Natural History vs Clinical Evidence

This is a topic that I have blogged about so many times, but it came up for me with a patient I looked at a few weeks ago. The previous posts included topics like: But…but…it worked for me!, Anecdotes are not evidence, and Why Ineffective Treatments Sometimes Work. I won’t be litigating all those issues again here.

I never cease to be amazed just how many people are more trusting of anonymous anecdotes from fellow sufferers of conditions than they are of evidence-based health professionals. From time to time I hang out in social media groups of people who have a particular condition (eg comments here on a plantar fasciitis support group). So many seem to be so accepting of this advice from well-meaning people who can not be held legally accountable for the advice if it goes wrong or does not work. Health professionals who are licensed/regulated can be held accountable.

Often you see advice that is just not plausible. There is no mechanical, physiological or whatever mechanism that the treatment or advice being given can actually work. Yet you see it recommended and you see people advocate for it and claim it cured them. Yet you know that there is no way that it could or would have worked.

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Professional Sports Team Embraces Pseudoscience

Here in Australia most professional sports teams have in place a salary cap regulated by the sports governing body. This means that they can only spend a fixed amount on players. In other countries in other sports there is no such salary cap, so the better clubs just go out and spend more money to buy a better player (and lead to the outrageous payments to players). That activity is somewhat restricted in those sporting codes in Australia that have this cap imposed. What this also drives is a better approach to sports science by those clubs: if you can’t spend more money to get better players, then spend more money to get more out of the players you have. In many areas I see Australia leading the world in sports sciences because of this.

There is, however, a downside to this. This can mean that sporting clubs start pushing the envelope and in some cases, that push may be too far and become illegal (arguably that is what underpinned a “drug” scandal in AFL a few years ago; they pushed the “supplements” so far as it went over the edge). It also means that while they try to embrace the “science” and evidence, they may push over into the pseudosciences.

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Cannabis Oil for Plantar Fasciitis

There seems to be increasing advocacy for the use of cannabis oil (medical marijuana) for plantar fasciitis recently, mostly from what I can see, from those who sell it. If you hang out in some of the online communities for those with plantar fasciitis, you see a lot of very bad advice being given, mostly based on anecdotes. In the last year or so, the most popular advice was to use magnesium supplements to cure plantar fasciitis. This was all the rage for a while with an extraordinary number of people advocating its use based on it working for them (when we have no idea if it actually worked or not or if it was just a placebo or just part of the natural history or any other explanation). There is no mechanism that I could find by which it could affect plantar fasciitis. More recently, the volume of advice for the magnesium supplements has started to drop off but is being replaced with an increasing amount of advice for the use of cannabis oil to treat plantar fasciitis. Some of the testimonials are quite compelling … if they are true.

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Platelet Rich Plasma for Plantar Fasciitis – writing about something I know nothing about…

Platelet Rich Plasma for Plantar Fasciitis

I have to be honest and admit that the use of platelet rich plasma (PRP) for plantar fasciitis is something that I have had no more than a superficial interest in. I pretty much scanned the abstracts of the studies and systematic reviews as they are published of it in this thread and the one comparing it to other interventions on Podiatry Arena. I also note comments in social media on it from those whose views I respect. From my superficial understanding, it works, it does not work, it works, it does not work … a lot of the studies that compare it to other treatments do not do the “other” treatment very well (ie wrong dosing), which can easily bias the study to PRP being better. Some of the comments in social media from people who I consider real experts, especially in the context of tendinopathy are that it does not work, yet a lot of people claim it does. Yes, I know that the “plantar fasica” is not a “tendon” and it may or may not be appropriate to translate “tendinopathy” research to “plantar fasciitis” (not that this stops people doing so or not doing so if the research on it matches their pre-conceived biases!).

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Google Scholar Ranking of Podiatry Journals

Today, Google scholar came out with their 2018 update to their ranking metrics. No point in me re-litigating what Google says about them, so read Google info. The rankings are not without some controversy and there are competing ranking metrics of journals. Each different ranking method put emphasis on different criteria and weight different criteria differently.

I checked their database for the ranking given to the podiatry and related journals and compiled this list:

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