What Evidence-Based Medicine Actually Means in Practice

[0:00] Now, this is actually a requested episode from a patient. I like to call it the Michael J. Fox effect. Yes. Okay. I trademark that. Scott, trademark it. Trademark. Yeah. Do you have a trademark button? And just Google it, Dr. Young. Just Google it. That’s exactly why people are having a hard time finding the truth, Kathy. And then number three is I think kind of the coolest one because this is not what people would think about, but it’s if I told you that spinal misalignments are

[0:31] blocking your life energy and that if I adjusted your T6 vertebrae, then I could cure your asthma, what would you say to that? I would say your time machine worked and you’re back in 1910. Okay. Well, that’s exactly right. But did you know that there’s some people out there that still practice like it’s 1910 and they call it healthcare? I did not know. So, today we’re going to break down what actual evidence-based practice looks like and why just because it worked once, it isn’t enough anymore. Okay. Yeah. And keep watching the whole

[1:01] episode because you do not want to miss today’s game, which is based on a popular TV game show. Can’t wait on the PTCH Podcast. What happens when a chiropractor and a physical therapist get together to make a health and wellness podcast? But chiropractors and physical therapists don’t like each other. Oh, think again. I’m Dr. Kathy Lynch, physical therapist who likes to help people move and get stronger. I’m Dr. Jason Young, an evidence-based chiropractor who uses humor just as much as adjustments to help people get better. Welcome to the PTCH Podcast. Remember, there’s no I in

[1:31] PTCH. All right, everybody. Welcome to the PTCH Podcast. I’m Dr. Jason Young. And I’m Dr. Kathy Lynch. Are you now? Okay. Good. Good to see you. And look, today Kathy, I’m wearing a hat. Look at that swag. Yes, we got swag. We got merch, people. Let’s go. I think that what we need to do is we need to open up a like a swag store so people can get their own merch. I know a place that can do that. You know a place? I think I know the same place and we like these people very much. Corvallis Custom. You could be a

[2:01] sponsor. They could be. You could be. Yeah. Right. No. Actually, I had some people that were requesting sit champion t-shirts. Yes. Yes. And so I feel inclined to make that happen. Kathy, I think that’s going to happen. Yes. So, but thank all of you for listening and participating. We’ve loved your comments and things like that. Heck, we love that you’re even watching. Yeah, we really do. Yeah. So, just to remind you, our mission here on the PTCH Podcast is

[2:32] to bring you honest, good health information, make you laugh, and teach you to think critically about health, which is an important focus of today’s episode. Now, this is actually a requested episode from a patient. They were listening to the little intro thing that hopefully you made it through. If you already swiped away, too bad, right? You’re missing out. You’re missing out big time. But they were listening to that part and

[3:02] I say on there, “I’m an evidence-based chiropractor.” And they’re like, “What does that even mean?” Is that true? Yeah. Well, I’m wondering, what do you think? Kathy, you know me. Do you think I’m an evidence-based chiropractor? Is this a game we’re playing? Like true or false? Harry Potter magic. Yeah. So, and that’s kind of what we want to talk about, not just about evidence-based chiropractic, but I think if we talk about this in the context of evidence-based medicine, which is bigger

[3:32] than just chiropractic, I think that’s really helpful to a lot of people. And so, we’re going to discuss that some today. We’re going to talk about what it means to have an evidence-based practice. We’re going to talk about what evidence actually is. Like real evidence. I think I should start with a story. Of course we always want to hear the story. Well, and it’s a story about my mom who is a big part of the reason that I’m a chiropractor today. She — we grew

[4:02] up and she was taking us to chiropractors and I have a brother who has got a lot of food allergies and so she got deep into natural medicine and she did like flower essences and aromatherapy herself. So, she was always just kind of in this space. And so, when I decided to become a chiropractor, she was so excited, right? I don’t know if she would like the type of chiropractor that I am because, you know, I lean very evidence-based and, you know, my mom was a little woo-woo, but she was very cool and everybody loves her. But I remember

[4:34] this one day we were having this kind of back and forth about something. She wanted me to like carry crystals in my clinic or something like that. And I was like, “No, no, no.” And I was like, “Okay, listen. Here’s what we’ll do. I have evidence that says that this doesn’t work.” And she said, “Well, I have evidence, too.” And so I was like, “Okay, well, you bring your evidence. I’ll bring mine.” So she came and she had — my mom, see, this was like early 2000s. And so if you were an older

