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A History Worth Telling
The popularity and the use of acupuncture for the treatment of animals in the United States is at its peak.
Medical Qigong for the Heart: Part III
Part 1 and Part II of this series focused on the physical aspect of the Heart and mental emotional aspects of the Heart respectively. Now, I would like to focus on the spiritual aspect of the Heart.
CCE Finally Takes a "Baby Step" Toward Reform
During a 16-month period from October 2010 to February 2012, I devoted four separate columns to the heavy-handed attempt by the Council on Chiropractic Education to radically change the chiropractic profession through the accreditation process.
Peer Points: Always Seeking To Grow
Ellen "Kiki" Geary has spent the last decade honing her craft. As a specialist in integrative holistic care, she went straight from completing her master's degree in acupuncture and chinese herbal medicine from Bastyr University to building a successful and thriving practice in the small community of Anacortes, Washington.
MPA Media Wins 7 Publishing Awards
MPA Media, publisher of Dynamic Chiropractic and DC Practice Insights, among other titles, has been recognized for editorial and design excellence with an unprecedented seven publishing awards by the American Society of Business Publication Editors (ASBPE), the nation's largest organization for business-to-business publications.
Why Young People Need Chiropractic Now More Than Ever
According to a recent study published in BMC Musculoskeletal Disorders, "It is now widely acknowledged that neck pain (NP), mid back pain (MBP), and low back pain (LBP) (spinal pain) start early in life and that the lifetime prevalence increases rapidly during adolescence to reach adult levels at the age of 18."
Chiropractic Research in Review
Chiropractic Treatment of Lateral Epicondylitis; Cost / Benefit Analysis: Different Doses of SMT for Low Back Pain; Imaging for Occult Rib and Costal Cartilage Fractures; Treating Neck Pain: Thoracic Thrust Manipulation vs. Non-Thrust Mobilization.
Pain Underfoot: Metatarsalgia
Foot pain can interfere significantly with normal activities and severely limit participation in sports. Metatarsalgia is foot pain involving the metatarsal bones in the forefoot – the complaint of pain on the bottom of the ball of the foot.
Finders Keepers: The Secret to Relationship-Based Marketing
Becoming a successful practitioner has less to do with what you learned in school, and more to do with your ability to find new patients and keep them!
Don't Turn a 2 Into a 10
The Wong-Baker FACES Pain Rating Scale1 is so useful because it can be used by almost anyone. Patients can use the numbers associated with the faces depicted on the scale or select the face that demonstrates their current level of pain from 0-10.
News in Brief
National Chiropractic Health Month: Be Proactive; Collegiate Roundup: Academic Appointments at Parker, Logan.
New Medical Technologies You Need to Know
We're all familiar with how fast computers become obsolete, as well as the rapid pace of development in the field of cell phone technology. The latest smart phones are far more powerful than desktop computers were only a few years ago.
Building From the Bottom Up
I caught up with my dear friend Honora Wolfe, in her Colorado painting studio where, if she is not praying in Bhutan or doing charitable work in a Nepali free clinic, she spends most of her time now.
9 Common Causes of Thyroid Imbalance and How You Can Help
How you sleep, how easily you wake up, and how much energy and stamina you have during the day are directly related to levels of the thyroid hormones.
A Guide for Talking to Doctors about Acupuncture and Brain Chemistry
Before I begin any discussion of how to talk about the effects of acupuncture on brain chemistry, nervous and endocrine function, it is essential to understand just what physicians most need help with.
A Vibrating Capsule for Constipation? Relevance to Your Chiropractic Practice
The relationship between gastrointestinal (GI) complaints and back pain is not typically written about or discussed.
Waking Up the Gluteus Maximus
In previous articles in this series, we expounded on the importance of the gluteus maximus (GM) in athletic performance and protecting the knee from injury. We also know there is a link between iliotibial band syndrome and GM weakness.
