A whack a mole issue

[Barrett Dorko]

Randy's attempt to find something predictable will never be requited because we're dealing with humans. Personally, searching for this in the face of all the research findings to the contrary makes me cringe.

Here's something I wrote a long time ago about it.

[norton]

Originally Posted by John W

I made no such inference of an "ulterior motive". That's your cynical interpretation of my position.

My position is that the IASP is, like many of us, making difficult choices about very complex, moving targets to advance its mission.

Your assessment of my position is narrow and inaccurate, and it is framed in a sensationalized way that puts me in an adversarial posture against IASP.

"is susceptible to pressure from a variety of stakeholders. In this case, the biomedical professionals not only have a large stake in the pain treatment industry, but their biomedical model continues to dominate the provision of all of health care in modern societies. It's the dominant paradigm and as such occupies a uniquely lofty status that the IASP must acknowledge if it is to be taken seriously as an organization providing education to medical professionals, a large portion of which are medical doctors."


if you have an ulterior motive for doing something, you do it partly because you think you will get some advantage from doing it



Well, John as I read this you do suggest an ulterior motive as shown above. You suggest that what is at stake is alienation of the doctors and a fear by the IASP to not be taken seriously. So the advantage by the IASP is to remain educated in the Doctor's eyes .

Perhaps normal should be replaced with usual and customary. One of my all time favorite guidelines, she writes tongue in cheek.

Yin and Yang coexist .
Just my thoughts this rainy morning.
Deb

[Barrett Dorko]

Does anybody else see the irony in this thread's title?

Is it possible that Randy can't see he's chosen the wrong game to play?

[John W]

Well, John as I read this you do suggest an ulterior motive as shown above. You suggest that what is at stake is alienation of the doctors and a fear by the IASP to not be taken seriously. So the advantage by the IASP is to remain educated in the Doctor's eyes .

Deb,
If we're going to define "ulterior motives" so broadly as to suggest that anyone or any entity that acts in self-interest according to their values, mission and goals, then I think that betrays what reasonable people infer when they accuse someone of having an "ulterior motive". My sense is that the ulterior part is venal in nature, and frequently misrepresented as motivated by something noble or altruistic.

I don't think IASP's motives are any more venal than I think, for instance, that the title of my recently completed online course "Current Concepts in Pain Sicence for the Orthopedic Physical Therapist" represents an "ulterior motive" in the sense I just describes.

I'm not a big fan of the term "orthopedic" to modify what it is I do for a living for a host of reasons, mostly to do with the associations with the biomedical model and all of its reductionism when it comes to treating pain. However, this is the culture that we exist and practice in. I could call it something else, like "Neuromusculoskeletal Physical Therapist", but that's awkward and alienates my audience, which is geared towards those seeking an "Orthopedic Certified Specialist" credential.

I'm as principled as the next guy, but I'm not dumb.

[amacs]

Originally Posted by Bas Asselbergs

Randy, you also asked "What is normal?" I think that goes to the core of the issue.
We will NOT be able to establish: a) whether there IS nociception, b) whether there are normal or abnormal responses to nociception (in the clinic), and c) whether anything we do is really addressing that nociception.

There are too many variables on the left side of the matrix to assign roles to the individual factors.
In fact, they become irrelevant as individual inputs.

As long as we keep trying to assign values of importance or normalcy, we are not giving due to the chaotic nature of the pain experience.

For what it's worth, I think the IASP is weak on its definition, exactly for the above reasons.

Thank you for the clarity of thought Bas

ANdy

[norton]

John it was McMillian Dictionary definition not mine. There is always a degree of marketing in what we present to the public. And I never believed you to be a stupid man. You didn't call me unreasonable did you?
Deb

[norton]

From my previous days at Chuckee Cheese I can recognize the frustrations incurred in both the game and debating here on Soma Simple.
Deb

[amacs]

what on earth is Chuckee Cheese?


sounds revolting

ANdy

[John W]

You didn't call me unreasonable did you?

Of course not.

sounds revolting

Oh, it is...and punishingly loud.

[Barrett Dorko]

I've compared Chuckee Cheese to several PT departments I've worked in. Not favorably.

Google it.