[5:04] person then, you still thought that you had to print out everything on the internet. If you didn’t print it, it didn’t actually exist. It’s not real. So, she came with a bunch of like emails and forum posts and things like that and that was her evidence. And so, it didn’t go well whenever, you know, I tried to break down — yeah, this isn’t real evidence. And so, yeah, that was heartbreaking. That was hard. Yeah. Yeah. And even so, I think that I wouldn’t say that she wouldn’t like the type of practice I have. I know that my mom is

[5:35] really proud of me and so yeah, but it’s an important thing to talk about especially this day and age because people have a hard time finding the truth. And just Google it, Dr. Young. Google it. That’s exactly why people are having a hard time finding the truth, Kathy. Yes. Because people are relying on what they find on the Googler. Yeah. Yeah. Dr. Google. So,

[6:05] let me break it down a little bit about what is evidence-based medicine. What is it? And a lot of times when people think about this — so the chiropractic college I went to, it was known to be on the evidence-based spectrum of chiropractic. There’s philosophy-based and evidence-based, and so I went to the most evidence-based school that I could find. And so one of the — when people are kind of critical of this idea of evidence-based medicine, what they think is that it’s

[6:36] like, hey, if the science says to do it, then you do it. Right? And it’s just like you don’t have a choice. You just got to do what the science says. But it’s really actually better than that. So, one of the challenges with that kind of model where it’s like we only do what’s in the literature is you eventually run out of things to do, right? Yeah. Exactly. Because not everything’s been studied. And for something to be studied, it requires somebody throwing some money at it. I like to call it

[7:08] the Michael J. Fox effect. Yes. Okay. I trademark that. Scott, trademark it. Trademark. Yeah. I don’t — Do you have a trademark button? Okay, good. I think he — Yeah, he hit the orange trademark button. No, but the Michael J. Fox effect, like when did people really start caring about Parkinson’s disease? Mhm. Yeah. Michael J. Fox got it. Right. Right. Right. Same with ALS. ALS. Right. When did people start caring about ALS? Lou Gehrig. Lou Gehrig. Right. So they even called it Lou Gehrig’s disease. Right. They did. And

[7:39] so, that’s one of the ways that things get researched is people have to care enough about it first. And that’s just not the way that it is with everything. And so, that’s kind of where the evidence-based, if it’s purely just what the research says, that’s where that breaks down — is not enough people care about the things that we all need to care about in order to give us enough to practice. Right. Right. So, there’s three pillars to evidence-based medicine. Number one. Number one is just what it sounds like.

[8:10] It’s the best available evidence, right? So, it’s what is in the peer-reviewed literature. We’ll hit that in a second. Go over what it means to have evidence. Number two is clinical expertise. So, you as a — how long you’ve been practicing, 10 years now. Okay. So, in your 10 years of experience, what have you seen? Right. And what works, what doesn’t work, right? And then number three is I think kind of the coolest one because this is not what people would think about, but it’s

[8:40] patients’ values and their preferences, what they believe will work and what their preferences are. Right. So we’ll get a little bit deeper into all these, but are you an evidence-based practitioner, Kathy Lynch? Yes, I am. Okay. Tell me a little bit about what it means to you. Like, do physical therapists even talk about this? Like, do we talk about — are you all like, “Of course, we’re evidence-based.” All we ever talk about. Okay. Well, what are those conversations? Evidence support that.

[9:12] Okay. So, what are the controversial things? Oh, stretching. Oh, you know, we should do a whole episode on stretching. Yeah. Yeah. Yeah. That would be great. We should just travel back in time and do it. Oh, we already did it. Yes. Yes. That’s episode four. Three. Episode three, people. Three, I believe. Mhm. Mhm. Yeah. Mhm. Yeah. We talk about evidence-based all the time. There’s a lot of good Twitter fights out there if you are — fight. I do. I’m like I’m totally gonna go look them up now. But

[9:42] like I would say the biggest fight we have in our profession is manual therapy versus exercise. Is manual therapy supported? Does it help people recover? Does it help people? Are you actually changing muscle tissue? Are we actually releasing that muscle or not? Those are some of the fights we have. Is it supported? Is it a placebo? What is it? Okay. Yeah. What is the evidence? Like you got to do what the papers say,

[10:12] right? Yeah, that’s an interesting one. And is chiropractic — like, sorry, is physical therapy like chiropractic where you have a bunch of like different specialties and stuff like that? Mhm. So you have like physical therapists that will just kind of zero in on one type of thing, right? Yeah. So like you could be a neuro-based PT where you work with people with spinal cord injuries or people that have had strokes. There’s orthopedic, which is what I do — outpatient orthopedic. So I

