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Thread: Are Some Canadian Doctors from the Dark Ages?

  1. #1
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    Are Some Canadian Doctors from the Dark Ages?

    Hi...

    I found the following article this morning:

    http://www.macleans.ca/topstories/he...19_100836_5800

    Here's the text:

    Does bracing straighten a curved spine?

    Decades-old treatment for scoliosis is supported by little scientific evidence
    For decades, doctors have been prescribing braces for children with scoliosis -- a sideways curvature of the spine -- but there is actually little scientific evidence to support the practice. A team of Canadian and American researchers is hoping to change that.

    Dr. James Wright, a co-investigator and surgeon-in-chief at the Hospital for Sick Children, says doctors aren't really sure braces reduce the risk of the curvature progressing to the point of requiring surgery. And wearing the uncomfortable and obtrusive device for several years could prove a heavy psychological burden for a teenager concerned about fitting in with her peers.

    "I have to say to the family, I think they're probably effective, but I'm not absolutely certain," Wright says. "This is one of those things which is quite inconvenient, it's quite expensive and it has side-effects, which are what it does to the psyche of a growing adolescent."

    Surgery, on the other hand, comes with "low but significant" risks for paralysis and blood transfusion, and could lead to long-term back problems as a result of the need to fuse the spine in a straightened position. "If we could reduce the risk of ultimate surgery, that would be a real benefit," Wright says.

    Showing whether bracing actually works would also address a controversy over whether children should be checked for scoliosis at school or the doctor's office. Some medical organizations support this practice, while others recommend against it because of a lack of evidence for an effective treatment.

    To determine whether bracing works, Dr. Wright and researchers at 19 other centres across North America are embarking on a five-year study in which they will randomly assign about 480 children (65 of them from Canada) to be fitted with a brace or simply observed. At the end of the study, they will see whether children who wore the brace were less likely to need corrective surgery.

    The Canadian Institutes of Health Research and the Shriners hospital system have promised funding for seven centres involved in the $3.5-million US study, contingent on the U.S. National Institutes of Health picking up the rest of the tab.

    The NIH turned down the group's initial request for funding but has given them permission to reapply this year.

    I'm not sure where this guy gets his information, but the Scoliosis Research Society funded a study, published in 1997, that showed definitively that bracing is effective in specific populations:

    Bone Joint Surg Am. 1997 May;79(5):664-74. Related Articles, Links

    A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis.
    Rowe DE, Bernstein SM, Riddick MF, Adler F, Emans JB, Gardner-Bonneau D.
    Kalamazoo Center for Medical Studies, Michigan 49008, USA. rowe@kcms.msu.edu

    With use of data culled from twenty studies, members of the Prevalence and Natural History Committee of the Scoliosis Research Society conducted a meta-analysis of 1910 patients who had been managed with bracing (1459 patients), lateral electrical surface stimulation (322 patients), or observation (129 patients) because of idiopathic scoliosis. Three variables - the type of treatment, the level of maturity, and the criterion for failure - were analyzed to determine which had the greatest impact on the outcome. We also examined the effect of the type of brace that was used and the duration of bracing on the success of treatment. The number of failures of treatment in each study was determined by calculating the total number of patients who had unacceptable progression of the curve (as defined in the study), who could not comply with or tolerate treatment, or who had an operation. The percentage of patients who completed a given course of treatment without failure, adjusted for the sample sizes of the studies in which that treatment was used, yielded the weighted mean proportion of success for that treatment. The weighted mean proportion of success was 0.39 for lateral electrical surface stimulation, 0.49 for observation only, 0.60 for bracing for eight hours per day, 0.62 for bracing for sixteen hours per day, and 0.93 for bracing for twenty-three hours per day. The twenty-three-hour regimens were significantly more successful than any other treatment (p < 0.0001). The difference between the eight and sixteen-hour regimens was not significant, with the numbers available. Although lateral electrical surface stimulation was associated with a lower weighted mean proportion of success than observation only, the difference was not significant, with the numbers available. This meta-analysis demonstrates the effectiveness of bracing for the treatment of idiopathic scoliosis. The weighted mean proportion of success for the six types of braces included in this review was 0.92, with the highest proportion (0.99) achieved with the Milwaukee brace. We found that use of the Milwaukee brace or another thoracolumbosacral orthosis for twenty-three hours per day effectively halted progression of the curve. Bracing for eight or sixteen hours per day was found to be significantly less effective than bracing for twenty-three hours per day (p < 0.0001).