June, 2011, Vol. 11, Issue 06
Models and Evidence-Bases
By Keith Eric Grant, PhD, NCTMB
The techniques we use as massage therapists are increasingly coming under scrutiny and review. To an extent, this is part of a general movement in health care to review both the effectiveness of interventions and to compare what is actually done in practice with what accumulated evidence suggests would be the "best course".Two reports from the Institute of Medicine out this year underline this review: "Clinical Practice Guidelines We Can Trust" and "Finding What Works in Health Care: Standards for Systematic Reviews". The motivation from this introspection was noted by Joseph Padula in his blog "Managed Care Matters" — even many medical guidelines have had little or no solid evidence behind them, often resulting in less than optimal treatment.
In part also, the scrutiny of massage techniques and conceptual models behind the techniques stems from a cohort of massage educators looking to frame a more sound basis for massage therapy as a component of health care and to bring what's being taught into agreement with modern knowledge of anatomy and physiology. This has turned into an ongoing, international discussion across multiple social media: Facebook, Twitter, and ABMP's "Massage Professionals" forums, in particular.
Looking at evidence requires asking two types of questions; questions that I believe are separable. First, are there specific conditions for which we have evidence that massage techniques provide an effective treatment or co-treatment? If so, what can we say about the reliability of the evidence? Is it supported by research in addition to anecdotal (narrative) observations? In the best of possible worlds, we would like research and anecdote to reinforce each other and add to our insights. Enkin and Jadad provide a context for this delicate process of integrating experience and research.
Those who really follow the principles of evidence-based health care, "the conscientious and judicious use of current best evidence from clinical care research to guide health care decisions," understand that conscientious and judicious use does not mean blind adherence. They are making efforts to integrate research evidence with other types of information, values, preferences, resources and circumstances. Enkin and Jadad also caution about the interplay of belief with anecdotal "evidence," especially when anecdotes and research disagree, leaving the clinical practitioner to face a paradox.
Despite its low ranking in the evidence hierarchy, anecdotal information exerts a disproportionately powerful influence on clinical thinking and behavior. The paradox was well described by William Asher: "If you can believe fervently in your treatment, even though controlled tests show that it is quite useless, then your results are much better, your patients are much better, and your income is much better too... It is an almost insoluble problem, and the majority of worth-while doctors are driven to a compromise in which they muster enough genuine belief in their treatment to keep their patients happy and maintain their own respect, while preserving enough doubt to admit their inadequacy during transient bouts of uncomfortable honesty."
It's in trying to resolve the interplay between research and clinical anecdotes that we find the second kind of question. Do we have an explanation for the effectiveness of our techniques that doesn't violate laws of physics and is in accord with modern knowledge of anatomy, physiology and neurology? I explicitly add neurology because our body is not just physical. Our brain does an amazing computational feat in taking the myriad of sensory signals as input and providing us with a body sense as output. This second type of question brings us into the realm of conceptual models or maps for the actions of our techniques. Any such model is an approximation of reality. We can further subdivide questions about such a map into: "Is it useful?" and "Is it a correct approximation?"
Gregory Bateson, in "Form, Substance and Difference," from Steps to an Ecology of Mind (1972), elucidates the essential impossibility of knowing what the territory is, as any understanding of it is based on some representation: "We say the map is different from the territory. But what is the territory? Operationally, somebody went out with a retina or a measuring stick and made representations which were then put on paper. What is on the paper map is a representation of what was in the retinal representation of the man who made the map; and as you push the question back, what you find is an infinite regress, an infinite series of maps. The territory never gets in at all. [...] Always, the process of representation will filter it out so that the mental world is only maps of maps, ad infinitum."
Elsewhere in that same volume, Bateson points out that the usefulness of a map (a representation of reality) is not necessarily a matter of its literal truthfulness, but its having a structure analogous, for the purpose at hand, to the territory. Bateson argues this case at some length in the essay "The Theology of Alcoholics Anonymous."
To paraphrase Bateson's argument, a culture that believes that common colds are transmitted by evil spirits, that those spirits fly out of you when you sneeze, can pass from one person to another when they are inhaled or when both handle the same objects, etc., could have just as effective a "map" for public health as one that substituted microbes for spirits. While treatments of the individual would differ between the two models, actions such as isolation and quarantining would not.
Our challenge as a health care profession in the modern world comes in the way we address these questions, identifying areas needing research, filtering out disproved myths and ensuring the transfer of knowledge into practice.
Click here for previous articles by Keith Eric Grant, PhD, NCTMB.
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