Rehabilitation of adolescent patients with scoliosis—what do we know?

[hdugger]

The only other contact between lay people and medical research is the media - whose summaries of research are, IMO, far worse then just reading the reports yourself.

The thing is, people are exposed all the time to information which they haven't had adequate training to make sense of. That says much less about the general capacity of people then it says about our educational system.

As someone who went to school with doctors studying medical research, my sense is that doctors aren't much better at making sense of the research then anyone else. They understand medical part of it, but they often don't have a good grasp of the research part of it.

Yet another reason why there ought to be an epidemiologist in every doctor's office

[Pooka1]

The only other contact between lay people and medical research is the media - whose summaries of research are, IMO, far worse then just reading the reports yourself.

The thing is, people are exposed all the time to information which they haven't had adequate training to make sense of. That says much less about the general capacity of people then it says about our educational system.

Agree 1,000%. And our august NIH director just drew another spanking, this time from a science journal editor for potentially undermining science education even more than it already it. And only Turkey, among 34 first world countries, is more ignorant about evolution and the age of the earth than the US. We are the laughing stock of the world when it comes to science knowledge among the unwashed masses because of this.

The research section on this forum is Exhibit A in the dangers of folks without a lick of science training talking at great length about medicine.

As someone who went to school with doctors studying medical research, my sense is that doctors aren't much better at making sense of the research then anyone else. They understand medical part of it, but they often don't have a good grasp of the research part of it.

Agree and have made this point myself. An MD is not a research degree as evidenced by the fact that there are joint MD/PhD programs. Still, these guys aren't dopes and can boot up quickly.

Yet another reason why there ought to be an epidemiologist in every doctor's office

Agree again!

[LindaRacine]

Access is limited to members I believe - but membership is open to all at no charge, and posting is optional :-)

No, not all.

[hdugger]

Well, this is going to have the odd effect of me responding, spookily, to nothing at all, but, here goes.

The link was interesting, but it's still science working out the details *based on a received moral code.* So, it's using scientific methods to test an already-established worldview, which has no (and can have no) scientific basis.

For example, in the second study, babies show that they can tell "good from evil" by rewarding "good" behavior like "helping those in distress." But I see nothing which indicates exactly how they decided that "helping those in distress" *is* good behavior. It's just a received moral code, no different from religion. There's no way, within science, to decide what *is* good and evil. That judgement has to come from the encompassing worldview.

[hdugger]

hmm, that didn't seem to go through.

But . . . then you can claim that anything is an axiom, "self-evident" and not requiring of investigation.

Why not take as self-evident any piece of cultural consensus, like the once-belief that women are not being capable of handing heavy intellectual lifting, and just use science to show why that is so? In what way is that "good science" - it's just providing the details to back up an un-investigated worldview.

Right? Aren't your "self-evident axioms" a "way of knowing."

[hdugger]

No the axioms are a starting point and can be assessed by what can be built on the basis of them. Mathematical axioms are accepted because they work.

Yes, you'd think so. But they often become an unquestioned part of all future research without any further examination.

Hence, the interesting tale of the IQ test.

When the IQ test (developed in France) was first brought to the US, they ran some testing sessions and saw that French children did better then American children. Well, that couldn't be right (self-evident), so they changed the questions until French and American children did the same.

Then they did some more testing and found that girls did better then boys. Once again, *that* could not be right (self-evident), so they changed the questions until boys and girls did the same.

Then they ran the test again and found out that whites did better than blacks. Hmm, what an interesting result, they said. I wonder why blacks aren't as intelligent?

Sometimes they tried to soften it - "oh, maybe they're just as intelligent but they're just less well-educated" - and sometimes they went all racist with it - "well, I guess this just goes to prove that blacks aren't as smart."

But *noone thought to re-standardize the test so that blacks did as well a whites.* And we've been dealing with the fallout from *that* "self-evident axiom" for lo these many years.

Science provides details within a given worldview - or your "self-evident axioms" (whose self-evidentness (!) varies across place and time) but it does not have the tools to examine those things which are considered "self-evident" because those questions are outside science's realm.