    --Linda
    Last edited by LindaRacine; 04-19-2005 at 11:37 AM.

  2. #2
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    Linda,


    In all fairness to Canadian doctors, the article refers to a study which has yet to be approved by the NIH that is being done by Dr. Wright and researchers ( meaning other doctors ) at 19 other centres across North America. Sixty five out of four hundred and eighty children will be from Canada, I assume the other three hundred and fifteen children will be from the U.S. ?

    I agree though, it seems like a redundant study.




    Celia

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    Celia...

    In my opinion, it's worse than redundant. The Canadian study will include fewer than 500 patients, some of whom will not be braced despite the fact that the proven natural history would dictate that they be so. (Who would knowingly want their child to be included in the observation cohort?) The SRS study included over 1,900 patients.

    --Linda :-)

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    Linda,

    I wonder if there is any way to form a coalition against the proposed study. Are doctors the only ones who have a say in the matter ? Could we write to the NIH ?




    Celia

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    Hi Celia,
    I have sent you a private message....did you get it?
    Cathy

  6. #6
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    Celia...

    Sorry, I don't have a clue.

    One can hope that the folks at the NIH are smart enough to know that definitive studies have already been published. I'm surprised that Shriners has already signed on.

    --Linda
    Last edited by LindaRacine; 04-19-2005 at 06:42 PM.

  7. #7
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    Quote Originally Posted by LindaRacine
    Hi...

    I found the following article this morning:

    http://www.macleans.ca/topstories/he...19_100836_5800

    Here's the text:

    [INDENT][I]Does bracing straighten a curved spine?

    Decades-old treatment for scoliosis is supported by little scientific evidence

    I'm not sure where this guy gets his information, but the Scoliosis Research Society funded a study, published in 1997, that showed definitively that bracing is effective in specific populations:

    Bone Joint Surg Am. 1997 May;79(5):664-74. Related Articles, Links

    A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis.
    Rowe DE, Bernstein SM, Riddick MF, Adler F, Emans JB, Gardner-Bonneau D.
    Kalamazoo Center for Medical Studies, Michigan 49008, USA. rowe@kcms.msu.edu

    With use of data culled from twenty studies, members of the Prevalence and Natural History Committee of the Scoliosis Research Society conducted a meta-analysis of 1910 patients who had been managed with bracing (1459 patients), lateral electrical surface stimulation (322 patients), or observation (129 patients) because of idiopathic scoliosis. Three variables - the type of treatment, the level of maturity, and the criterion for failure - were analyzed to determine which had the greatest impact on the outcome. We also examined the effect of the type of brace that was used and the duration of bracing on the success of treatment. The number of failures of treatment in each study was determined by calculating the total number of patients who had unacceptable progression of the curve (as defined in the study), who could not comply with or tolerate treatment, or who had an operation. The percentage of patients who completed a given course of treatment without failure, adjusted for the sample sizes of the studies in which that treatment was used, yielded the weighted mean proportion of success for that treatment. The weighted mean proportion of success was 0.39 for lateral electrical surface stimulation, 0.49 for observation only, 0.60 for bracing for eight hours per day, 0.62 for bracing for sixteen hours per day, and 0.93 for bracing for twenty-three hours per day. The twenty-three-hour regimens were significantly more successful than any other treatment (p < 0.0001). The difference between the eight and sixteen-hour regimens was not significant, with the numbers available. Although lateral electrical surface stimulation was associated with a lower weighted mean proportion of success than observation only, the difference was not significant, with the numbers available. This meta-analysis demonstrates the effectiveness of bracing for the treatment of idiopathic scoliosis. The weighted mean proportion of success for the six types of braces included in this review was 0.92, with the highest proportion (0.99) achieved with the Milwaukee brace. We found that use of the Milwaukee brace or another thoracolumbosacral orthosis for twenty-three hours per day effectively halted progression of the curve. Bracing for eight or sixteen hours per day was found to be significantly less effective than bracing for twenty-three hours per day (p < 0.0001).

    --Linda
    He's right. Look at the study that you've qouted.

    First it says that "The number of failures of treatment in each study was determined by calculating the total number of patients who had unacceptable progression of the curve". ANY amount of progression is UNACCEPTABLE. If people are going to ambigously determine what is failure or not depending on how small or large a curve progresses, you're bordering into pretty deep territory. Success means zero progression. Failure means any amount of progression.

