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published May 1, 2009, updated 12/14/09

SaveYourself.ca Reading Guide for Skeptics

A tour of SaveYourself.ca features and resources for readers who have doubts about the efficacy of popular treatments in alternative health care, especially manual therapies like massage therapy and chiropractic

by Paul Ingraham, Vancouver, Canada MORE

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.

Were you at TAM7 in Vegas? So was I! And I wrote a lot while I was there. See My Brain is Tingling! A comedic diary of my experiences at The Amazing Meetin’ 7 and the Science-Based Medicine conference in Las Vegas, July 8–12, 2009.

This document introduces SaveYourself.ca to my favourite audience: skeptics. Skeptics should feel at home on this website. I am a card-carrying skeptic myself, literally — I am member of the James Randi Educational Foundation,1 and I have a card! I recently attended my first Amaz!ng Meeting — the world’s largest critical thinking conference. I also attended the science-based medicine conference that preceded it, and was honoured and greatly educated by several conversations with physicians like Dr. Steven Novella.

But you’re a massage therapist! Aren’t scientifically questionable claims common in massage therapy?

According to Dr. Stephen Barrett of QuackWatch:

Ordinary massage and the legitimate practice of massage therapy should not be categorized as quackery. Massage can help people relax, relieve aching muscles, and temporarily lift a person’s mood. However, many therapists make claims that go far beyond what massage can accomplish. And even worse, massage therapy schools, publications, and professional groups are an integral part of the deception.

Massage Therapy: Riddled with quackery

I realized early that I had joined a profession that was not dominated by critical-thinking rationalists. To this day, I struggle emotionally with whether or not I should stay in the profession as an advocate for reform, or just move on and wear my “science journalist” hat full-time.

Update: I no longer struggle with that decision. I made it. I closed my massage therapy practice January 1, 2010, to devote myself full time to science writing.

Skeptism about physiotherapy, chiropractic, massage therapy, and other professions that deal with aches and pains and musculoskeletal health

Unscientific practices in massage therapy may not have a “body count” like some other kinds of alternative health care,2 but they may be just as harmful to your pocketbook, and they may distract you — for years, maybe even forever — from effective, science-based care.

Finding science-based care for injuries and pain problems can be difficult for patients. There are many intellectually immature and pre-scientific ideas3 in musculoskeletal health care. And yet many of them are repeated ad infinitum by all kinds of professionals.

For instance, Physician Richard Deyo of Seattle has spent most of his career publishing in distinguished medical journals trying to educate his colleagues and slay several myths about low back pain that, zombie-like, just won’t die.4 In 2001, the infamous Philadephia Panel published a series of articles that were deeply critical of common practices in mainstream physical therapy.5 And many professionals, lacking training in formal logic and science, routinely confuse correlation with causation,6 with significant consequences. And so on.

I found it impossible not to notice these glaring issues during my training and ever since. I also find writing about them irresistable!

Many ideas in my field remain, to this day, completely unsupported by any research — that the science simply has not been done yet. Musculoskeletal science is basically in its infancy.

Disclaimer: you might stumble on some woo on this website

Forgive me, and let me know, if you stumble across anything “pre-scientific” on SaveYourself.ca. It’s a big website, and I started writing it years before I embraced skepticism. There is probably old writing hanging around that I no longer agree with — it’s hard to keep well over a million words of content fully consistent with my current views.

What skeptics should read on SaveYourself.ca

Here are my hand-picked articles for skeptics. Have fun!

