Impersonation alert: If you’ve received a rude message that seems to be from me, it was not from me. I do not send rude messages. Someone has been impersonating me, a form of identity theft. There is a suspect & police are involved. If you get one of these messages, please contact me. ~ Paul Ingraham
I am a writer and former overqualified massage therapist in Vancouver, Canada. I publish this website with help of several editors and contractors, and correspondence with many expert colleagues I am honoured to know. In particular, I have been the assistant editor for ScienceBasedMedicine.org since 2009, and work closely and constantly with their world class team and authors. PainScience.com is huge and busy, with about 25,000 visitors every day, and it routinely attracts the attention of anyone who might care about the science of painful problems. The site is funded by sales of educational e-books, and not icky advertising. I keep it clean. My main qualifications are:
I get asked this so often I had to add it to my site FAQ:
Q Do you have any practical experience?
A YES. Yes yes yes. Yes! Even with much of the flakier stuff I debunk.
Many readers want more information about my qualifications and credentials, because I deal with a lot spicy subject matter — myths and quackery in health care. I am often mistaken for an “expert,” but I am merely well-acquainted with the work of many actual experts. I’m a liaison, translator, and popularizer. But I am not unqualified either! The rest of this page answers the question, “Who am I to say?”
It’s impossible to thank everyone who matters without getting tedious. Just like at the Oscars!
Dr. Lorimer Moseley, Diane Jacobs, PT, and Jason Silvernail, PT, are particularly responsible for teaching me some mind-bendingly important lessons about neurology that changed everything (and still are). Tony Ingram, a PT destined for research, and BBoy Science author, regularly helps me make sense of the science.
The entire team at ScienceBasedMedicine.org, but especially Drs. Steve Novella, Harriet Hall, David Gorski at ScienceBasedMedicine.org, have all been particularly generous and supportive, and taught me how to think about health care.
Blogger-massage-therapists Alice Sanvito, Todd Hargrove, Laura Allen, Ravensara Travillian — out of literally dozens of other worthies — have all routinely given me invaluable ideas, advice, perspective, and so on.
Chiropractic apostate Sam Homola, DC has particularly been an inspiration and a resource; Eyal Lederman’s writing has taught me much, and I’m privileged to correspond with him. Anti-quackery activist Dr. Stephen Barrett has offered various kinds of support over the years. Psychologist and massage researcher Dr. Christopher Moyer has contributed expertise and comments to PainScience.com many times over the years.
Many critical readers accuse me of having no practical experience with patients. It’s just so deeply ironic and amusing when people assume that the only possible explanation for my skeptical opinions is that I must not have any work experience as a massage therapist. I was a “Registered Massage Therapist” or RMT for a little under 10 years, from 2000–2010. My downtown Vancouver practice was a success by virtually any measure.1 I quit happily at the end of 2010 to focus on my writing career.
I was what would be called a “medical” massage therapist in most places — that is, I was not just a “masseuse.” I was trained in and have extensive knowledge of musculoskeletal health science and injury rehabilitation. I also carried on to do vastly more academic post-graduate study than most of my colleagues. That’s no empty boast: I have the large body of work to prove it.
RMT’s certified in British Columbia, Canada, are unusually well-trained compared to other massage therapists around the world. I studied for 3 years, a 3000 hour program including 500 hours of internships. Three years of training is three times longer than most regulated jurisdictions in North America and Europe. For more information about these unusual certification standards, see Massage Therapy In British Columbia, Canada.
In BC, Graduates have to take some large government certification exams; they are tested on anatomy, physiology, pathology, physical assessment, and several manual therapy modalities. About half my graduating class failed on the first attempt, and some even required 3 and even 4 attempts. (Yes, I did pass on the first try, with excellent grades.)
