“We started out in our research with a deep interest in understanding the origin and development of pattern during embryogenesis. None of us expected that our work would be so successful or that our findings would ever have relevance to medicine,” Nüsslein-Vollhard said in 1995 when she received her Nobel prize. “But it has now become apparent that at least some of the fundamental principles we learned from the fly apply to higher vertebrates as well, including humans.”9
What she, Wieschaus, and Lewis did was basic science, research done for the sake of understanding a specific phenomenon with no or little consideration for its real-life applications. What came after was translational science, using fruit flies for a variety of scientific disciplines, including evolutionary biology and behaviorial genetics that could identify certain genes that increase the likelihood for humans to get a certain disease.
However, in manual therapy research, we should be careful about extrapolating basic research to our hands-on practice since the researchers may not often have practicality of their work in mind. Conversely, sometimes translational research in manual therapy do not consider basic science and may come up with false positives.
“There is a tendency to not scrutinise basic mechanisms of research through the same critical lens that we do clinical trials,” Dr. Neil O’Connell explained in an online interview with Massage & Fitness Magazine. “But this is a mistake as the field is troubled by small sample sizes and avoidable biases that are not controlled.” He cited a paper by Professor Andrew Rice who highlighted this problem in preclinical pain research and potential solutions in Pain in 2016.
“Beyond bias and quality, folks often take a biological phenomena, perhaps observed in a cell or animal model, and use it as evidence that a particular therapy is effective. That evidence may be directly related to the mechanistic claims of the treatment, but it often is rather more indirect. They will often presume that any evidence of some physiological change is evidence that a treatment is plausible. You see this lots with acupuncture brain imaging studies in humans.”
O’Connell cited a study in 2011 that finds sticking needles in certain parts of the forearm can change how the brain perceives pain. However, such changes does not mean the interventions “work.”
“Brain activation in response to needling neither validates acupuncture nor provides a cogent mechanism for therapeutic action. That it activates sub-cortical networks involved ‘endogenous pain modulation’ also does not distinguish acupuncture as a possibly effective active treatment since these networks are also implicated in the placebo response. Also, as I have often repeated, given that our best evidence
clearly indicates that it really doesn’t matter what you do with those needles, the sensory qualities of, or cortical responses to acupuncture seem unlikely candidates for a mechanism of action. It is not that the data in this study tells us nothing important. It adds to an existing body of data regarding how sensory input is cortically processed. But as a study of therapeutic mechanisms it attributes possible mechanisms to an effect that the best evidence tells us does not exist,” O’Connell explained in Body in Mind.10
“Some how the finding that some physiological effect exists is taken to legitimise the intervention,” O’Connell told me. “Of course, there is the age-old problem of how far experimental models, —particularly in animals but also in healthy humans—can really tell us about the experience of clinical pain, stripped as they are of the context of threat, fear, and real suffering and consequences.
“This kind of research is used to build biological plausibility [going back to number one in the list], and that is really valuable. But the other thing we tend to forget is that even
when a biologically
plausible mechanism
exists, it is not a
given that it will
translate into a
meaningful clinical
effect. Think of the
scale of failed new
pharmaceuticals
where the biological
plausibility work all
looked good. None of this is to denigrate the value of various types of evidence. The danger lies in taking any evidence, not matter how removed from the patient, as some form of tacit legitimisation of your therapy du jour.”
“Beyond bias and quality, folks often take a biological phenomena, perhaps observed in a cell or animal model, and use it as evidence that a particular therapy is effective. That evidence may be directly related to the mechanistic claims of the treatment, but it often is rather more indirect. They will often presume that any evidence of some physiological change is evidence that a treatment is plausible.”
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