1. SY
    My Brain is Tingling! — A comedic diary of my experiences at The Amazing Meetin’ 7 and the Science-Based Medicine conference in Las Vegas, July 8–12, 2009
2. SY
    Does Chiropractic Work? — Notes from a science-minded massage therapist who gets asked about it every day. (This article generates more angry mail than any other article on SaveYourself.ca — a must-read for all skeptics!)
3. SY
    Smarter and Funnier — Publication standards for SaveYourself.ca and why you can trust the information published here. I try to make SaveYourself.ca about 800% better than most health care information on the web. Here’s why, and how.
4. SY
    Alternative to What? — “Alternative” health care professionals need to decide what they are really the alternative to. This article expresses what I think alternative health care should be, as opposed to being an unscientific substitute for medical care.
5. SY
    Does Acupuncture Work for Pain? — Evidence now clearly shows that acupuncture can’t help people with common chronic pain problems, especially low back pain and neck pain. Hot off the press! I’ve only just recently weighed in critically on the subject of acupuncture.
6. SY
    Does Massage Therapy Work? — An overview of the science of massage therapy … such as it is. A little out of date now, but still a good overview of the issues.
7. SY
    Extraordinary Claims — A guide to critical thinking, skepticism and smart reading about health care on the web.
8. SY
    Quite a Stretch — Stretching research clearly shows that a stretching habit isn’t good for warmup, injury prevention, preventing or treating muscle soreness, enhancing athletic performance … or even flexibility!. This is SaveYourself.ca’s original “controversial” article. Stretching was the one of the issues that got me writing.
9. SY
    Do Epsom Salts Work? — There is (still) no good reason to believe that Epsom salt baths aid recovery from muscle pain, soreness or injury. Hardly the most controversial article I’ve written, but this is the single most popular article on SaveYourself.ca. This seems odd to me. I really have no idea why so many people are searching for information on Epsom salts, but they do, and they land here.
10. SY
     Your Back Is Not “Out” and Your Leg Length is Fine — The story of the obsession with crookedness in the physical therapies. This is my thesis, the “big idea” of my career, my pet issue …
11. SY
     Does “Lose the Back Pain” Actually Help Low Back Pain? — A review of the popular low back pain treatment system. Nothing irritates me more than bad information about low back pain. In this rather harsh review, I strongly criticize a prominent product.
12. SY
     Buyer (of Therapy) Beware — All other things being equal, always choose the cheapest and most comfortable therapeutic option for your pain problem — a vital basic consumer advocacy principle.
13. SY
     “I Have Been Humble For Two Decades Now” — A disturbing example of arrogant and addle-brained alternative health care, based on an encounter I had with a therapist with an extremely specific theory about the origin of “all pain.” One hint: it’s in your foot, apparently.
14. SY
     Battle of the Experts — A guide for patients caught between conflicting diagnoses and prescriptions. What are health care consumers to do when experts disagree? Disqualifying some of the “experts” as poor sources is a good start!
15. SY
     Water Fever and the Fear of Chronic Dehydration — Do we really need eight glasses of water per day? A profile of one of the most irritating and persistent bits of unscientific health advice under the sun.
16. SY
     The Power of Avogadro Compels You! — James Randi defies death by poisoning and explains how the mathematics of dilution make homeopathy look 10X more silly than it already did. I wrote this one after seeing James Randi speak in Vancouver early in 2009. What fun! Thanks, Mr. Randi!
17. SY
     Therapy Babble — Another warning sign of therapy of dubious quality. More curmudgeonly skeptics will enjoy this ranty little article … plus the fantastic comic strips from Cectic.
18. SY
     SSRI Antidepressants Are Not Medicine — Frightening side effects, cover-ups on the record, and no reason to believe they do what they are supposed to. SSRIs are a pet issue of mine, and a great example of how unscientific medicine doesn’t happen only in so-called alternative health care.

Recommended Resources for Skeptics

With a bit of an emphasis on skepticism about health care in particular, but also some of the classic general sources like the JREF, SGU, Skepchick and Snopes…

• What’s the Harm? (http://WhatsTheHarm.net/)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.
• 
  QuackWatch: Your Guide to Quackery, Health Fraud, and Intelligent Decisions (http://www.QuackWatch.org/)Quackwatch fights health-related frauds, myths, fads, fallacies, and misconduct. Its primary focus is on health consumer information that is difficult or impossible to get elsewhere. Dr. Stephen Barrett, the founder of QuackWatch and author of most of the articles, is one of the great figures of anti-quackery activism. For many years now, I’ve been watching his work and the controversies and legal battles that swirl around QuackWatch, and I have been consistently impressed by Dr. Barrett’s integrity and intelligence — and unimpressed by the tactics and quality of his critics. He is also providing a vital service and a sorely neglected perspective on health care.
• Science-Based Medicine: Exploring issues and controversies in the relationship between science and medicine (http://www.ScienceBasedMedicine.org/)Science-Based Medicine is now the single best source of critical thinking about health care available anywhere. Founded by Yale neurologist Dr. Stephen Novella of the Skeptic’s Guide to the Universe, it’s written by several physicians who are alarmed by the soaring popularity of dangerous and pointless alternative health care. The title of the blog expresses the elegant idea that the value of ideas in health care ideas must not only be based on evidence, but must also be reasonably consistent with a well-established body of scientific knowledge of how the human body works.
• James Randi Educational Foundation: An educational resource on the paranormal, pseudoscientific and the supernatural (http://www.Randi.org/)James Randi has an international reputation as a magician and escape artist, but today he is best known as the world’s most tireless investigator and demystifier of paranormal and pseudoscientific claims. The James Randi Educational Foundation is a not-for-profit organization founded in 1996. Its aim is to promote critical thinking by reaching out to the public and media with reliable information about paranormal and supernatural ideas so widespread in our society today. The JREF also sponsors the “One Million Dollar Paranormal Challenge,” which offers a million bucks to anyone who demonstrates a paranormal ability or phenomenon. Since 1964, every single one of about 1000 challengers has either failed the preliminary test, or failed even to agree to acceptable rules for the test.
• Skeptic’s Guide to the Universe (http://www.theSkepticsGuide.org/)The SGU is by far the best of the skeptical podcasts, and has attracted an audiences of tens of thousands of listeners over the last couple years. Led by the frighteningly bright and knowledgeable Yale neurologist, Dr. Stephen Novella, every episode is a great mix of news, humour, substantive interviews and entertaining regular features.
• Skepchick (http://skepchick.org)Skepchick is a group of women, led by founder Rebecca Watson, who write about science, skepticism, and pseudoscience. With intelligence, curiosity, and frequent snark, the group routinely tackles alternative health care, as well as many other topics from astronomy to astrology, psychics to psychology.
• Snopes.com: Urban Legends Reference Pages (http://www.Snopes.com/)Barbara and David P. Mikkelson have been publishing the Urban Legends Reference Pages on Snopes.com since 1995. It is one of the most thorough collections of debunkery available anywhere. Although relatively few items concern health care specifically, it is an essential bookmark for every critical thinker.

