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new posting rule, double-blind studies

Posted by Scott R on 2/21/04 at 08:11 (144906)

To keep me out of legal trouble let me make a new rule: do not post anything that presents as fact that one machine is better than another. I agree with elliott that a claim cannot be made unless the machines are directly compared with a substantial study group, including placeabo, although i consider any ESWT study that claims double-blind to be suspect since the treatment group can feel the shockwave pain and vibrations in their bone (personal experience) even if there is anesthesia, at least with high-energy. And the doctor can feel the vibrations also. But double-blind is not always or maybe even usually required for something to be valid science, but it is a way to help keep pharmaceuticals in control of american medicine by keeping the little guys with great cures out of the FDA game. For example, if i have two identical skin injuries, and i cover the one that appears possibly worse with a band-aid and keep it constantly moist with neosporin and let the other one air-dry. It's certainly not double-blind. Now if it takes the neosporin side 3 days to heal completely and the dry side 10 days, what's the probability that neosporin is better than dry? Any sane person would conclude there is a very high probability that neosporin is better even if the test is done only once on one person. The FDA would concede nothing. But i guess there's probably some protocol medical journals follow that seperate objectively measureable outcomes as opposed to patient or doctor judgement so that only the later situations require double-blind (as in ESWT).

I got blisters from ice skating in both heels. The left side is neosporin. First pic is 2 days after injury, the second pic about a week. In the most imnportant first 24 hours i had left both of them dry, so the neosporin works better than this shows. It's porbably just keeping them moist that helps, but the neosporin is to prevent infection due to keeping it moist.





Re: new posting rule, double-blind studies

Pauline on 2/21/04 at 10:00 (144914)

Scott,
I'm impressed that you can still put your legs in the required position
to take the pictures. Must be Julie's Yoga Exercises.

I think your new policy not to post which machine is good, better, or best is a sound one.

Recently 3 North Carolina High School Students disproved the conclusion reached by their own teacher in his submitted PHD dissertation. The team won first prize in a Westinghouse's Science Contest because of their work earning $100,000 dollars in scholarship money.

Their teacher is a former NASA scientist. Needless to say the Astronomy World is amazed and excited by the work of these three students. As a result they are currently working with their professor to correct his original paper.

Luckily the students' findings were not dismissed simply because a NASA Scientist's PHD paper had already be accepted and published. Instead they were embraced for their findings, and perhaps somewhat bittersweet their professor is proud of them.

The students' plans are to study astrophysics in college.

An uplifting story about todays youth when we see and hear so much negativity

Re: new posting rule, double-blind studies

Dorothy on 2/21/04 at 10:53 (144917)

Scientists are always building on each other's work, proving, disproving, questioning, correcting. It's the nature of science. Non-scientists seem to think of this as some kind of problem or flaw, but it's science.

Re: science

Scott R on 2/21/04 at 11:13 (144918)

Science is like life. It does not evolve to find the truth. It evolves to promote theories that can breed more theories that are difficult to kill. It is guided at the highest levels by political forces. It has nothing to do with describing the world, but a lot to do with describing what the world is not. 'There is no perpetual motion machine' describes all of thermodynamics and conservation of momentum. 'There is no absolute frame of reference' describes all of relativity. There are other anti-science ideas like this: physics theories have to be valid today and tomorrow (in time) and here as well as there (in space) because humans need to know things that will help them survive in space and time, not because they seek the truth. Survival always supercedes truth. Truth just happens to be temporarily beneficial to survival. Same thing with in business. The valid in time requirement forces us to think the conservation of energy theory is important. Valid in space makes us think conservation of momentum means something important. It's all just humans trying to survive, not us trying to know the mind of God.

Re: new posting rule, double-blind studies

Pauline on 2/21/04 at 11:16 (144919)

Dorothy,
What's funny is their professor gave the kids his paper which he thought was sound work to help them with their team science project The paper dealt with matter remaining after the death of a specific star.

As the kids began researching their topic they began to discovered the flawed conclusion he had reached at the time of publication.

New technology allowed the kids who are teenagers to correct his findings.

I don't know if you've ever read anything about the formation or death of stars, but it's a very interesting and amazing topic.

