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What's wrong with Alternative Medicine?
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What's wrong with Alternative Medicine? - July 29, 2005 2:36:00 AM
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JLS_PT_OCS
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Many PTs I have talked with on the forum seem to show a propensity to agree with or support many alternative health care practices and think very highly of alt med practitioners, especially the very rich ones who sell lots of books (ex Andrew Weil, Deepak Chopra, etc).
Since discovering things like the scientific method, physics, chemistry, and critical thinking, I have universally considered all such things worthless.
I had a good website that I used to link to on a skeptical website that discusses those issues, but I found Barrett Dorko did a much better job of relating it to our profession in these links:
http://www.barrettdorko.com/articles/no_more_mister_nice_guy1.htm
http://www.barrettdorko.com/articles/no_more_mister_nice_guy.htm
Please share your thoughts about alternative medicine, pro or con, and why you feel the way you do.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: What's wrong with Alternative Medicine? - July 29, 2005 2:41:00 AM
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JLS_PT_OCS
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I do think all of alternative medicine is quackery, it is because:
1. the rationale upon which treatments are provided is not based in scientific thought
2. the methods are not subject to review or research
3. the practitioners are more concerned with making money than with examining their practices
AND/OR
4. there is no attempt to study any given treatment to sort out what part of it is useful, and what part is theoretical baggage
Of all the alt med I can think of at the moment, perhaps only acupuncture meets some basic criteria as an alternative practice that is trying to move into mainstream with research evidence, both mechanistically and with outcome measures.
That doesn't mean I want to do it, but it does seem to be moving toward what could be considered responsible medical treatment.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: What's wrong with Alternative Medicine? - July 29, 2005 2:43:00 AM
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JLS_PT_OCS
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At the risk of copyright infringement (sorry Barrett) here is another link discussing the Problem of Empiricism in alt med practices, this could be subtitled the "But It Works!" argument.
http://www.barrettdorko.com/articles/no_deep_model.htm
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: What's wrong with Alternative Medicine? - July 29, 2005 2:47:00 AM
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JLS_PT_OCS
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Here's a great site called Quackwatch that I have visited for many years now.
It's a great place to get a good education about what Quackery is and how to recognize it, as well as how to combat it.
http://www.quackwatch.org/
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: What's wrong with Alternative Medicine? - July 29, 2005 2:52:00 AM
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JLS_PT_OCS
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Here are some great comments from the Quackwatch site:
Does every field have to put up with this crap? Do engineers constantly have to argue with people who BELIEVE, in the face of all testable evidence that bridges and highrises could actually be built from toothpicks and cream cheese if only the engineers were more open-minded and better informed?
--Ken Phelps, D.D.S.
Sadly, it was more common for patients to become extremely depressed and demoralized when the latest fad "didn't work." It's my opinion that most Americans with chronic illnesses do believe that "something is missing" from conventional/orthodox western medicine. Still, I believe that most alternative medical practitioners cynically manipulate these kind of patients and only provide a cheap substitute for the "missing something."
--David Russo, DO/MPH student
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: What's wrong with Alternative Medicine? - July 29, 2005 3:40:00 AM
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SJBird55
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The only reason I’m posting here… Feldenkrais. It is an alternative approach. Since Barrett had mentioned that he bases his approach on Feldenkrais (or that’s how I interpreted what he wrote), then this may be helpful to understand the premise:
http://www.somatic.com/articles/feldenkrais_overview.pdf
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Re: What's wrong with Alternative Medicine? - July 29, 2005 3:41:00 AM
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SJBird55
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Barrett’s techniques may not be exactly “Feldenkrais,” but from the reading I’ve been doing lately, there seems to be some similarities.
J Altern Complement Med. 2005 Apr;11(2):333-42. Related Articles, Links
Bias control in trials of bodywork: a review of methodological issues.
Mehling WE, DiBlasi Z, Hecht F.
Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA, USA. mehling@itsa.ucsf.edu
OBJECTIVE: To review and summarize the methodological challenges in clinical trials of bodywork or handson mind-body therapies such as Feldenkrais Method, Alexander Technique, Trager Work, Eutony, Body Awareness Therapy, Breath Therapy, and Rolfing, and to discuss ways these challenges can be addressed. DESIGN: Review and commentary. METHODS: Search of databases PubMed and EMBASE and screening of bibliographies. Published clinical studies were included if they used individual hands-on approaches and a focus on body awareness, and were not based on technical devices. RESULTS: Of the 53 studies identified, 20 fulfilled inclusion criteria. No studies blinded subject to the treatment being given, but 5 used an alternative treatment and blinded participants to differential investigator expectations of efficacy. No study used a credible placebo intervention. No studies reported measures of patient expectations. Patient expectations have been measured in studies of other modalities but not of hands-on mind-body therapies. Options are presented for minimizing investigator and therapist bias and bias from differential patient expectations, and for maintaining some control for nonspecific treatment effects. Practical issues with recruitment and attrition resulting from volunteer bias are addressed. CONCLUSIONS: Rigorous clinical trials of hands-on complementary and alternative therapy interventions are scarce, needed, and feasible. Difficulties with blinding, placebo, and recruitment can be systematically addressed by various methods that minimize the respective biases. The methods suggested here may enhance the rigor of further explanatory trials.
PMID: 15865501 [PubMed - in process]
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Re: What's wrong with Alternative Medicine? - July 29, 2005 3:41:00 AM
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SJBird55
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I haven’t quite got a grasp between what’s different with Body Awareness Therapy and Feldenkrais – and then how that is different than Barrett’s approach, but this may be give some insight. The abstract isn’t enough to answer my questions regarding patient population and inclusion criteria, nor what “physiotherapy” entailed, which HRQL was used and I have no idea what a SOC is… but this might be an interesting read.
Disabil Rehabil. 2002 Apr 15;24(6):308-17. Related Articles, Links
A comparison between three physiotherapy approaches with regard to health-related factors in patients with non-specific musculoskeletal disorders.
Malmgren-Olsson EB, Branholm IB.
Department of Community Medicine and Rehabilitation, Umea University, Sweden. eva-britt.malmgren-olsson@physiother.umu.se
PURPOSE: The main aim of this study was to compare the effects of Body Awareness Therapy (BAT), the Feldenkrais (FK) method and conventional physiotherapy on changes of health-related quality of life (HRQL), self-efficacy and sense of coherence (SOC) in patients with non-specific musculoskeletal disorders. A second aim was to explore the relationships between SOC, HRQL and self-efficacy and to examine whether SOC could be a predictor of the treatment outcome. METHOD: A total of 78 patients, 64 women and 14 men, were recruited consecutively to the three treatment groups. The instrument used were the Swedish version of SF-36, the 20 items Arthritis Self-efficacy Scale and the 29-item questionnaire by Antonovsky. RESULTS: The results showed that there were significant improvements on all subscales of SF-36 except for one. By using effect-size values it was found that the BAT and FK groups reached larger effect-size than did the conventional therapy group. These two groups also improved in self-efficacy of pain and stayed stable while the third group deteriorated at the one-year follow-up. There were significant correlations between the mental dimensions of SF-36 and SOC indicating that the instruments may measure aspects of the same global construct. CONCLUSIONS: Although few significant differences between the three treatment groups the BAT and FK seemed to improve health-related quality of life and self-efficacy of pain to a somewhat higher degree than the conventional physiotherapy. SOC seemed to be a stable trait measure over time.
PMID: 12017464 [PubMed - indexed for MEDLINE]
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Re: What's wrong with Alternative Medicine? - July 29, 2005 3:42:00 AM
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SJBird55
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I’d like to read this article… This abstract leads one to think that there is a certain population that can be targeted AND there are expectations in outcomes.
Phys Med Rehabil Clin N Am. 2004 Nov;15(4):811-25, vi. Related Articles, Links
Alexander technique and Feldenkrais method: a critical overview.
Jain S, Janssen K, DeCelle S.
