Who is to blame? We are.

I’ve had a post on pseudoscience drifting around in my head for a while now and it just isn’t coming together the way I want. I won’t bore you with the particulars of it, but know that there will be one coming…sometime. In the meantime, while pursuing those elusive thoughts, I’ve been trying to figure out WHY we have such an influx of pseudoscience cropping up. 

Some people I’ve talked to believe it is because of some great marketing schemes by the companies. They wrap up these therapy “tools” (term used lightly) in pretty packaging, tie it up with anecdotal evidence, and tag it with a CEU and many people tend to think of it as a gift and swear it works.

Some people think blame it on the universities and their lack of teaching critical thinking skills. After all, we can’t expect people to do something they’ve never been taught, right?

Some believe it is because people in the trenches are just too busy to read the research and really delve into the topic. Who has time for that with insane caseloads and far too much to do?

Some blame ASHA because they offer CEUs that aren’t well-rounded in science. They feel that if there’s an advertisement on the ASHA page or it’s an ASHA CEU it obviously must be evidence based…right?

Finally, some have actually blamed the parents. They state that parents request a certain technique and rather than actually say “that’s not supported by research,” and rather than tell the parents the technique isn’t supported by research and risk them taking their money elsewhere – they get the training and support the pseudoscience.

So…whose to blame? SLPs?  Universities?  ASHA?  Marketing?  Parents?

time for change

In reality…we ALL are to blame. Yes…everyone.

Companies ARE guilty of wrapping up pseudoscience techniques in pretty wrappings. They create some research that looks pretty but doesn’t bear up under scrutiny (poor research design) or they make it so complicated there is no way to replicate it without serious training – which then makes it so that it can’t be effectively researched by an outside researcher (you know that old saying, “If you can’t dazzle them with brilliance, baffle them with bullsh_t?…Yep, it applies). Some of those techniques may work, there’s no arguing that and some don’t work any better than other techniques, but because of the cost of the training – people are reluctant to put them away and are unable to critically appraise whether it’s the technique or something else that is being effective.

Some universities ARE guilty of not promoting and actively teaching critical thinking skills. I think the universities haven’t caught up with the fact that these are NOT taught in K-12 schools anymore. They used to be…but they haven’t been for a while now (and most likely won’t be in anytime in the near future). Prior to working in the university system, I didn’t realize exactly how lacking these skills are… Now I know…first hand. We have to teach students how to think critically about the information they are presented…and it is not something that can be learned incidentally.

The people in the trenches ARE guilty as well. Yes, they are insanely busy and, in my not so humble opinion, flat out abused. Between ever growing caseloads (80-100 is NOT uncommon) and a far too encompassing (and ever expanding) scope of practice  – they simply do not have time to delve into the research with enough detail to actually ferret out the false research from the faulty research from the true research. Please know, I am NOT making excuses. We are required by our ethics to keep on top of research, but I also know how busy many (most) of you are. I know you bring work home and I know the last thing you have time for is deciphering research results. You do, after all, have to sleep sometime. [I’ll save the rant on caseloads and scope of practice for another day. Let’s just say they both need to get smaller and let it go for now.]

Which brings is to ASHA…and yes, I believe ASHA IS guilty. ASHA sends mixed messages and refuses to take a stand. They allow companies that insult SLPs into the ASHA convention, they put adds for questionable techniques (NSOME companies anyone) on their webpages, and they put the ASHA CEU label on courses that are not grounded in sound science. When someone goes to the ASHA webpage and sees these adds or takes CEUs for these techniques that are wrapped up so nicely, the busy SLP just accepts that it must be okay…After all, ASHA is supposed to be a guiding force, right?

I can’t say parents are to blame, but they definitely add to the problem. Parents ARE trying to be advocates for their child. They do what we all do, google a disorder and look to see what comes up. [Come on! You KNOW you’ve done it.] In their quest to help their child, they demand the treatment from the SLP who doesn’t have the information to say NO, it’s not really effective (because caseloads…). If the SLP happens to be private practice (like the ones who told me they do pseudoscience techniques so they don’t lose business), they often feel like they can’t afford to stand up to the parents who have been sucked in by the pretty marketing packaging. (see how it is all intertwined?)

In short…we’re all guilty.

The real question is how do we fix this growing problem? That’s a harder question to answer.

