What is the difference between cancer and whiplash?
I have been loitering lots in doctors’ surgeries in the last few weeks taking a loved one on the rounds for assessment and treatment post cancer diagnosis. Lots of stressy waiting but an awful lot of time to ponder. Last week in yet another waiting room , now sick of reading “Who” magazines, coughed upon copies of “National Geographic” and outdated sports mags, I pondered my own profession and others in the rehabilitation world of neuropathic and musculoskeletal pain and contrasted it with cancer treatment.
A quote from Anton Chekov, the Russian author and physician came to mind. He said “When a lot of remedies are suggested for a disease, that means it can’t be cured”. Quite a remarkable quote when you consider Chekov lived in the late 19th century.
Of course, many forms of cancers such as that of bowel, lymph, prostate and blood are now very treatable, especially if managed early. They are probably more treatable than some neuropathic pain states. I noted in the situation I was in, how treatment outcomes could be stated with great accuracy, side effects accurately described, and a management process could be mapped out with confidence. There was little argument between, and support from all professionals involved. The whole process, while not pleasant itself, probably engendered its own placebo add on. Surely I am not being too “out there” suggesting that the process allowed immune cells in the tumour and those representing the meaning of the tumour to release their surveillance potency, their need to protect and to be more accommodating. That is, a bit of a better balance.
Whiplash, which is really just “Sprained Neck at Speed with frequent Neural Irritation” (SNSNI) – is it really more difficult than a cancer to treat? Chekov looms – so many remedies offered by so many groups for the problem. Perhaps some of the problem starts when we whack the useless and danger enhancing metaphor “whiplash” onto it.
You are not often offered such an opportunity to reflect about your own professional world and contrast it with that of others. For instance, so many professions want to help SNSNI in so many different ways that there is almost a sectarian war in the rehab world, held only in place because all participants are currently reasonably well fed. But where does a reasonable truth start? Look around – the obstacles are everywhere – a lasting guru culture exists in physical therapy, promulgating an ugly self righteousness- “follow me first and then maybe the science”, there are still course participants who sometimes say “just give me the techniques, I don’t want the lectures” or the dangerously deluded who sometimes say “we know all that anyway”. Politics abounds between and within groups, researchers pack up and move on, such as the ex motor controllers now moving to other fields without saying a word (or apologising) and leaving the debris at the feet of first contact clinicians, Pilates practitioners and other groups. It goes on – the sales catalogues put out by therapy suppliers increasingly look like the “skymall” booklets on aeroplanes, there is an exponential growth of dry needling, unmatched by growth in research, making it cult-like in some circles. Even national bodies sell education without a defined overarching curriculum goal statement.
I guess this blog is all about asking people to reflect on where you want to be and where your moral compass lies; and to create a greater awareness of how the patient is the sandwich in the middle. In cancer there is no room for bullshit. Why should whiplash be any different?
Further reflections most welcome.
David Butler
Dear David,
Thank you for you wonderful post. I think that it is really one of your best. I am sorry that the inspiration for your thoughts and insights is the one word most of us never want to hear, especially for a loved one. Elisa and I hope all is well. In the recent Brain Pickings site on Placebos that I have linked below, there is a link to Neil Degraff Tyson’s lecture on Nothingness. Fantastic. Sometimes it is only through nothingness that we realize what is real or through darkness really see the light.
The richness of your blog is fantastic. I love your Chekov quote. How simple but true. I found your analogy of our “sectarianisms” to be particularly true and the realization that what prevents all of us who have strong view from really battling with each other is that there is still a lot of financial meat and fat on the bones of our health care systems. I shutter to think what will happen as those resources become thinner.
Again thank you. I think this link to Brain Pickings fits in perfectly with your post. Enjoy. In addition, take the time to listen to the Tyson lecture. There is much in nothingness. JohnB
http://www.brainpickings.org/index.php/2014/06/23/nothing-jo-marchant-heal-thyself/
Best wishes to you Dave. That feeling of confusion and despair is sometimes best met with surrender. Remind yourself of what you want – a good outcome – and let life play out as it will.
Regards,
EG
Excellent post David – I have been involved in assisting a loved one with cancer for the last 2 years and have spent far too much time contemplating over similar issues.
I spend time wondering how things would be different in physical therapy if unsuccessful treatment could result in mortality? I bet we would consider our options a little more carefully. We’d be a little more keen to listen to the lectures behind the techniques. We’d be a little more quick to question that which seems implausible. We would take a little more interest in what the research says AND what it doesn’t say. I’m guessing those who fund research would be a little more selective in who gets what as well. How much money invested in dry needling studies may have been better suited to investigating those cancers which we know little about? It’s worth considering.
Does it really take the threat of death for us to truly consider biologic plausibility in research? Or in treatments? Shouldn’t the prospect of enduring suffering be enough? At times I wonder if we spend so much time flaunting our positive outcomes that we completely neglect those we have failed and why we have failed them. It’s a shame – those are often the best opportunities for learning and growth as clinicians.
Thank you David for a great post.
Almost reluctantly, I agree with you, reluctant because what does this mean for our profession. We’re probably in the best position to help people but how well are we doing at effectively helping people. As you said researchers pack up and leave, we are left with techniques that aren’t well researched but popular.
So where do we go from here, do we give a bit of what the person wants not because of the effectiveness of the treatment has been shown in clinical trials but because we are managing the patients’ brain in giving them what they believe will make them better and gp having the positive effects mentioned in the “nothing” article.
Do we take the guru culture on head on, thereby are we making ourselves guru’s? Should we not take them on and be swamped by another poorly research but popular craze in the next few years??
This is truly a wonderful post, David.
I wonder if it’s not just the metaphor—-could there be an explanation for the syllables used in a diagnosis? For example, Less fear-provoking words such as sprain and strain, are simple, one syllable words. They provoke little angst because of the terms written simplicity.
Two syllable words (with strong concinents) such as “whiplash” “cancer” “Bone-spur”, sound like they carry more weight. Moving towards three+ syllables becomes very scary (fi-bro-my-algia) (arth-rit-is).
I suspect if we changed the language, we could do wonders. What if we simply began attributing a number, or ICD code, to a cluster of signs/symptoms? For example, you have diagnosis 124. What do you think may happen? I can assure you drug manufactures and lobbiests would not be thrilled….
I wish your loved one a full recovery and thank you again for a great article
Interesting observation. Focusing on the ‘open season’ approach to assessments of neurological responses to nerve threatened conditions, if I’m not mistaken. From a patient’s perspective, it looks like a vortex of confusing overviews, offered up by equally accredited professionals, and doesn’t help much with planning a unified re-hab strategy. Just my opinion, but I think there’s a massive failure to understand nerve responses when the nervous system detects a threat to itself. Seems to me that there’s a lack of willingness to assess complex reactions, in such situations, as protective responses, of a less threatening nature than would be expected from injuries to less vital organs than the neck. The neck must maintain some flexibility, and there’s a residual price to pay for that….dispersed symptoms. Some refer to such responses as ‘malfunctions’ without any explanation of what proper functional responses ought to be. Thus the ‘open season’ overview.
Whiplash should be no different to cancer, in terms of how it’s dynamics are assessed. In fact, it should be easier to define.
Wow. You may not have gotten dissenting chemo opinions because you were at one hospital. Oncology is all over the place in regards to which combo of surgery/radiation/chemicals (if any) will help, what the prognosis is, etc., and their accuracy is all over the map. I agree that NMSK care is as well, but we are far from alone in that sad state of affairs. Egos and lack of attention to new evidence that contradicts the prevailing paradigm abound across all disciplines. Welcome to healthcare.