[Ryan Appell]

After reading through this thread I thought these couple paragraphs from Wall's The Science of Suffering, the chapter entitled A "Normal" Pain response, would be appropriate here:

...There are, however, three caveats we must consider if these results are to be applicable to pains that occur in ourselves or that we observe in the clinic. First, it is obvious that the experimenter and the subject are certain that the stimulus will not produce any prolonged injury or pain. This is a necessary restriction but makes it an artificial pain outside normal experience, where pain comes together with a packet of worry and doubt. Second, the subjects are assured by the scientist that they are able to stop the pain at any instant when they decide it is not tolerable. What is being measured is pain without suffereing that can be instantly abolished. We should all be so lucky if that was the type of pain we wish to understand....

...Inherent in these trials is the concept of a pure sensation of pain liberated from perceptions and meanings. Many believe such a sensation exists. I do not. I think it an artifice generated in part by our dualistic culture and confirmed by the experimental design in which the subject has agreed to play the Cartesian game...

My bold.

[Randy Dixon]

Originally Posted by PatrickL

I don't understand what you have said here- sorry. If we can't define a normal pain output, how can we predict or recognize it?

Don't you? Didn't in your first post on this thread say that a patient wasn't displaying the pain you would expect? How is that not having a "normal"?

Yes, it isn't exact. What we define as normal is not a clear objective standard, we can't say there are 8.25 pain units any more than we can say there are 8.25 fear units or sadness units or any other subjective exoerience, but we can recognize when these things are not normal. When we look at a person's movement, we also use a normative standard. Barrett looks at hip abduction in supine as one of his measurements of "normal" for example. Does he measure it and is it objective? No (although it is measurable). Is it recognizable? Yes.

The fact that we have difficulty with the tools and the metrics doesn't change what happens.

[Barrett Dorko]

Objective means it can be seen, not that is measurable or has been measured.

[Randy Dixon]

Sorry for the formatting. I am still trying to figure out how to reply to a reply and keep the attributions correct. So I am doing it manually.

Quote:
Originally Posted by Randy Dixon
Do you think that troops in the midst of battle are experiencing normal neurodynamics?-Randy

Certainly not...but Shacklock states that an abnormal neurodynamic can be symptomatic, asymptomatic, relevant or irrelevant. And the neuromatrix model takes into account a lot more than nocioceptive input. Most would argue that the neurodynamic doesn't change in the hospital after battle as much as the psycho-social variables "computed" within the neuromatrix...but again, no one really knows. We only know that any of it may be important.-Keith

My error might be this, I consider psycho-social influences to be part of neurodynamics. I see no way of separating them. Yes, it is most likely the pyscho-social variables that change above. The contradiction between what Shacklock states and what I stated is that if Shacklock is correct, then an abnormal neurodynamic may still produce a normal pain response. I'll accept that.


Quote:
Originally Posted by Randy Dixon
If you have a patient come in, let's say with Patrick's example of a SLAP lesion or surgery to repair it. Do you consider, like Patrick did, that this may be contributing to pain, or do you just ignore the fact that there is tissue damage?-Randy

I understand that the patient (in this example) has mechanical deformation of tissue coupled with an inflammatory response (both nocioception) that is processed by the brain in an unpredictable manner based on that patient's expectations, personal history, biases (etc).
-Keith.

Of course. That is just restating the question though. Would you ignore the tissue damage or would you think it is a contributing factor? If you think there is NO correlation, then you would not consider the tissue damage at all. Is there no normal pain response in this case for you, is someone screaming in pain and someone feeling no pain both normal?



Quote:
Originally Posted by Randy Dixon
If there is no correlation between tissue damage and pain with a normal neurodynamic then why would you even consider the tissue damage.-Randy

I do not think that I make patient's tissues heal faster, do you?-Keith

No. I don't understand the relevance of the question. It is not about how you practice and what you can influence, but what occurs. How can you evaluate a person's neurodynamics if you have no notion of what is normal or expected?


Quote:
Originally Posted by Randy Dixon
You should just ignore it. I suspect you don't. I suspect you think differently about a patient with a recent SLAP lesion repair complaining about pain in their shoulder and one with no discernible or known tissue damage or pathology complaining of the same pain.-Randy

I rarely see SLAP repairs, so feel more comfortable talking TKRs compared to (for instance) "OA pain". Both patients receive education to reduce fear avoidance/catastrophic fears, gentle mobilizations, movement therapy...I emphasize thermal agents post op (CP for 20-30 mins every hour).--

I cannot help their TKR heal faster, nor have I read that I can alter the cytokines likely responsible for nocioception in the "OA knee" with my hands or exercise...I understand that I am limited in this regard.-Keith

