should not to be discarded unless the cost/profit would be bad or risks would be terrible. And brace principle is extremely logic and the cost, if it helps to avoid surgery could not be seen as so much great.
    It has some risks and are not insignificant risks (even some are never mentioned) , but may be monitored and it may be suspended at any moment! Something so much different would be if we were talking about something irreversible.

    When you analyze the convenience of some kind of solution, you should allways do the triple analysis: Feasibility, Cost/Profit and Risk analysis and in none of those seems to be so much weak in order to promote that should to be discarded.
    It seems not logic to say that that people are doing the right!.
    They should to do something else.
    Last edited by flerc; 07-21-2012 at 04:21 PM.

  2. #32
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    Quote Originally Posted by flerc View Post
    Something so much different would be if we were talking about something irreversible.
    I have never understood the argument against fusion that it is bad because it is irreversible. Unless there is something better than fusion, nobody would want to reverse it (not counting the small percentage who have more pain). I do NOT count revisions because it is arguable that the fusion plus revision likely puts most patients in a BETTER position than no fusion. If that is wrong then I will amend my comment. There is a reason fusions are the standard of care for certain patients.

    The other thing is the hope that some non-fusion solution will come along but not be available to fused patients I suppose. That would be a rational reason to dislike fusion for being irreversible but this really only applies to the cusp of when some viable treatment is being developed. There doesn't seem to be anything like that on the horizon now though. So for now, I don't understand the argument for many/most curves.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
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    "We are all African."

  3. #33
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    EXCELENT Hdugger!! Impossible to say it in a best way.

  4. #34
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    Quote Originally Posted by Pooka1 View Post
    I have never understood the argument against fusion that it is bad because it is irreversible. Unless there is something better than fusion, nobody would want to reverse it (not counting the small percentage who have more pain). I do NOT count revisions because it is arguable that the fusion plus revision likely puts most patients in a BETTER position than no fusion. If that is wrong then I will amend my comment. There is a reason fusions are the standard of care for certain patients.

    The other thing is the hope that some non-fusion solution will come along but not be available to fused patients I suppose. That would be a rational reason to dislike fusion for being irreversible but this really only applies to the cusp of when some viable treatment is being developed. There doesn't seem to be anything like that on the horizon now though. So for now, I don't understand the argument for many/most curves.
    Reversibility of course is a so much important property of solutions, that is, the faculty of the solver, to reverse in a voluntary way the effects provoked by the solution.. goods and bads. Certainly if we see it as the property giving the possibility to return to the same state before applying the solution, it would never be any risk in applying those kind of solutions. Of course it's not the case of fusion. Certainly researches should to be looking for the way for doing it reversible.

    Even if it would be true that is small the percentage who have more pain, it should to be enough argument for you.
    I know about people who would give what they haven't for reverse the time and have again the choice to refuse fusion. And not all of them are in pain.

  5. #35
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    Quote Originally Posted by Pooka1 View Post
    But kids have a much higher standard for risk reduction because they have to wear the damn thing.
    I know people referring to it as the holy thing.

    Quote Originally Posted by Pooka1 View Post
    Some parents resist it and would brace a kid with only a 1% chance of succeeding I suspect.
    At least while something as fusion remains being the only other option offered by medical community, brace will remains view as a good option for many parents.
    Last edited by flerc; 07-21-2012 at 11:23 AM.

  6. #36
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    Given ongoing clinical trials and other studies, most notably including BrAIST, it is impossible to deny that bracing is experimental.

    In BrAIST, we have the bioethicists okaying the design of randomizing kids to a no brace control group. In that same study, there are experienced pediatric orthopedic surgeons from at least 26 medical centers with combined years of experience that likely runs to the hundreds of years that agree it is ethical to randomize kids to a no brace control group.

    Then we have experienced guys who brace like Sponseller admitting they have no good evidence bracing works. That easily explains why it is being studied in EXPERIMENTS. In science, you cna't just KNOW it. You have to SHOW it.

    ETA: We also have at least three groups who were NOT able to replicate the results for Spincor that the inventors report. So that is still experimental.

    To deny bracing is experimental is to deny the obvious. It is perverse or ignorant to do so.
    Last edited by Pooka1; 07-21-2012 at 08:22 AM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  7. #37
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    Quote Originally Posted by flerc View Post
    I know people referring to it as the holy thing.
    Yes. Those are the people in no danger of ever having to wear the damn thing. Easy for them to be cavalier.

