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WHEN PARADIGMS FAIL
©Copyright December 27, 2000
[All Rights Reserved]
JOHN M. CURTIS
Los Angeles Daily Journal
(310) 204-8700
Since Traube's discovery of "the strangled voice" in 1871, the
medical community hasn't offered a single cure in nearly 130 years,
preferring to attribute spasmodic dysphonia to arcane neurological
and psychiatric explanations. Early on in their medical training,
physicians are told to show deference to Occam's razor by giving
practical explanations without undue mystification.
Complicating the picture is pharmaceutical companies whose drugs
are designed to treat only organic conditions. Take Merck, for instance,
the publishers of medicine's prestigious treatment bible known as
The Merck Manual, their own research found that bad and raspy voices
were caused by GERD [Gastroesophageal Reflux Disease]-a condition
in which regurgitated gastric juices irritate the vocal cords. How
convenient that Merck's popular heatburn drug Prilosec was serendipitously
discovered to treat troubled voices. There's only one minor glitch,
the vast majority of bad and raspy voices aren't caused by GERD
or any other organic cause according to Dr. cooper and his research.
Extending Prilosec to treat voice problems, Merck added to the bottom
line, but hasn't helped too many disabled voices. Because most voice
problems aren't organic, but due to misuse and abuse, drugs have
limited therapeutic value beyond the welcomed placebo effect. While
today's medical paradigm only accepts drugs or surgery, it still
doesn't deal with the real causes of voice problems.
Admitting that most SD stems from misuse and abuse of the voice
would automatically take the problem away from doctors and put it
into the hands of non-medical speech therapists. With most speech
pathologists abiding by the medical model, they accept the prevailing
wisdom that there's no cure for "the strangled voice." More that
30 years ago, Dr. Morton Cooper developed Direct Voice Rehabilitation,
a natural, non-invasive procedure for curing troubled voices. Based
on the Reciprocal Inhibition therapy of Joseph Wolpe, M.D., Cooper
found that the vast majority of voice problems were due to bad voice
habits not, as the medical community suggests, to neurological.
Like Wolpe, Cooper noticed that behavior modification worked surprisingly
well with all kinds of voice problems.
Cooper found that disabled voices were due primarily to forcing
the voice from the lower throat. That caused added wear and tear
leading to strained voices and to "the strangled voice." No matter
how much drugs or surgery, it wasn't going to correct the patient's
bad voice habits. By training patients to lift their voices out
of the lower throat and project sound through the mouth and nose,
Cooper was able to reduce the stress causing bad voices. No magical
pills, just basic undoing bad habits and retraining good ones. Lifting
the voice out of the lower throat enables patients to recover their
natural voices. If the medical community were right, Cooper wouldn't
obtain results from patients suffering from "the strangled voice"
and other common voice problems and neurological disorders. Despite
astounding results, Direct Voice Rehabilitation still isn't accepted
by the medical community.
For "the strangled voice," mainstream medical treatment involves
either injections of Botox [botulinum toxin] or surgery on the vocal
folds. Believing that "the strangled voice" is caused by lesions
in the basal ganglia and resultant seizures in the vocal folds,
physicians routinely prescribe Botox injections to paralyze the
muscles. Used to paralyze facial wrinkles, Botox is a dangerous
drug now used to treat "the strangled voice." When surgery fell
into disrepute, Botox became the medical treatment of choice. Like
Merck and its drug Prilosec, Allergen found a convenient use for
Botox outside cosmetic surgery. While it's tempting again to blame
troubled voices on organic causes, there's scant evidence that it's
true. Botox treatments have claimed limited success in treating
"the strangled voice," based the mistaken theory that gravely disabled
voices are due to faulty neurology. Despite widespread failures,
Botox continues to represent the most popular medical treatment
for "the strangled voice."
When natural, non-invasive approaches like Dr. Cooper's Direct
Voice Rehabilitation [DVR] obtain ongoing cures for "the strangled
voice," the medical community still maintains that there are no
cures for the condition. Despite curing the problem, DRV doesn't
qualify as a legitimate cure because it doesn't use drugs or surgery.
