SaveYourself.ca •Sensible advice for aches, pains & injuries
 

Reading Guide for Skeptics

A tour of SaveYourself for readers who have doubts and concerns about the validity and efficacy of popular treatments for injuries and chronic pain

2,500 words, published 2009, updated May 19th, 2014
by Paul Ingraham, Vancouver, Canadabio
I am a science writer, the Assistant Editor of ScienceBasedMedicine.org, and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I’ve written hundreds of articles and several books, and I’m known for sassy, skeptical, referenced analysis and a huge bibliography. I am a runner and ultimate player, and live in beautiful downtown Vancouver, Canada. • full bioabout SaveYourself.ca

You can skip down to the recommended articles for skeptics.

Skeptics, critical thinkers and scientists will feel at home on SaveYourself.ca. I have good skeptical credentials. In particular, I am a rare example of alternative medicine apostate: I actually quit my alt-med day job, exasperated with pseudo-science. I have renounced many flaky beliefs, and today I am the Assistant Editor for Science-Based Medicine, which gives me daily access to some of the smartest health science writers in the world. SaveYourself.ca has the honour of being recommended on QuackWatch. I have been militantly skeptical enough to get legally harassed for it, which earned me a number of amazing new skeptical friends and allies. And although I have many articles I’m proud of, one in particular is the most detailed critical analysis of the world’s best-selling homeopathic products (homeopathic arnica creams), which ranks at or near the top of most relevant web searches.

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SaveYourself.ca is one of the few skeptical resources focussed on pain and injury treatments. Are they dubious? Dangerous? Distracting? This popular Venn is one of my skeptical greatest hits. See The 3 D’s of Quackery.

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SaveYourself.ca is one of the few skeptical resources focussed on pain and injury treatments. Are they dubious? Dangerous? Distracting? This popular Venn is one of my skeptical greatest hits. See The 3 D’s of Quackery.

Quitting massage for science

Massage therapy has the potential to be a science-based profession, making reasonable claims and providing a service of modest but genuine value to many patients. Alas, so far, it has fallen well short of that potential in many ways, and many “leaders” of the profession routinely endorse egregious quackery1 and generally drag massage down into the mud of alt-med’s many manufactroversies. That has given me a lot to write about! Massage itself is not quackery … but it is badly polluted with it.

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

Massage therapists can spot logical fallacies and care about EBM are not unheard of, but we are quite rare — too small a minority, in my opinion. For a long time I struggled with whether or not I should stay in the profession as an advocate for reform, or just move on and don my “science journalist” hat permanently. I closed my massage therapy practice in 2010 and have not looked back.

Pseudo-science is common in all health care for common painful problems

As a skeptical writer, I’m working almost by myself in my niche. Exercise science is drowning in skeptics. Nutrition? Plenty of skeptics there! Medicine in general? There’s probably more skeptical writing in that category than any other. But a rigorously skeptical and science-based perspective on treatment common painful problems is rare. For example, my tutorial about iliotibial band syndrome (runner’s knee) is the only detailed skeptical review of that problem in existence. My popular mythbusting YouTube videos on that topic stand nearly alone — hundreds of competing videos make little or no attempt critically consider any of the popular treatment claims (like foam rolling).

It’s badly needed. Finding good care for injuries and stubborn pain problems can be surprisingly difficult for patients. There are many intellectually immature and pre-scientific ideas2 in musculoskeletal health care, and not just in alternative medicine. There are many intellectually immature and pre-scientific ideas in musculoskeletal health care — treatments that aren’t on the skeptical radar, but should be. Many of those ideas are baked into the clinical reasoning of all kinds of professionals. That’s why I wrote about “pseudo-quackery” in conventional care for SkepticNorth.com — treatments and therapies that aren’t on the skeptical radar, but should be.

Physician Richard Deyo of Seattle has spent his career publishing trying to educate his medical colleagues and slay several myths about low back pain that, zombie-like, just won’t die.3 In 2001, the infamous Philadephia Panel published a series of articles that were deeply critical of common practices in mainstream physical therapy.4 And many professionals, lacking training in formal logic and science, routinely confuse correlation with causation,5 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!


Should we keep an open mind about astrology, perpetual motion, alchemy, alien abduction and sightings of Elvis Presley? No, and I am happy to confess that my mind has closed to homeopathy in the same way.

