Saturday, December 12, 2015

If science were sandpaper

Yes, I'm still dangling in the chasm.
I'm still procrastinating. But I do think I'm making a little progress.

Not that I didn't write several more heavily referenced pages, an entire new intro chapter, not that I didn't include all the ideas I wrote about that I wanted to include, not that I haven't farmed it out to people I know who not only can write but who can edit too.. so, not that I haven't made some progress, because I think I have - but the timing is lousy because, time of year, and only one person has got back to me with lots of lovely suggestions.

So, to kill time I'm watching videos.
Not just cat videos.
I've watched almost all Harriet Hall's excellent video series on science-based medicine. As I listened to her methodically demolish all quackery on face of the planet, I applauded all the medical people and scientific hard work that has gone into making life more physically bearable for humanity over the last century. Oh yeah sure, there is a long way to go and there are inherent contradictions, but every day I wake up grateful that, since I had no choice but to endure physical existence as a female human primate, I was born in a place and time where I have had legal access to vaccinations and antibiotics and public health and 
and general anesthetic and birth control.

It made me think that if medical science were sandpaper, biomedical science would be the roughest, toughest grit size. And you need that, if you are trying to remove hardened goop or paint from a board or something...  or if you're trying to get humanity in general to wake up from all its inherent bias.

However, there are other grades of sandpaper that work way better for other jobs. Like polishing lacquer, or jewelry... 


I read Engel's wonderful 1977 paper arguing for a new biopsychosocial model of disease and illness, The need for a new medical model: A challenge for biomedicineReading it word for word really made me think.

In that paper, speaking from a psychiatrist's perspective, he discussed the biomedical model as a scientific model that, in the process of making huge progress, understanding disease and finding solutions, became a cultural dogma of reduction and exclusion which considers anything that doesn't fit the model as heretical, and anyone arguing for anything else as heretic. So, he embraced himself/his profession as heretic, I guess, and argued for a new model. Thank you, Engel.

I feel a bit that way myself - like manual therapy was hung out to dry in the chasm, put into the heretic category, become an 'unmentionable' or something, even though every PT on the face of the planet, just about, uses it without thinking about what it really means or how to resolve its contradictions. It doesn't have a very good evidence base. What evidence base does exist is kind of flimsy. Just about every intervention model that osteopaths and chiropractors, for example, invented or have heavily promoted, once it has been studied, has pretty much gone down in flames. 

So, as a manual therapy (as currently understood) atheist, as a heretic, I argue for a new model.

Barbara Gibson wrote a great blogpost recently on disability, quality of life, and the various tools that have been designed to "measure" it: "Whither 'Quality of Life'?" She points out that: 

"Quality of life measurement has exploded in the last several years. Myriad tools have been devised to measure the quality of life of populations, groups and individuals; and quality of life arguments are advanced in momentous decisions such as withholding or withdrawing ‘futile’ medical treatments. These developments have not only changed research and health care practices, they have helped structure how we think about what it means to be ‘healthy’ and ultimately what it means to be human (Gibson 2016; Rapley 2003). Quality of life is a useful concept that has contributed to moving healthcare away from a disease model but QOL judgements are always necessarily relational, reproducing social ideas of what constitutes a good or deficient life. Given the complexity of life quality, it is crucial that we tread very carefully with measurement and its interpretations. As Annemarie Mol (2008, p.75-6) notes:‘It is important to do good, to make life better than it would otherwise have been. But what it is to do good, what leads to a better life, is not given before the act. It has to be established along the way. It may differ between lives, or between moments in a life.' "

My bold. Who is to say what quality of life really means, except to those who either have some or don't have some?

Her post reminded me of how the body-beautiful fitness enthusiast people have been dictating since for-fricking-ever what "health" and "attractiveness" is, according to how well-defined a six-pack one sports. 

Culture imposing itself on individuals.


Any-hoo, what does any of this have to do with manual therapy, you might ask?
I don't know yet. Other than I think we've probably been using the wrong kind of sandpaper to try to understand what it is good for.
So, still wrestling with existence. And uncertainty. 

  1. Engel, George L. (1977).  The need for a new medical model: A challenge for biomedicine. Science 196:129–136.
  2. Gibson, B; "Wither 'Quality of Life'?" Critical Physiotherapy Network,  December 2015