It starts with you…and me…and everyone. One person at a time.

First, don’t subscribe to the pretty marketing. THINK. Those companies are out to make money – pure and simple. They wrap things up nicely and spend a lot of money on marketing because they KNOW parents will request and SLPs will succumb to the packaging. Does it mean that the technique doesn’t work – no…but it probably means that it doesn’t work any better than the absolutely free techniques that are available. There are people who firmly believe if they pay a few hundred or thousand dollars for the training then it is obviously better than anything else – and that simply isn’t true. So, rather than succumbing to the pretty packaging – let’s start holding those companies accountable for REAL research and techniques that can be replicated.

The universities (and K-12 schools) need to actively teach critical thinking. We can’t assume students know how to be skeptical and think critically (it really is a learned skill). We ARE responsible for shaping the next generation of SLPs. If we want to fight pseudoscience – the way to do it will be to teach them to see the difference.

For the SLPs in the trenches, as tough as it is, carve out 10-15 minutes a day for research reviews. Brush up on your research design so you can effectively critique the information. Really TALK about the research, the design, the results with peers. CRITICALLY. SKEPTICALLY. Decide if it’s based in theory, is the design right, is it logical, can be replicated?

I’m really not sure what the answer is for ASHA. In the long run, ASHA is a business and it has a bottom line to meet. I HATE that it panders to pseudoscience and I detest that it won’t actually take a stand against some practices…but I get it. I think the only way to change that is to volunteer and be the force that changes it from within. If YOU are unhappy wtih something about ASHA (regardless of what it is) then I challenge each and everyone of you to do the same thing.

ASHA IS US. 

Plain and simple…it is US. The SLPs and Audiologists who are the members CAN make a change if we try.

We can’t change parents, and really shouldn’t want to. They are researching what their child needs and are searching desperately for answers. What we CAN do is have the backbone to advocate for their children and say “NO…I won’t do pseudoscience.” Educate them. Show them YOU are the expert.

So…what do you think? From what I see on twitter, facebook, etc., pseudoscience appears to be gaining a bigger hold on our practices than real science…do you agree with that? Is it something that needs to be changed? If so, do you have suggestions for how to do it? I’d love to hear them here… drop me a note.

Until then…Adventure on!

Mary

**Update: Please know I am not pointing fingers at any one problem or person and I am including myself in some of these issues. With the increased access social networking has provided, we seem to have an increased scourge of questionable practices popping up and being shared and taken as “true”. We need to enter an age of accountability.

Regarding ASHA – I firmly believe in the vision of ASHA. I am NOT anti-ASHA. Ideally, ASHA would not accept non-evidence based products for advertising or exhibiting…but in reality, it is not ASHA’s job to police the information available to us. It is OUR job to critically appraise that information and decide to accept it or question it.

I do, absolutely, think it is wrong to accept non-evidence based practices for CEUs and I wish ASHA would quit doing it. Providing ASHA CEUs for non-EBP practices, in my opinion, decreases the “science” portion of our profession and it weakens the stance against pseudoscience.

 

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14 thoughts on “Who is to blame? We are.

  1. Thanks Mary, once again you nailed it. We all need to take personal responsibility AND we need to hold our professional associations responsible. They can’t let the market decide, they must take a stand.

  2. Excellent post!

    Since there are so many of ‘us’ to blame for our practices as well as our complacency it will take all of us to make a concerted effort to untie and change our historical practices.

    • Absolutely…it all starts with one…I can’t control what anyone else does, but I can make that effort to check my own practices. Am *I* making the time to critique the research, am *I* speaking up and volunteering for the changes at ASHA, am *I* advocating for best practices with my clients and am *I* refusing to succumb to the temptations and pretty wrappings in marketed prodcuts and REALLY researching them…holding them accountable? It will take time, but every person starts with just one (themselves), it’ll take less time than it took to get here.

  3. Thanks for this awesome post. Posts like this renew my commitment to continued research and keeping on top of the research along with everything else.

    • Thanks for commenting…I know how much you already do to fight against pseudoscience…and you’re right. Those of us that are already doing things – need to keep doing things. Hopefully our inertia will help others.

  4. Thanks for your post Mary. It made my day as I received the rollout notice of the IEP program that our state will be switching to 2018. Unfortunately pseudioscience is an issue beyond our area. Time, energy and being overwhelmed by increasing demands are overwhelming all of us. There is a desperate need for teaching critical thinking skills at all levels. ASHA is what it is. I have been disappointed by ASHA’s practices for years. As you stated it is a business.

