søndag 27. november 2011

The Back Letter Back Again

The back letter is an American medical journal giving information on the diagnosis and treatment of spinal problems and back pain. In April I wrote on my blog about their 2008 article on the Alexander Technique and the ATEAM trial (Randomised controlled trial of Alexander technique lessons, exercise, and massage for chronic and recurrent back pain). (1) 

In the September issue they wrote about the Alexander Technique again. This time the occasion is a program on the National Public Radio back in April in which an Alexander Technique teacher, her pupil and also the researcher behind the ATEAM trial were interviewed. (2) 

You can listen to the interview and/or read a transcript here: 

In the headline of their article The Back Letter asks rethorically: 
Is the Alexander Technique «Highly Effective» for Chronic Back Pain? (3)

The Back Letter claims that:
A recent feature on “National Public Radio” brought this therapy back into the public eye, describing it as a “highly effective” treatment for chronic back pain. 

This is actually not quite true. The description «highly effective» is not used in the radio program and not in the transcript itself. You find this description in the caption to a link to a BMJ video about the ATEAM trial. The words refers to the findings in the study. 24 lessons of Alexander Technique reduced the number of days in pain per month from 21 to only 3. In this connection «highly effective» is an appropriate description.

But the Back Letter is absolutely right when they say: 
If there is a lesson to be learned in the back pain literature, it is that any therapy has to be evaluated in multiple clinical trials before it is anointed as “effective.” And, at this point, it is not all that clear that any treatment for chronic back pain would merit the phrase “highly effective.” 

A single study is not sufficient to prove that the Alexander Technique is «highly effective», although it is very promising. Surprisingly the Back Letter admits this by saying: 
The Alexander Technique could represent a breakthrough in the treatment of chronic back pain. But evidence to this effect would require further research. 

Medical research must follow very strict guidelines. By being sceptical of the Alexander Technique The Back Letter is doing their job. The NPR feature of the Alexander Technique is not balanced as it is only presenting the 'pro' Alexander Technique side. 
But the presentation of the Technique in the program is actually very moderate. The Technique «may be an effective way to treat back pain», lessons are «no cure all», and research show the «apparent success» of the Alexander Technique. 

I understand and respect the scepticism of the Back letter. After all The Alexander Technique is very often defined as an «alternative therapy» and is there anything in this world you should be sceptic towards it is "alternative therapy". 

There is however one thing I find a little peculiar, and that is the words the Back Letter is using when describing the technique. It is very obvious that they do not really know what the Alexander Technique is about. 
They say «Alexander Technique therapist» although the NPR program uses words like «lessons», «instructor» and «teacher». They also use the phrase «Alexander Technique therapy». 

There is no such thing as Alexander Technique therapy 

The words «therapy» and «patient» are used in the NPR article, but not in the text itself. When you click to hear the audio the text in the window reads: 
A doctor thinks the therapy might help strengthen deep lumbar muscles in the lower back. 
(Which by the way is a tautology since «lumbar muscles» means they are in the lower back.) 
There is a photo of the Alexander Technique teacher «with a patient». These are the words of the journalist.

Anyone who has ever been interviewed by a journalist knows how difficult it is to be presented accurately. This is especially the case with any field of expertise that is outside the knowledge of the average person.

One should think that The Back Letter is serious enough not to trust the mass media to give accurate description and information on a subject. If you want to know something in depth you have to go to the specialists in the field. In this case the Alexander Technique teachers. 

Next time The Back Letter is going to write about the Alexander Technique they should contact the highly skilled professionals of AmSAT, The American Society of Teachers of the Alexander Technique. Then they could at least make sure that they use the correct terminology. 

The Back Letter and the Alexander Technique - the hazards of misinterpreting a clinical trial

The Alexander Technique: a balm for back pain?

Is the Alexander Technique «Highly Effective» for Chronic Back Pain? The Back Letter Vol. 26, No. 9 September 2011 (You have to pay or be a subscriber to read the article).


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