I understand why you are focused on what you can do and that is influence abnormal neurodynamics but that is not what I am discussing. I am talking about normal neurodynamics and they may be something you can't influence at all in your practice. If a person hurts because they have tissue damage that needs healing, you can't help them. They will feel pain, and if that pain is a normal pain response, there may be nothing you can do. That doesn't mean that this type of pain should be ignored in our understanding of pain though.-Randy

Quote:
Originally Posted by Randy Dixon
Why? Because you know there is a correlation between pain and nociception with a normal neurodynamic.-Randy

I am still confused as to how you are measuring nocioception and how you account for the potential classification of an irrelevant or asymptomatic abnormal neurodynamic.-Keith

I'm not measurig nociception. I am saying given a noxious stimulus that we have some knowledge of, we can predict a normal pain response What happens between the application of the stimulus and the output of the pain isn't being measured.

As to the irrelevant and asymptomatic abnormal neurodynamic, I'm stil considering that one. Where I am right now, from where I was 5 minutes ago, is that I should amend my statement from "an abnormal neurodynamic is defined by this lack of correlation" to "a relevant or symptomatic neurodynamic is defined by this lack of correlation". -Randy

And NO I do not KNOW that there is a correlation. I do not argue that there isn't a potential relationship, but I am uncertain how I assess nocioception or how I treat it directly and measure the effect of my treatment without taking into account all the other variables that impact an individual's pain experience.-Keith

I think not KNOWING is a good thing. It is pretty much why I started this, because there seemed to be far too much KNOWING while much of that was contradicted by other pain researchers KNOWING. Again though, if you confine your understanding to how it influences you practice then you are not going to move beyond the abnormal neurodynamic. I don't argue that this isn't what your focus should be on in your practice, but not in your understanding of pain.-Randy

I have a subluxing ulnar nerve bilaterally...which always made for fun parlor tricks in PT school but really hinders my ability to maintain a buff physique (although Diane could attest to the fact that my buttocks are sublime ). If I go out and throw a football around for 30 minutes in my backyard, I may or may not develop pain in my throwing elbow...sometimes it hurts, sometimes not. I will always have a positive ULTT finding...ALWAYS. So what? Are you arguing that the environment that I am in, how much fun I am having, how well I am performing and/or the weather play no role in whether I have a painful experience or not? It seems apparent to me that if I am throwing a ball around (approximately) the same number of times across the same yard with the same abnormal neurodynamic and the same noodle-arms as always, but the result is consistently variable...well, I attribute those bad days to more than just nocioception alone.-Keith

I think I am just going to take your word for the sublime buttocks. As to the rest, I think everyone, or almost everyone has misunderstood my statement. This may be because I used the word "neurodynamics" to encompass all the dynamics of the nervous system, including the input and processing from the brain, not just the physical structure of the nervous system. If this is wrong terminology, I apologize for the confusion. I did ask for a source for terminology.




Quote:
Originally Posted by Randy Dixon
There has been a logical fallacy presented on this site that because pain can occur without nociception and nociception can occur without pain that the two don't have any correlation. This is a type of "false dichotomy" or black-white reasoning that argues that because something isn't ALWAYS true, it is NEVER true.-Randy

I am sorry, it is late, and do not have time to go back through the thread at the moment (been typing longer than anticipated already)...but...has anyone said that an individual never experiences pain from nocioceptive input or have they said that the degree of pain that a patient experiences (directly as a result of nocioceptive input) cannot necessarily be measured/accounted for by any tools presently available to us?-Keith

I think so. Diane has stated that it tissue damage is only coincidental to pain. Patrick said that there is NO correlation between pain and nociception or tissue damage.

I need to wrap it up too. Thanks for the thoughts-Randy



Respectfully,
Keith

[Randy Dixon]

Originally Posted by Bas Asselbergs

Randy, you also asked "What is normal?" I think that goes to the core of the issue.
We will NOT be able to establish: a) whether there IS nociception, b) whether there are normal or abnormal responses to nociception (in the clinic), and c) whether anything we do is really addressing that nociception.-Bas

I agree with you. I don't think normal neurodynamics play much part in the way people practice here except to alert you and allow you test for abnormal neurodynamics. You can't test nociception. You do regularly use "normal" as a measure though, even with regards to pain. If you do an apprehension test for a suspected dislocation, aren't you looking for a response, and if a dislocation is present that response is normal. If you don't get that response you suspect it is something other than a dislocated shoulder. However, I wasn't focusing on how my statement would impact the way you practice so much as how you understand pain. Frankly, I think the majority here already recognize some correlation between pain and tissue damage and nociception.

