Consumer's Guide To Health - Episode 36: Evidence, Science And Beliefs

Transcription Of Episode 36: Evidence, Science, And Beliefs

Welcome, welcome, and welcome to the Smart Life Project's "Consumer's Guide To Health" for February 2, 2012! I'm your host, Allan Besselink, coming to you live from Austin, Texas as I do every other Thursday morning at 11:00 am central time. This show is brought to you by the Smart Life Project, a health initiative based in Austin, Texas committed to providing sports science solutions for training, rehab, and life. Life is a sport - play smart.

Becoming a consumer of your own health and health care is critical in this day and age. The health care and fitness worlds can be a challenge to negotiate. But we are also, fortunately, in an era of accessibility to information, and as I always say, knowledge is power - if only we'd use it. The primary goal of this show is to increase awareness of these issues so that people can become better consumers of their own health - from the grass roots level on up. With that in mind, our call-in number is 347-843-4753 should you have any questions, concerns in the discussion for today.

I do have a rather unique perspective on health, having experienced it from a number of different angles – as a physical therapist, an endurance sports coach, educator, author, participant, and patient. But first and foremost, I am passionate about the improvement and optimization of the health and fitness worlds, and stand by the power of the sports sciences, evidence-based practice, and sound clinical reasoning to lead us from the dilemma that is the current status of the health care and fitness communities.

Let's face it though - the inability to challenge our belief systems in the face of good scientific evidence is the primary limiting factor in the advancement of both health care and coaching, as well as human performance and injury prevention. And as I always say, please, please, please, don't shoot the messenger.

Today's episode is entitled "Evidence, Science, And Beliefs". This topic stems from a number of recent events. They range from my doing a lecture on clinical reasoning, all the way to the brouhaha that has developed over the APTA (the American Physical Therapy Association) and visceral manipulation. I have written articles on both of these topics on my website allanbesselink.com and I hope you will refer to them. With that said, these recent events have made it readily apparent to me once again that the issues of evidence, science, and beliefs are deeply interwoven and highly relevant in effective clinical practice.

When legislators show disdain for concepts like comparative effectiveness research, we should be appalled. Science should be the basis, the foundation, the bedrock for a system of health. As it stands right now, we have plenty of studies to both support and refute many assessment and treatment approaches in health care, along with many approaches to fitness and health.

The latest catch phrase is "evidence-based practice". It has become a trendy phrase, indeed. But I will admit, I am losing faith in the phrase "evidence-based". It has become a rallying cry of sorts, much like the use of the terms "wellness" and "empowerment" as they are bandied about in the health and fitness world.

What becomes apparent is that if someone is willing to pay money for the treatment - evidence or no evidence - then it appears to have become acceptable in the psyche of the general public. Ultimately, this is a consumer issue - buyer beware, as they say.

Meanwhile, back in the evidence-based world, I am constantly reminded of one of the significant problems facing health care these days: the growth of pseudo-science. When clinicians and fitness professionals are faced with little or no evidence to support their far-fetched, hypothetical “scientific” interventions (“scientific” being in quotes), we are inundated with the standard responses.“Science can't measure and explain everything yet". “It just works”. “Can all these people that it obviously helps all be wrong?”. Or worse.

My own professional association - the APTA - continues to straddle the evidence-based fence. They are advocates of it, yet how many clinicians, members of the same professional association or group of educators, still continue to embrace treatment approaches in spite of the evidence? It has gone so far as to have clinicians molding a new phrase: "evidence-informed". More often than not, the broader definition you use, the more wiggle room it leaves when you are rationalizing the use of any approach to care. And besides that, I have watched clinicians disregard it no matter what you call it.

We are now at a significant crossroads in all of this "evidence" mess – and it is, indeed, a mess. I think we are now at the point where we have to call out the advocates of evidence-based medicine. Let's remove a little hypocrisy from the discussion.

Evidence-based practice should become "science-based practice". The scientific method must be the gold standard in terms of how we approach clinical practice. Anecdote provides us with reasons to ask good questions in the research world. Anecdote provides us with a starting point to review the evidence-based cellular physiology that has existed for 50-odd years. But as they say, the plural of anecdote is not data.

So perhaps we need to get rid of the phrase "evidence-based medicine" completely and truly play some hardball. If there is not good science to support a hypothesis, then it must be revised or discredited. Science-based medicine would not implement a broad definition to allow clinicians to use whatever they want simply because of what they believe in.

As Johnnie Cochrane noted in the OJ Simpson trial, and I quote, “If the glove doesn’t fit. you must acquit”. Simple as that. In legal circles, they call it "beyond a reasonable doubt". Maybe that's what we could do with science-based medicine.

In many ways, it comes down to the application of logic and sound thinking skills. It comes down to testing hypotheses.

As Rand once noted -

“To arrive at a contradiction is to confess an error in one’s thinking; to maintain a contradiction is to abdicate one’s mind and to evict oneself from the realm of reality.”

I suspect that not far off in the same breath, she also noted that

“No concept man forms is valid unless he integrates it without contradiction into the sum of his knowledge.”

Ponder that for a moment. Therein lies one of the big problems of this whole evidence-based mess. You can arrive at a contradiction – fair enough - but you must then make a choice to integrate that into your thinking - or not. We have lots of great research readily available, but we must also be prepared to accept and acknowledge it. You cannot abdicate yourself from reality. Your task is to simple perceive reality, and not invent it. If all of this was just about evidence, then we could make simple decisions. But, sadly, it is not.

The primary limiter in all of this is contained within our own minds. "Evidence-based clinical practice", as we know it, is only as good as the belief systems of the practitioner and patient. The practitioner's beliefs drive their choice of treatment just as much, if not more, than the actual evidence to support the choice. Clinicians continue to ignore decades of research because "they know they make patients better".

As I noted in my book RunSmart, and as I use in the intro to this show:

"The inability to challenge our belief systems in the face of good scientific evidence is the primary limiting factor in the advancement of both health care and coaching as well as human performance and injury prevention"

If you believe in rational thought, in the scientific method, and in the refinement of science as we know it, you cannot also choose to abdicate yourself from the scientific method when it is convenient (or economically beneficial) to do so simply because you believe something to be so.

We must ultimately serve as patient advocates. We must ultimately serve as advocates for a system of health. Let’s face it - patients deserve the best that science can offer them, not our beliefs and what those beliefs offer them.

That actually brings us to the end of this episode of “Consumer Guide To Health”. I hope you’ll be able to join me in two weeks for my next episode as we discuss another consumer-related topic in health and fitness.

As we move forward in health and health care let us all remember the eloquent words of Albert Einstein who noted “we can't solve problems by using the same kind of thinking that we used when we created them”. I am your host Allan Besselink and you have listened to “Consumer’s Guide To Health”, a show produced by the Smart Life Project in Austin, Texas. For more information, you can find us on the web at www.allanbesselink.com/slp. This show is released under the Creative Commons license. The intro music was written by none other than your host and performed by myself and fellow Canadian musician Terry Baldwin - what seems like a long long long time ago in a galaxy far far away. Hopefully, Groundhog Day was good to you and you don’t have another 6 weeks of winter ahead!

Photo credits: joehardy