    What's the minimum efficacy rate you would accept to brace your child? The efficacy rate has not been shown but can be no higher than about 10% or so based on results to date. And that is just at the point of maturity. The overtreatment rate is very high and is the vast majority according to that one talk by Newton and his buddy. Others have independently concluded the same.

    Let's say they established the efficacy rate for being subsurgical at maturity was 10% , would you brace your child? What about if they showed it was 1% or 0.001%?

    It is unlikely that they will show the efficacy rate past the point of maturity so I won't even ask about that.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  8. #38
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    Quote Originally Posted by Pooka1 View Post
    Here are Shaughnessy's pubs.

    http://www.ncbi.nlm.nih.gov/sites/en...aughnessy%20wj[Author]%20AND%20mayo[All%20Fields]%29

    He has been working on other matters and may have dropped the claims he tried to make in the 2009 POSNA talk. They seemed irrationally exuberant any road.
    I am taking this back. It was a 2011 talk, not a 2009 talk. It is premature to suggest that material can't or won't be published. I'll post the abstract if it is published.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  9. #39
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    Quote Originally Posted by Pooka1 View Post
    Yes. Those are the people in no danger of ever having to wear the damn thing. Easy for them to be cavalier.

    What's the minimum efficacy rate you would accept to brace your child? The efficacy rate has not been shown but can be no higher than about 10% or so based on results to date. And that is just at the point of maturity. The overtreatment rate is very high and is the vast majority according to that one talk by Newton and his buddy. Others have independently concluded the same.

    Let's say they established the efficacy rate for being subsurgical at maturity was 10% , would you brace your child? What about if they showed it was 1% or 0.001%?

    It is unlikely that they will show the efficacy rate past the point of maturity so I won't even ask about that.
    I understand people referring to braces as something damn if it was something traumatic and didn't work for them, but you cannot say that people are cavalier (if I'm understanding what you means) if they are eternally thankful with it because saved their sons from fusion. Would you not be also eternally thankful with it if this would have been your case?

  10. #40
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    Quote Originally Posted by Pooka1 View Post
    There is no good evidence that bracing does that for any curves. There is some evidence that surgery can likely do that for certain curves.
    There is not good evidence evidence with surgery for the entire life until death. You cannot be sure about not good evidence with braces until death, if for a moment you understand 'evidence' as something that really happened.
    Last edited by flerc; 07-21-2012 at 11:40 AM.

  11. #41
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    Quote Originally Posted by Pooka1 View Post
    The efficacy rate has not been shown but can be no higher than about 10% or so based on results to date.
    With how much reduction in brace and how much compliance? I have not the least interest in any study about cases without high values in those variables. Certainly I also should have not any interest if brace was the only one method used in the treatment.

  12. #42
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    Quote Originally Posted by flerc View Post
    if they are eternally thankful with it because saved their sons from fusion.
    How do they know if the brace stopped the curve or if their child wore the brace for no reason? Just because you are wearing a brace and the curve stopped doesn't mean the brace did a damn thing. In everyone's favorite bracing study(TM), 72% of the kids who were compliant did not progress >6* but 60% of the non-braced/non-compliant kids also didn't progress >6* per the talk by Newton and his buddy. That's a sliver of a difference and may not be significant if the error bars are large and I bet they are.
    Last edited by Pooka1; 07-21-2012 at 12:14 PM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  13. #43
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    Quote Originally Posted by Pooka1 View Post
    How do they know if the brace stopped the curve or if their child wore the brace for no reason? Just because you are wearing a brace and the curve stopped doesn't mean the brace did a damn thing. In everyone's favorite bracing study(TM), 72% of the kids who were compliant did not progress >6* but 60% of the non-braced/non-compliant kids also didn't progress >6* per the talk by Newton and his buddy. That's a sliver of a difference and may not be significant if the error bars are large and I bet they are.
    In cases of the people about I was talking, curves was >=35 and low riser..anyway I suppose because the same reason in cases with early surgery.
    And please, don't talk me any more about any study if you are not sure if it has any sense, that is, all cases with at least high compliance and reduction in brace.
    Last edited by flerc; 07-21-2012 at 01:08 PM.

  14. #44
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    Quote Originally Posted by flerc View Post
    Certainly I also should have not any interest if brace was the only one method used in the treatment.
    Only an inconceivably extreme idiocy (or some personal interest) would lead someone to discard boxing from a self defense method as MMA (mixed martial arts) is, because used alone is not so much effective.

  15. #45
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    Nobody may deny that exactly the same may be said replacing 'boxing' by 'brace' and 'self defense' by 'non surgical'.

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