Turing things inside-out, failed medical treatments prove that there
are no cures for spasmodic dysphonia apart from current trends in
health care away from drugs and surgery, non-medical approaches
are quietly discredited as 'alternative' treatments. If severe voice
disorders aren't really caused by organic defects, then why are
only medical treatments viewed as legitimate? Because the medical
community doesn't recognize cures for "the strangled voice," they
frequently deny that successfully cured patients had an accurate
diagnosis. Even when independent medical experts from the Mayo Clinic,
Scripps La Jolla, UCLA Medical Center, and Cedars-Sinai confirm
the diagnosis and cure by 'alternative' treatment by DVR, physicians
attribute the cure to luck or spontaneous recovery.
When a medical paradigm fails, devotees continue to force square
pegs into round holes. No matter how poorly the fit, physician's
find creative ways to defend their theory, despite the fact that
clinical picture points in a different direction. Because the medical
model only permits organic diagnoses, they only accept medical treatments.
If SD and the vast majority of voice problems are functional, how
can organic treatments produce results? After nearly 130 years of
failed treatment, it's time to face the music: the vast majority
of voice problems are due to bad habits not tainted heredity or
faulty neurology.
When patients go to their doctors, they have reasonable expectations
for precise diagnoses and effective treatments. White coats, high-tech
equipment and perma-plaqued degrees create the aura of credibility
needed for successful treatment but can't produce cures of SD. For
most voice problems, superimposing medical solutions on non-medical
problems leaves patients in the dark. While we'd like a pill for
every problem, common sense tells us that it's just not possible.
Well-intentioned physicians need to understand their limits in managing
the vast majority of voice problems. Though it's tempting to treat
everything that steps into the office, it's also advisable to know
when to consult and refer. Denying and discrediting a legitimate't
erase its effectiveness.
Today's medical-pharmaceutical complex dictates approved treatments,
even where the treatments may be worse than the disease. When Saddam
Hussein packed Botulinum toxin into the warheads of Scud missiles,
few people imagined that a highly toxic biological warfare agent
would have any medicinal value. With Botox sales proliferating,
it's time to take a searching inventory of its real medical benefits.
Botulinum toxin is a key component in biological warfare and one
of the deadly agents responsible for the Gulf War Syndrome. Curing
frown-lines in one thing, but assuming that a lethal poison will
help recover failed voices stretches credulity to the breaking point.
While rehabilitating bad habits takes some work, it's still preferable
to controversial surgeries and toxic chemicals with known adverse
side effects.
While physicians hold considerable credibility, they don't possess
the right paradigm for dealing with the lion's share of voice problems.
When multinational pharmaceutical companies try to push prescription
drugs, it's no guarantee of eventual success. Voice experts have
yet to establish a convincing link between acid reflux and troubled
voices. Prescribing hefty doses of Prilosec might help relieve sour
tummies but doesn't offer too much relief for disabled voices. For
patients suffering more serious conditions like "the strangled voice,"
paralyzing the vocal folds with Botox or performing controversial
surgeries hasn't produced a single cure of SD.
Holding a virtual monopoly on the treatment of voice disorders,
the medical/pharmaceutical community should open their arms to established
treatments like Direct Voice Rehabilitation for dreaded conditions
like spasmodic dysphonia. In the age of managed care, natural healing
should trump old fashion medical treatments that have limited therapeutic
value and risky side effects. Shooting down proven approaches simply
because they fall outside the medical/pharmaceutical paradigm or
corporate profit centers is no longer acceptable. Giving patients
the best possible options is all that counts.
About the Author
John M. Curtis, Ph.D. is editor of OnlineColumnist.com. He writes
the Spin Report for The Los Angeles Daily Journal analyzing spin
in the news. He's director of a Los Angeles think tank and author
of Dodging The Bullet and Operation Charisma.
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