Update: Clinical outcomes still don't validate treatment’s explanatory rationale
For approximately 300 years, the scientific method has helped humanity make sense of the world around us by providing a framework for developing theory and objectively testing hypotheses. But according to local Physiotherapist and passionate “online” debater, Donny Dogooder, the scientific revolution has managed to pass over large swathes of his profession.
“Sometimes I wonder if all the energy is worth it. You can spend weeks debating a colleague about the scientific merits of a specific intervention. You might actually make some inroads… But then the next week, you happen across the next joker making all the same erroneous claims. Time and time again practitioners assume that a favourable clinical outcome validates the theoretical underpinnings of a specific treatment approach or technique. But it doesn’t. There’s no way around it.
Look at Craniosacral Therapy as an example. There’s no doubt that it’s a helpful intervention. Patients walk out of the clinic feeling great. Great, good for them. But does all that gentle manipulation validate these ideas about cerebrospinal fluid rhythms and stuck cranial bones? The answer there is a simple no. The clinical outcome does not and can not validate the theory underpinning an intervention. That’s shouldn’t be up for debate. But somehow it is… again and again and again.
Don’t get me wrong, there’s nothing wrong with developing theory to explain observations, we need to do that… that’s part of how science works… but geez the overreach of some of these theories is just gobsmacking. Whatever happened to minimising assumptions and accounting for confounding variables? Prior plausibility? Parsimony anyone? How likely is it that a Craniosacral Therapist is feeling what they think they’re feeling? Palpatory pareidolia anyone? Are there competing explanations that make less assumptions and account for more confounding variables? If there are (spoiler: there are), and if we value ourselves as a science based profession, aren’t we obliged to update our theoretical descriptions of our clinical observations…you know, trim away those unnecessary assumptions and incorporate those confounding variables into the theories that inform our treatment techniques?
Why the hell would you persist with an unnecessarily convoluted, unfalsifiable and ultimately unscientific theory? It doesn’t do anyone any favours. But I tell you, when I present these ideas to a colleague 9/10 go off in a huff accusing me of attempting to undermine an effective treatment modality.
Honestly, it just leaves me scratching my head. I don’t really give a fuck what technique a clinician uses… if the gentle manual handling that characterises Craniosacral Therapy helps your patients, go ahead and keep doing it, but c’mon, let’s do away with a theory that is untestable, unfalsifiable and therefore unscientific. Surely we can do better than that”.