I maintained a busy full-time practice here in Vancouver from mid-2000 to 2010. I did about 5000 treatments in that time — that’s a lower number than many therapists, but “busy” is defined in many ways (all my appointments were long, for instance, and I did an extraordinary amount of rehab consultation with clients outside of their appointments). I was certified by the College of Massage Therapists of British Columbia, which is regulated by the Province of British Columbia.
Most of my critics assume that I must be ignorant of all things alternative, magical, spooky, and flaky. In fact, my “street cred” in this area is quite solid — so much so that I find it fairly embarrassing today. My modern skepticism is all the more credible for having left that world behind.
In my teens, I incorrectly believed that I had serious health problems resulting from steroids which had been prescribed to me by a physician at the Vancouver Childrens’ hospital. It took years and many important lessons for me to accept that steroids and doctors were not to blame. The early phase inspired my original interest in alternative health care, while the latter discovery triggered my interest in science-based medicine.
I practiced taijiquan and qigong seriously for twenty years, and participated in a number of other martial arts, such as aikido. I got started when I was a child. I was exposed early in life, way back in the mid-80s, to some of the world’s foremost experts in the idea of vital “energy” and traditional Chinese medicine — Jock McKeen and Bennet Wong, the remarkable founders of Haven, analogous to the Esalen Institute. Jock and Ben and Haven influenced me strongly until as recently as a few years ago. Those experiences are responsible for so much of who I am today both professionally and personally that calling it just an “influence” would be quite the understatement — it’s more like a foundation.
I started to move decisively in a new direction around 2000, but from about ages 12 to 32, I was obsessed by and immersed in vitalism and “subtlety” in health and the martial arts, and many other marvellously flaky things. For instance, I had a rather sensational year of travelling around on my motorcycle, working for room and board on organic farms in the Southern Gulf Islands of British Columbia.
So I was pretty crunchy.
I went far deeper into deepities and spookyisms than most, to the point of being a pretty eccentric teenager and young adult. So not only am I not merely an armchair theoretician, I was really quite barmy about this stuff, truth be told!
And I also grew up, eventually. I consciously rejected much of it, and moved on, taking a few good ideas and discarding countless bad ones. I started massage therapy college in 1997, and by the time I graduated in 2000 I had already lost much of my appetite for “flaky stuff.” A couple relationships with hippie chicks during school had convinced me that I didn’t really like hippies anymore — one too many nauseatingly earnest, holier-than-thou references to “the Goddess Mother Earth” will do that to you. And this before my career in massage had even started!
I continued to teach taiqi and qigong for a while, and I probably did “energy work” with my clients in my own way until at least 2005.
I’m currently nearing completion of a Bachelor of Health Sciences degree. Just two more courses to go! My last was a history of science course, which exceeded my high expectations — it was the most entertaining studying I’ve ever done, and I’ve actually continued studying the topic independently since then, just for fun.
Now that I am retired from massage therapy, I am considering pursuing another science degree as well — probably biology.
I respect academic accomplishment immensely — and yet the effort I’ve put into this website is not just comparable to the effort required to earn a degree, but is almost certainly greater. The volume of work I’ve done is extremely large: about two million words of original articles and tutorials — roughly 10–20 books worth3 — with a large, well-maintained and carefully annotated bibliography.4
Nor was it a passive intellectual exercise. I am not an “armchair therapist.” The publishing process was powered by the clinical challenges right in front of me. For several years, everything on PainScience.com was written for a patient, to answer a question I didn’t have time to address during an appointment. Then, once an article was published, readers from around the world weighed in with their comments, anecdotes, and of course their constructive criticisms, bitter complaints, and even insults. Feedback inspired round and after round of research and revision.
Eventually, though, interactions with experts and readers actually became more important than clinical experiences. Particularly since about 2008, I haven’t been able to publish anything without getting email about it! It’s like having 10,000 editors & critics.It’s like having ten thousand editors and critics. My readers won’t let me neglect or forget any important point. Countless times it is my readers who have suggested something I never would have thought of, or reminded me of something I should have.
