Approaches to Speech-Language Intervention and the True Believer: A Response (Letter to the Editor)
Gruber, Lowery, Seung, and Deal address threats to the inference that positive outcomes for communication disorders result solely from the treatment administered. They caution that treatments should not be selected and justified on the basis of a clinician’s experience that “they work.” They discuss five potential biases–placebo effect, Hawthorne effect, natural history effect, experimenter or “Pygmalion” effect, and regression to the mean–that may confound the results of treatment outcome research. Good for them! Certainly, a clinician’s selection and justification of a treatment should be based on empirical evidence that supports the treatment’s efficacy. Furthermore, empirical evidence should flow from experimental conditions that controlled for potential bias. The following is a consideration of Gruber et al.’s discussion of the five potential sources of bias in treatment outcomes research and the solutions they offer for controlling each. First, however, it may be useful to consider the clinician’s role in selecting, justifying, and providing treatment. Sackett, Richardson, Rosenberg, and Haynes (1998) say, “The practice of evidence-based medicine means integrating individual clinical expertise with the best available clinical evidence from systematic research” (p. 2). A clinician’s expertise is his or her proficiency and judgment acquired through clinical experience and practice. The best available evidence is that provided by clinically relevant research, for example, that demonstrating the efficacy of specific therapeutic regimens. Thus, the clinician is always in the picture. He or she selects and administers a treatment based on his or her knowledge of the results of treatment outcomes research; however, he or she also employs clinical expertise to avoid tyrannizing a patient with a treatment that is inappropriate or not applicable to the patient’s condition, rights, and preferences.
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