What is Safer? Going to the Gym or Eating a Jelly Donut?

Written by: James Demetrious, DC, DABCO

Evidence-Based Practices

I am grateful for opportunities to teach post-graduate coursework throughout the United States. During my lectures, I review evidence-based practices and the importance of clinical intuition toward diagnostic and therapeutic decision-making.

When discussing evidence-based practices, I always stress the balanced importance of highly powered studies and doctors’ experience. David Sackett, MD is considered, “The Father of Evidence-Based Medicine.” He wrote,

“The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”

My Friends in New Jersey

I was privileged and honored to speak a few years ago, on behalf of the Association of New Jersey Chiropractors. It was a terrific venue. About 100 doctors of chiropractic were in attendance.

While reviewing the American College of Radiology Appropriateness Criteria, a doctor in attendance raised concerns regarding the appropriate use of MRI studies. He suggested that sometimes, insurers rely too heavily upon research guidelines and do not adequately take into consideration doctors’ experience.

At times, I would agree with that doctor. Clinical guidelines are established and utilized based on available literature. The lack of respective data and bias is often reflected in those guidelines.  Too often insurers wield those recommendations like a billy club.

Highly Powered Studies

The bane of scientific progress is bias. It is relatively easy to develop questionable research conclusions. While addressing the 100 doctors in attendance at the ANJC conference I asked for their indulgence to participate in a very informal study. I asked those doctors the following two questions:

  1. How many doctors have seen patients who sought care due to injuries sustained while working out at the gym? 100% of the doctors indicated that they care for patients due to workout and gym-related injuries.
  2. How many doctors have seen patients who sought care due to injuries after eating a jelly donut? 0% of the doctors indicated that they cared for patients due to eating a jelly donut.

From this sophisticated and carefully conducted study we can derive certain conclusions:

  1. Working out at the gym is dangerous and can lead to injuries.
  2. Eating a jelly doughnut is safe and does not lead to injuries.

I offer this silly example to illustrate how easily data and conclusions can be skewed.

Thoughts and Conclusions

I teach post-graduate coursework to share new literature and reflect upon my clinical experience. I attempt to condense information in an unbiased manner that is meaningful to improve outcomes. As physicians, we are ultimately responsible. Our clinical insight is extraordinarily important.

That being said, I think I’ll get a jelly donut.

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Disclaimer

The views and opinions expressed in this presentation are solely those of the author. We offer this only to educate and inform. Patients should seek the care of their doctors regarding their conditions.

PostGradDC offers advanced post-graduate chiropractic continuing education. Our founder, Dr. James Demetrious, is an internationally distinguished board-certified chiropractic orthopedist, educator, author, and editor. For current, evidence-based, and clinically intuitive CE Coursework, attain your advanced training at PostGradDC.com.