When Paradigms Fail

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.