To scientist it must be important to correct what is found to be incorrect. My hat's off to these young scientists for all the work that they did.

They interviewed the three boys and they were just delightful. They appeared to have bright, interested and challenging minds. Through them our future looks good.

Re: science

Pauline on 2/21/04 at 11:36 (144921)

Scott,
I think this sums it up well.

Truth in science can be defined as the working hypothesis best suited to open the way to the next better one. -Konrad Lorenz

Re: new posting rule, double-blind studies

Julie on 2/21/04 at 12:06 (144923)

Pauline

A wonderfully encouraging story: thank you. Now I shall see what I can learn about the death of stars.

As for Scott's photos, not even those yoga exercises could have grown him arms long enough to take them without a mirror, so my guess is that's what he did. Maybe he will tell us...
.
.

Re: new posting rule, double-blind studies

Ed Davis, DPM on 2/21/04 at 12:24 (144924)

ScottR:

Of course one could argue that it was the action of keeping the wound moist with an ointment as opposed to the active ingredient in neosporin that led to the more favorable result. If you put vaseline/petroleum jelly on a 3rd wound we could better answer that question.

I do like Neosporin although I am finding more and more allergic reactions to it - more than 20 years ago and don't know why. Sort of like the latex allergy issue. 'Neosporin' is a brand name and is often termed 'triple antibiotic ointment' generically as it contains 3 active ingredients: Neomycin, Polymyxin B Sulfates and Bacitracin Zinc. I usually recommend that patients obtain generic Bacitracin ointment (one active ingredient)instead, particularly if they are going to be applying it for 2 weeks or more. Two prescription alternatives include Bactroban ointment/cream and Gentamicin ointment/cream.

My ESWT experience is a bit unique compared to some in that I have used three different machines-- Ossatron, Dornier and Sonocur with results which I deem equivalent. Interestingly, Storz had a booth at the ACFAS convention last week in which they demonstrated a table top RSWT (Radial Shockwave Therapy)(one may rememeber a fellow named 'Bill' who argued that RSWT was not 'real' ESWT back around June of 2003 if I remember correctly) unit which is used in Europe and Canada but in the US, only in the veterinary profession, primarily for race horses (high value animals). The rep told me that they were expecting FDA approval before the end of the year.

I do think that eventually we will find that certain protocols have an advantage in specific applications. For example, Sunny Jacob had posted that he prefers low energy via Sonocur Plus for intractable PF but prefers to switch to high energy after surgery. I have somwhat followed his lead on that. For now, I would support the assertion that differences in machines and protocols is speculative but, as always, practitioners need to be left with enough latittude to use their best judgement.
Ed

Re: new posting rule, double-blind studies

Dr. Z on 2/21/04 at 13:02 (144926)

What I see happening is individual groups will have their own protocols with in house studies showing their sucess rate. This is very popular in the lasik industry.
This could bring out alot of good research with alot of publishing.
I look forward to this type of productive competition

Re: Hmmm

wendyn on 2/21/04 at 16:02 (144949)

Scott, I was scrolling down when I saw the pictures (I had not read the post itself).

I will not tell you what this looked like at first glance (thought I was on the wrong website)

;)

Re: Hmmm

Pauline on 2/21/04 at 16:40 (144957)

Wendyn,
I thought the same thing. Were we being mooned??????? What a hoot. Took me a minute to notice the open wounds.

Re: Hmmm

Julie on 2/21/04 at 16:53 (144960)

...and so did I.
.

Re: Third invitation for Elliott.!.

Ed Davis, DPM on 2/21/04 at 17:51 (144967)

Elliott -- please come over to http://www.f**tch*t.com We will welcome you with open arms (as we really would do for anyone here as I feel our different 'structure' is apaptable to the needs of many).
Ed

Re: Third invitation for Elliott.!.

Ed Davis, DPM on 2/21/04 at 17:53 (144968)

Now 'Bill' from back in last spring may be a different story.
Ed

Re: Third invitation for Elliott.!.

