Cost/Benefit of Non-Operative Treatment in Adults

[hdugger]

Sorry, I feel like we're ganging up on you. That's not my intention. I'm going to step back for a bit.

[Pooka1]

What if we substituted the word "theory" for "belief"? In the sense that it's a viewpoint supported by some emperical evidence, and logically coherent, but not yet scientifically tested.

That would be a hypothesis, not a theory, yes?

A theory captures all or most of the data and there is little if any data in opposition. An example is the theory of evolution which seeks to explain the FACT of evolution over a few billion years.

I agree hypothesis fits.

[Pooka1]

Sorry, I feel like we're ganging up on you. That's not my intention. I'm going to step back for a bit.

Is this addressed to me?

I do not feel ganged up on. Should I?

[mamamax]

Assume the Attitude - Not the Belief ;-)

Sharon -

Is the word believe and all derivatives thereof a word to be avoided in conversation with those with research backgrounds? I don't know. I'm not a research scientist. If I were to change the word to something else, for the sake of getting along - the word attitude comes to mind.

Let me revise my answer to Sharon (who takes exception, for some reason, to the word believe).

I have difficulty comprehending how you would not know what I would say to this. I would say ...

Martha Hawes

Seriously if people adopted the same attitude that you are proposing I adopt - then folks would still be spending several months in plaster casts following surgery - or surgical methods would have never been developed much less refined year after year.

Myself on the other hand Sharon - acknowledges that you firmly assume the attitude that there exists absolutely no non surgical rehabilitation methods. But the knowing of that does not confuse me.

Serial casting of infants has proven successful. Thank God Min Mehta did not assume the same attitude as you propose I should.

Is this better?

[Pooka1]

Nice cartoon!

I am not saying conservative solutions shouldn't be sought. I am characterizing the state of evidence as woeful which is compounded by the length of time some have been under study.

I am also pointing out the obvious that just because a conservative approach is sought doesn't mean one exists to be discovered for any particular condition. Hence the perpetual motion machine example.

[mamamax]

Nice cartoon!

Thanks - thought you would like :-)

I am not saying conservative solutions shouldn't be sought.

But, are you saying that those that currently exist (Schroth, SEAS, et al) are not deserving of research and funding?

I am characterizing the state of evidence as woeful which is compounded by the length of time some have been under study.

And I would say that the state of documented evidence is woeful due to lack of research funding

I am also pointing out the obvious that just because a conservative approach is sought doesn't mean one exists to be discovered for any particular condition. Hence the perpetual motion machine example.

That just sounds like a bit of psychobabble to me.

[hdugger]

Is this addressed to me?

I do not feel ganged up on. Should I?

No, I just creeped myself out writing about what "we believe," like it was some kind of organized religion or something

[mamamax]

Hence forth ... I'll have a new attitude

[Pooka1]

But, are you saying that those that currently exist (Schroth, SEAS, et al) are not deserving of research and funding?

Correct. For example Schroth has been at it for ~90 years. How many more years do they need to rule it in or out? I'm actually asking that seriously, not rhetorically.

And I would say that the state of documented evidence is woeful due to lack of research funding

That is an interesting hypothesis. I think some of these conservative methods have been studied quite a bit. What's holding Weiss back?

[Pooka1]

No, I just creeped myself out writing about what "we believe," like it was some kind of organized religion or something

"I wouldn't want to belong to any club that would have me as a member." -- G. Marx

[hdugger]

Nice cartoon!

I am not saying conservative solutions shouldn't be sought. I am characterizing the state of evidence as woeful which is compounded by the length of time some have been under study.

I am also pointing out the obvious that just because a conservative approach is sought doesn't mean one exists to be discovered for any particular condition. Hence the perpetual motion machine example.

I really think we're going at the whole study of conservative treatments in the wrong way, and I suspect that's bogging down the research. All we need to show is that conservative treatments help reduce the pain of mild to moderate scoliosis. I think that's pretty well agreed upon (current study notwithstanding!)

I'm pretty sure Weiss already has some studies in this area, and I suspect the SEAS people could pull one together if they haven't already. I'd hope the simpler exercise protocols (particularly torso rotation and side-shifting) could do the same.

The research would test these treatments as a *pain reduction* alternative, and not as a *treatment* alternative. Unlike scoliosis progression, pain is simple and non-invasive to measure, and you can do a simple comparison of pain before treatment and pain after treatment in the same patients.

If my hypothesis is correct, this *pain reduction* will also slow progression. But, even without that, the conservative treatments are legitimized and patients have a safe method to use to treat pain.

[hdugger]

Correct. For example Schroth has been at it for ~90 years. How many more years do they need to rule it in or out? I'm actually asking that seriously, not rhetorically.

Is that a trick question?

For the same reason that the bracing people can't rule it in or out, even with the force of the medical community behind it. Because you'd need a very large number of people randomly assigned, and you can't get a very large number of people randomly assigned unless the medical commuity is already behind it, and you can't get the medical community behind it because it hasn't been proven. I thought Kevin's summary of this was pretty succinct.

You *can* do it on problems that tend to reverse themselves normally, like lower back pain, where you can show that one group got better faster. But, for a disease which does not reverse itself, it's very, very hard to show that people who are still suffering from the disorder are suffering "less" because of your intervention. Only very large numbers will show that. Hence, Catch-22.

[Pooka1]

All we need to show is that conservative treatments help reduce the pain of mild to moderate scoliosis.

I think that is settled, no?

That's why I keep shifting back to the case of halting or regressing large curves and I think Mamamax has joined me in that with her reference to Hawes.

Wanting an effective conservative treatment for that is not, perforce, going to make one possible if that isn't in the cards of the universe.

[Pooka1]

Is that a trick question?

For the same reason that the bracing people can't rule it in or out, even with the force of the medical community behind it. Because you'd need a very large number of people randomly assigned, and you can't get a very large number of people randomly assigned unless the medical commuity is already behind it, and you can't get the medical community behind it because it hasn't been proven. I thought Kevin's summary of this was pretty succinct.

You *can* do it on problems that tend to reverse themselves normally, like lower back pain, where you can show that one group got better faster. But, for a disease which does not reverse itself, it's very, very hard to show that people who are still suffering from the disorder are suffering "less" because of your intervention. Only very large numbers will show that. Hence, Catch-22.

WELL! So you are ruling out proof of efficacy of conservative approaches in principle!

Alrighty then!

I tend to agree but I have to think about it some more. There could be some slick way devised to measure things that we can't measure now.

[hdugger]

I think that is settled, no?

It's not settled until it's routinely prescribed/paid for by insurance.