Mike Baum,6 The dangers of complementary therapy, Breast Cancer Res. 2007; 9(Suppl 2): S10

How to build bridges and trust with people who don’t agree with you yet

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At TAM8, Phil Plait, the Bad Astronomer, implored skeptics not to be dicks. This was surprisingly controversial! Whatever my opinion, I have no choice, however: Saganic super-civility is clearly a key component of my success in persuading readers of this website.

This website has a surprisingly good track record of actually changing minds — a challenge that fascinates the skeptical community (particularly after Phil Plait’s infamous Don’t Be a Dick speech at TAM8). Despite the fact that I “debunk” and criticize a great many bad products, services and ideas in the world of therapy for pain — every one of which is someone’s cherished belief, the basis for entire careers or revenue streams, or the subject of a passionate healing anecdote — I am happy to say that I get a great deal of heartening email of the “thanks for bringing me around” variety. Many of my readers believed in something dubious … and then stopped believing in it after reading about it here.

This situation has also improved: I used to get a lot more hate mail than I do now. Over the years, apparently, my style has become less provocative and more effective. Here are my impressions of what strategies I use on SaveYourself.ca to successfully build bridges and trust with people who don’t (yet) agree with you:

There’s a fine line between engaging readers with humour, and pissing them off with sass. And of course the line is in different places for different people on different topics. So you can only please some of the people some of the time — but make it as fun as possible for the ones you reach.

There’s a fine line between engaging readers with humour, and pissing them off with sass. And of course the line is in different places for different people on different topics. So you can only please some of the people some of the time — but make it as fun as possible for the ones you reach.

What skeptics should read on SaveYourself.ca

Greatest hits! Some articles have attracted more attention — and gotten me into more trouble — than other articles. The following five stand out:

  1. SY Do Epsom Salts Work? — There is 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, this is nevertheless the single most popular article on SaveYourself.ca, attracting thousands of readers per month. 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. They also send me an extraordinary amount of hate mail — that’s right, mail that is hateful, about Epsom salts — potently demonstrating that people do not like to have their beliefs challenged, even when their beliefs are about things as trivial as bath salts.
  2. SY The Three D’s of Quackery — Beware of the many Dubious, Dangerous and Distracting treatments for aches and pains. A short article built around a highly condensed caveat emptor infographic, a Venn diagram — shareable and social media friendly. Grab the full-size image and pass it around.show
  3. SY Placebo Power Hype — The placebo effect is fascinating, but its “power” isn’t all it’s cracked up to be. This article is one of the few of its kind about this topic on the internet: the most annoying trend in alternative medicine: the exaggeration of “the power of placebo” as a justification for therapy that can’t beat a placebo. Therapies that perform no better than placebo are now predictably spun as being “as good as placebo,” as though placebo is the new gold standard to meet. Oh my.
  4. SY Does Arnica Cream Work for Pain? — A detailed review of popular homeopathic (diluted) herbal creams like Traumeel, used for muscle pain, joint pain, sports injuries, bruising, and post-surgical inflammation. Traumeel has the distinction of being the most popular of all homeopathic products … and this has routinely been by far the most prominent skeptical article about homeopathic arnica creams (although a recent article by skeptical pharmacist Scott Gavura has been competing with it quite effectively).
  5. SY Quite a Stretch — Stretching science shows that a stretching habit isn’t doing much of what people hope This is SaveYourself.ca’s original “controversial” article. Stretching was the one of the issues that got me writing. Again using hate mail as a measure of success, I knocked this one out of the park. However, the cranks have an extraordinarily consistent habit of accusing me of holding an opinion I do not actually hold — that stretching is “useless.” Not only do I not say this, but I go out of my way to contradict it. The problem is that the haters rarely read past the first screenful of the article before firing up their flame throwers. Haters are funny that way. Don’t miss the much newer and very popular A Stretching Experiment.
  6. SY Does Chiropractic Work? — An introduction to chiropractic controversies like aggressive billing, spinal adjustment as a panacea, treating kids, neck manipulation risks, and more. Irony: this is not a particularly good article. It has been de-clawed and edited to within an inch of its life for legal reasons. Try to guess what reasons those are! I’ll give you three guesses and the first two don’t count. If you cannot instantly guess, you can’t really call yourself a skeptic yet (but keep working it, baby). In its current, tame form — just a mild-mannered summary of the issues — it doesn’t generate much hate mail. But back in the day, before I knew better than to poke certain beasts, it sure did!
  7. SY Alternative to What? — “Alternative” health care professionals need to decide what they are really the alternative to. This article contains the highest concentration of criticism of CAM found anywhere on the webite, and also talks about what alternative medicine could have been in an alternate universe — what it could and should have been, as opposed to being an not-so-complementary anti-scientific substitute for medical care.
  8. SY Does Massage Therapy Work? — A review of the science of massage therapy … such as it is. Massage consists of a mess of overlapping, vague claims that range from the utterly absurd to the plausible but messy. There is no question that massage interacts with human nervous systems in interesting ways (but hopelessly understudied), so the debate is going to stay lively for a long time. This is the most concentrated and heavily referenced critical analysis of the topic I’m aware of. A closely related and particularly skeptical article (which earned me many new enemies in alt-med this year) really picks apart one of the hype-iest claims in massage history: “massage reduces inflammation.” Um, no.