I have a problem with the meme that there is no correlation, and I think that there is a problem when the terminology on SS is different than it is in the rest of the Pain Science world. -Randy



There are too many variables on the left side of the matrix to assign roles to the individual factors.
In fact, they become irrelevant as individual inputs.

As long as we keep trying to assign values of importance or normalcy, we are not giving due to the chaotic nature of the pain experience.-Bas

It isn't a good choice, I agree. I just think it is the best one we have.-Randy

For what it's worth, I think the IASP is weak on its definition, exactly for the above reasons.

Yes, I understood your first answer regarding that, but how would you define a condition of an abnormal neurodynamic without referring to "normal"? How would you define "hyperalgesia" without making reference to a norm?

I also don't think we focus too much on the left side of the matrix, these just don't happen to be the things that can be influenced much by the people here, it doesn't mean that they aren't as important.

(Maybe someone can help me out and show me how to reply to a reply without chopping it up.)

[Randy Dixon]

Andy,

I'll get back to you once I figure out what isomorphic means.

It sounds like a good thing to market at the gym though.

[Randy Dixon]

Originally Posted by Barrett Dorko

Does anybody else see the irony in this thread's title?

Is it possible that Randy can't see he's chosen the wrong game to play?

Certainly not Randy. He is enjoying the game.

You don't have to play though.

I mean I don't want to take up your time. I don't want to miss the exciting sequel about why your chair was empty and why we should all be fascinated by it. I was going to guess about the first but couldn't remember how to spell hemorrhoids (I looked it up), then I was going to guess about the second but couldn't remember how to spell Narcissism (I didn't look that one up, I hope I got it right).

[Randy Dixon]

Originally Posted by Barrett Dorko

Objective means it can be seen, not that is measurable or has been measured.

In what dictionary?

I mean, I'm not arguing that Objective means "something that is measurable", only that it doesn't mean that it can be seen. Observable, I would go with. .

[keithp]

Hi Randy:

This may just be semantics, but I really have a problem with the use of the term "correlation". To me, it infers a predictable ratio or numerical/measurable relationship between nociception and pain. Is this what you are actually implying? Or, are you simply saying that a "typical/everyday" pain is usually related to nocioceptive input?

Don't mistake me, this seems more outwardly plausible, however, I would still argue that there is no way that we could ever know... As Diane would phrase it, "It is a perceptual fantasy".

Take the pinprick test, for instance. It is very likely that there would be variation between left and right sides of the same patient based on expectation, whether there was classical music or heavy metal in the background, if the room was lit with red or blue light bulbs, etc...despite objectively using the same level of pressure application in both trials. It is likely to assume that this would even result in a measurable difference between left an right sided GSRs.

Additionally, I (personally) have never used the term "normal" or "abnormal" in documentation...it is a judgement that I am not qualified to make.

Respectfully,
Keith

[gollygosh]

Randy,
I want to thank you for asking these qustions re normal, abnormal, and details re nociception. The questions, and answers are helping to further my understanding.

Geralyn

[keithp]

(redacted...PM sent instead to avoid disruption)

[Bas Asselbergs]

but how would you define a condition of an abnormal neurodynamic without referring to "normal"? How would you define "hyperalgesia" without making reference to a norm?

Hyperalgesia as defined by the patient's nervous system - an area where the patient feels severe discomfort or pain with very light touch. It is the unique patient's norm that determines a clinical finding of hyperalgesia. Why is hyperalgesia an issue here?
It is clearly a product of the patient's nervous system.

The IASP has done a lot of good trying to bring attention to pain and the related sciences. However, they still are in the model of defining each and every variation of pain experience.
In my opinion that is an interesting exercise, but rather unhelpful in the sense that we can not use that in a true meaningful way.
Not unlike the detailed research that determines that the VMO develops its greatest force moment between 46 and 53 degrees flexion of the knee, but only if the hip is flexed to 87 degrees. What use is this?

All in all, I think is more than reasonable to dismiss the whole issue of "nociceptive" pain. Just way too many examples of "no pain" in the presence of nociception for the term to have any value.

[PatrickL]

Hi Randy,
For those quotes within a quote, just highlight the whole text and click on the quote icon, then choose each bit of text from each person and click the quote icon again. Then it looks like a box within a box. That's what I do anyway.

