You heard me…Don’t bother reading the research!
Are you wondering why I would possibly say something like that? I mean, speech-language pathology IS a science based career, right? Anyone who has read me here or on Facebook/Twitter, knows that evidence based practice and research is something that I drone on (and on and on) about…so why on earth would I possibly say don’t bother?
See…I have been fighting for research and research-based practices for a long time. I’m constantly talking about pseudoscience and the need for critical thinking and not being led by anecdotal evidence and I am constantly being shutdown by my peers. So out of desperation, I have turned to reverse psychology.
I (and others) go on and on about the need for research to direct our services and the importance of applying critical thinking to treatment methods, and I am ignored (by many) and the anecdotal evidence continues to be spouted and loved and practiced while the research is ridiculed or ignored. By now, I can almost guess which posts will generate the most anecdotal evidence and arguing for/against research. I can also (usually) tell which posts will generate the most discussion among which type of clinician. For instance, a question about PROMPT or some other expensive method will have lots of discussion among the private practice people while something that claims to save time (such as speech buddies) is big among school based clinicians. (Of course there is some overlap…but I’ve started making a game out of which type of posts will generate which responses.)
On Facebook recently a post came up regarding Therapeutic Listening (but really, you can change Therapeutic Listening to any other treatment method such as Prompt, NSOME, Facilitated Communication, Rapid Prompting, kinesio taping, etc. and have the same conversation). During the discussion the lack of research based evidence was pointed out. For this particular post, there were links posted to research showing it wasn’t effective…but there were still the arguments supporting it.
“But I’ve seen it work.” “It makes sense.” “It can’t hurt…why not try it”
Another SLP brought up potential backlash of arguing against non-EBP practices. Her argument was that when individuals state a program is not evidence based practice, that there is a decided lack of research to support the efficacy of a treatment (or heaven forbid research that actually shows it is NOT effective), it can harm the profession because perhaps, maybe, years down the road, it may become evidence based but people won’t stay current so they’ll still think it’s not EBP.
I find myself…conflicted. In some ways, she is correct. To boldly state something is not EBP is a bit … negative (it’s true…but negative). We could say “there’s no research to support that yet, but they are working on it.” That’s certainly far less negative…but, it also sounds like giving tacit permission to go ahead and use the treatment method. That obviously isn’t the right thing to do either.
I understand and fully support the need to keep an open mind. I agree that there are many treatment practices that are in their infancy and with limited funding it can be challenging to get research completed. I also understand that just because something is pseudoscience doesn’t mean it doesn’t work…it may work, for some. However, we have to clinically evaluate – does it work BETTER than a researched method. Not does it work, does it work BETTER. If it doesn’t DON’T DO it.
I have heard the argument that “it’s what parents want so as a private practice SLP I have to do it or they’ll just pay someone else.” I’ve had another private practice owner (an SLP) tell the group that she wants all of her new hires to be certified in certain programs (despite the fact that they are controversial and non-EBP) because parents want them even if they don’t work.
What does that say about us? About our profession?
Why is it that so many of these controversial treatments are SO very expensive that to get trained to do them correctly (which is necessary for outside research to be valid) is prohibitive? Do they do that on purpose, so that outside researchers aren’t able to show that it is ineffective? There are other programs that are so convoluted in how they should be done that any research that is completed and shows it as ineffective could easily be discounted because the treatment protocol wasn’t followed exactly or there’s too many nuances (e.g., according to one SLP choosing the exact right music and prompts for TL falls into this category).
In some ways, I have to applaud the creators of some of these products. They are raking in the money on trainings, materials, certifications, etc…all with the secure knowledge that even though there is no research to show it works, someone somewhere will buy it because it’s marketed well…because parents who are desperate to “fix” their child ask for it and SLPs who are desperate for business buy into it or need to please the parent.
When did it get to be accepted to not only look for research to support our treatment methods, but to turn our backs on research that shows our chosen methods don’t work? When did the responsibility to our clients change?
I’d love to hear your thoughts regarding research and our responsibility.
Until then…adventure on!