Turf Battles in Health Care: The Patients Suffer

The “turf” battle between Acupuncturists and Physical Therapists has waged with ever increasing attention, media coverage and cost. But who really benefits, and more importantly, who suffers? This most recent article is a great example of how the media loves to stir the pot, making obvious the fact that their goal is RATINGS. This battle over a tool, the Solid Fine Filament Needle, has been waging for the last 10+ years with enormous costs of finance, time and resources to both the acupuncturists and physical therapists. We are taught in our professional education to, “Do no harm”. With ever increasing training, skills and techniques that physical therapists employ (many with a potential for adverse effects) to better eliminate functional impairments, pain, and barriers to healing, if we are not able to apply these techniques in our patient management, aren’t we also doing harm? Isn’t withholding effective care another example of “doing harm”?

A recent survey of physical therapy patients treated with dry needling had some very interesting preliminary data. It indicated that for those patients who received dry needling as part of their physical therapy treatment, greater than 79% had a reduction in medication use for pain and functional limitations, and 25% stopped taking pain medications altogether.

As Tim Flynn so effectively identified the significant issues that our medical profession continues to propagate (Keep the Wolves & Opioids Away), we see a continued release of information that should motivate us to fight for all professions to use tools to help patients in pain. The statistics are staggering.

 

 

Pain “management” is a huge industry. Opioids and surgery are the answer being marketed by “Big Pharma” and the media. We have all heard it: “Are you missing out on life…” and “Less than a one inch incision…” are solutions to solving spinal issues. While medical professions fight over “tools” of their trades, we have patients suffering from unnecessary medications and surgeries.

But consider this: Has the patient been asked what they would like to receive by their respective providers?

We know back pain, as one example, is a huge problem with most Americans suffering from it at one time or another. “Carey and Freburger noted that more than 80 percent of Americans will experience an episode of low back pain at some time in their lives and that total costs of the condition are estimated at greater than $100 billion annually, with two-thirds of that due to decreased wages and productivity.”

The issue shouldn’t be whether there is enough business for all medical providers to develop their niche in treating patients, but whether the patient is given the access to the care they need, want to try, or have found really works for them.

If the patient doesn’t know what is available for treatment, of course the commercials for medication and surgery will seem like the answer.

But, rather than continue this battle for “tools” of the trade, we should be educating, supporting and progressing non-pharmaceutical and non-surgical means of treatment and working together to determine proper cross referral strategies and support.

 


Edo Zylstra PT, DPT, OCS

is CEO, Founder and Lead Instructor for KinetaCore–an Evidence In Motion partner company. Learn more about Edo, and KinetaCore’s dry needling continuing education offerings at KinetaCore.com.

Interested in more of Edo’s posts? Click here for a listing of Clinical Pearls on the KinetaCore website.

 

 

10 responses to “Turf Battles in Health Care: The Patients Suffer

  1. Lisa Maczura says:

    AZ won its state battle for DN use against the acupuncturists because PTs and patients took the threat seriously and fought back strategically. PT’s have to care enough about the broader patient population to market widely and ethically. PTs need to stop re-converting themselves and look outward to community and individual needs.

    1. Edo Zylstra says:

      Thank you for the comment Lisa. I couldn’t agree more. This is less about a technique and more about a scope of practice and more importantly, the patient that seems to always lose when professions resort to turf battles. Keep pushing your colleagues to become and/or maintain their professional membership as we can’t afford not to.

  2. Matthew says:

    Edo,

    You ask if withholding a treatment is doing harm to a patient. If the treatment has demonstrated an efficacy and effectiveness that exceeds the risk/harms associated, maybe. There are situations where withholding treatment may be more beneficial than providing treatment.

    http://www.bodyinmind.org/targeted-therapy-for-acute-whiplash/

    The use of a solid fine filament needle for dry needling or acupuncture has been shown to follow a similar trend. The evidence for using such an intervention with a relevant risk/harm and little/no benefit should make us question why we continue this so-called turf war.

