Bias In Evidence-based Care of Learning Difficulties

The term ‘evidence-based medicine‘ (EBM) has risen to celebrity, perhaps religious, status among healthcare practitioners. The term, when used, suggests that a particular treatment is preferred because there is evidence that it works. The medical and pharmaceutical industries love this term because it lulls practitioners into the often false belief that the treatment in question is the best, sometimes only, option for care because some study is presented as ‘evidence’. The flip side of this is that if a given treatment is not typically labeled as evidence-based in the literature, it is dismissed as implausible, or quackery.

Still, in spite of the use of the EBM label, study after study used in support of this ‘evidence’ conclusion in medicine can be shown to be significantly flawed, or that on balance, the marginal benefits of a treatment are perhaps no better than other alternatives.

A great example of this in the current medical emphasis on drug treatments for academic and behaviour concerns in the classroom. While some studies will show that some ‘academic-related’ behaviours improve with drug treatment, for example, overall, these children continue to struggle in school. Furthermore, there is plenty of evidence to show that the treatment itself can be dangerous and leads to new problems. While we attempt to ‘medicalize’ child behaviour concerns following recommendations of the medical and pharmaceutical industries, we follow along a path of trust that is not always leading us in the right direction and deserves to be questioned. There are many contributing factors to a child’s behaviour concerns, and drugs do little to affect these concerns. It is tempting, however, to believe that a pill can magically wipe away the underlying developmental and environmental factors that do contribute to troubled learning and behaviour – anything else requires conscious effort.

This ‘practice with lack of evidence’ is dramatically demonstrated when MD’s who are not developmental or education specialists prescribe ADHD medications with the implicit, and incorrect, belief that they will boost academic performance. This sets a dangerous precedent and takes our focus away from those issues that should be addressed:

http://www.cbc.ca/thecurrent/episode/2012/10/16/prescribing-adhd-medication-to-children/

While we struggle with discerning the meaning of ‘evidence’ and at what point a marginal change amounts to significant enough evidence, the obvious sometimes gets lost in the shuffle. To wit:

Not all learning and classroom behaviour problems are caused by difficult vision, but difficult vision will almost always impede learning and lead to behaviour concerns. Why we don’t check vision but insist on filling gaps with potentially toxic solutions is almost beyond comprehension.

Mandatory comprehensive vision assessment is the most important issue facing eye care professionals today. This is not simply a matter of best practice, but is truly the balance between social equality and the maintenance of suppression of people and populations. Still, adequate vision assessment is essentially absent in our schools. A great many children struggle against vision problems, and most of these are ‘invisible’ to the untrained eye. Not all learning and classroom behaviour problems are caused by difficult vision, but difficult vision will almost always impede learning and lead to behaviour concerns. Why we don’t check vision but insist on filling gaps with potentially toxic solutions is almost beyond comprehension.

In light of the evidence and experience (described in greater detail in a paper slated to be published this Winter), it is clear that children who struggle with Visual Impediments to Learning (VIL) are much less likely to succeed socially, academically, professionally, and much more likely to participate in criminality and to end up in prison, or on social assistance. The effects of VIL are noticed in all classrooms, and all populations. Research shows, for example, that the prevalence of VIL among the aboriginal population declines with advancement through Grades 1 through 12. Anyone who is familiar with the principles involved will quickly acknowledge that VIL do not ‘disappear’, but rather cause children to leave school.

Ignoring vision leads to the subjugation and marginalization of some populations especially. Disallowing children to participate fully in democracy by the vehicle of education is an unconscionable abuse of basic human rights, and fully incompatible with fiscal conservatism. The lack of initiative in this area is nothing less than another implicit form of Jim Crow.

Ignoring vision leads to the subjugation and marginalization of some populations especially. Disallowing children from participating fully in democracy by the vehicle of education is an unconscionable abuse of basic human rights, and fully incompatible with fiscal conservatism.

The evidence in this case is clear: Many children struggle with behaviour and school simply because of difficult vision. Furthermore, checking and addressing vision for all children has been shown to raise academic outcomes and increase graduation rates. These are not things pharmaceutical companies will quote, or study, or promote, in spite of the evidence.

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