Ed Davis, DPM on 2/21/04 at 17:54 (144969)

Actually, I could even see a place for 'Bill' if he simply would tell us who he works for or represents....
Ed

Re: new posting rule, double-blind studies

Ed Davis, DPM on 2/21/04 at 18:02 (144970)

Dr. Z:
Good point. Consider the fact that all of the patients in the Werber/Norris study are Werber's patients. Did I tell you that the editor of the ACFAS journal rejected the paper because it had nothing to do with 'surgery' so it sat on his desk for months?! It will need to be published in the APMA Journal instead.
Ed

Re: science

Ed Davis, DPM on 2/21/04 at 18:41 (144972)

Pauline:
Good point but never forget that medicine is an 'art' and a science.
Ed

Re: Hey guys, I invited Elliott over to the "other' website twice so please give me some credit...

Pauline on 2/21/04 at 19:19 (144975)

Ed,
Pleasure derived from within is a much greater gift than any from external sources. You know that.

Re: science

Pauline on 2/21/04 at 19:20 (144976)

I don't know about that Dr. Ed, have you looked at some of the road maps left by surgeons lately?:*

Re: science

Ed Davis, DPM on 2/21/04 at 19:35 (144977)

Pauline:

With all respects to surgeons and I do a fair share of surgery and instruct residents at a surgical residency, I would not consider surgeons to necessarily be the most creative in the medical community. It is also very easy to get tunnel vision when in a 'narrow' surgical specialty. One thing I like about my profession, is that we are broadly trained in all aspects of foot and ankle treatment and are not pure surgeons. Surgery is often viewed as definitive, often pays more than conservative modalities and, for some reason, is always favored by insurance companies (and hospitals)-- so surgery is often the path of least resistance.

There is nothing better than a well educated patient who understands how and why medical decisions are made and that is one of the virtues of websites like this one.
Ed

Re: Hey guys, I invited Elliott over to the "other' website twice so please give me some credit...

Ed Davis, DPM on 2/21/04 at 19:35 (144978)

Good advice. Thank you Pauline.
Ed

Re: Hmmm

wendyn on 2/21/04 at 21:27 (144986)

Okay, I'm glad I'm not the only one.

Except I thought it was boobs. Bad boobs. But boobs.

Re: new posting rule, double-blind studies

wendyn on 2/21/04 at 21:37 (144989)

Aren't those just the soles of Scott's feet placed together and a pictureof his inner ankles taken from above? I would not think that would be hard to photograph, but then again - these pictures have really confused me right from the start!

Re: Hmmm

Pauline on 2/21/04 at 21:50 (144992)

I'll have to take another look. I missed that completely and went to the other end!

Maybe Scott could post a 'What is it?' picture on the social board now and then. You know when he has nothing better to do than to entertain us.

Re: science

Dr. Z on 2/21/04 at 21:54 (144995)

I like that one. It does have alot of truth to it

Re: Hey guys, I invited Elliott over to the "other' website twice so please give me some credit...

Pauline on 2/22/04 at 09:48 (145014)

Dr. Ed,
Now when you invite me to your website, you'll have really done something. Unfortunately I never saw your site address so I have no idea where to find it.

Maybe you like it that way:*

Re: Hmmm

wendyn on 2/22/04 at 12:00 (145021)

Pauline, knowing Scott and his sense of humour, I think that would be a very bad idea.

Re: new posting rule, double-blind studies

Dr. Z on 2/22/04 at 18:11 (145026)

There have been other articles published in the ACFAS jouranl on ESWT. The Weil study is the one that comes to mind.

Re: Hey guys, I invited Elliott over to the "other' website twice so please give me some credit...

Ed Davis, DPM on 2/22/04 at 22:00 (145061)

Pauline:
You ARE invited but Scott does not allow us to mention the site here. I am hoping that he will change his mind in the future as the presence of two sites with similar objectives does not dilute or detract from each other. You must email me at (email removed) in order to obtain the site information. There are 'structural' differences with more categories which intentionally were created in order to avoid conflict. To some degree, the other site served to pull apart two 'groups' of individuals that were having trouble getting along. Luckily, no 'trolls' or troublemakers came over to the new site and this site has quieted down a lot. It seems that the net result was in everyone's best interest including Scott.
Ed