[10:44] just kind of specialize in injuries in the shoulders, knees, hips, back. Then you can even get more specialized in an orthopedic setting where you only treat, technically, you know, sports injuries, those kind of things. Young athletes. So, sports PTs. Nice. Yeah. Okay. And then do you guys have woo-woo physical therapists? 100%. You do? Okay. Well, what are woo-woo — I could tell you about woo-woo chiropractors all day, but like what’s a woo-woo physical therapist like? And this is not to

[11:15] offend anyone, but it’s — Do it. No, do it. It’s the — Let’s lose some listeners right now, Kathy, cuz they’ll be replaced by angrier listeners. Oh man. Good thing I’m not on social media that much. The visceral manipulators. Oh yes, we have those too. Okay. All right. Yeah. Yeah. Where it’s like, oh, I need to adjust your liver. Your liver. Yeah. It’s always the liver. It’s always freaking liver. It’s the liver. I know. Oh jeez. You had too

[11:47] much Tylenol last night. I feel that. No prostate manipulation though. I haven’t heard of that one yet. Yeah. You know, to get through chiropractic school, you have to be able to do a prostate exam. Yeah. Oh, yeah. Okay. This is unexpected. They don’t tell you about this in orientation. Of course, they don’t. No, they do not. And I remember — so, whenever we did ours in school, this is what we wanted to talk about, right? Yeah. Whenever. That’s on my list right here. Prostate exam. Yeah. Scott, unmute me. Okay.

[12:17] No. Okay. I gotta tell the story, though. So, you know, you go and you do this lab where you have to be able to do like a breast exam, a gyno exam, prostate exam, just all these different exams because in Oregon you are a physician. So, you better know how to do all the exams. So, they work with these people and it’s really uncomfortable because they call them models, right? This is your model. It’s like, all right. So, our model — I remember his

[12:50] name because you always remember the name of somebody whose prostate you palpate. But I’m not going to share it just cuz — yeah, that’s a little weird, but I do remember his name. Yeah. Or maybe not. And so, nice guy though. And he’s getting like, you know, 10 exams a week. Nice. And paid for it. 50 bucks a pop. Yes. Absolutely. So, retirement. So, I did my exam, got through it. Woo. And, uh, then my

[13:23] Wife and I are walking through Costco and, you know that thing where you’re like walking and you see somebody you recognize, you’re like, “Hey, what’s up?” They’re like, “Hey, what’s up?” And so then, like, maybe you don’t register who it is at first, but you know that you know him. So, that happens, right? We’re walking through Costco and here goes this guy and I’m like, “Oh, hey, dude.” And he’s like, “Hey.” And so then he goes walking by and I’m walking and she’s walking and she looks at me. She says, “Who’s that?” And then it dawns on me, “Oh sh— I had my finger

[13:56] on his prostate.” Yes. Which was very healthy. It was a healthy prostate. Great. And so I was like, he’s a guy I know from school. And thankfully that was it. She’s like, you know, I definitely have never felt this prostate, but — Hey, Kathy, what was I talking about before? Before that — pillars of evidence-based medicine, right? Yes. Okay. So, let me get into — let’s talk about

[14:28] evidence first. Okay. Yes. What is it? So, back to that thing that I talked about with my mom. So, there’s a few types of evidence out there and there’s kind of a whole pyramid. If I was like really prepared, I would have drawn the pyramid. We could put the graphic up. But some of you are just listening to this. Hello, listeners. And so, I’m just going to describe the pyramid for you. So, picture a pyramid. There’s three sides to it. And at the base of that pyramid — at the base, we’re going to call that like

[14:58] the worst evidence, the weakest stuff. Okay. There’s also like the most of this kind of evidence. And this is called anecdotal evidence, right? It’s basically expert opinions, and you give these, I give these, right? People give them on Reddit all the time, right? It’s like, hey, I ate two red popsicles and, you know, I instantly got over COVID or whatever, right? That’s how it works. And so, there’s a lot of anecdotal evidence out there. And is

[15:28] anecdotal evidence bad evidence? Not necessarily bad. It’s not bad evidence, right? It’s a lot of times how we start a scientific inquiry. And if you don’t have a whole bunch of research, because nobody’s thrown a bunch of money at it, that might be all the evidence that you have. But alas, it is the least reliable evidence that we have. And it’s because what you observe is biased, right? Because you’re observing it and you have your lens that you see everything through. And also, you’re probably looking at a real small

