Flat Earth Syndrome

It was a memorable Looney Tunes cartoon. You might remember it – the one in which we hear Bugs Bunny’s witty repartee with Christopher Columbus - "the world, she's a round" ... "no, the world she's a flat"! It might be as funny now as it was when I was 10 years old.

The perceptual debate that underlies this snippet of animated humor is a common challenge in the world of health and fitness and just about any topic of conversation or study. And it never seems to go away.

Let’s just give this phenomenon a name and call it "Flat Earth Syndrome". Better yet, so that it looks more “medical”, or perhaps more imposing, let’s give it an acronym – FES. Ohhhhhh. Ahhhhhhh, The power of the acronym.

But why a syndrome? It has a consistent pattern of symptoms that are characteristic of a particular disorder – a disorder of thinking, a fight between evidence and belief. It could be the shape of the earth, the treatment you receive for your back pain, or the fitness program you use to lose weight.

There was a time when people would proclaim (on a stack of Bibles or other books of worship) that "the world is flat". It was a cornerstone to the commonly-held belief system of the ages. But then science discovered something rather important - it wasn't. If you sailed a ship, you didn't fall off the edge of the world. You actually just kept on sailing until you hit the next big land mass. There was science to prove that the world was, indeed, spherical.

But lo and behold, people weren't ready for the science. It was near-heresy to proclaim that the world was round. People continued to select “data” that supported their beliefs. And try as science might, it was a supreme challenge to get people to move past their beliefs into the realm of "scientific evidence". But now look where we are. We traverse the world in airplanes, we go to other planets, and all while watching our globe circle below us.

FES is symbolic of how challenging our belief systems can be an incredibly emotional topic. It can be terribly uncomfortable. FES can be seen in virtually every realm of study – and that includes health, fitness, and health care.

Health care in 2011 is more often defined by the practitioner’s belief systems than it is by good scientific evidence. Let’s examine back pain as just one example. It may in fact be the poster child for this syndrome. The evidence in countless clinical guidelines indicates that MRI, x-ray, injections, and surgery are well beyond over-utilized in today’s health care environment. Most forms of treatment have little to no scientific evidence to support their use. But clinicians continue to do them, insurance continues to pay for them, and patients continue to trust their provider’s expertise and judgment in the midst of all of it.

When faced with good scientific evidence to the contrary, most clinicians simply resort to the "well, I have good results with what I am doing" mode and ignore the evidence. Instead of simply learning from the evidence and moving forward, the clinician ends up stuck on the visceral "how can I admit that I am wrong" aspect driven by ego defense more than efficacy.

This is what makes evidence-based practice so frustrating. There is a collective regression to the lowest common denominator of care. Sadly, the one that is most adversely affected is the consumer.

When our belief systems are challenged - be it with religion, health care, fitness, or politics - we are faced with an opportunity. It is an uncomfortable one, but an opportunity nonetheless. We can go onward into the abyss simply refusing to acknowledge that it is our beliefs that make us uncomfortable. We can become defensive to those around us who espouse different beliefs. We can be afraid to sail away from the shore.

Or, perhaps we can simply open ourselves to reflection, self-assessment, and learning. We can set sail to explore the vast horizons at the edge of our thinking that contain the truths that we seek.

That is a choice – a choice that we can all make. FES is a syndrome we can cure.

Maybe the cartoon rabbit had it right all along …

Photo credits: Wikipedia