A few weeks ago, one of my instructors was telling us about the treatments they used to perform in hospitals for ulcers, which included applying sugar and placing the ulcerated part of the patient under a heat lamp. (For those non-nursing types, current treatment is re-positioning patients to relieve the pressure that causes ulcers and prevents them from healing...)I don't know where the idea that putting sugar on an ulcerated rump would make it get better, but really that's not such an interesting question. Even today, there are all kinds of crazy ideas for therapy that crop up. Most of them simply die before reaching the trial stage. A much more interesting question is why nurses and doctors persisted in the idea that a sugary bum was health-promoting long after it must have been obvious to anyone and everyone that it didn't work.
In large part, this is the same question that one would ask about traditional medicine in tribal or third-world societies. And Tanaka, Kendal, and Laland determined to answer that question.
Writing in PLoS ONE, the researchers have created a mathematical model that seeks to demonstrate the primary factors that contribute to persistence of ineffective treatments throughout the world. Using what seems to be a Bandura-style social cognitive model, the researchers assume that learning is based on observation. Keeping this in mind, it stands to reason that treatments that are performed (or demonstrated) more often will create more learning. Since effective treatments end the conditions for their use, ineffective treatments will be performed more often, resulting in increased learning and greater persistance.
The researchers have created a mathematical model that takes into account the factors that contribute to social learning. I'm not qualified to critique their model, but to the extent that I understand it, it makes sense. If you enjoy wading through math, you can read the Methods section of this article yourself.
What's the relationship to nursing? If I understand this article properly, it is implying that the way to identify and end ineffective practices is simply to end practices that aren't supported by Evidence-Based research. As nurses, this is difficult to do in the face of medical staff who operate without evidentiary basis for their prescriptions. What IV fluid protocol is best for burn victims? No real consensus, but lots of definitive opinions. The role for hospital practice councils here would be to continue to push for reviews of the literature. On an individual basis, questioning protocols and calling for transparency in publishing the evidentiary basis for protocol adoption would be appropriate.
- Tanaka, M., Kendal, J., & Laland, K. (2009). From Traditional Medicine to Witchcraft: Why Medical Treatments Are Not Always Efficacious PLoS ONE, 4 (4) DOI: 10.1371/journal.pone.0005192
It certainly wouldn't be as effective as medical ointment easily available in those conditions, but I do remember a study done years ago that tested the idea of sugar healing a wound. They mixed a little iodine with it and bandaged cut fingers with sugar (or without) to test it, and the sugared ones supposedly did heal slightly faster. But perhaps the iodine was the real factor there.
ReplyDeleteMy guess was that sugar might dehydrate the inflamed area, speeding the process of reforming the usual surface layer of dead skin.
ReplyDeleteBut I'd also be more interested in applying the methodology to measure how quickly various global warming scientists notice that the planet has been cooling.
Well, the sugar isn't really a crazy idea, it just doesn't address the issues keeping the ulcers from healing. In high enough concentrations, sugar has antibacterial properties, but if you keep applying pressure or shear forces to ulcerated areas, they won't heal no matter how much sugar you put on them.
ReplyDelete