Carle Foundation Hospital, 602 W 810 W Anthony Drive, Urbana, IL 61802, USA. sanjiv.jain@carle.com
This article develops an overall better understanding of the Alexander technique and Feldenkrais method. Initially, a brief history is provided to lay the groundwork for the development of these techniques. A description of the techniques, training requirements, and mechanism of action follows. Indications, contraindications, and patient selection are discussed. This article reviews and identifies what research has been completed and what areas need further investigation. Overall, the goal is to establish a guide to aid in determining who may benefit from these techniques and outcomes to expect when using these techniques.
Publication Types:
• Review
• Review, Tutorial
PMID: 15458754 [PubMed - indexed for MEDLINE]
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Re: What's wrong with Alternative Medicine? - July 29, 2005 3:42:00 AM
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SJBird55
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A really old study, done back when the Feldenkrais stuff was being introduced…
Maybe the researchers were measuring the wrong things or the tools for measuring outcomes weren’t as valid and reliable as they are now. Interesting… the talk about sympathetic nervous system in previous posts somewhere… no change in heart rate (which is the only way I have seen that we can actually supposedly measure autonomic involvement?)
J Gerontol. 1977 Sep;32(5):562-72. Related Articles, Links
Feldenkrais versus conventional exercises for the elderly.
Gutman GM, Herbert CP, Brown SR.
Tenants in retirement housing given a 6-week program of Feldenkrais exercises were compared with a group given conventional exercises and with control groups given no exercises. Analysis of covariance of preliminary and subsequent measurements failed to yield any significant differences between groups. Measurements included height, weight, blood pressure, heart rate, balance, flexibility, morale, self-perceived health status and level of performance of activities of daily living, also the number of body parts difficult to move or giving rise to pain. Several possible reasons are given for the results. Attention is drawn to the necessity of medically screening and monitoring elderly registrants for exercise programs since it is apparent that some sign up who should not.
PMID: 886162 [PubMed - indexed for MEDLINE]
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Re: What's wrong with Alternative Medicine? - July 29, 2005 5:05:00 AM
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JLS_PT_OCS
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I think also an important point to consider that many people supposedly teaching Feldenkrais are not really doing anything that has anything to do with the original work.
I don't know enough about it to be certain, but this seems much like trials that compare something to "physiotherapy", without really defining what that is.
If they mean "Feldenkrais" like movement reeducation and body awareness, then I would say that is ergonomic education and exercise training, which not only has a firm footing in evidence, but is practiced by PTs everywhere.
If they mean "Feldenkrais" like something else, then that changes the debate considerably.
But with just the studies and no descriptions of actual practices, we'll never know.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: What's wrong with Alternative Medicine? - July 29, 2005 3:25:00 PM
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jma
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I agree with Jason with his second post in this discussion. Can't really be explained any better.
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Re: What's wrong with Alternative Medicine? - July 29, 2005 4:11:00 PM
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nari
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Jason
True Feldenkrais practitioners, as I understand it, would not teach ergonomics and exercise training; these do not address the CNS as well as what Moshe was trying to do. I am rereading his book at present, and it is far removed from traditional physiotherapy. But like Pilates, trainers can have a go at whatever seems attractive to customers; it is a free for all.
If you haven't already done so, his text is worth reading. But I do take your point; that anyone's work can be altered to suit a market demand and follow-up studies are quite grey.
Nari
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Re: What's wrong with Alternative Medicine? - July 29, 2005 4:15:00 PM
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PTupdate.com
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What about trigger point therapy? I cannot recall seeing anything that really supports it in the scientific literature, and it certanly is categorized as "alternative". But lets face it...people have been jambing their scapulas into door frames, sitting on tennis balls and pressing on sore spots probably for thousands of years. It hurts, you feel very good after (sometimes permanently), so what's the harm? Especially if a PT is providing the care and layering it with other effective treatment methods.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: What's wrong with Alternative Medicine? - July 29, 2005 4:18:00 PM
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karmzack
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I don't know whether to laugh or to throw something at the wall when I read some of the alternative crap offered. It’s worse than a pyramid scheme. Just surf around the [URL=http://www.quantumtouch.com/]Quantum Touch[/URL] website (discussed in a previous thread), make sure to visit the page that shows a [URL=http://www.quantumtouch.com/QTOverviewReport.php]'healed' rose[/URL]. I feel sorry for patients that get suckered into this stuff. It all comes down to money, just browse the online store and you’ll see $300 pendants that are guaranteed to increase your energy and enhance your mental performance.
