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Letter to Editor - Advance :(
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Letter to Editor - Advance :( - October 18, 2000 5:52:00 PM
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mcap
Posts: 652
Joined: February 8, 2000
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Group:
Did you read the letter to the editor inthe most recent Advance. It stated that it was time to move away from modality based treatment and get on with what works...AKA
Jones/CranioSacral/Wisselfish-Giammatto etc.
It is the middle of midterms for me right now so I will not have the time to write the proper letter. But I am hoping that one of you takes up the evidence-based cause.
As I have said before......I am not saying those methods do not work. But the level of research in support is not acceptable.
mcap
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Re: Letter to Editor - Advance :( - October 18, 2000 6:51:00 PM
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Andrew M. Ball, MS, PT
Posts: 500
Joined: October 8, 1999
From: Chapel Hill, NC, USA
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I agree Mcap. That's just CRAZY! As a PT that makes me want to scream. I’ll take the opposite position and let my MBA side argue this point for once though . . .
The public just wants to be touched. Period. It doesn't seem to matter what works and what does not. Most people walk away from PT talking about the moist heat, ultrasound, a manual technique, etc. etc. That’s what they perceive as having helped them. It’s all about short term gratification in most cases. Carry over and outcomes are a concern real clinicians . . . not the public.
If the public wants to pay for it OUT OF POCKET, as an MBA I'm all for it, but as an evidence-based PT, I've got to fall back on what should be the fundamental truth . . . It's not been proven effective.
If it's going to used as a sham placebo treatment, there's a place for that and I'm not sure that it's fair to call it unethical (though I've done so in the past in order to spark discussion on other points). The real problem is when the PT has deluded him or herself into believing that any of it is based in science or fact.
The patient should be fooled into the healing process . . . not the professional. The use of the techniques doesn’t have to stop as long as the public is willing to pay for it, but we should NOT delude ourselves into thinking that it’s EVER been proven effective . . . or even that the underlying physiology is correct. It isn’t, but who cares as long as the public is willing to pay for it.
At some point we’ll have to choose as a profession if we want to become a truly respected clinical profession like dentists, or pimp ourselves out like chiropractors. The APTA has a very clear position on this, as do I . . . but I can understand both sides of the argument. We’ve got to understand that we can’t expect to be respected as professionals AND continue on with this scientific recklessness. As choice must me made. Are we in the business of clinical science, or simply in the business of business?
The eventual answering of this question will surely shape our ethical standards as a profession.
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Re: Letter to Editor - Advance :( - October 19, 2000 7:59:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
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Drew:
I couldn't agree more about people wanting to be touched. They are drawn towards mysterious treatments even more than the PTs.
Here in NYC the patient population can be exceedingly demanding. They want and crave hands on attention. In order to stay in business the local practices must cater to that demand and it works. Most private practices state they want manual therapy experience in their advertisements.
BUT..................
There are points I would like to make:
1. As we all know, third party payers won't keep paying for this. And, physicians in the know, are not impressed by us because they read the journals. Professionally we have thrown our lot in with them and so we need to be aware of their attitudes.
2. I think this is a unique time in medical history. Consumers are armed with more information and resources more than ever. I may be wrong, but I think people are ready to hear that we don't have all the answers and they are ready for the research realities. When I treat low back patients privately I spend most of the treatment time trying to tell them how much we DONT know about low back pain. When the explanations are clear and I present a researched based treatment options they are more than willing to proceed without manual therapy.
I beleive that manual therapy can work very well (the mechanisms are unclear). But I am also inclined to beleive that the benefits are short-term. If therapy is used to restore normal activities, prevent fear avoidance behavior, and to initiate exercise then it definitely has a place. But I think that too many clinicians are using it as a complete cure. In the long run, these patients will relapse. And some patients develop an unhealthy reliance on their clincian. Just a theory and I know it will draw criticism.
mcap
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Re: Letter to Editor - Advance :( - October 19, 2000 8:23:00 AM
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Bobcat
Posts: 493
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Nicely put, mcap mcap.
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Re: Letter to Editor - Advance :( - October 19, 2000 9:08:00 AM
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Andrew M. Ball, MS, PT
Posts: 500
Joined: October 8, 1999
From: Chapel Hill, NC, USA
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That's true from a clinical perspective.
Business strategy is a little different though. I'm not saying which I subscribe to, just trying to debate the alternate position and spark some discussion here . . . I'm hoping someone who feels passionately will take over, but I doubt that will happen. Most people who are brave enough to admit to themselves that for them, PT is still a business, are self-chastised and branded unethical by their own conscience. Not many people would admit to this line of thinking in public forum.
Chriopractors however, have created a very lucrative repeat business by doing just that. What's interesting is that they've got less evidence of their science than we do, but patients are willing to pay for that short-term pain relief OUT OF POCKET. Only recently did some insurance companies begin to cover DC treatments. Long term effects are ignored by the patient in most cases. It's an issue for us as therapists, but just about no one else.
That brings me to my last point. Chiropractors have made a great living by focusing on the short-term relief but non-curing model for quite some time. The public bought into it, and continues to buy into it, to the point that the majority of DC patients pay out of pocket.
What's wrong with this trend in PT? Would we be pimping ourselves? Sure we would. Would be giving up science for art? Absolutely.
Hard ethical decisions are the nature of business, but we should NEVER delude ourselves that it's anything more when we employ sham treatments such as strain-counterstrain or craniosacral therapy. I don't have a problem with people using these techniques, but they shouldn't be taught as science, and the therapists using them should not be respected at the same level as true clinical scientists. They're not, but there’s really nothing wrong with that. These kinds of PT's should realize that they are providing a service, not a science. For this reason, things like SCS and craniosacral therapy, have no business being used anywhere but out-of pocket private practice models where the patient pays for the short-term relief.
Where that simple truth to be realized, than the world of PT would be a better place. We wouldn't peddle shoddy neuroscience to support what we think is going on. It wouldn't matter. All that would matter is the perceived short-term benefit that the patient received and paid for. It would be no different than a massage. And before some of you hard-core manual clinicians get angry, let's be honest folks we know more about the effects and neurophysiology of massage than we do about SCS or CST. I don't want to see PT go that way, but I understand that it may need to go that way at some point. I just think that if we're going to move that way, that we need to be willing to sleep with the demons it brings and not complain about not being respected by the rest of the healthcare community.
We shouldn't be, you reap what you sew, and the scenerio I described is little different than a con-artist with a clinical degree. Sad commentary on our profession really, but not exactly unethical.
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