Concussions have always had a particular interest for me. The politics around concussion in sport and the alleged cover-ups and the significant public health consequences have long been a fascinating issue to follow. Will Smith’s 2015 movie, Concussion and the 2013 book, League of Denial highlighted just how political and controversial it has become. Who remembers or knows what the Lonergan Shuffle is?
Chilblains are generally not that responsive to treatment with most interventions having some effect, but no one intervention really curing them or having any great consistent affect. Lots of people have opinions and preferences for treatments, most of which have not yet been shown to do any better than a placebo. When there are no definitive treatments shown to work for a condition, then the wide range of anecdotal recommendations and choices to treat will contain many treatments that simply can not work and if they do appear to work, then its more likely to be the natural history rather than the treatment.
Continue readingSome people must think some people are really stupid. I recently screen shot some pictures posted on a website that I stumbled across and has now been taken down. They must think that people really are that stupid. It was from a website promoting and selling a “bunion corrector”.
Here is the first image. This was the bunion allegedly before the use of the bunion corrector:
Continue readingThis 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.
Continue readingHere 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.
Continue readingThere 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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