[15:58] sample size — just like one person — which actually kind of brings us to our next level in the pyramid, which is case reports or a case series. And so it’s like, I had this one interesting case, and you’ve had an interesting case, I bet, before — just one, only one. Okay. But so you might write about something interesting that you saw, or you might write about a group of people where it’s like, oh, I’ve been observing this — you know, like I think in that stretching episode I talked

[16:29] about how I had noticed that high-performance sprinters tend to have tight hamstrings. Okay. So I could write a case series about that. That’s not actual science. No, but it’s a little higher up than anecdote. Mm-hm. You know, the next level — systematic review. We’re not there yet. That’s closer to the top. But next, we have to go for observational studies. Okay. So, there’s several types of studies that fit into this, like cross-sectional studies and blah blah blah blah blah. In a nutshell, an observational study

[17:00] says we’re going to look at something without disturbing it, right? So, we’re going to look but not touch. And so, we might pick a population of people — oh jeez, there’s this huge study that gets done — it’s, of course now that I need the knowledge, I can’t think of it, but it’s a bunch of nurses and they followed them for decades and they observe their health and everything and different things they do. And so it’s really kind of fascinating and interesting because you can spot health trends, right? This

[17:31] is part of the reason we know things like cigarettes are bad, because you can look at a group of people over time and you see who’s getting lung cancer. Oh, it looks like it’s all the people that smoke cigarettes, right? Yeah. And observational studies, they give you some clues as to where do we go looking for more evidence, more truth, and things like that. And so that’s kind of the next level. And these studies can be very well designed sometimes, where we’re following a population, and in general with studies the bigger the population we’re looking at the better,

[18:02] because sometimes you get outliers where it’s like, oh, you know, everybody’s got an aunt Margaret or something like that who, you know, she swallowed some toothpaste and there went the tumor on her kidney. That was it. It was definitely Crest. Yeah. It was Crest. It was Crest — right, with fluoride. Absolutely. And teeth whitening. And so that got rid of the tumor. So she’s an outlier. But most people if they get that same

[18:32] tumor, there might be a different outcome, right? So yeah, that’s the other type — an observational study. That’s right smack dab in the middle. And then you have controlled trials. Okay, so a controlled trial is like, okay, we’re going to set up two study groups. We’re going to have an intervention and we’re going to use that intervention on this group of people. Then over here we’re going to have a separate group of people and we’re not going to do anything, but we’re just going to see what they do. We’re not going to intervene. Okay? And we’re going to see the differences between

[19:02] this group and this group. And so when you start to get into these controlled trials, that’s when you start to be able to discover cause and effect. So you might notice a trend like, oh, these people who are smoking, they tend to get lung cancer. But then if you wanted to prove that smoking caused lung cancer, then you would give these people a bunch of cigarettes. Okay. Ethically, you can’t. Kathy, you can’t do that. Kathy, you can’t do that. Did you listen to the podcast about informed consent? You can’t do that. But no, so

[19:33] you make some sort of an intervention. And usually it’s we’re doing this the other way around with drugs. Drugs work really well in this model. So it’s like, “Hey, these people have this condition. These people have this condition. We’re going to — these people have the same condition. We’re going to give them some medication and we’re going to see if it changes things.” Okay? And so then we can prove that that medication works. Then the next step up from that is the randomized control. That’s — yes, the big one. The big one, right? Because if these people know that they’re being treated with something, there’s a powerful thing that happens in our brain called

[20:03] placebo. And placebo can cause healing. In fact, placebo is the gold standard against which all other treatments are measured. And what is placebo? Placebo wins. Yeah, it wins every time, right? It’s just the power of your mind to get stuff done with your health, right? I believe it and so it’s going to happen and it works. It’s the sugar pill. It is the sugar pill. And that’s where we use this in the randomized control trial. So, you have your two separate groups.

