- Todd Capistrant DO, MHA
By definition a Model is hypothetical.
Every week in my clinic me and my partners see cases that excite us. Cases that seem to challenge traditional medical thought. We evaluate patients and their presentations in the FDM model and we are often thrilled with the results. Results that we expect when working in the model but still leave our traditionally trained minds reeling. We discuss as a group that these are the cases we really should take the time to right up. The outcomes that we should submit as case studies. The case study is the beginning of the scientific process in gathering of evidence. It is the bottom rung of the evidence based ladder, but it is a start.
Imagine your busy practice. Imagine seeing something during the course of your day in that busy practice that the model you have embraced predicts and the outcome defies what you learned to expect as a student in traditional training. These are the cases you really want to write up. The effort involved in writing up a case is significant. The process is not as simple as sitting down and typing up a report on what happened. Finding a journal that might be interested in publishing the case is one step. Introducing people to the FDM model in the case report is another part of the process. Writing a case report for another FDM practitioner is not challenging. The language and frame work of the model is in place. But what about those who are FDM naive? How does one explain an exciting outcome to those unfamiliar with the model? How much energy do you have to continue to pursue publishing this case study? How many more people could you treat if your energy was directed towards patient care rather than writing? But just imagine if other providers new what you had seen? Here is the difficult part of the evidence process.
Recently, we have had energetic students tackle the process of writing case reports. Two separate cases with two exciting and important outcomes that should be the beginning of the evidence building process in different fields. Outcomes and treatments that could help other patients. In both incidents it seems that there is a bias that prevents the publication of information on FDM. One journal responded that there was not enough literature available on the FDM, therefore it was not going to publish the case report. Answer me this, how does one get information in the journals if they are not willing to publish a case report? The second journal administrator stated that the case report did not specifically identify the Fascial Distortion Model as a hypothetical model and there for even if its reviewer's were to deem the case fit for publication they would likely block the publication because there was not sufficient tangible evidence that the model was real. They suggested expensive imaging studies and dissection prior to the publication of a case study.
Several things about this second journal's stance were confusing. First, the nature of a model is by definition hypothetical. A model is something that is used to describe those things that can't or haven't been seen. The model is a postulated explanation of how the fascial matrix works and can be distorted . Second, is the idea that in order to begin work on a model it must first be visualized anatomically. We began wondering how far would the coronary plaque model, heart failure models, and other models have progressed if first they could not be discussed as a theoretical construct? It appears that we may have placed the proverbial cart before the horse if we expect expensive imagine experiments to be carried out prior to case reports.
We are fortunate in the FDM that even inexperienced practitioners are able to achieve impressive results that sometimes defy medical expectation. The problem is that no matter how much anecdotal evidence is gathered we still need to work through the process of gathering evidence. But how can we expect the experiences and outcomes, seen by so many providers, to be shared if there are road blocks to publication that are not based on the merit of a case but rather the need for direct visualization of the model before acceptance?
While we struggle with these issues I encourage all of you to be excited by your success. Allow your success to fuel your interest to share what you know with your colleagues. Take the time and submit cases to journals. Push the FDM agenda. We know that patients benefit from care in this model. We need to show others that the FDM is indeed measurable, objective, predictable, and reproducible. Once we have enough cases showing this we can then look for funding to perform the more expensive and time consuming studies to "visualize" the model.