Or see the help page for answers to common customer questions.
Please, never hesitate to (politely) tell me that you think I got something wrong (heck, I know it’ll be popular if I admit it). Here is good example from my mailbag. Reader TW thinks “measuring force in pounds is a disgrace for your books.” I agree. He continues:
Your audience is probably quite international — which is where the SI system of measurements is used. As far as I know, it is at least taught in science classes in the United States and Canada as well. The SI system is clearly superior! As you advocate clear thinking, I would love to see if you use SI measurements primarily. The Imperial system is outdated and only used in North America.
Officially, Canadians are on the metric system. Unofficially, we often still do as the Americans do. Some metric measurements we have adopted wholeheartedly, like the kilometre. But most Canadians still give their height and weight in feet, inches, and pounds. I entirely agree with the criticism, and I’ve done a round of conversions, particularly where most needed. I can’t promise there aren’t some Imperial strays — it’s a really big website — but it’s much improved.
The Painful Quotations page now has an even 200 quotes about aches, pains, injury, therapy, and science and critical thinking. There are many more to come over time. When I realized it was close to 200, it was virtually effortless to dig through my files and boost it up to that nice round number.
I have really noticed this in my publishing career: self-effacing mea culpa blog posts are always super popular... but I routinely get vilified for (correctly) calling bullshit. (This suggests an effective strategy for blogging success: be wrong a lot, admit it a lot!)
It’s easy to win forgiveness for being wrong; being right is what gets you into real trouble.
I recently got a question about the value of FAST (“focused aspiration of scar tissue”), a minimally invasive surgical treatment for tendinopathies like tennis elbow or Achilles tendinitis. According to one doctor’s press release, it’s “advanced technology” — of course! — “designed to remove the source of tendon pain.” Good luck finding any other kind of information about it. There are no clinical trials of FAST. It seems to just be tendon scraping (debridement, if you want to be more formal). The mechanism is unclear, obviously speculative, and based on the rather simplistic notion that one can “remove tendon scar tissue” or “diseased tissue” from tendons to solve the problem. Bad tissue is bad! MUST CUT OUT. I also saw a number of references to “stimulating” recovery, which is quite a different idea (see Tissue Provocation Therapies).
Giving it the benefit of the doubt: maybe it can work on some kinds of patients. Tendinopathy develops in stages, and in the degenerative later stages there might be something to scrape away, for whatever that’s worth. Or not, because degenerative tendinopathy is mostly characterized by a kind of withering of the tendon (acellularity and disorderly connective tissue), and not by anything that can be removed. And in any event “there is little capacity for reversibility of pathological changes at this stage” (Cook 2009). Many cases never get that far in the first place and wouldn’t be candidates even in principle, since they involve little or no obvious “diseased tissue” in the first place, and even if they do it’s almost certainly a symptom of tendinopathy, not the cause of it. So the whole idea of a treatment based on the removal of tendon crud is dubious.
There’s a never-ending supply of minimally invasive procedures for stubborn musculoskeletal problems, like platelet-rich plasma (PRP), which has probably reached peak hype by now. They are easy to sell, because they sound simultaneously impressive but still quite safe. They can be potent generators of false hope and drainers of wallets, and they are all highly suspect for this reason. But FAST seems more desperately in need of some proper testing than most.
I am often mistaken for an “expert,” but no, not in my subject matter: I am merely well-acquainted with the work of many actual experts. I’m a liaison, translator, and popularizer. I’m good at that, and it’s good work if you can get it. Many of the actual experts are also acquainted with me, and they follow and check my work. These days, I can be confident that if I get anything too far wrong, I’ll hear about it from a source I can trust. But the only thing I am truly expert at is the craft of writing and web publishing … and even in that I am humbled by the achievements of others, of course.
“I skipped class to read your book.”
That has to be one of the best mini-testimonials I’ve ever gotten. It was regarding my muscle pain book.
But seriously kids, stay in school.
Unless school is teaching pseudoscientific bollocks. In which case, you probably should stay home and read one of my books. Or watch Cosmos or something.
I first wrote about the Functional Movement Screen™ (FMS) in 2011, mostly hype-griping: “I think the marketing cart may be in front of the research horse.” It particularly rankled me that FMS was (and still is) being mis-used by many practitioners as a way of diagnosing allegedly dysfunctional movement as the origin of injuries and chronic pain, which over-reaches its intended purpose in a crassly self-serving way. FMS promoters were making claims about a “growing body of research,” of course, but it wasn’t yet persuasive to me back then … and maybe things have gotten worse.