[20:33] You don’t get to choose who’s in the groups. You have some sort of a process that randomizes these people. And so then you’re randomizing the treatment that they’re receiving. So some people are going to get sugar pills, some people are going to get the medication, but we’re not going to decide who gets what. We’re going to randomly select which group gets it. And then if you have a double blinded, the people who are giving out the pills, they don’t even know. They don’t know what pill they’re giving, right? Because in science, bias

[21:04] is the enemy, right? So, anything where it’s like, “Man, I really need this drug to work so we can make a billion dollars, please.” Right. Yeah. Come on. That — that would influence — and rightly so. If there’s a billion on the line, I’m going to cheat. I’m probably — probably — I do have a — yeah, I have a price tag. Okay. One billion will do it. I can be bought. Yeah, I know. So, sadly — sadly, mine is 900 million. I’m just —

[21:34] just a little cheaper than you. So — sponsors. No. So yeah. So you want to double blind that so that I don’t know which treatments are being given out to who. They don’t know which treatments they’re receiving and we can track progress over time. That is a very good study. It is like close to the top of the pyramid. The best you can get. But the tippy top of the pyramid is — you said it before — the systematic review. Systematic review. And there’s even a couple of types of these now, like there’s a network systematic review and there’s

[22:04] a systematic review — or a meta-analysis is what it’s called — and you’re taking pieces of all of that triangle. You’re looking at the control trials, the randomized control trials, the observational studies — not so much the anecdotal stuff; you’re using that more for context — but you’re comparing all these and you’re just saying, “Okay, what does the preponderance of evidence say about this treatment or this condition or this drug or anything like that?” And so that’s really really powerful evidence if those

[22:34] studies are done properly, right? Yeah. Yeah. And so that is the evidence portion of it. That’s what evidence is. And it’s really cool. We live in a time where you have more access to more studies like this than ever before in the history of the world. And it tends to be really reliable. So have you ever noticed people who get really frustrated with science and they’re like, “Oh, the science is always changing.” Like eggs. Yes. Right. You know what I’m talking about with eggs? Eggs are changing. Yeah. Well, are the eggs — oh, I know what

[23:04] you mean. Yeah. Are eggs healthy? Yeah. Eggs are healthy and they’re bad now. They’re bad. They’re good. No, but they’re bad now. They’re good. Yeah. No, but they just went bad, right? And so all that stuff flips back and forth. And part of the reason we fall into that is number one, nutrition is difficult to study because setting up these trials and everything is difficult. There’s a lot of problematic things in nutrition, but also sometimes the media gets involved — jerks — and they’ll go out and they’ll find like

[23:34] a case study and they’ll be like, “Hey, this is evidence. Look, these people who ate eggs, they’re all blind now.” I don’t know. There’s no study. There’s no study that says that people who eat eggs are blind. Eggs are good. Yeah. But when we look at the preponderance of evidence, we find out — eggs good, actually. And they were always good. They were — it was a marketing thing. It was. Yeah. Well, it was often the media grabbing one study and being like, “Oh,

[24:04] my gosh, this changes everything.” And that’s the other thing that’s good about these meta-analyses is that when you get a study that then says something that goes against that meta-analysis, we don’t have to freak out and throw all the science in the trash because we now get to examine and say, “Why did they get that result and everybody else is getting this result?” And nine times out of 10, you know what the answer is? Oh, these guys screwed up. Yeah. Somebody did something wrong. Yeah. We could find some way where they’ve biased it or something. Or every

[24:34] once in a while you find something where it’s like they’ve considered an angle that everybody else hasn’t. So, all right, that’s science. Wow, there’s a science. Yes. How do you use evidence in your business? That’s funny you should ask. So, when I say that I’m an evidence-based chiropractor, what I mean is that I care about what that research says. And this is a difficult thing because it requires a certain commitment, which is that even though I really really like a certain therapy or

[25:06] treatment or something like that, if all the evidence says that it’s not doing what I think it’s doing, I have to change the way that I practice or the way that I think about it or the situations that I’m using it in. Which sometimes is difficult because maybe I’ve — well, I’ll give you a really good example. Do you use therapeutic ultrasound in your clinic? That’s a trick question. We have an ultrasound machine. Yes. In

[25:36] our clinic. I do too. I do use it on occasion. Okay. Mm-hmm. See, I think that the therapeutic ultrasound machine is maybe the ultimate example in the application of evidence-based medicine. It is. Because when you were in school 10 years ago, like we were ultrasounding everything, right? I know. And I was too. I remember the very first time I did ultrasound on a patient. Like we worked in teams, right? So it was me and this other guy and we had a dude come in. He had a knee problem and we’re like, “Oh, let’s do

[26:07] some ultrasound on his knee. Let’s do it. Let’s ultrasound it.” Right? And so we go in there and we’re like, “Yeah, let’s do this.” So we’re doing it. We’re like, “Okay, this is great.” And we get done. Okay, so like are you better? Like how is it now? He’s like, yeah, that was great. He’s like, but what’s that supposed to do for my left knee? We did his right knee. Yeah, we did the wrong one. And I was thinking in that moment, I should come up with something about how it’s all connected. Yeah. And oh,

