published May 1, 2009, updated 9/07/11
Reading Guide for Skeptics
A tour of SaveYourself for readers who have doubts and concerns about the efficacy of many popular treatments in alternative health care, especially manual therapies like chiropractic and massage therapy
by Paul Ingraham, Vancouver, Canada
skip down to the list of recommended articles for skeptics
This document introduces SaveYourself.ca to my favourite audience: skeptics. Skeptics should feel at home here. I am a card-carrying skeptic myself, literally — I am a member of the James Randi Educational Foundation,1 and I have a card! In 2009 I attended (and wrote about) 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. Those conversations led to me being a regular volunteer copyeditor for Science-Based Medicine.2 I even know Simon Singh just a little bit.3
But you’re a massage therapist! Aren’t scientifically questionable claims common in massage therapy?
(I was a massage therapist. I’m not any more.4 But regardless…) 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
Massage therapy has the potential to be a science-based profession, making reasonable claims and providing a service of 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 quackery5 and generally drag massage down into the mud of manufactroversies. That has given me a lot to write about!
Skepticism 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,6 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 ideas7 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.8 In 2001, the infamous Philadephia Panel published a series of articles that were deeply critical of common practices in mainstream physical therapy.9 And many professionals, lacking training in formal logic and science, routinely confuse correlation with causation,10 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,11 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
At TAM8, Phil Plait, the Bad Astronomer, implored skeptics not to be dicks. This was surprisingly controversial! Whatever my opion, 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 obsesses 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:
- Humour, humour, and also humour. Funny, that!
- Candid self-deprecation is very disarming. I’m terrible at it, but I do my best.
- In particular, go out of your way to show that you know you can be wrong (as I did quite recently).
- Rigorous, thorough, substantive referencing!
- Story-telling and anecdotes that challenge the hype. Antimonials rock.
- Always, always get agreement on easy, smaller points first. Once someone is nodding, they tend to keep nodding.
- Make it about the money. Time and again it’s the consumer advocacy angle that turns on the light bulb. No one wants to be perceived as a sucker.
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:
- 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, 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.
- SY Does Traumeel Work? — A detailed review of Traumeel® and other homeopathic/herbal arnica creams used for muscular pain, joint pain, sports injuries, bruising, and post-surgical inflammation. Traumeel also has the distinction of being the most popular of all homeopathic products … and this article about it has routinely been by far the most prominent skeptical article about Traumeel (although a recent article by skeptical pharmacist Scott Gavura has been competing with it quite effectively). It also generates more hate mail than anything else I’ve ever written. Of course.
- SY Quite a Stretch — Stretching research clearly shows that a stretching habit isn’t good for much of anything that people think it is 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.
- SY Does Chiropractic Work? — An introduction to chiropractic controversies. 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!
- 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.
And here’s a bunch more …
- SY Why “Science”-Based Instead of “Evidence”-Based? — The rationale for making medicine more science-based
- 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
- 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.)
- SY Bogus Citations — References to “scientific evidence” are routinely misleading and scammy
- SY Dear Scientists — It’s okay to be elitists!
- 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.
- 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. Hot off the press! I’ve only just recently weighed in critically on the subject of acupuncture.
- SY Does Massage Therapy Work? — A review of the science of massage therapy … such as it is. A little out of date now, but still a good overview of the issues.
- SY A Critical Review of Myofascial Release (MFR) Therapy — Concepts and controversies in one of the most popular of all styles of massage therapy.
- SY The Functional Movement Screen (FMS) — The popular screening system for athletes failed to detect recent injuries in a new study 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.
- SY Extraordinary Claims — A guide to critical thinking, skepticism and smart reading about health care on the web.
- 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 …
- 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.
- 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.
- SY The Humble Therapist — Why you need to be skeptical when your massage therapist, physiotherapist or chiropractor tells you where the pain is really coming from — criticizes alt-med practitioners for not actually being humble, and includes a great story about 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.
- 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!
- 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.
- 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!
- 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.
- 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.
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…
- 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.
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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. Steve 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. Steven Novella, every episode is a great mix of news, humour, substantive interviews and entertaining regular features.
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Rebecca again, founder of Skepchick.
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.
- Skeptic: Extraordinary claims, revolutionary ideas, and the promotion of science (http://www.skeptic.com). The Skeptics Society, headed by Dr. Michael Shermer, is a scientific and educational organization for “anyone curious about controversial ideas, extraordinary claims, revolutionary ideas, and the promotion of science.” In many ways, this is the best of the skeptical websites, and the organization also publishes a pretty good podcast.
- Skeptic North (http://skepticnorth.com). I’m a Canadian skeptic, so Skeptic North is near and dear to me, the first Canada-wide blog for skeptics: a rag-tag team of skeptical misfits from coast to coast to provides you with a one-stop destination for all things “Canadian skeptic.”
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…
- 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 comprehensive reviews of what the science can tell us so far about medical treatments, and they promote and facilitate evidence-based medicine. Although not perfect — in recent years their quality control has slipped a little — they still generally produce the most authoritative reviews available about musculoskeletal health care.
- SY Top journals for pain and injury science — Medical journals that every physiotherapist, chiropractor, and massage therapist should be paying attention to
Notes
