I have been studying and weighing the pros and cons of treatments for many years now — every imaginable way of helping all kinds of pain problems and chronic injuries. Always, the most important question to ask is, Does it work? But that can be hard to answer … and there are some other reasonable questions. The choice boils down to the same handful of priorities over and over again: even if it isn’t proven, does it at least make sense? Is it safe? Cheap? Reasonably convenient?
Many unproven treatments get a pass this way: they might not work any miracles, but they are still effective, safe, and/or cheap enough to be “worth a shot.”
And then there’s the ones that probably aren’t …
Many treatments are quite dubious (implausible), or particularly distracting (time consuming, costly), or somewhat dangerous … or even all of the above. This Venn diagram illustrates the intersection of these considerations.
Pain is often a tough problem, and there are no perfect treatments for it. The diagram aims to illustrate the concerns that we should juggle — not just knock everything.
The worst possible treatment would score strongly on all three Ds. Fortunately no common pain treatments are quite that bad, but my examples all have problems — at least two Ds, to some degree — that are often denied or ignored by the people selling and using them. And yet many of them are widely available, popular, packaged and promoted attractively and aggressively.1 And many of them come from giant, greedy industries. Supplements, for instance, are nearly as big an industry as pharmaceuticals, and amazingly unregulated.2 Make no mistake: selling false hope is big business.
Dubious treatments require your mind to be so open that your brains fall out. Some may be hopelessly at odds with solid science or even logic. Or they may be too good to be true, supposedly good for “all pain” and other delusions of grandeur. Many started out as “a good idea at the time,” but have simply not panned out — either don’t work at all, or not well enough to take seriously.3
When people innocently ask “what’s the harm?” there are usually answers they’ve never thought about.6 “Natural” is not always good, and often it isn’t even safe.7 By definition, anything that actually has any effect can also have too much of an effect, and some treatments are just inherently more hazardous. Bizarrely, history is actually packed with examples of popular but extremely dangerous treatments.8 There are also serious underestimated risks in the delicate business of treating chronic pain — pain-wracked nervous systems may respond very poorly to “intense” therapies and fear and worry.9
Classic examples: a variety of unusually intense manual therapies, such as high velocity spinal adjustments or really strong massage, like old-school Rolfing and other “deep” styles. Many medications involve well-known and significant risks, of course.
Distraction is another kind of danger, but I set it apart because it’s the one people tend to forget about, and it encompasses a wide range of non-medical hazards, particularly the hazard to your wallet and your schedule. People will tell me they’ve “tried everything,” but when we break it down it turns out they’ve really only made an investment in, say, five things — three of them were expensive, dangerous and/or dubious, while the fourth actually interfered with the only good choice of the bunch, leaving the patient broke, frustrated, in more pain than ever, and believing that their problem is too difficult to treat. This is a bad situation — and tragically common. “Distraction” can be serious, even lethal.10
Classic examples: strengthening is common distraction,11 one of the more common forms of the wild goose chase to achieve postural and structural correctness — often taking a great deal of time and money that could have been much better spent.12 Stretching is another time-consuming and mostly useless approach to fixing pain problems.13 Chiropractors are legendary for selling long, expensive treatment plans.14
Each example represents a particularly strong combination of two of the three D’s. It’s not an exact science.
Not all of the examples are condemned as entirely useless — such treatments would belong at the heart of the diagram! I deliberately chose not to include examples that probably do belong there, because the diagram is not the answer, but the importance of the question.
Alternative health care has an undeserved reputation for being harmless and wholesome. In fact alternative medicines and treatments are just as full of hazards and risks as medical care, yet with virtually no proof of efficacy or regulation. While many other skeptical websites focus on the question of efficacy, WhatsTheHarm.net is devoted to cataloguing the costs of alternative health care: the many lives ruined and even lost.BACK TO TEXT
The colorful history of medicine and quackery is overflowing with people who “swore by” treatments that were bizarre and perilous. Bloodletting was popular almost until the 20th century, despite being relentlessly harmful. Some of the most lethal “cures” in history were inspired by the discovery of radiation. People happily drank metals like mercury and silver. Even drinking urine had near fad status for a while! They tried to purge disease with sulfuric acid, and stimulate their vitality (and virility) with powerful electric shocks. Women were sold Lysol as a douche … and women actually went along with it for a while. Voluntary lobotomy may be the craziest of them all: it was a popular treatment for all kinds of psychiatric disorders, and at least fifty thousand people volunteered to have their brains lanced.
All of these terrible treatments, and many more obscure examples, had many fans and enthusiastic testimonials. People paid for them, believed in them, loved them, swore by them — that is how misleading testimonials can be. People believe what they want to believe.BACK TO TEXT
This experiment tested the effect of ibuprofen on hard-core marathoners. There were 29 ultra-marathoners on high doses of ibuprofen and 25 controls that completed the race without meds. There was no measurable difference in muscle damage or soreness between the two groups. Lead researcher David Niemen: “There is absolutely no reason for runners to be using ibuprofen.”
For some good mainstream journalism about this research see Convincing the Public to Accept New Medical Guidelines, by Christie Aschwanden. For a good plain language tour of the topic in a major medical journal, see Warden.BACK TO TEXT