published 8/28/04, updated 10/08/09

Smarter and Funnier

Publication standards for SaveYourself.ca and why you can trust the information published here

by Paul Ingraham, Vancouver, Canada MORE
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Credentials and qualifications

I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.

For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.

Health information is the largest category of online self-help … and much of it is obsolete and sloppy. I want to publish a website that offers better quality information to consumers than is generally available. On the one hand, nothing could be easier: online health advice is such a mess that I can “do better” with practically no effort at all. On the other hand, it’s never enough for me to just hop over a low bar: I want to offer something a lot better, both heavily referenced and substantive, and as entertaining as possible. Smarter and funnier.

In a nutshell, here’s why you can trust the information published on SaveYourself.ca:

What would Adam & Jamie do? You know, if they were doctors?

I’m inspired by the MythBusters approach: I question everything and I have fun doing it. (No explosions, alas.) I love how they are relentlessly rational and assertive, yet polite and decent and amiable. I met Adam (very briefly) in 2009, and he seemed like a tremendous gent. Incredibly, I had never seen his show before. After watching just a few episodes, I realized that there’s a bizarre similarity between their show and my website: this is how I write.
I assume that anything that sounds too good to be true probably is. Because I cannot remember the last time something that sounded too good to be true actually was true. Just doesn’t happen.
I make no big promises and offer no miracle cures. The pain problems I write about are tough. There almost always options that patients and professionals aren’t aware of. But miracle cures? Definitely not.
I keep it real, dude. I do not claim to the know the one true cause of pain, like seemingly every other alternative health “professional” on the internets.
Minimal conflict of interest: I am not selling a treatment system or my own services.
I’m charmingly candid. I like how mysterious and unknown it all is. I say “I don’t know” when I don’t know and I say “I’m guessing” when I’m guessing.
And — crazy thing — I actually read scientific journals, I cleary explain the science behind every key point I make, I link to the original sources so you can check them yourself. More about sourcing below.

Some of my favourite sources

I spend a lot of time on PubMed, and I cite from the best sources whenever possible, like The Cochrane Collaboration and The New England Journal of Medicine and PLoS Medicine.

So the two most important things about SaveYourself.ca are:

Having a sense of humour
Citations up the wazoo

Both are critical to credibility. Both are critical to health care. And they really do go together. That’s what the rest of the article is about: SaveYourself.ca is smarter and funnier.

Funnier? Seriously?

Seriously funnier, yes! The single most desperate pain client I have — a woman with a terribly painful disease — is also one of the funniest. We laugh through every appointment. Sometimes we have to stop working we’re laughing so hard. Why? Because, if you can’t laugh, you’ve got nothin’. It’s the only sane response to an insane world and a harsh life.

Dr. Patch Adams

Dr. Patch Adams, portrayed by Robin Williams in the film Patch, has tried and failed to convince the world that health care should be as personal and as much fun as possible — that laughter and a light spirit are healing. He has spent his career trying to reform the American health care system and basically make it, in a word, friendlier. Unfortunately, he has largely been ignored, thanks to the juggernaut-like character of Big Medicine in that country.

But he convinced me.

Most health care and health care publishing is conspicuously lacking in a sense of humour. In my opinion, this is not a trivial matter — it is actually tragic, a clear and present danger. This is not an easy case not make. In a world full of tragedies, it barely even registers.

The absence of a sense of humour in health care is actually tragic, a clear and present danger.

But it does matter to people who are injured and suffering from chronic pain. It matters to people who are trying to get good information in a health care system virtually devoid of personality, common sense, or straight talk. A sense of humour is absolutely crucial to good communication. I would argue that you almost literally can’t help people without it.1

It’s not that hard to see why a sense of humour matters to patients in pain. But why, exactly, being funny important to credibility?

You should never trust anyone who isn’t cynical: they aren’t paying attention to the world. Someone who isn’t cynical has their head in the sand.

Similarly, you should never trust anyone who doesn’t find things amusing. More obviously: you can’t trust anyone who takes everything too seriously. The irreverence of a good sense of humour is critical to seeing through crap. The problem with most really awful people in this world is that they don’t have a sense of humour and are taking something, probably lots of things, entirely too seriously: skin colour and sexual preference jump to mind as excellent examples.

You can trust me because I find my subject matter amusing. From the get go, I wanted SaveYourself.ca to be fun and funny. Not a scream, mind you, not a knee-slapping good time — it’s not a comedy website, and there’s only so much fun we can have talking about your tendons — but definitely light.