    Then the study goes on to say that braces worn 23 hours of the day were the most successful. Is this surprising to you??? Think about it for two minutes. These people are wearing the brace for the WHOLE DAY! There is only one hour out of every day where they're not wearing the brace. This is NOT an effective treatment unless you consider having people wear braces every hour of every day of their lives. That's ridiculous. The whole basis of the study and what it found is so obvious and downright dumb. I wonder why some studies are done and what kinds of doctors actually conduct them because they're a waste of time and money.

    Finally it ends by saying "The difference between the eight and sixteen-hour regimens was not significant". Again, logic tells us that if the uneven muscles are given opportunity to continue to bend the spine, they will. Having plenty of hours in each day allowing the spine to continue to bend and we will see scoliosis progress. And realistically most people who use braces will use them 8-16 hours or less so what happens in this group is more important than the resuts in the 23 hour group.

    The study is a joke and all the studies that it cites are a joke. Taking a educated guess and one will have already known what the results would be. This does nothing to further scoliosis treatment. It just re-affirms how useless back braces are for long term treatment of scoliosis.

    The doctors who are living in the dark ages are ones that think that attaching huge metal things called a brace to a human beings back for 23 hours a day is an acceptable treatment. Sadly, it seems to be most of them right now. The thinking in this area of study is so backward and defies all logic. It's the ultimate in arm chair academics, doctors and researchers steeped in frivolous studies instead of being concerned with reality and real solutions.
    Last edited by Shaun26; 06-28-2005 at 08:14 PM.

  8. #8
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    As far as I can see both the new study, and the old one only look at short-term effectiveness of bracing .
    Have any studies been done to show how effective bracing during adolescence is to prevent progression in later years. I remember a post (on another forum site) from a woman who had been "succcessfully" braced in adolescence, her curve remaining well below 40 degrees, but who discovered later in life (I think she was in her forties) that it had increased by over ten degrees

  9. #9
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    Shaun...

    I hate to be so blunt, but since you're so smart, why don't you just develop something that will change our world, instead of preaching to us about how horrid all these doctors are... Can you image... putting us in barbaric braces and operating on our spines? When you do better, perhaps you'll deserve to be so critical. Until then, you're just one of us schmoes.

    Braces are meant to hold curves until a child is skeletally mature. They've kept thousands of kids from ever having to have surgery. As long as most of the braced patients are kept from ever having to have surgery (and they are), the brace is better than nothing.

    --Linda

  10. #10
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    WAY TO GO LINDA!!!!!!!
    Theresa

    April 8 & 12, 2004 - Anterior/Posterior surgery 15 hours & 7 hours
    Thorasic - 79 degree down to 22
    Lumbar - 44 degree down to 18
    Fused T2 to sacrum
    June 2, 2005 - Pedicle subtraction osteotomy @L3 7 hours
    MAY 21, 2007 - Pedicle subtraction osteotomy @ L2, extended the fusion to S2 and added pelvic instrumentation 9 hours

    FUSED T2 - SACRUM 2

  11. #11
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    Shaun, my daughter's doctor DISCOURAGED the use of the brace when she originally was diagnosed, but was willing to do it. He gave us the statistics and we were freaked out at the thought of surgery, so we gave the brace a try, even though all the medical professionals gave little hope for it to work. As one surgeon said, "who know, maybe she will be the one to prove the medical field wrong!" And I know he honestly hoped she would, for her sake. If nothing else, the brace helped us all to accept her condition and gradually accept the need for surgery. I do agree with Linda, it gets depressing to constantly read your articles about trying to change the scoli world and how bad the current methods are. I would love to wait for future advances in surgery or whatever, and your thoughts do make sense, but my daughter is getting closer to the dangerous area as time goes by. She even asked me recently what will happen if she starts having trouble breathing because of the size of the curve. Do you think I want her hearing (or me thinking about) other future possibilities constantly, knowing they will be way too late for my daughter? I wish you the best for the future, but please share your findings with the research area until there is something more conclusive! Good luck and God be with you, Kris

  12. #12
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    Quote Originally Posted by LindaRacine
    Shaun...