One of my favorite discussions on this forum was [URL=http://www.rehabedge.com/ubb/ultimatebb.php?/ubb/get_topic/f/9/t/000278.html]Cross Country 22-The Culture Comes Through[/URL] started by Barrett. The link he provided in the first post is a must read to expose the bizarre world of myofacial release. Very strange!
Duff- where would trigger point injections fall?
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Zack Solomon MPT, OCS, CSCS
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Re: What's wrong with Alternative Medicine? - July 29, 2005 5:00:00 PM
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JLS_PT_OCS
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I don't agree with making trigger points an industry as some fibromyalgia advocates do, but I think treating trigger points at least has a plausible rationale for why it is done.
I mean, I don't equate treating TPs with Reiki or something like that...
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: What's wrong with Alternative Medicine? - July 29, 2005 5:11:00 PM
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chiroortho
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Yeah but if you grunt loudly while you're treating the trigger points your patient will be able to tell the difference.
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Re: What's wrong with Alternative Medicine? - July 29, 2005 7:12:00 PM
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dragonfire
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I think a definition of alternative medicine is important. I got the following from
http://nccam.nih.gov/health/whatiscam/
It also goes on to distinguish complementary vs alternative medicine, the definition of integrative medicine,and the major types of complementary and alternative medicine which are:
1. alternative medical systems
2. mind-body interventions
3. biologically based therapies
4. manipulative and body based methods
5. energy therapies
Out of these major types, in PT, I think we use some of# 2 but mostly #4. The whole of #5 and most of #1 and #3 I consider quackery.
I would consider a form of therapy if it has been researched and shows evidence and/or based on a credible theory grounded in science. That includes trigger point therapy. I'll have to read up on Feldenkrais. As for acupuncture, still undecided eventhough I work closely with a physiatrist that also practices acupuncture.
It is interesting for me to find out that cognitive behavioral therapy used to considered alternative. I always thought that it was mainstream.
What may be quackery before can turn mainstream, if only research is done to prove it.
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Re: What's wrong with Alternative Medicine? - July 30, 2005 10:21:00 AM
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Randy Dixon
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While I agree with a lot of what Jason says I disagree or have a different perspective on others.
A. If you define alternative medicine as practices that have no scientific evidence or that are based on sound scientific principles, which seems to be the definition applied, then of course AM is hard to defend, on the other hand, how much of what is accepted today was once "alternative" and isn't there other practices that seem to be transitioning form "alternative" to "mainstream"? Wouldn't some people consider PT to be Alternative?
B. The alternative people, even the quacks, are demonstrating the failure of most mainstream medicine to satisfy the emotional and psychological components of patients. There is no good reason that we can't learn from that or that providing these aspects equate what you do with quackery.
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Re: What's wrong with Alternative Medicine? - July 30, 2005 10:28:00 AM
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PTupdate.com
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Perhaps it is best to avoid that definitive line of what is "alternative" and what is not. After all, this is what I hate about the music industry...so much is placed into these categories of alternative, metal, grunge, punk, country, etc.
What makes something "alternative" anyway? Lack of evidence? I'd bet everybody that participates on this website does a few things that don't have a bit of scientific merit to them...but they work for us.
Trigger point therapy has some plausible reasons as to why it works. Accupuncture actually has some decent literature behind it. Reiki? Waaaaaaaay out there. But, then again, if someone has been through the medical system with no relief, and some Reiki guy "gets rid of their evil energy" and makes them pain free for a year, what's so bad about that? Most likely their symptoms are in their head, but what are your options? "Hey buddy, I don't care if it worked...it is not scientific enough for me, and therefore you need to spend long hours with a psychologist, cause that's where your problem really is"
Duffy
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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