    How to go forward? I like your idea to take 10 minutes to read an article. I would add doing it during the work day. I would add stand, walking in place, doing squats, etc at the same time. It does the mind and body good.

    I look forward to your scope of practice post. I think in public schools SLPs have taken on / been given parts of so many other people’s jobs that it is hard to do our core job.

    • I agree completely Emily. I recognize that language encroaches on every aspect of life – obviously…but in the schools at least the Scope of Practice has become far far too encompassing. We are in increasing danger of losing our status of “specialists” and becoming “generalists.” We are taking on the roles of several other people and it results in increased caseloads and serious overworking.

      Great idea about incorporating a bit of walking, squats, etc… Love it!

  5. Great post. Love Emily’s idea – maybe i’ll add a daily ‘to do’ of movement break + hydration (my own personal goal this year) + EBP review all rolled into one! The part about private practitioners speaks to me specifically – I’m working harder to help educate parents when they ask for a specific technique – also asking them where they learned about it so I can possibly dig down to the source of the info and address it there. Looking very forward to Bowen & Snow’s new book soon!!

  6. By the same token, there are programs that are evidence based and produce great results. But SLPs who have not bothered to read any of the research say, “This isn’t research based,” before reading the research. It makes me mad when I am working with a child and another SLP tells the parents to stop what I am doing. Sensory-motor work never works? Then why did a child who drooled in buckets for 4 years stop after a month of doing that ‘worthless’ program with so-called tools? I hope you see my point.

    • I am allowing your comment because it speaks to an important topic…however, I nearly didn’t since you are anonymous (just so you’re aware).

      It is obvious you are frustrated – but I think it is important to look at all aspects of the situation. For instance, your “sensory-motor” work…it would depend on what the GOAL of the work is as to whether or not it is evidence based.

      Let’s consider Oral Motor exercises (yes, I know a hot topic – particularly recently on Facebook). Oral Motor exercises for speech purposes (blowing horns, feathers, bubbles, and other “strengthening” exercises) when not paired with a speech sound HAVE been proven to not be beneficial for SPEECH. The exercises to strengthen lips, tongue, etc. HAVE been proven to be less than effective for sound production – the perceived benefit doesn’t last – and frankly there is no way to measure the lip/tongue strength needed for articulation. Now that said – that’s for speech. It may be beneficial for OTHER things (drooling, swallowing, texture awareness, oral awareness)…but then it no longer becomes oral motor for speech purposes, it becomes sensory which is a completely different beast.

      I agree completely that it is wrong from another SLP to tell the parents of a child you’re working with – that you need to stop if that SLP hasn’t spoken with you first…However, it may be an ethical issue if she sees a (to her mind) “malpractice” occurring and doesn’t speak up. (please note, I am in no way suggesting that you are involved in malpractice – it’s just the term that comes up for ethics)

      In many cases the “research” that is promoted for many packaged products is faulty at best. It is created by people who have a vested interest in making sure the research looks good (that automatically makes it suspicious) or the research design is faulty – and often (seemingly) purposely done to make the research look positive. Sometimes (like in the case of NSOME for speech purposes) the research IS there to show that it doesn’t work and yet clinician’s turn their nose up at it because it goes against what they are doing and they don’t want to listen. (again, please know I am not suggesting this is what you are doing) It sounds as though, in your specific situation that you’ve brought up here, it’s a case of saying you’re working on speech – when in reality that might be the long-term goal – but perhaps it is NOT the goal right now (sensory and oral awareness is) OR that you are pairing it with speech sounds and therefore is no longer NSOME.

      For me…I take the view of the term “pseudoscience” doesn’t necessarily mean BAD science…It means there is more research that needs to be done by outside people. It has potential – but it’s not REALLY researched yet (by anyone who isn’t going to make money off of it) OR the research is inconclusive because of one thing or another. Personally, I’m still really hopeful that we’ll find that research that supports things like PROMPT – but right now, this second, that research has been elusive because almost everything has been done by people who have a vested interest – OR – is so weak the results are inconclusive.

      It is a very frustrating situation and it sounds as though you’ve received some ugly discussions on it – and for that I am truly sorry.

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