    What are we fighting for, if not billable units/money?

    I’ve yet to see a well conducted trial showing this intervention’s efficacy exceeding the risk/harms (money, time are harms). The opposite may hold true.

    http://www.jospt.org/doi/10.2519/jospt.2017.7389
    http://www.jospt.org/doi/10.2519/jospt.2017.6994
    http://www.jospt.org/doi/10.2519/jospt.2017.6698
    http://www.jospt.org/doi/10.2519/jospt.2014.5229

    Being an anonymous poster and having been on the opposite end of an “argument from authority” here I think its important I reference those with more respect in the profession.

    https://www.ncbi.nlm.nih.gov/pubmed/25477053

    http://ptpodcast.com/pain-science-and-sensibility-episode-24-trigger-points-the-third-space-and-the-merit-of-pain-theories-with-dr-milton-cohen/

    http://www.bodyinmind.org/dry-needling-myofascial-pain/

    http://www.pudendalnerve.com.au/2015/02/01/what-do-i-do-with-my-trigger-points-now-dr-quintner/

  3. GB says:

    The above entry by Matthew raises some important points and I am eagerly awaiting some feedback from either Edo or the EIM crew (since they are affiliated).

    Having been involved in clinical practice for 20 years now and also certified FDN level one (by Kinetacore), I am extremely wary of how this “treatment”…. with poor efficacy studies, clear documented adverse effects and dubious scientific merit has been embraced by our profession.

    The notion that Edo appears to be positing that there is an unfortunate turf war interfering with patient care seems to have placed the cart way ahead of the proverbial horse so to speak.

    And to be frank, I find it shockingly over-exuberant to suggest that not providing this treatment is somehow harmful.

    Really?

    Is this evidence in motion?

  4. Edo Zylstra says:

    GB and Matthew, forgive me for the delay in response to your comments. I typically don’t spend a lot of time discussing these things in forums as I find in-person conversation and discussion greatly accomplishes the goal of establishing a healthy dialogue.

    This may surprise you. I agree with you, for the most part. The research does not support DN well at all. It doesn’t refute it well though, which is equally important. We really need to ask the question: why doesn’t the research support the growing demand by patients for DN treatment, and the increasing numbers of Physical Therapists seeking training? I feel this is the question that is lost when evaluating clinical research. If we are doing something in the clinic that is showing objective gains and is sought after by patients, why is the research not showing this?

    Instead of picking one treatment to aggressively pursue to downplay, make irrelevant and possibly make unavailable to the consumer, shouldn’t we be evaluating why clinical integration and success of a specific technique or tool often looks surprisingly ineffective in a sterile and highly controlled research environment where the “blinding” may be the most limiting factor? If you were required to treat a patient without the use of the faculties available to you (sight, touch, hearing, etc), as required by high level research, it would be logical to expect less than optimal objective improvements.

    I say objective because that is important for us as clinicians to be honest with our treatment plan and its success. Interesting note however is if we don’t ask the right questions we won’t know the answers that may impact our care. For example, in a study comparing peripheral vs paraspinal dry needling, the PI’s found that the largest change was in the geriatric depression scale. To me, that is a very interesting finding that should lead us further down the trail of the global neuroplastic impact we are having, not only with DN but all the interventions we include in our care as PTs.

    I am happy to discuss this further, but not on social media. My email is edo@kinetacore.com. A phone call or an in-person conversation would be much preferred.

  5. Matthew says:

    Edo,

    I am a bit concerned by your comments. As the CEO and founder of a company promoting/teaching dry needling I think it would be beneficial for those participating here and those silent readers “out there” to learn from an in-depth discussion of this modalities’ application. This is not a low cost modality to “learn” and patients or third party mayors are spending their money for its application.

    Social media is the best platform to have these discussions. It allows us to connect with our students, clinicians and public.

    Its no secret there have been many conversations, debates, discussion both on social media and in the public setting (APTA Women’s Health Oxford Debate).

