blog post #392
Why so negative? Why am I so full of bad news about treatment options for things that hurt? Shouldn’t I be a cheerleader instead of a curmudgeon? This is the most common gripe I get from SaveYourself.ca readers. Here’s a typical example from YouTube, where the comments are particularly articulate. I'm not making this up.
i think its so wrong to give out all that nagative response to people who are in pain and desperate for a cure an d some pain relieve! lots of us have't got loads of money to go and see expensive physios! every week! so why don't you get some bonfide people on a video and show us your miracle cure? or your going to share that to the good of man kind.... naarrrr didn't think so.!
(Many such complaints come from people selling treatments and therapy for a living — a coincidence, I’m sure.)
On March 26, I answered accusations of “nagativity” from an ethical perspective. To recap, it’s the sad truth that the world of pain therapy is unusually polluted with bad ideas, and pain patients deserve either better treatments or, failing that, at least better information. So even if a health myth is relatively harmless, I’m still going to bust it. It’s an honour thing.
Today I will answer from a scientific perspective. This won’t hurt a bit. In fact, there’s “nothing” to it.
That pun will make more sense by the end of this. Come back to groan at it later.
Cynicism is baked deep into science. No one can possibly study the history of science — especially medical science — without becoming super-duper cynical. There are so many strange ideas that have been believed for such outlandish reasons and with such caustic consequences that you can get whiplash switching between laughing and crying. The number of nakedly evil scams alone is just gobsmacking, but it’s dwarfed by the earnest delusions!
Sobering indeed, then, to realize that the treatment of pain is a bit of a medical backwater (see A Historical Perspective On Aches and Pains). While we’ve made huge strides on other fronts, pain treatment has languished in an almost primitive state.
At the heart of every scam and delusion is a medical idea: a notion about what would help and why … which turned out to be wrong. So many strange ideas that have been believed for such outlandish reasons and with such caustic consequences that you can get whiplash switching between laughing and crying.And how many medical ideas in history of medical brainstorming have turned out to be worth a damn? Almost none. Maybe 1%.
Indeed, almost all the ideas that we humans cook up about anything at all are flawed and turn out to be wrong. People are wrong-answer-generating machines. But we’re especially prone to wrongness in medicine, because disease and pain and suffering are so complex and scary. It’s all too easy to be wrong when you’re desperate.
It is the business of science to check those ideas carefully. And wrongness is so incredibly common that scientists have learned (the hard way) to just assume that an idea is wrong until proven otherwise. In 1935, that cynicism was given a name, which stuck and became An Official Science Thing. Ronald Fisher, a British geneticist, called it the null hypothesis — the assumption that an idea will amount to nothing when carefully checked.
The null hypothesis is basically cynicism wrapped up in a lab coat.
People had been noticing that most ideas crash and burn when tested long before it became a requirement of the scientific method. I was always naturally inclined towards the null hypothesis. I was often its champion, defending it from believers in untested ideas, before I’d even heard of it.
The null hypothesis is extremely powerful. It’s the winning hand. It’s the safe bet. Because most of the ideas humans cook up are deeply flawed, betting against them is where the smart money is, and betting against the null hypothesis is just throwing your money away. When in doubt, always pick the null hypothesis. Like a casino, it usually wins.
I’m starting to really groove on the elegance of the null hypothesis. It’s as pretty as Occam’s Razor. In fact, they’re cousins. Occam’s Razor says “bet on the simpler explanation.” The null hypothesis is the default “simpler explanation” — namely, that nothing significant is really going on here.
The legal principle “innocent until proven guilty” is reflected and reversed in the null hypothesis: treatments should be considered useless until proven effective. The burden of proof is on the pusher of the idea, and it’s a heavy burden. Treatments must work well and clearly to actually beat the null hypothesis. They must impress.
When a treatment is truly shown to be effective, it’s exciting! It makes headlines, and it should. But it’s also incredibly rare.
The null hypothesis is formidably reliable … but common, unsexy, and “negative.” It wins all the time, but it doesn’t make headlines doing it. Being the champion of sobering reality is a major drag, and the bane of my existence as a writer in this field. Do you think MythBusters would be popular busting myths without explosions? If it was mostly just a show of null hypothesis confirmations? Yaaaaawn.
Without explosions, one way tart up the triumphs of the null is to frame them as “debunking.” The comeuppance of a claim is always a source of minor thrills. Fortunately, because the null is so often confirmed, I get lots of chances to debunk.
People are constantly claiming premature victory over the null hypothesis. If a therapeutic benefit is so tenuous that it hangs on debates about p-values and effect sizes, then either it doesn’t exist at all, or it’s so trivial that it doesn't matter if it exists! And yet based on mere scraps of encouraging evidence, the believers will cry, “Eureka! It works!” And it makes headlines.
Not so fast.
This happens so much, and so egregiously, that it seems like the null hypothesis has almost been forgotten by a lot of modern researchers. Researchers should, in a sense, actually set out to prove the null hypothesis. As Cory Blickenstaff, Physical Therapist, put it, “Not doing so means you are trying to prove your pet theory, and in comes Mr. Bias.” It is clear that Mr. Bias has moved in and taken over a lot of research projects! In fact, this is a major point of one of the most famous scientific papers in recent history, by John Ioannidis, “Why Most Published Research Findings Are False.”
The need to contradict this kind of nonsense is (literally) my full-time job, and the number one reason that I am “so negative” — because I am honour bound to point out that the null hypothesis probably has not been defeated.
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