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Occam’s Razor

William of Ockham (Occam) was an English philosopher and logician who lived from 1285 -1349.  He is remembered for his views on minimalism, most notably Occam’s Razor:  

“It is needless to do more when less will suffice.”

This maxim is frequently quoted in philosophical discussions on healing.  In its essence it reminds providers that just because you can do more to a patient, does not mean that you should do more. Consider this illustration comparing complex and minimal interventions:  Who would be more essential to a patient’s care: a skilled neurosurgeon who is able to perform an intricate spinal surgery to spare a patient infirmity or a technician who was able to teach that patient the spinal mechanics needed to prevent surgery?  We can agree that both practitioners may be valuable at different stages in the patient’s care.   However, the technician could conceivably prevent the need for the highly trained surgeon.  By that standard the technician would be more valuable.  This illustration can work equally as well with other specialties:  Would a nutritionist who educates patients in how to prevent heart disease or diabetes be more important than the expensive specialists who would later try to minimize the effects of these diseases?  Of course simple preventive measures are substantially more effective than complex treatment. 

Occam’s Razor in Integration

There is a lack of strong evidence on what works best for most spinal conditions.  So in the absence of clear treatment superiority, we should employ the simplest and safest treatments first.  If conservative care fails, then transition to more complicated and risky treatments such as spinal injections, medications, and surgery. 

The Annals of Internal Medicine recently published a set of Guidelines for managing low back pain.[i]  These guidelines incorporate the promotion of an active lifestyle, training patients in self-care, interdisciplinary rehabilitation, exercise, spinal manipulation, and behavior training.  These are all modalities that fall within the scope of chiropractic practice.  The guidelines also recommend acupuncture, over-the-counter analgesics, yoga, and progressive relaxation.   More complicated interventions were not included in the early treatment of back pain.  These guidelines clearly follow Occam’s Razor, and chiropractors are clearly able to provide most of guideline’s recommendations.

Complex Conditions

While a useful tool, it is dangerous to apply Occam’s Razor too liberally.  There are many conditions that are complicated and need dramatic and complicated treatments.  For example: a conus medularus syndrome is a medical emergency and may require an invasive surgical solution.

H.L. Mencken provided us with a cheeky retort to over simplification:  "For every complex problem, there is an answer that is clear, simple—and wrong."

Some conditions are complicated and need to be referred to interventional specialties.   Complex problems may require a complex solution, but it is preferred to start with less invasive treatments before proceeding to more invasive interventions. Having a trusted team of specialists allows the patient to have continuity of care. The patient begins with the non-invasive treatment of a chiropractor and, if necessary, concludes with an interventional specialty.   In forming a team of diverse specialists, promote yourself as the conservative non-pharmaceutical, non-surgical specialist of the team. 
There is a brief time when most health conditions are large enough to be recognized, yet small enough to be resolved with a simple intercession.  If untreated, they will progress into conditions that cannot be healed.  It is our calling to be the providers who recognize conditions when they are small enough to be corrected. 

[i] Chou R et al. Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007 Oct 2; 147:478.