Are Some Canadian Doctors from the Dark Ages?

[Celia]

Melissa,

I can't see any of his posts! He's on my ignore list. *YAY*!!!!!!! Oh HAPPY HAPPY DAY!!!!!!!! FREE AT LAST! FREE AT LAST!!!! THANK GOD ALMIGHTY, I'M FREE AT LAST!!!!!!

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[structural75]

real mature... I can't believe I've been a part of this again... sorry folks

[Celia]

Getting back to the topic at hand before I was so rudely interrupted by someone trying to rehash old vestibular testing/rehab wounds and unproven expensive "comprehensive treatments" ... what do these children deserve? Are their lives less worthy than Dr. Weinstein or the other doctors participating in this study? As I mentioned previously, I value *all* human life! All children deserve a fair chance!!!!!! It's one thing refusing to wear a brace and opting out of treatment because a child refuses to wear the brace.... it's quite another when these doctors start playing God and deny someone treatment. I think we have already made enormous strides in scoliosis research that we have a fairly good idea who will benefit from bracing and who won't and what will happen to children who are not braced during the adolescent growth spurt. When I refer to doctors playing God I'm referring to these doctors condemning half these children to a life long battle with a deformity and requiring surgery. If an individual wants to volunteer him/herself or a family member to be one of the participants in a control study or placebo group, go right ahead! Is this what we call scientific progress????? Honestly....how many more bracing studies are needed? Do we really need sacrificial lambs to complete these studies ??? Take a look at the annotated bibliography on this link:



http://www.srs.org/professionals/bracing_manuals/

[structural75]

Getting back to the topic at hand before I was so rudely interrupted by someone trying to hash out old vestibular testing/rehab wounds and "comprehensive treatments"

My case in point... you simply don't quit!

(Again, I don't do vest rehab or testing, but I do give credibility to neurologic factors in cases of scoliosis - as do many of the top specialists in the field.)

Onward... I sympathize with your sentiment about 'innocent' children, I really do. And I don't think it's appropriate to deny people proper treatment either. But do we know how the control group is being selected in this study? (I'm asking that question for real) I don't personally know... ?

I'm just thinking about all of those children/people who haven't been helped by bracing of any kind, including spinecor. What can be done for these folks outside of surgery? And how can we enhance the effectiveness of existing bracing methods and why are some failing to respond to it? I think more bracing studies, of some kind and without the victimization of children involved, could help shed some light on the matter. I think it's probably safe to say that bracing is hit or miss. Reliable predictability is still a real challenge... further inquiry is necessary.

it's quite another when these doctors start playing God and deny someone treatment. I think we have already made enormous strides in scoliosis research that we have a fairly good idea who will benefit from bracing and who won't and what will happen to children who are not braced during the adolescent growth spurt. When I refer to doctors playing God I'm referring to these doctors condemning half these children to a life long battle with a deformity and requiring surgery.

I think we have made positive strides yet there are still children being prescribed braces and having little success with it if at all. This leads me to question why these children are being braced in the first place if we supposedly have a good idea who will benefit and who won't.

I don't know that bracing methods and studies have been exhausted. What if we took that stance before the introduction of spinecor? We would have sold ourselves short of a 'new' approach to bracing. So to think that the spinecor, and other hard braces, are the end of the evolution of bracing seems a bit god-like as well.


structural

[gerbo]

personally I think that it is well established, from the available evidence, that more patients who are braced have a good outcome, than patients who are not braced.

One wonders whether the main issue with regards to those who do not respond are not patient issues (beyond the ones who have just gone too far) but issues to do with the quality and method of bracing. it is obvious that not everybody works to the same standard, protocol or technique and this might just account for the many failures.

Ofcourse if you do not pay much attention to your bracing (as you do not believe in it anyway) your results will be poor, which then becomes a self fullfilling prophecy, also resulting in all these very divided opinions.

I have referred before to the orthotist in germany, who uses a modified cheneau brace and apparantly often achieves 100% or more correction in the brace. His results, alledgedly, are very good. Unfortunately there is no proper study available to back this up, but on german forums they do rave about him (and are absolutely scathing (?) about anglo-american bracing)

so, in my mind, the study should be about why some bracing helps, and other doesn't, and really I believe there is a case for each major center collecting figures on their results, which than could be compared. (the same happens in the UK with regards to (amongst others) succesrates for heart surgery, survival rates after major surgery etc, etc, . The ones with the worst results might in that scenario have to face up to the fact they are not doing their job properly..... (surgeons have lost their jobs on the back of these type of comparisons)

[Celia]

Remember also that when the Spinecor brace was introduced over 15 years ago, people were taking risks but it wasn't a matter of doing "nothing" at all. I believe that children who were in the intial study had the option of trying the brace and if there was progression they were offered a rigid brace. This is *exactly* what I would have done with my own daughter if there was progression! The BrAIST study is completely different and there is no way anyone can compare the BrAIST study to the Spinecor study.

I also find it ironic that the NSF made the following comment in it's recent issue of "Talk Back"

"One of the fundamental beliefs of the National Scoliosis Foundation is that every child regardless of race, creed or socio-economic status deserves an equal opportunity for the early detection of spinal deformities such as scoliosis and has access to the least invasive, less expensive, and most effective treatment options possible."


Yet a few of the members of the SOSORT who are presenting their findings in May are providing unproven expensive treatments to patients.



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[CurvySAT05]

I can't help the fact but to think that in this "study" they are still requiring all of the participants to have insurance coverage or willingness to pay for treatment. I think that they would get better results if they were to find participants who were underprivilaged and would not recieve treatment otherwise and were good bracing candidates. Or if they [the doctors and facilities involved in the study] just treated the study patients for free during the length of the study. Many "clinical trials" pay their participants for being involved in research. I personally think that if the people in the study are paying for the braces, and the treatment that they are less likely to be as compliant with the study because they are still paying for their treatment the same as "normal" patients. If the child gets frustrated with the brace, or has a "I hate my spine" moment, they will have nothing to fall back on such as, "give it a try, the doctors gave you your brace, they just want to see you succeed."
I remember something a good friend of mine said one day (who works with Juinor Highers) "they [the kids] leave the house with the brace on, the parents praise them, and then once down the street out of sight they take it off and hide it behind a bush until after school and walk back in the door with the brace on and their parents never know they had it off all day."
Who is going to measure their compliance during the study? Are all 250 children in the brace going to have the same standards in the brace 23/7 or 18/7 or are they going to be different for each center, or doctor? Will the change in standards change the results of the study?
I will be excited to read the results of the study when they come out.
I would not go so far as to say avoiding certain centers like the plague, but I do know where you are coming from. My first surgeon said I was done growing when I was diagnosed (I was 5'8" tall) so I was never braced, and like the "control group" I progressed to surgery (I was 14 y.o. at diagnosis). When I got a second opinion 2 years later, I had grown 2 inches and my curve had progressed 10* (which my first surgeon said had not progressed at all). I think that some surgeons are more likely than others to give braces, or to "wait and watch" and will not necessarily have 50% of their patients in each category.

[Celia]

I'm sure many are familiar with the Hippocratic Oath which doctors recite upon graduation. Here is the modern version:

Hippocratic Oath

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.


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