Scientific journals and other research resources of particular interest to skeptics…

• The Scientific Review of Alternative Medicine.The Scientific Review of Alternative Medicine (SRAM) is the only peer-reviewed journal devoted exclusively to objectively analyzing the claims of “alternative medicine,” applying the best tools of science and reason to determine whether hypotheses are valid and treatments are effective. The publication of SRAM has been endorsed by the Commission for Scientific Medicine and Mental Health, a panel that includes prominent physicians, scientists, and Nobel prizewinners.
• The Cochrane Collaboration.The Cochrane Collaboration publishes reviews of medications and treatments and promotes the search for evidence in the form of clinical trials. Although not perfect, they have produced many of the most authoritative reviews available about musculoskeletal health care.

Notes

1. James Randi Educational Foundation (http://www.Randi.org/) James Randi has an international reputation as a magician and escape artist, but today he is best known as the world’s most tireless investigator and demystifier of paranormal and pseudoscientific claims. The James Randi Educational Foundation is a not-for-profit organization founded in 1996. Its aim is to promote critical thinking by reaching out to the public and media with reliable information about paranormal and supernatural ideas so widespread in our society today. The JREF also sponsors the “One Million Dollar Paranormal Challenge,” which offers a million bucks to anyone who demonstrates a paranormal ability or phenomenon. Since 1964, every single one of about 1000 challengers has either failed the preliminary test, or failed even to agree to acceptable rules for the test. Return to text.
2. When you poll skeptics about their most hated nonsense, so-called alternative medicine is pretty much at the top of their list these days, because of the high stakes. Skeptical luminaries like Dr. Steven Novella (of the Skeptic’s Guide to the Universe podcast) have popularized the idea that unscientific and unregulated health care actually has a “body count” — it kills people, either directly or through neglect of appropriate medical care, as in the case of deaths due to paranoia about vaccines: see the Jenny McCarthy Body Count website. Or consider the homeopathy scandal in the UK, in which the BBC exposed the widespread practice of recommending completely ineffective homeopathic “medicine” in place of genuine anti-malarial medications. Although the stakes are lower in my own field, there is one exception: evidence shows that cervical spinal manipulative therapy — neck cracking — performed by chiropractors may be lethally dangerous (see Smith). Even chiropractic authorities agree that “there are considerable case studies describing the onset of vertebral artery injury following a manipulation” (Triano). For a more detailed look at this topic, see What Happened To My Barber? Return to text.
3. What I mean by “pre-scientific” ideas is twofold: first, I mean ideas that were spawned before medical science had taken root in the world (such as the “Big Idea” of chiropractic, that spinal problems cause all disease); and second, I mean that a great deal of basic science about pain problems simply has not been done yet. Return to text.
4. Deyo et al. New England Journal of Medicine. 2001. Although now several years old, this is still an excellent tutorial for health professionals, offering a thorough and sensible survey of current medical knowledge about low back pain. Deyo and Weinstein are strongly critical of overmedicalization and excessive imaging and surgery for low back pain, and emphasize the favourable prognosis for most back pain, the poor correlation between imaging results and symptoms, and the absence of any clear pathophysiological mechanism to explain most low back pain. Their key points have been reinforced by more recent scientific evidence. Return to text.
5. Davis. Physical Therapy. 2002. A fascinating letter (plus replies) to the editor of Physical Therapy, regarding the October 2001 issue, which published the “shocking” results of the Philadelphia Panel, showing that “so few of the modalities that we have come to believe in actually show evidence of efficacy in controlled trials.” See “Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions: overview and methodology”. Return to text.
6. For instance, a tendency to assume that pain must be caused by minor anatomical abnormalities observed in the same patient. But such abnormalities are so common that they are present in most patients to some degree, and even the correlation breaks down with a little more careful observation — other patients with the same symptoms lack the crookedness, or they have a more prominent abnormality but lack the symptoms. For more information, see Your Back Is Not “Out” and Your Leg Length is Fine: The story of the obsession with crookedness in the physical therapies. Return to text.

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SaveYourself.ca is © 1999–2010 by Paul Ingraham & Regeneration Training, Vancouver, Canada
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