Randy said:

Don't you? Didn't in your first post on this thread say that a patient wasn't displaying the pain you would expect? How is that not having a "normal"?

I said:

This to me, points to a lack of correlation between nociception and pain in the absence of an abnormal neurodynamic.

This was me pointing out an example of where nociception and pain seem to be at odds with each other. I think that very often i observe an apparent correlation between pain and tissue damage. This could reasonably be extended to an apparent correlation between pain and nociception. But I have come to think that this apparent linearity is only apparent, not real. I definitely do not think there is a causal relationship. I can't help forming a data base of experience from all the clinical encounters I have had. I think my judgment of what is normal or not is derived from those experiences. This was discussed in the 'Tissue requiring healing or repair' thread. I thought Bas put it nicely here
http://www.somasimple.com/forums/sho...&postcount=141
It is still a battle for me, accepting that I can't really know what normal is.

I said:

1. i think that what i observe in 'most' patients, in keeping with a bell curve, is a relatively linear resolution of most painful problems
2. i'm not sure how to reconcile that with the notion that pain is an emergent property, a non-linear output. How does an emergent property 'dissolve/resolve/submerge' in a linear manner across a population group?
http://www.somasimple.com/forums/sho...&postcount=123

It seems to me you are getting at the same point. Any suggestions or solutions you can think of?

[Randy Dixon]

Originally Posted by Bas Asselbergs

Hyperalgesia as defined by the patient's nervous system - an area where the patient feels severe discomfort or pain with very light touch. It is the unique patient's norm that determines a clinical finding of hyperalgesia. Why is hyperalgesia an issue here?
It is clearly a product of the patient's nervous system.

Bas,
Of course it is a product of the patient's nervous system, and it may very well be that unique patient's norm that determines your clinical finding, but that is still a norm. There is still greater pain than should be EXPECTED with the stimulus given. If the stimulus gives the expected pain response (none) then you would suspect a normal neurodynamic, if the stimulus evokes pain, then you suspect an abnormal neurodynamic. -Randy

The IASP has done a lot of good trying to bring attention to pain and the related sciences. However, they still are in the model of defining each and every variation of pain experience.
In my opinion that is an interesting exercise, but rather unhelpful in the sense that we can not use that in a true meaningful way. -Bas

I don't disagree. The IASP though has a broader focus than those here on SS. I understand the desire to focus on what is useful and relevant to how you practice but we shouldn't let it interfere or distort how we understand things.

I'll use the old cliche about blind men and the elephant. Those here at SS are blind men and pain is the elephant. The people at SS only have access to the trunk. They may be very smart, but no matter how deeply they study they trunk it does not give them the whole picture of the elephant. IASP is like a blind man getting information from all the other blind men, those studying the tail, the legs, and the trunk etc. I think we run the risk of ignoring the whole picture in our understanding if we reject ideas that don't fit into what we know about the trunk. -Randy

Not unlike the detailed research that determines that the VMO develops its greatest force moment between 46 and 53 degrees flexion of the knee, but only if the hip is flexed to 87 degrees. What use is this?

All in all, I think is more than reasonable to dismiss the whole issue of "nociceptive" pain. Just way too many examples of "no pain" in the presence of nociception for the term to have any value.

I'll just say that no value in your practice doesn't mean that it should have no value in your understanding or in your communication with others.-Randy

[Randy Dixon]

[QUOTE=keithp;130130][LEFT]Hi Randy:

This may just be semantics, but I really have a problem with the use of the term "correlation". To me, it infers a predictable ratio or numerical/measurable relationship between nociception and pain. Is this what you are actually implying? Or, are you simply saying that a "typical/everyday" pain is usually related to nocioceptive input?_Keith

Correlation is just co-relation. They are connected, this does not mean that we can formulate a logarithm to explain this connection. I am stating that Pain and Nociception have a correlation with a normal neurodynamic, this is "Normal" . It is when we don't see that correlation that there is evidence of an abnormal neurodynamic.-Randy

Don't mistake me, this seems more outwardly plausible, however, I would still argue that there is no way that we could ever know... As Diane would phrase it, "It is a perceptual fantasy".-Keith P.