A summer 2014 paper by Whiteside et al echoes my original concerns, but with data. The researchers focussed on the accuracy of FMS grading in particular: “virtually no investigations have probed the accuracy of FMS grades assigned by a manual tester.” So they probed it! They compared “the FMS scores assigned by a certified FMS tester to those measured by an objective inertial-based motion capture system.” Alas for FMS, the results were “poor,” which is exactly what I’ve been betting on all along.
Manual grading may not provide a valid measurement instrument. The levels of agreement between the two grading methods were poor in all six FMS exercises. It appears that manual grading of the FMS is confounded by vague grading criteria.
The discussion section of the article is detailed, readable, and full of ominous understatement. “Dubious grading presents a concern for FMS clientele,” they write. They graciously allow that, with better objective criteria, FMS grading might “improve to acceptable levels.” I’m shocked, simply shocked, to learn that FMS practitioners might be a tad overconfident!Meanwhile, FMS testers are officially encouraged to aim for lower scores when in doubt, but in this test, even under scrutiny, apparently they didn’t have much self-doubt, consistently scoring “0.54 points higher than the IMU system.” (I’m shocked, simply shocked, to learn that FMS practitioners might be a tad overconfident!) The authors also point out that FMS has not only failed to reliably forecast injuries, but all FMS predictions may be “a product of specious grading.” Which is hardly surprising, since FMS fails to take into account “several factors that contribute to musculoskeletal injury.” These concerns must be addressed “before the FMS can be considered a reliable injury screening tool.”
Clearly more research is needed — of course! Naturally! But it’s worse than that:
The high potential for subjective and/or inaccurate grading implies that standard procedures must be developed before FMS performance and injury rates can be conclusively studied.
Before it can be studied. They seem to be saying that not only is the cart is still in front of the FMS horse, the horse may now be falling well behind. FMS research so far may be a bit of a write-off, because it can’t inform us without better criteria, and everyone should probably just go back to the drawing board and try again. Which suggests that my article about FMS is still reasonably sound after three years without an update.
In my main acupuncture article, I make the case that acupuncture as we know it is basically a modern invention and “not so ancient after all.” A reader politely complained to me that there were indeed needles and meridians and points in ancient Chinese medicine, and therefore acupuncture is ancient. Is there anything to that criticism?
Not really. There were some recognizeable antecedents to the modern forms of “points” and “meridians” and “needling.” However, they were so different that there is no meaningful continuity between them. David Ramey (see “A true history of acupuncture”) elaborated on this for me via email:
There is nothing from the time that describes what was actually done. When we have descriptions and pictures, it shows something wildly different from modern acupuncture. And, yes, the ancient Chinese used “needles.” The first written description of the needles was that of ten Rhijne, which showed that the needles were large awls that were pounded in with a hammer. I have a Japanese picture from the early 1600s that showed that the “needles” were lancets and hooks (not needles). And, yes, there were channels (“mai”). The points didn’t necessarily rest on the channels, and there were all sorts of different channel maps. But all this eventually turned into today’s mostly French interpretation (Soulie de Morant).
Ergo, modern acupuncture is its own thing, and ancient practices were clearly something else. Calling acupuncture “ancient” is like saying scientific medicine is ancient wisdom because the Greeks got the ball rolling 2500 years ago.
“The smell could almost be heard.”
That image refers to a child’s rotting leg — rotting because of the incompetence of traditional Chinese medicine, as described in The Reality of Ancient Wisdom, by Dr. Harriet Hall.This article is essential, morbidly fascinating reading. I didn’t think I could get any more cynical about ancient folk medicine. I was wrong! Dr. Hall packages up a few excerpts from an old book by a physician working in China in the late 19th Century. His matter-of-fact reports of the actual medical habits of the Chinese at that time are chilling, and a harsh reminder that traditional Chinese medicine was not wise and profound, but rather cringe-inducingly horrible, just as brutal and bizarre as any pre-scientific European “medicine.” In particular, the stories concerning acupuncture expose a mess of superstitious and vicious excess. Bloodletting was the tip of the iceberg. Little wisdom is possible in a state of profound ignorance.