And so throughout this site you will find expert opinion delivered with an irreverent twinkle in the eye.

Now, let’s seriously get serious: the internet really is a terrible place to get health care information

Science and health are corrupted by markets. Advertising — both deliberate deception and crafty propaganda — play a far larger role in people’s lives than science. Selling stuff that people want (because they've seen the ads) takes precedence over the provision of what they need.

Dr. Jonathon Tomlinson, MBBS, DRCOG,MRCGP, MA, The Lawson Practice, London

Really, you can’t believe how bad the situation is. Not only are there the obvious hazards of quackery and snake oil salesmanship,2 and of well-intended but hopelessly sloppy amateur publications, but the appalling proliferation of obsolete conventional wisdom, what I call the “misinformation explosion.”

One would think, and one would hope, that most information published by doctors is reasonably reliable. One would be wrong! Virtually all information about musculoskeletal health care online is hopelessly inadequate, regardless of the credentials of the author. Not only is it dry and boring and usually poorly presented, it has several severe, common deficiencies:

No references to scientific literature at all in 90% of credentialled authorship, or sketchy references that, when checked, prove to be entirely irrelevant or poorly interpreted.3

One would think, and one would hope, that most information published by doctors is reasonably reliable. One would be wrong!

Obsolete information, hopelessly out-of-date recitations of conventional wisdom that read like they were copied out of a 15-year-old textbook, completely ignoring at least a decade of recent scientific research.
Brief, shallow articles with nowhere near enough detail about complex subjects that literally cannot be understood without more information.
Glib overconfidence, offering false hope, and general failure to acknowledge the limitations of medical knowledge or curative ability, usually due to the fact that the author is publishing for the purposes of selling a product or himself.
Irrational conclusions that constantly reveal that the authors simply aren’t good at their jobs.

That last one sounds like I might be on the verge of frothing at the mouth with arrogance — which could well be another flaw we should add to the list! Unfortunately, I refuse to ignore the evidence before my eyes. I call ‘em like I see ‘em, and I do not suffer fools gladly.

General practitioners are exceedingly poorly educated in musculoskeletal health care, something that has been proved by other doctors,4 yet they often publishing their unsubstantiated opinions anyway. Even highly educated medical researchers are unnervingly prone to basic logical errors, such as mistaking correlation for causation, as in this thoroughly explored example. Countless “expert” writers have demonstrated their inability to put two and two together. Many experts just aren’t actually all that expert!

I refuse to ignore the evidence before my eyes: I call ‘em like I see ‘em, and I do not suffer fools gladly.

The exasperating reality is that most health care professionals weren’t at the top of their class. I graduated with several people who were not ready to be therapists, in my opinion. All of them failed their certification exams on the first try — indeed, at least a third of my class failed on the first try — and some of them failed the 2nd and 3rd. While that does not necessarily mean that they are bad therapists now, many of them probably are. If they didn’t understand basic concepts when they graduated, I doubt they’ve picked it up since then.5

Therapists have considerable responsibility, and need to be smart, literate, highly competent professionals — not just earnest and compassionate, that’s simply not good enough. Consider this example: I recently received an angry letter from the president of a prominent chiropractic organization who misspelled “professional” three different ways, and misspelled “cervical spine” as “cervicle spine” three times. The former I might be able to chalk up to sloppy typing … but “cervicle”? Come on! If there is one word in the entire medical dictionary that a chiropractor should be able to get right, it’s “cervical”! It has disturbing implications for his competence. What else doesn’t he know?

And so on. And on and on.

I try to do much (much) better when publishing on SaveYourself.ca. Here is how …

Self-imposed standards?

As far as I know, there is no certification process for health care information on the internet, nor even an peer-endorsed standard to which independent publishers can voluntarily adhere. Therefore, I have a ethical obligation to set a high standard for myself. These are my publication standards:

Authorship is always identified, and my biases and credentials as a practicing massage therapist are clear and acknowledged.
Promotion of my services is separated from health information. No article recommends my services specifically, and massage therapy is never exclusively recommended.
Evidence is provided for all relevant or potentially controversial claims. More and better evidence is provided for claims that are more extraordinary.
Evidence is offered in the form of references to publications in peer-reviewed scientific journals. The relevance and quality of the evidence is discussed. Randomized and controlled studies with larger sample sizes are preferred. Whenever possible, direct links to articles or abstracts are provided to facilitate the reader’s ability to check my references.
When evidence is not available or of questionable quality, this is noted. Opinion is acknowledged as such.
An attempt is made to acknowledge uncertainty and alternative viewpoints.