    I hope you change your mind. If so, I love to hear your answer to a few questions.

    What is the “right” question?

    What would it take for you, someone with vested interests in this modality, to change they support of this intervention?

  6. GB says:

    I also find it peculiar that you are happy to discuss but not on social media? Is this platform not where open debate and discussion best occurs these days? I would say that some of the best advances in understanding how best to treat has occurred over the past 10-15 years with the advance of social media. A place where professionals can discuss, disagree professionally and ask others to effectively defend what they are saying. Why are you against open dialogue on social media? To me it begs the question that perhaps you would rather not air dirty laundry for all to see?

    That’s fine. I’ll respond regardless and hope some of the readers might start to question things a bit.

    From your response Edo, it almost appears as though you don’t give any consideration to the ritualistic nature of the needle. There is a rather high probability that any success (as you refer to it) is non specific in nature and indeed no better than placebo.

    Then you somehow seem to be implying that the growing demand must therefore mean that there is value that research just can’t seem to capture.

    This sounds eerily similar to the appeal from subluxation based chiropractors. I fully understand that much of what we do tends to struggle when measured with RCT’s (except exercise and leading patients towards self-efficacious behaviors and resiliency). But at what point are we crossing the line?

    For me it’s performing highly invasive techniques with known (documented) adverse consequences, virtually no evidence and dubious scientific explanations.

    Frankly…I’m shocked that otherwise seeming intelligent individuals seem all too willing to just so whatever with the fall back position being that placebo is a “powerful” thing that we should not be ashamed of harnessing.

    Well…the placebo research tends to suggest that the outcomes are not at all powerful, short lived and extremely unreliable.

    By all means let’s investigate this further but patients deserve better than throwing darts in the dark don’t you think? What because they seem to like it?

    Nonsense.

    Patients seem to like this as well and seek it out: https://www.youtube.com/watch?v=rqntd2AjcD4

    Should we start this as well then?

  7. John Childs says:

    Some good back and forth dialogue here and plenty of room for differences of opinion. I agree that social media, blogs, etc. are a great forum for discussing ideas. The EIM blog has served this purpose for many years, and we’ve been quite generous in allowing even original posts at times from authors who viewpoint may or may not reflect our own as a company. Further, we couldn’t agree more that spirited but mutually respectful debate is a great thing that moves our profession forward. Having said that (and I won’t speak for Edo), I personally wouldn’t see the point engaging in this sort of discussion anonymously. That’s simply my 2 cents and humble opinion having learned many lessons about the advantages and pitfalls of blogging over the years. I used to go down

    John

  8. Josh says:

    John,
    I am typically a silent viewer of this blog and have been a supporter of EIM. However, there appears to be a trend here that is a bit of a concern regarding some of the well-known individuals in our profession.
    There have been a few instances where Matthew and GB have provided legitimate arguments challenging some of the posts on this website. Rather than provide a strong counter-argument or just solid reasoning, some including yourself seem to focus on their decision to remain anonymous.
    Could you or others please explain to me what you are going to gain by knowing the names of these individuals? Is their posts more evidence-based because they provide you their first and last name? Both have made it clear that they are everyday staff clinicians. They have acknowledged that they do not publish research or are well-known. Therefore, when you google their names from a PT standpoint, I’m guessing you probably will not find out much more than their NPI. Should that matter? What more do you really need to know ? Have a good one!

    Josh

  9. GB says:

    Thank you Josh.

    For the record, I opt to remain anonymous for a variety of legitimate reasons including that my professional viewpoints often run counter to those of some of my colleagues… some of whom are in positions of authority.

    And I wholeheartedly agree with Josh. The points Matthew and I have brought forth are legitimate regardless. We have never been disrespectful or unprofessional.

    Discounting them on the grounds cited by Edo (doesn’t like debates on social media), Adriaan (prefers to only debate those with published work), and now yourself John (does not like debating with anonymous posters) seems a straight forward case of avoiding the issue.

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