[26:38] yeah. I meant to do that leg. Yeah. Oh, yeah. Totally. Yeah. That’s what we do. We usually start with the knee that’s no problem at all. You can’t put this straight on the knee that hurts. Yeah. Right. That’s not a good way to start. Jeez. Yeah. So, okay. Ultrasound back in the day, it was like, yes, this is good. We like it. Ultrasound is powerful medicine. And then the studies started being done. It’s very easy to test because what does ultrasound feel like? Nothing. It feels like nothing, right? Sometimes if it’s on for a while, it’ll get kind of hot, right? But for the most part, it feels

[27:09] like nothing. And what we found out was that when you have a treatment that feels like nothing, it’s very easy to find a sham treatment, right? Because it’s very easy to do nothing. Nothing, right? And so what they’ve done is they’ve done studies where they tested groups of people where they had the ultrasound plugged in and they’ve tested groups of people where the ultrasound’s not plugged in. And guess what they found? Same. Everybody got better. Yep. And it’s not just like nobody got better. Everybody got better. They got

[27:40] better at the same rate. And that is placebo. Placebo. Yeah. Everybody had an expectation that I’m getting a treatment. I’m getting better. This is supposed to help me. This will help me. Right. And so you have an ultrasound machine in your clinic. I have an ultrasound machine in my clinic. So is ultrasound useless then? No. It’s not. Very good. So even though we have science that says ultrasound does not do what we think it was doing, doesn’t mean that it’s useless. Because there’s still some times when I would use it. Yep. Like what are some times when you would

[28:10] use it? When the patient comes in and they ask for it. Mm-hm. I’m going to use it the first couple visits, right? Because that’s what they want. That’s what they think is going to help them get better. And is that evidence-based medicine? Yes, it is. Right. It’s that third pillar — what patients believe and want and expect. And that’s powerful medicine, right? If there was evidence that said that this is going to be harmful to a patient, or somehow dishonest, then it wouldn’t be

[28:40] ethical, right? But it’s okay to have a conversation with people and say, “Hey, look, the evidence isn’t really strong for this, but if you want to give it a try, we can give it a try.” Absolutely. And that’s evidence-based medicine, right? Because it’s all three of them. So we’ve considered the evidence. You’ve had experiences where it’s been helpful for people. So that’s your clinical experience, and then the patient has an expectation around it. So boom, evidence-based medicine. Yeah. Right. So your question was has this

[29:11] applied to chiropractic. So chiropractic has an issue. Just one. Just one. Just that one. Just one. Just one. Okay. Now so we have, like in our little cold open there, we talked about medicine from 1910. Yeah. So we have this old theory of subluxation — this idea that if a bone is out of place, it’s sitting on a nerve, and then that nerve is like the vital energy to the rest of the body is blocked, and all we have to do is just move that bone off of that nerve and

[29:41] we’re good to go, and that person’s probably going to live forever, right? And so yeah, that’s what you heard. So that’s an old theory, and we have enough science now to say that that’s not actually the way that works. Bones don’t sit on nerves and they don’t block the flow of vital energy to organs. You don’t have liver disease — we’re picking on the liver — we don’t have liver disease because this bone was out of place. And so it takes some humility to then say, “Yeah,

[30:11] I’m not going to talk about it in that context anymore, because it just isn’t what’s going on. Science has said something else right now.” Here’s the thing — you can still adjust people and they get great results, right? So with physical therapy, and this — do we do manual therapy, do we not do manual therapy — the thing that’s always going to be challenging for the people that say the science says manual therapy does nothing, right? Yeah. They all have a

[30:43] Jason: speech impediment.

Kathy: They do.

Jason: They can’t argue with the fact that people get better from manual therapy, and also patients enjoy manual therapy. Absolutely right. Absolutely. And also the fact that it’s not unethical to do manual therapy. It is not unethical. That’s right. And so there’s a place for it. There’s room for it. Now, we can’t overpromise what it’ll do, right? And we have to acknowledge it for what it is. If I do this manual therapy on you, it’s giving you an opportunity to then make

[31:14] yourself better, get out there, exercise, blah blah blah blah. And we also have to present the evidence that exercise is a powerful, powerful tool there too. Right. Well, some people can’t exercise. That’s right. Yeah. They can’t — or they can’t do all the exercises. They can’t do all the exercises. Yeah. So they need the manual therapy to help them exercise. And even if they are people that, you know, maybe they had a stroke, can’t use that left leg, can’t use that left hand, they need the manual therapy to that hand.

