From the Cranium to the Calcaneum

A sneaky way for me to continue the tour of the wonderful book by physician/author Gavin Francis, Adventures in Human Being, subtitled A Grand Tour From The Cranium To The Calcaneum – a fancier way of saying from Head To Toe, the calcaneum being the large bone forming the heel.  You can listen a charming interview with Dr. Francis on ideas, whose Scottish lilt I can still detect traces of in the voice of our good colleague, Dr. Patrick Quaid.

Head to Toe

In prior blogs I’ve referenced that many visually involved conditions are not eye or vision problems in isolation, but  indicative of head-to-toe problems or adaptations.  This is strikingly the case in problems related to visual-vestibular interactions.  Dr. Francis explores this in some detail in Chapter 5, bearing the title of Inner Ear: Voodoo and Vertigo.  As I describe Gavin’s exploration of Benign Paroxysmal Position Vertigo (BPPV), see if you can draw any parallels to the our calling and experiences through vision therapy.


“When vertigo comes on only in certain positions it’s defined, helpfully, as ‘positional’.  When it arrives in sudden and overwhelming bouts it’s called ‘paroxysmal’ … Though the syndrome is an ancient one, it wasn’t described until 1921 when a Viennese physician called Robert Barany finally defined ‘episodic vertigo’ as a syndrome.”

Dr. Francis then introduces the theory promulgated in the 1980s by the American otolaryngologist, John Epley, based on loose particles rolling around in the semicircular canals and repositioned in maneuvers that would subsequently bear his name.  Epley had been in involved in trials on the first cochlear implants in the 1960s, so he was far from a quack whose theories could be easily dismissed.  Yet they were, by mainstream medicine.  Francis continues:

“Surgeons whose livelihoods were bound up with recommending expensive procedures for BPPV were skeptical, and the fact that Epley had been holding vibrators to patients’ heads allowed them to label him a crank.  He was laughed at in conferences, accused by some as unfit to practice.  His maneuvers were perfected in the early 1980s, but it took a decade until his harmless, effective, medication- and surgery-free treatment for positional vertigo was published in a journal respected by his peers … It was more than a decade after Epley published his findings that i first heard of the sequence and gave it a try.  Epley reported a 90% cure rate in his Orgeon clinic: the results could be just as astonishing when I began to use it in Scotland.”

piece de resistance

“Why did a treatment so simple, risk-free and effective take 10 years to be reported int he medical press?  It’s wrong to assume that doctors are rationalists, that the medical gaze is as emptied of bias and as open to new ideas as the best science aspires to be.  Physicians are just as prone to prejudice and protectionism as professionals in any other sphere of life – it’s just that we rightly hold them to higher standards.”

Bravo, Dr. Francis.

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