The Whole Foot: Blog

Engineers, Scientists, and Zealots: Who is giving you medical advice?

This discusses:

  • Differing opinions that you can get on medical problems depending on the point of view of the expert.
  • Usefulness of the information.
  • Caution that is necessary in interpreting marginal medical treatment.
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Let’s assume that because you have come to this website that you are interested in foot problems.  Maybe you have foot pain yourself or maybe you are looking for information for someone else.  You must realize that different sources will vary in their portrayal of medical topics.  It is up to you to use your own intelligence to decide whether the things that these sources say ring true to you.

The first type is the scientist.  This is what you get when you open a textbook of medicine.  The Mayo Clinics have a very nice website that interprets their information like this.  The information will sound very dry and unfortunately the recommendations will be very non-specific and difficult to follow. This is because science offers us very few clear answers when it comes to the treatment of foot and ankle problems in specific circumstances.  Scientific study can speak to the results of treatment within populations, but for individual conditions and all of the myriad of complications and idiosyncrasies that arise, it says much less.

Here is the Mayo Clinic Treatment for plantar fasciitis (http://www.mayoclinic.com/health/plantar-fasciitis/DS00508/DSECTION=treatments-and-drugs):

  • “Physical therapy. A physical therapist can instruct you in a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilize your ankle and heel. A therapist may also teach you to apply athletic taping to support the bottom of your foot.
  • Night splints. Your physical therapist or doctor may recommend wearing a splint that stretches your calf and the arch of your foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight and facilitates stretching.
  • Orthotics. Your doctor may prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly.”

When you read this, what are you left with—really, nothing.  Overall, these websites may be useful for general information, but do not help with self treatment or give the reader a clear idea of where to go or what to do.  The good news is that they will not lead you wrong.  The bad news is that they often will not lead you anywhere.

Scientists are responsible for the great advancements of medicine, but, as doctors, they are not particularly effective.  Many are unwilling to take the risks necessary to give the specific instructions required to institute a treatment plan.

The second are the zealots.  They are usually on the crest of the latest medical fad.  When approaching medical treatment, these sources begin with a premise–that their procedure, medicine or whatever is the answer to whatever is bothering you.  The scientific information is spun so that their treatment is supported and all other information is ignored or discounted, sometimes with an angry righteous fervor.  Perhaps, they believe that one single way of treating things works for a wide assortment of problems.  This is the case with Prolotherapy, and a number of other treatments.  Don’t get me wrong.  These treatments and techniques may be very useful.  Before widespread usage of these techniques is recommended, some proof is necessary.

Here is an excerpt from the prolotherapy.com website:

“The treatment is useful for many different types of musculoskeletal pain, including arthritis, back pain, neck pain, fibromyalgia, sports injuries, unresolved whiplash injuries, carpal tunnel syndrome, chronic tendonitis, partially torn tendons, ligaments and cartilage, degenerated or herniated discs, TMJ and sciatica.

Prolotherapy uses a dextrose (sugar water) solution, which is injected into the ligament or tendon where it attaches to the bone. This causes a localized inflammation in these weak areas which then increases the blood supply and flow of nutrients and stimulates the tissue to repair itself.”

First, notice the claim.  What doesn’t it work for?  Second statement, this is full of many factual inaccuracies.  Dextrose injection does not cause inflammation.  For the most part, it diffuses into the tissue rapidly.  Even if it did hang around a bit, increased levels of sugars like dextrose essentially simulates the diabetic state, which has been shown in past experience to be unhelpful in healing soft tissue (as anyone with diabetic foot problems can attest).  The other claims such as “increases in blood supply” are unsubstantiated by any research.  Prolotherapy may be helpful.  No one knows because all the claims are anecdotal.  This means that the therapy was tried, it worked on someone, but no one says whether it did or didn’t work on many others.

Some zealots sincerely believe in their product or procedure.  Others may have a financial stake in whether the product sells or not.  If a clinic or doctor offers only one form of treatment, run away!! No one treatment fits all problems or situations.  Be especially suspicious if the treatment’s indications are very broad or the claims are too good to be true.  My advice is to carefully assess any claims and do your homework on any form of treatment.  If the evidence isn’t there, then weigh the claim and the risks and decide for yourself.  Realize however that faith in an unproven medical treatment comes with substantial risk.  Many times, the risk is the wasted money and mild pain, but there are some very real complications for unproven treatments.

People with an engineer-mentality make the best doctors.  Engineering is applied science as is medicine.  An engineer takes the science (all the facts) and applies it to the real world.  Unfortunately, everything that an engineer does is not proven either, because the facts have not been completely established for every problem, every circumstance, every person, but an engineer considers all of the facts and tries to objectively come to the best solution for a real world problem.  He weighs all treatment options and objectively decides which has the best risk/benefit ratio.  In the best circumstance, an engineer has no stake in the outcome of his assessment and is willing to change his view on problems as new information arises.  All of us come to the problems with which we are presented with some bias, however.  Many times this means that the assessment will be subjective in some sense.  Errors will happen, because the outcome has not been proven.

In the end, it is you, the patient, who makes the final decision.  All of the sources to which you turn may inform you well or poorly, but you have to weigh them all and decide what is best for you.

–Brett Fink, MD.  Co-author of The Whole Foot Book:  A Comprehensive Guide to Taking Care of your Feet

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