[31:44] Yeah. Right. To enable them to function at home. So let me ask you about this. What about wellness care? Like, do you treat people that aren’t symptomatic? Is Medicare listening? I mean, do you treat young people, people under 65? Yeah. Yeah. Do you do preventative care? We don’t do that in this country. Are you kidding? Yeah. Do

[32:14] you treat people that aren’t symptomatic? Sure. Yeah. Yeah. Like what are you treating them for? Weakness. They’ll come in and say, “I’m feeling weak here. My balance doesn’t feel good with this.” So yeah, I treat them without pain symptoms, I guess. Yeah. There’s other symptoms other than pain, but sure. Mm-hm. Well, and do you think that there’s a place for — let’s say somebody doesn’t have pain symptoms, okay, but then you also find out that they don’t have any functional deficits either. Like, is there

[32:44] Kathy: Something that physical therapy can do for them?

Jason: Yeah. Okay. Yeah. Like I can always find a deficit.

Kathy: Yeah. That’s what they — that’s what they trained us to do. Like the freaking IRS of the body. We’re going to audit this. We’re auditing this.

Jason: Yes. And the audit will end whenever we found something.

Kathy: Yeah. That glute medius is definitely going to be weak. Absolutely. Guaranteed. Oh my gosh. I can’t tell you how much I love it when people come in. They’re like, “I went to physical therapy,” or, “I went to physical therapy and they told me that, you know, yeah,

[33:14] my glutes, my glutes aren’t working.” Nope. No, they’re not firing at all. My core — my core. The core is so weak. The core — I can barely stand up. I almost legit fell out of the chair. That would have been exciting.

Jason: And that’s the last episode of The PTCH. And that’s it.

Kathy: It’s just now going to be known as the — because the chiropractor died.

Jason: Yeah. So, I hope that that kind of helps give some context for evidence-based medicine.

[33:44] And I think that, you know, hopefully there’s some value in that to patients. We’re following the research.

Kathy: Following the research. Yeah. Our practice changes based on the research sometimes.

Jason: Absolutely. We have the humility to do that. And we’re not afraid because we know when something has been beneficial to a patient.

Kathy: Right.

Jason: And I think another thing that’s important to point out is that we don’t do research on patients.

Kathy: No. No. Research is done on

[34:15] subjects, test subjects.

Jason: Yes. And they’re very exclusive in how they choose them. So they might choose somebody who is not above a certain age or who doesn’t have a certain level of a certain condition or disease or something like that, because we want to be very specific about how that works. And so just because that study says it, it doesn’t mean that the person in front of me fits into that research group. They probably couldn’t have qualified for that group. And so I’m always tasked

[34:46] with treating the person in front of me, never tasked with creating a test subject, right? And so that, I think, is where when we talk about healthcare, we’re talking about it as a science, but also as an art. And so some of that clinical experience — having the time to speak with patients, to listen to patients, hear what’s important to them, what they do and don’t believe in — that’s really important, too. What do they want when they come in? What do

[35:16] they need? Now, I think one of the things that’s unfortunate is that some people come in with some really messed up ideas, and sometimes it’s of their own design, sometimes it’s from other healthcare providers. And you’ll hear it from all kinds — like chiropractors, probably the worst thing that we tell people is that you can’t be healthy without an adjustment, right? Your spine is going to decay or deteriorate without an adjustment. You’re going to fall out of bed tonight.

Kathy: Yeah. Gosh. Oh jeez.

Jason: I had a patient today actually

[35:47] who came in. He told me about a bad experience that he had with a doctor locally. This was a long time ago. The guy doesn’t practice here anymore, but I knew exactly who he was talking about. He said, “Yeah, he showed me these X-rays. My spine was falling apart and told me that I was going to be in a wheelchair in 10 years if I didn’t get these adjustments.” And it’s like, that’s unethical and it’s not true.

Kathy: Right. Right. Miraculously, he was not in a wheelchair. Okay. He’s still walking.

Jason: Yeah. But then sometimes you’ll get doctors who are like, “Oh,

[36:18] yeah, you’re just getting old. You’re falling apart. You’re only 18.”

Kathy: Yes. Right. Even using words like that — it hurts people.

Jason: Harmful words.

Kathy: Harmful words. Well, okay. I think we probably beat that one to death.

Jason: Yep. We covered it.

Kathy: Yes. You want to play a game?

Jason: Let’s do it. Always. So, this is based on the old TV game show — well, there’s a couple of them, but there’s Password. There’s also Pyramid.