I have improved my publication standards over time. Some older articles on the website still do not meet all of these standards, but are being upgraded just as fast as I can type, and I’m catching up. All new articles for at least two years now have met or exceeded these standards. Fortunately, I must be doing something right. This website has been endorsed repeatedly by just the sort of people I would like to impress: scientists, doctors, and scholars. Dr. Tomlinson once again:

SaveYourself.ca is an excellent (and rare) example of good quality health care information on the internet. It deserves special mention for its transparency, evidence base, clear presentation, educational content, regular documented updates, and lack of any commercial promotional material.

Dr. Jonathon Tomlinson, MBBS, DRCOG,MRCGP, MA, The Lawson Practice, London

I know I’m doing something right when you get a compliment like that.

A (brief) case for universal standards (briefly)

This is not going to be all that funny. I get a little academic here. Honestly, this section is really only intended for a (ridiculously small minority) of curious professionals.

The web needs publication standards for health care information.

The public could be well-served by a certification process in which documents are reviewed by accredited health care professionals for compliance with some kind of publication standards. It is not reasonable, practical or desirable that these standards be as high as those for peer-reviewed scientific journals. Somewhat like certification of organic food, the standard should be just sufficient to guarantee that information is not “tainted” with profit motives, unsupported claims, and other flaws that pose a threat to the public.

The intention is not, of course, to regulate all health care information, or the internet, or even to make it difficult for health professionals to publish their opinions — even in scientific publications, opinions are acceptable, as long as they are identified as such. Rather, the goal is to educate information consumers and give them a choice between publications that do or do not meet a modest standard.

A certification standard for health care information should be just sufficient to ensure that it is not “tainted” with profit motives and unsupported claims.

The strength of the internet is in the diversity of information available, and I would never want to see even the most obscene abuses of the medium suppressed — I have always believed that one of the great advantages of free speech is letting people make asses of themselves if they wish. What I do want is for misinformation to be seen in stark contrast to better, certified information, so that irresponsible publishers can be identified for what they are.

Notes

This opinion was also deeply influenced by the work of fun, rebellious psychiatrists Bennet Wong and Jock McKeen on Gabriola Island (Canada), whom I am honoured to know personally, and child psychologist Joann Peterson of Bellingham, Washington (recently deceased). All three taught me that being fun was a health care philosophy. See Haven for more about their life’s work. Return to text.
QuackWatch, and several related sites, have been documenting literally thousands of scientifically bankrupt health products and services for decades now. The sheer volume of material reported on is overwhelming. Quackery is a gigantic business. Return to text.
See Bogus Citations: References to “scientific evidence” are routinely misleading. Return to text.
Most doctors are well aware that there are serious shortcomings in the medical management of most musculoskeletal problems, especially chronic pain cases. Dr. Jonathon Tomlinson, an instructor at St. Leonards Hospital in Hoxton, explains that “undergraduate training is focused on hospital orthopedics (broken bones and anything else that’s amenable to surgery) or rheumatology (nasty inflammatory diseases) which comprise a minority of the aches/pains/strains and injuries that people actually suffer from.”

Medical researchers have done many studies showing that most doctors do not understand aches and pains or heed expert recommendations. A good recent example is a paper in the Archives of Internal Medicine showing that family doctors frequently ignore guidelines for the care of low back pain — see Williams et al.

More generally, the Journal of Bone and Joint Surgery, and the Journal of the American Osteopathic Association, have both published papers recently showing that physicians simply do not have an adequate understanding of musculoskeletal medicine. In 2002, Freedman et al felt that “It is ... reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.” Then again in 2005 in JBJS, Matzkin et al concluded that “training in musculoskeletal medicine is inadequate in both medical school and non-orthopaedic residency training programs.” Most recently, in 2006, Stockard et al wrote “82% of allopathic graduates ... failed to demonstrate basic competency in musculoskeletal medicine.”
Return to text.
It’s important for patients to understand that even the best therapists are simply not that well-trained, period. This is discussed more in the article Therapy Babble: Another warning sign of therapy of dubious quality. Return to text.