CTE and Iatrogenesis

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WisNeuro

WisNeuro

Board Certified in Clinical Neuropsychology
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PSYDR said:
I predict there are going to be some AWESOME debates/duels from some big names at conferences.
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The listservs are somewhat quiet at the moment, but yeah, I'm hoping for some good discussion panels in the next year as things heat up. Though, I fear that #fakeCTE has won the misinformation war for the foreseeable future.
 
WisNeuro said:
The listservs are somewhat quiet at the moment, but yeah, I'm hoping for some good discussion panels in the next year as things heat up. Though, I fear that #fakeCTE has won the misinformation war for the foreseeable future.
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The silence after the fraud was discovered was incredible.
 
WisNeuro said:
The listservs are somewhat quiet at the moment, but yeah, I'm hoping for some good discussion panels in the next year as things heat up. Though, I fear that #fakeCTE has won the misinformation war for the foreseeable future.
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I'm just surprised that the NFL hasn't invested in some high-quality research. They could have gotten way ahead of this problem.
 
DynamicDidactic said:
I'm just surprised that the NFL hasn't invested in some high-quality research. They could have gotten way ahead of this problem.
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The NFL isn't exactly known for it's great foresight on many issues. But, the thing is, there is a ton of high quality research already in existence, it's just ignored for reasons of sensationalism, ignorance, and unscrupulous providers who do not care about iatrogenic damage as long as they can profit from it.
 
The problem is also propagated (unlike tau!) by otherwise well meaning providers and researchers who know the truth (or know that we lack the truth) for fear of ticking off patients or losing research participants. Behind closed doors, after a patient interaction, they exclaim, "Can you believe he thinks this is all from his TBI in '02?!" Why, yes, I can, because no one is really telling him-- I mean really, at least with a pinch of confidence-- that it's not that. It's maybe your A1C that's 9.9. The way to empathically and sensitively convey this information is not to withhold, or (a popular choice) hedge your bets for fear of retaliation, but to explore what the information means to the patient and how to cope with what that brings. It is utterly frustrating that I don't see this happening more often. What many patients come away with is the fact that we still haven't ruled out CTE, and the fixation on illness proceeds. We need to be better at showing folks we are operating with some kind of steady hand and faith in the advice we're offering, despite the many unknowns.
 
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Kadhir said:
The problem is also propagated (unlike tau!) by otherwise well meaning providers and researchers who know the truth (or know that we lack the truth) for fear of ticking off patients or losing research participants. Behind closed doors, after a patient interaction, they exclaim, "Can you believe he thinks this is all from his TBI in '02?!" Why, yes, I can, because no one is really telling him-- I mean really, at least with a pinch of confidence-- that it's not that. It's maybe your A1C that's 9.9. The way to empathically and sensitively convey this information is not to withhold, or (a popular choice) hedge your bets for fear of retaliation, but to explore what the information means to the patient and how to cope with what that brings. It is utterly frustrating that I don't see this happening more often. What many patients come away with is the fact that we still haven't ruled out CTE, and the fixation on illness proceeds. We need to be better at showing folks we are operating with some kind of steady hand and faith in the advice we're offering, despite the many unknowns.
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A provider who knowingly lies to a patient to keep their business, is anything but "well-meaning." They're just selfish cowards.
 
Having worked for a little while now with people on both sides of the fence, in the city that spawned it all, I'm not so severe in my assessment. I don't actually believe most people are lying, although a few bad apples may exist. Either way, there is definitely a problem, and it has taught me to reevaluate how I communicate with patients even if I can't change others' behavior.
 
Kadhir said:
The problem is also propagated (unlike tau!) by otherwise well meaning providers and researchers who know the truth (or know that we lack the truth) for fear of ticking off patients or losing research participants. Behind closed doors, after a patient interaction, they exclaim, "Can you believe he thinks this is all from his TBI in '02?!" Why, yes, I can, because no one is really telling him-- I mean really, at least with a pinch of confidence-- that it's not that. It's maybe your A1C that's 9.9. The way to empathically and sensitively convey this information is not to withhold, or (a popular choice) hedge your bets for fear of retaliation, but to explore what the information means to the patient and how to cope with what that brings. It is utterly frustrating that I don't see this happening more often. What many patients come away with is the fact that we still haven't ruled out CTE, and the fixation on illness proceeds. We need to be better at showing folks we are operating with some kind of steady hand and faith in the advice we're offering, despite the many unknowns.
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That's called colluding with the patient. It's been a no no for about for a century.
 
PSYDR said:
That's called colluding with the patient. It's been a no no for about for a century.
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You mean we have to tell the patient the truth even if it is difficult? 😱
Seriously though, I don't typically don't correct my patients' misinformation unless it is relevant to my treatment. When it is central to the treatment, such as explaining how benzo use or even avoidance tactics increase anxiety, it does take great skill to deliver that information effectively. That's why we get the big bucks!
 
I'd imagine what can happen with some providers, over time, is essentially ideological shift. From, "yeah, there's no strong evidence that this exists," to (with continued discomfort in patient discussions), "well, maybe we don't really know as much as I thought, so it's unlikely, but it could be the case...," to, "yeah, I've seen it lots, and there's definitely something going on here." Cognitive dissonance and all that. Especially if there are external pressures to toe the line.
 
Come on guys and gals, we know the truth. I saw the movie and I know that Will Smith figured out that CTE exists. It's amazing everything that Will Smith can do; rapper, actor, pathologist discovering CTE, pilot killing aliens, etc. Stop telling me different, you're wrong!
 
AcronymAllergy said:
I'd imagine what can happen with some providers, over time, is essentially ideological shift. From, "yeah, there's no strong evidence that this exists," to (with continued discomfort in patient discussions), "well, maybe we don't really know as much as I thought, so it's unlikely, but it could be the case...," to, "yeah, I've seen it lots, and there's definitely something going on here." Cognitive dissonance and all that. Especially if there are external pressures to toe the line.
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That's is why this stuff is so insidious. It would be easy to just point to some bad actors that were just selling their professional opinions from the get-go. I have no doubt these people are out there, I just don't know how prevalent they are. For other providers, the further out they get from their foundational training, the more pseudoscience, anecdote, and other crap creep in. It's probably even more likely for those who only pay lip service to maintaining their expertise, especially minimal CEUs and not keeping up with the literature relevant to their domains.
PSYDR said:
The silence after the fraud was discovered was incredible.
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Holy crap, I wasn't aware this was going on.
'Probable' Fraud By Lawyers, Docs In NFL Concussion Settlement, But Investigator Not Appointed
 
WisNeuro said:
Imagine that. Giving people a huge financial incentive to lie, causes a significant number of people to lie. Can't imagine how we would have predicted that outcome.
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But what if we incorporate it into a ton of other television like law & order. Won’t that make the search for the truth more objective?
 
PSYDR said:
But what if we incorporate it into a ton of other television like law & order. Won’t that make the search for the truth more objective?
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Of course. Because the layperson is a shrewd consumer of empirical literature and frequently makes the best decision based on the available data. What could go wrong?
 
WisNeuro said:
Of course. Because the layperson is a shrewd consumer of empirical literature and frequently makes the best decision based on the available data. What could go wrong?
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We’ll probably need some chelation, essential oils, grief /angel therapy, oriental medicine, and neurofeedback.
 
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