And here’s a bunch more …

  1. SY Why “Science”-Based Instead of “Evidence”-Based? — The rationale for making medicine more science-based.
  2. SY Ioannidis: Making Medical Science Look Bad Since 2005 — A famous and excellent scientific paper … with a dangerously misleading title. (One of the nerdiest articles on the site … with one of the strongest skeptical points.)
  3. SY Bogus Citations — 11 classic ways to self-servingly screw up references to science, like “the sneaky reach” or “the uncheckable”. Fine link bait, this one! Share it!
  4. 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.
  5. SY Does Acupuncture Work for Pain? — A review of modern acupuncture evidence and myths, particularly with regards to treating low back pain and other common pain problems.
  6. SY Does Fascia Matter? — A detailed critical analysis of the clinical relevance of fascia science and fascia properties. Fascination with fascia looks quite silly by the end of this article.
  7. SY The Functional Movement Screen (FMS) — The benefits of the popular screening system for athletes might be over-sold by some professionals Publishing this one was one of my first experiences with “going viral” — not on a mainstream scale, but certainly sweeping through Therapy World like a wild poopstorm.
  8. SY Extraordinary Claims — A guide to critical thinking, skepticism and smart reading about health care on the web.
  9. SY Your Back Is Not “Out” and Your Leg Length is Fine — Debunking the obsession with alignment, posture, and other biomechanical factors as a major cause of pain. This is my thesis, the “big idea” of my career, my pet issue …
  10. 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.
  11. SY The Humble Therapist — Overconfident theories about the cause of pain are very common in massage, chiropractic, and physical therapy. Criticizes alt-med practitioners for not actually being humble, and includes a great story about an encounter I had with a therapist with an amusingly specific theory about the origin of “all pain” …
  12. 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!
  13. 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.
  14. SY The Power of Avogadro Compels You! — James Randi and Alexa Ray Joel try to poison themselves — one of them deliberately and the other accidentally making homeopathy look 10X sillier than it already did. I wrote this one after seeing James Randi speak in Vancouver early in 2009. What fun! Thanks, Mr. Randi!
  15. SY Therapy Babble — Hyperbolic, messy, pseudoscientific theories about therapy are all too common. More curmudgeonly skeptics will enjoy this ranty little article … plus the fantastic comic strips from Cectic, and the fantastic example of the butt-reflexology hoax.

Other 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…

Skeptic North

Canada’s national skeptical blog, eh?

Skeptic North

Canada’s national skeptical blog, eh?

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

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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.

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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.

Notes

  1. For instance, anti-vaccination sentiments are more or less rampant throughout the massage community. While many massage therapists sensibly defer to medical opinion on the topic, many others cannot seem to resist the temptation to over-reach their training and knowledge and use their time with patients to promote their views or at least (and really just as harmful) express their “reasonable doubts.” BACK TO TEXT
  2. 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. BACK TO TEXT
  3. Deyo et al. Low Back Pain. 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.

    BACK TO TEXT
  4. Davis. More questions than answers. 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”.

    BACK TO TEXT
  5. 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: Debunking the obsession with alignment, posture, and other biomechanical factors as a major cause of pain. BACK TO TEXT
  6. This quote is usually attributed to Edzard Ernst, because he co-authored a later version of the paper; however, I think Mike Baum is the original author. BACK TO TEXT