    I hate to be so blunt, but since you're so smart, why don't you just develop something that will change our world, instead of preaching to us about how horrid all these doctors are... Can you image... putting us in barbaric braces and operating on our spines? When you do better, perhaps you'll deserve to be so critical. Until then, you're just one of us schmoes.

    Braces are meant to hold curves until a child is skeletally mature. They've kept thousands of kids from ever having to have surgery. As long as most of the braced patients are kept from ever having to have surgery (and they are), the brace is better than nothing.

    --Linda

    Did you re-read the article you quoted? Where has everybody's reading comprehension gone? I feel like I'm in the twighit zone. There are doctors that disagree with it so I'm not the only one that feels this way. These are the doctors that need your support.

    Where have I said there is something wrong with operating on spines? I'm encouraging operating on spines. The article you quoted barely supports what you say about braces.

    I will do better. I'm buying my first house in two months. Then I'll return to University to get the 1.5 credits I need to complete my Bsc (I started an adult oriented online business 5 years ago and make money that I couldn't turn away from, so I took time off school 2 years ago). After I'm finished I will at least have some credibility and can either go to work on this on my own or with somebody already in the field.

    The kind of helplessness so many with this condition seem to display is directly related to scientici progress made in this area (or lack thereof). While what I type may sound preachy it only sounds that way because I don't openly accept the conclusions being made about scoliosis without critically thinking about it for myself. Doctors, lawyers, and scientists are regular people like you and me. They can make mistakes and suffer from tunnel vision just like you and I can. They're not immune, nobody is. Few geniuses exist in the world in any field of work. I will definitely do my part to try and contribute something positive to scoliosis treatment. I hope to do you all proud.

    I also respectfully disagree with your statement that I can only be critical if I develop something of my own. If I'm not involved in Government, does that mean I don't have the right to be critical of my Government? Of coarse not, as a citizen affected by Government policy I can be critical. If what I say is ludicrous it will be dismissed by thinking people. If it holds merit, people will listen. Never, I repeat never take what anybody says, even authority figures when it comes to important issues, without thinking about it for yourself. Ask questions, get to know your doctor, their way of thinking. Not doing this has cost people their lives after going under the knife of hack doctor with no real credentials.
    Last edited by Shaun26; 06-29-2005 at 06:05 AM.

  13. #13
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    Quote Originally Posted by KRIS ATKINSON
    Shaun, my daughter's doctor DISCOURAGED the use of the brace when she originally was diagnosed, but was willing to do it. He gave us the statistics and we were freaked out at the thought of surgery, so we gave the brace a try, even though all the medical professionals gave little hope for it to work. As one surgeon said, "who know, maybe she will be the one to prove the medical field wrong!" And I know he honestly hoped she would, for her sake. If nothing else, the brace helped us all to accept her condition and gradually accept the need for surgery. I do agree with Linda, it gets depressing to constantly read your articles about trying to change the scoli world and how bad the current methods are. I would love to wait for future advances in surgery or whatever, and your thoughts do make sense, but my daughter is getting closer to the dangerous area as time goes by. She even asked me recently what will happen if she starts having trouble breathing because of the size of the curve. Do you think I want her hearing (or me thinking about) other future possibilities constantly, knowing they will be way too late for my daughter? I wish you the best for the future, but please share your findings with the research area until there is something more conclusive! Good luck and God be with you, Kris
    Because we cannot offer more effective treatments at this time, I would recommend using all available treatments that currently exist. It cannot hurt.

    I'm advocating curing scoliosis, not simply stopping the progression of curves. Some of the studies have been done showing it is possible to reverse curves but they're not readily available or widespread treatments. Have a look at the botox article somebody posted or the article where it showed weight training reversing scoliosis. None of these on their own have completley corrected it but they have not been used in conjunction with each other either. So perhaps that is the answer.

    What I'm saying is that there are so many more possibilities than what we're focused on. Let's widen our horizons.
    Last edited by Shaun26; 06-29-2005 at 05:21 AM.

  14. #14
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    Shaun...

    You need to understand that we are not the medical community. We are people who suffer from scoliosis, most of us with large curves. Perhaps you could find a forum for medical professionals who want to debate. I'm sure they're all much more qualified to argue with someone as smart as you.

    --Linda

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    Obviously I'm in the minority but I do find Shaun's way of thinking quite original and refreshing. O.K now I'm in trouble, right ?



    Celia
    Last edited by Celia; 06-29-2005 at 11:34 AM.

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