[tonibunny]

Please, if I ever get things wrong, interpret studies the wrong way etc, tell me! It is always OK to let me know if I'm wrong about stuff, I don't mind - I'm happy to admit that I'm just an amateur (or "bunny", it goes with my name ) and I won't learn otherwise! I was trying to help Mamamax out here by posting the study as to my untrained eyes it looked like the sort of thing she was after, but of course I'm no scientist, I'm not going to get my panties in a bunch if you tell me I'm barking up the wrong tree

[Pooka1]

Please, if I ever get things wrong, interpret studies the wrong way etc, tell me! It is always OK to let me know if I'm wrong about stuff, I don't mind - I'm happy to admit that I'm just an amateur (or "bunny", it goes with my name ) and I won't learn otherwise! I was trying to help Mamamax out here by posting the study as to my untrained eyes it looked like the sort of thing she was after, but of course I'm no scientist, I'm not going to get my panties in a bunch if you tell me I'm barking up the wrong tree

Tonibunny! Nobody was referring to you! Your analysis was top-shelf and I'll bet it was correct. You have been in this game for a long time and I think you are on Hawes's level in terms of picking up this field... someone with no formal training but who knows a lot. Linda is also in this category though might surpass Hawes in this regard.

I was referring to most of the stuff that gets posted in the research section for the longest while now.

[hdugger]

But pretending to know things that can't possibly be known or that are in fact NOT known is intellectually dishonest. The Pope or any religious figure or person has no more knowledge of these things than atheists. They just pretend to have this knowledge whereas atheists admit they don't know.

But . . . those following science are doing the same thing. All these years of having discussions about why it is that whites are smarter than blacks because it's a "fact" proved by science, when, in fact, it's nothing other than gussied up "self-evident truth."

With a flip of a self-evident switch, we could have been making decisions based on the "fact" that girls were smarter then boys.

It's not as if people claim they don't know these things. Because of all of the scientific research using IQ tests, this stuff forms the basis of lots of things we "know."

Yes, it's possible that in time someone will correct that fact, but anyone acting on that "fact" now, just because it came from science, is no different from someone acting on religious faith. We have faith that our science *is* fact. But testing and replication aren't what makes something a fact - if the self-evident truth that it's based on is wrong, then the whole thing is wrong, no matter how many times you've tested and replicated.

On the study Linda posted yesterday, none of those measures (SRS-22, etc.) are real measures - they're just surveys people made up to get at the real thing. Yet, here we are discussing the results as if they're facts. Do they mean that old people got more improvement? Could be. Or, maybe, it's some kind of cognitive dissonance that they felt like they *had* to feel better because they went through so many complications. (I'm not strongly suggesting this, I'm just throwing it at as an alternative fact).

But, that study could easily become some codified "fact" - look old people show greater improvement in how they feel - even though we have no real way of measuring how people really feel. It's maybe not unknowable, but it's not measurable by science.

So, science is just giving us the illusion that we know something, which we believe because we have faith in it's ability to ask and answer questions. But, that's doesn't make what it produces a fact. Many times, it's just our faith that it's a fact.

[hdugger]

hdugger, I think all your comments reduce to your idea that psych is a science. There is little to no evidence for that of which I'm aware. Folks are invited to edify me on that.

But, much of medical research is based on psychology or people's reported feelings. How do you know if a treatment improves scoliosis? Yes, the Cobb angle is measurable, but some treatment which reduced that angle while putting people in excruciating pain would not be a successful treatment. Or one which improved the Cobb angle but decreased their quality of life.

So, I'd venture that *any* useful measure of a scoliosis treatment would have to include unmeasurables - like pain or quality of life.

That makes scoliosis research a mixture of medical research (not so great) and psychology research (terrible). That makes is largely "unknowable" by science.

[Pooka1]

But, much of medical research is based on psychology or people's reported feelings.

WHAT?!? I would guess 99% of it is based on lab tests and invasive and non-invasive imaging.

How do you know if a treatment improves scoliosis? Yes, the Cobb angle is measurable, but some treatment which reduced that angle while putting people in excruciating pain would not be a successful treatment. Or one which improved the Cobb angle but decreased their quality of life.

I don't see the problem. Either surgery can help pain or it can't. Either PT can help pain or it can't. If it can, how variable is the result? The issue with scoliosis as far as I can glean is the HUGE variability in its course, both treated and untreated. The least variability I think is probably associated with fusion in adolescents. Those testimonials group pretty tightly as restoring the look and feel of normalcy though of course there are outliers.

So, I'd venture that *any* useful measure of a scoliosis treatment would have to include unmeasurables - like pain or quality of life.