I think you do know, you use this knowledge in your clinical reasoning every day, you also use it in your daily life. Whenever you feel a pain, you consider the severity of the pain and then you decide how seriously to take it. I am talking about the conscious reasoning you employ, not the stuff that happens before the pain output. You evaluate the pain and you dismiss it if it is slight and react if it is more severe. You don't react equally to all degrees of pain at the conscious, reasoning level. I am not saying that you will never have pain without nociception or vice-versa, or that our predictive ability doesn't have flaws.-Randy



Take the pinprick test, for instance. It is very likely that there would be variation between left and right sides of the same patient based on expectation, whether there was classical music or heavy metal in the background, if the room was lit with red or blue light bulbs, etc...despite objectively using the same level of pressure application in both trials. It is likely to assume that this would even result in a measurable difference between left an right sided GSRs.-Keith

Yes. Nociception is not the ONLY factor, EVER, at least while we are conscious. -Randy

Additionally, I (personally) have never used the term "normal" or "abnormal" in documentation...it is a judgement that I am not qualified to make.-Keith

So how do you document those instances where there is a pain response with no known stimulus or tissue damage? Shacklock and Butler make use of "normal" and "abnormal" both in their definitions and as a part of their diagnosing. I really can't see how to get around it.

[Diane]

This might be useful - Tony Ingram's latest blogpost on why we need science.

[bernard]

Originally Posted by Randy Dixon

Sorry for the formatting. I couldn't figure out how to quote a quote.

http://www.somasimple.com/forums/mis...o=bbcode#quote

Originally Posted by quoting a quote

[Randy Dixon]

Originally Posted by Diane

This might be useful - Tony Ingram's latest blogpost on why we need science.

Maybe if I was in third grade that would have been helpful.

[Randy Dixon]

Originally Posted by Randy Dixon

Maybe if I was in third grade that would have been helpful.

Of course, since I can't get this quote thing down, perhaps the third grade reading material made some sense.

[bernard]

A bbcode uses two tags an opening one and the ending one with a slash followed with the same term.
They uses, also, brackets [open][/open] :
For quote: [quote]text to quote[/quote] :
it gives:

text to quote

You may nest quotes [quote]second text[quote]first text[/quote][/quote] :

second text

[Bas Asselbergs]

I'll just say that no value in your practice doesn't mean that it should have no value in your understanding or in your communication with others.-Randy

What? Did you think my practice is somehow separate from my understanding - or that I do NOT communicate with others there? I thought I made that clear years ago: my understanding is what drives my practice.
And my understanding is that the presence - or absence - of nociception in non-ER situations, has little significance.
And that is what I tell my patients - in my communication with others.

It is interesting to consider the potential roles of nociception - as is the research on the role of mitochondria in cancer. Trying to define or assign a value to this is in my opinion rather useless.
So what if you want to call something "nociceptive pain"? Go ahead - it probably exists.
But what good is it to have a definiton or concept, if it only serves to describe something we - and here I go again - can not measure, reliably assess, specifically affect or change?

I have broken enough bones in my life to know that in some cases setting them did not do much to alleviate the pain, while in others, there was no pain to begin with, and yet others, the pain completely disappeared when I was casted.
And it can be safely assumed that nociception must have been triggered at some point or other during those fracture-events.

What is the use of trying to catch this ephemeral phenomenon?

[Barrett Dorko]

Bas asks:

But what good is it to have a definiton or concept, if it only serves to describe something we - and here I go again - can not measure, reliably assess, specifically affect or change?

Exactly.This is why I didn't get into the "define pain" thread. The variable is someone's assignation of value to input - and that's a variable that cannot be predicted from one moment to the next, not even by the person assigning the value.

[norton]

I do understand your frustration Randy. However it is you beating your head against the wall. When does it hurt and when does it feel good?

In the clinic, we now ask what has changed since our last visit? No VAS.
Deb

[John W]

Maybe if I was in third grade that would have been helpful.

Confirmation bias, cognitive dissonance, logical fallacies, placebo effect are 3rd grade concepts? I doubt that 90% of the 3rd year DPT students in this building could adequately explain those concepts.

I guess, Diane, you should just keep your helpful posts to yourself in this case, geez...

[Diane]

Originally Posted by John W

Confirmation bias, cognitive dissonance, logical fallacies, placebo effect are 3rd grade concepts? I doubt that 90% of the 3rd year DPT students in this building could adequately explain those concepts.

I think Randy may have been alluding to the fact that he is currently at at least a 4th grade level, and (probably therefore) labels anything he feels beneath his consideration to therefore automatically be categorizable as merely 3rd.

I guess, Diane, you should just keep your helpful posts to yourself in this case, geez...

You're probably right. But I'll just keep trying, probably. There is all that stuff posted today by Deric Bownds about insular cortex being egalitarian, etc.