[36:48] Kathy: Oh, yeah. You remember that?

Jason: Yeah. The $100,000 Pyramid or what?

Kathy: Yes. Okay.

Jason: So, what I have here is I have some words. They’re on these slips. These have to do with evidence-based medicine.

Kathy: Okay. Oh, no.

Jason: And so we’re going to each draw a slip and you’re trying to give one-word clues to get the other person to guess your word.

Kathy: Oh, all right.

Jason: And we’ll say the first person to two points wins. Okay. So if you guess my word, then I get a point. Okay.

[37:18] If I guess your word, you get a point.

Kathy: I get a point. Now we have to do our honest best to really guess. Okay. Because if I do good, you win.

Jason: Exactly. Hey, we’re on the same team. We’re on the same team. It’s us against Scott. All right. Okay. Holy smokes.

Kathy: What?

Jason: Yeah. Why did I pick such hard words? Okay. Do you want to go first or second? One word. One word.

[37:48] Okay. So this is my word. Got it. You got it. Okay. All right. Let me give you a clue. Treatment.

Kathy: I have to guess what your word is. You’re giving me one clue?

Jason: Mhm. And I’ll keep giving you clues so all the clues will emerge.

Kathy: Exercise.

Jason: No, that is incorrect. Not even close. Okay. Let’s see.

[38:20] Modality.

Kathy: How about this — I’m just throwing things out. Pain.

Jason: No.

Kathy: Confrontation.

[38:51] Fight.

Jason: No. Oh jeez. You’re not going to get it. No. I’m out of words for it.

Kathy: Okay. I think you’re supposed to be giving me clues, too. Should I be giving clues?

Jason: Yeah, give me a clue.

Kathy: How can you only use one word? One word. Could be hyphenated, I guess. Result.

Jason: Oh — outcome.

Kathy: Yeah. Did I get it?

Jason: Yeah. Oh, I get a point.

[39:21] Kathy: Yes, you get a point. Mine was intervention. Oh. Okay. Intervention — drugs. All right. Pick a new word. See if you’ll shut me out.

Jason: All right. Well, that’s empty. What? How do I come up with these words? You’re going to go first, sister.

Kathy: Okay, I get to go this time. Okay. You got to show that word.

[39:53] Study.

Jason: Research?

Kathy: Yes. Are you kidding me? Why are you so good at this? All right. What is this game called? You know, Headbands. All right, here’s mine. Let’s see if we can get this — plan.

[40:26] methods. Dang it. That’s the next clue I was going to get was method. Shoot. Plan. Okay, it was protocol. Listen, Kathy, you beat me. You beat me. All right. You killed it. So, you are the better clue giver. Okay. Well, this has been our show about evidence-based practice. And again, it’s not about being perfect. No. And it’s not about just doing everything that they say to do in a book, right? It is kind of a symphony, a

[40:56] collaboration between the provider and the patient and the best research that’s been done out there, and I love it. It’s a fun challenge to do. Final thoughts and takeaways? No, just, you know, ask your provider, are you evidence-based? Yes. I think they probably all claim to be, right? Yeah, that’s a good question to ask. And maybe there’ll be some self-reflection. Yeah. If they look like they’re going to throw up before they’re like, “Yeah, yes, I am.” Well, the evidence, right?

[41:27] So, yeah. And I think that’s — jeez, I think that’s a really good point — is this is a conversation that we should be having. What does the evidence say? Yeah. And so yeah. Okay. Good stuff. Well, and I think that for the doctors out there, be humble. Stay curious, keep up with the literature, stay with the literature, because if you don’t, I’m going to embarrass you, right? Don’t be afraid to change. Yeah. I will talk bad about you to that patient. So, all right. That is it.

[41:59] We’re out of time. So if you’re listening still, we would love it if you would follow the PTCH Podcast. We also want your feedback. We want to know what’s important to you to talk about. Just like this episode was 100% from something that a patient talked to me about. At least that’s what I told Kathy. So the way that you could do that, comment on any of the platforms. We’re on Spotify, Apple Podcasts, and YouTube.

[42:29] If you’re listening to this on Apple Podcasts, did you know that you can watch video of this on Spotify or YouTube? Yeah. There’s some of you that are really missing out. Like, we have fancy shirts. And you see this? The PTCH Podcast app. We’ve reached a level of notoriety where we have our own swag. So, okay. I think that that’s it, except you might have one more thing to say. What is that? There’s no “I” in PTCH. That is correct.