Thursday, January 26, 2012

APTA section exposed for including visceral manipulation

In her recent blogpost at Science-based Medicine, Visceral Manipulation Embraced by the APTAHarriet Hall paraphrased a response by the Director of Education, Carrie Schwoerer, to another member, J.W. Matheson who complained about APTA's inclusion of visceral manipulation, as:

"In other words, “We don’t need no stinkin’ science! We support any treatment that can provide positive anecdotes. We believe the plural of anecdote is data. Instead of offering guidance, we’ll let our members sink or swim: we’ll make them responsible for knowing ahead of time how much evidence supports a treatment and deciding whether they believe it is sufficient to merit a personal decision to study it.”This is beneath contempt. I don’t think I need to elaborate. Another formerly respected organization has drunk the CAM Kool-Aid."

I think she translated correctly.

The comment section went a long way - 93 comments (several from yours truly).
Some of them were memorable: David Gorski replied:
"Ack! I frequently use a line about chiropractors that usually gets a laugh and, as far as I know, I originated, specifically, “Chiropractors are physical therapists with delusions of grandeur.” Inherent in that line is the assumption that physical therapy is science-based, while much of chiropractic is not. After this, I might have to rethink my line. I don’t want to (it’s a great line and physical therapists can do amazing things), but if the APTA keeps this up, I’ll have no choice."

As it turns out, "visceral manipulation" was added to the organization through the "Section of Women's Health". Commentary ensued about how important this was or wasn't to the overall organization.

I lived in a rain forest climate for 25 years. My opinion is, woo is like water: if water finds its way, any way at all, small nail hole even, into your condo building, it will get in and accumulate and rot the walls - eventually the whole building will cave in.

Erik Meira entered the comment section. He is battling from within, has a podcast site, The PT Podcast. He interviewed the same J.W. Matheson who wrote the initial letter to APTA with his concerns, and then sent the reply to Harriet Hall, for comment.

Several comments came from several PTs, and SomaSimple was mentioned. Eric put out a challenge:
"The main thing that I am trying to get across is how muddy the waters get when you try to create a line of demarcation for con ed. Is scientific plausibility enough? Sure, if presented objectively but who does that (even I don’t)? Scientific plausibility is a continuum from “not likely at all” to “almost definite” (no absolutes) so where do you draw the line? The black and white position that I just presented creates such a line, but who would be happy with it? This is the problem we have had trying to create a policy in the past. Every modification we give to that hardline position that I described creates enough of a crack to let a whole lot of things come pouring in. 
I challenge the moderators of SomaSimple (obviously very smart, scientific, and have their heads on straight) to create such a policy (even the “10 steps”). Then see how easily one can make a little tweak to something like MFR to make it fit on a technicality and all of a sudden you need to let them present or face a lawsuit for restraint of trade. Think this won’t happen?"
So: we have been challenged.
It will take some thinking.
My line in the sand has always been, if it's a mesodermal* derivative you suggest you can alter by using your hands, you're dreaming. If it's an ectodermal* derivative you suggest you can alter by using your hands, we're getting somewhere closer - perhaps. Probably not. A patient's umwelt isn't going to tolerate a therapist as its umfeld, not for long, biopsychosocially speaking, not unless it gets something real (from ITS perspective!) out of the treatment encounter that it can use for becoming more efficient or effective in the world.

*Mesodermal derivative: majority of structural elements and tissue - bone, muscle, connective tissue, tendon, ligament, visceral organs
*Ectodermal derivative: nervous system and neural support tissue (CNS and PNS), skin, teeth, eyes, adrenal medulla, their associated system afferent and efferent functionality

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