That makes scoliosis research a mixture of medical research (not so great) and psychology research (terrible).

Okay. By the way, some day maybe fMRI can help in quantifying pain. Pain is a very complex physical and mental state. It may never be cracked. All we can do is hit it with our only tool.. science/medicine.

[LindaRacine]

I guess that deleting dozens of posts over the last few days has not been enough of a hint that there are some things that cannot be tolerated on a public forum such as this because 1) they are totally off topic and 2) someone always gets hurt. Stop it now!

On the study Linda posted yesterday, none of those measures (SRS-22, etc.) are real measures - they're just surveys people made up to get at the real thing. Yet, here we are discussing the results as if they're facts. Do they mean that old people got more improvement? Could be. Or, maybe, it's some kind of cognitive dissonance that they felt like they *had* to feel better because they went through so many complications. (I'm not strongly suggesting this, I'm just throwing it at as an alternative fact).

Yes, but I get to see these people in clinic every week. They don't just indicate their outcomes on questionnaires. They tell us all the time how happy they are. Our patients are fully informed prior to making their decision to have surgery. People over the age of 65 have a very significant chance of having one or more complications, and they make the decision that the reward outweighs the risk. So, when they have complications, they're smart enough to know that it's actually "normal." They get through the complication and go on to having a real qualify of life.

[mamamax]

I guess that deleting dozens of posts over the last few days has not been enough of a hint that there are some things that cannot be tolerated on a public forum such as this because 1) they are totally off topic and 2) someone always gets hurt. Stop it now!

Thank you Linda.

[hdugger]

I guess that deleting dozens of posts over the last few days has not been enough of a hint that there are some things that cannot be tolerated on a public forum such as this because 1) they are totally off topic and 2) someone always gets hurt. Stop it now!

Actually, we'd already wrapped up our discussion, but I'll reply to this post.

I'm puzzled at the idea that reasoned discourse is the one intolerable sin on a discussion forum. You're the moderator, of course, so feel free to delete, but I do wonder why you don't step in so firmly in cases where people actually *are* being hurt, as opposed to cases where we're just boring everyone to tears.

I would argue pretty fervently, though, (and be pretty fervently deleted, I suppose) that "factiness" of medical research is not off topic in a medical forum, particularly one in which medical research is posted and discussed.

Yes, but I get to see these people in clinic every week. They don't just indicate their outcomes on questionnaires. They tell us all the time how happy they are. Our patients are fully informed prior to making their decision to have surgery. People over the age of 65 have a very significant chance of having one or more complications, and they make the decision that the reward outweighs the risk. So, when they have complications, they're smart enough to know that it's actually "normal." They get through the complication and go on to having a real qualify of life.

Yes, exactly. You know because you've seen it. Not because of the science. That was exactly my point.

I'm not questioning the veracity of the outcome. I'm saying that it cannot be subject to rigorous scientific investigation because feelings (happiness, pain, quality of life) are not clearly defined nor precisely measurable. All science can say is what that study you quoted said - old people score higher on their SRS-22 after the surgery then they did before. It cannot claim, with any veracity, to pretend to know what that higher score means. It's all just reading tea leaves after that.

That doesn't mean it's not knowable - I take personal experience pretty seriously. It's just means that it's not knowable through science.

[LindaRacine]

Actually, we'd already wrapped up our discussion, but I'll reply to this post.

I'm puzzled at the idea that reasoned discourse is the one intolerable sin on a discussion forum. You're the moderator, of course, so feel free to delete, but I do wonder why you don't step in so firmly in cases where people actually *are* being hurt, as opposed to cases where we're just boring everyone to tears.

I would argue pretty fervently, though, (and be pretty fervently deleted, I suppose) that "factiness" of medical research is not off topic in a medical forum, particularly one in which medical research is posted and discussed.



Yes, exactly. You know because you've seen it. Not because of the science. That was exactly my point.

I'm not questioning the veracity of the outcome. I'm saying that it cannot be subject to rigorous scientific investigation because feelings (happiness, pain, quality of life) are not clearly defined nor precisely measurable. All science can say is what that study you quoted said - old people score higher on their SRS-22 after the surgery then they did before. It cannot claim, with any veracity, to pretend to know what that higher score means. It's all just reading tea leaves after that.

That doesn't mean it's not knowable - I take personal experience pretty seriously. It's just means that it's not knowable through science.

So many responses come to mind, but I'll show remarkable restraint.