So, the total educational value of creating this website is unique and incalculable. And, like anyone who tries to study a subject deeply, I have inexorably, inevitably discovered that “the more you learn, the less you know.” I have gone down the rabbit hole, and discovered that there is practically no solid ground at all in musculoskeletal health science — that basically everything about pain and injury is mysterious and controversial and complicated when you put it under the microscope.
Above all, creating PainScience.com has taught me to be extremely skeptical of anyone who thinks that they “know” something. It’s going to take another century of good scientific research before anyone can really “know” anything about chronic pain problems.
At the 2009 Amaz!ng Meeting in Vegas (Skeptics convention) I met famous Yale neurologist Dr. Steven Novella of Skeptic’s Guide to the Universe and Science-Based Medicine and chatted him up at a party hosted by Skepchik.org (which was far more party than I know what to do with, and where I also bumped into several other semi-famous people and tried to not stare at what was going on around the pool.) I wanted to know how I could volunteer to help Steve with one of his many worthy projects, especially SBM — since PainScience.com has basically the same mission and values, just with a narrower focus on rehab and pain science.
Steve was gracious and interested. It was a fanboy thrill for me to talk with him, but he gets a lot of empty offers, and I’m sure he was taking me with a pretty large grain of salt. But I stuck to my guns, and 7 years later I’m proud to say that Steve didn’t waste his time talking to me that night.
We now have a well-established working relationship; I am the Assisant Editor for SBM. I regularly work with several contributors, especially Dr. David Gorski, Dr. Harriet Hall, and Scott Gavura. It’s a pleasure and an honour, and being involved in a project like this keeps me interacting with (and learning from) some extremely serious people and big ideas. It’s hard to overstate how valuable those relationships are, and how great it is that I can call up one of my fellow BSW board members, or fire off an email to any one of several geniuses at SBM, and ask, “Check my thinking on this?”
I write a lot about sports injuries, so it would be nice if I had some significant experience with athletics, eh? And I do: a decade of playing and coaching ultimate, a hard-running Frisbee sport, comparable to soccer in its speed and intensity. I have had my fair share of direct, painful, and highly educational experiences with some of the athletic injuries I write about, especially iliotibial band syndrome.
We should all evaluate health ideas on their own merits … not the merits of the messenger. Credentials, “tone,” conflicts of interest all matter — they are factors to consider — but they aren’t critical. Even uneducated jerks with vested interests still say true things sometimes.
No one is more aware than I am of the fact that I’m not a doctor or a scientist. I wish I could throw a nice juicy “MD” or “PhD” behind my name, and I have a lot of respect for those who do: those are careers I seriously considered, but rejected because I lacked the intestinal fortitude, the sheer stamina required to get through the training. Ironically, I ended up working just as hard to compensate for my lack of credentials as I would have to earn them in the first placeAnd then, ironically, I ended up working just as hard to compensate for my lack of credentials as I would have to earn them in the first place. Life is funny!
I try to never ask my readers to take my word for anything. Instead I do my best to understand and explain the ideas of people who do have impressive credentials — not because we should trust them for that reason alone, but because they are participating in the most interesting and valuable dialogue available. What do they say? Why? Should we believe them? Should we be skeptical? Why? It’s that devotion to the discussion, I hope, that makes me trustworthy in spite of the lack of credentials.
It all comes down to having unusually high journalistic standards for myself and for this website. For more information about that, see:
If creating PainScience.com was so dang educational, you’d think I could have gotten some professional continuing education credits for it, right? A few measly CECs?
The CMTBC will give out a few CECs to registrants if they publish in a “recognized” magazine or journal, which includes even amateur publications like their own journal — a silly little rag, an amateurish publication in every way.5 The CMTBC gave me a few credits for a series of articles I published there long ago (which required no continuing education and no more than a few hours of work), but flatly refused to give me even one lousy credit for anything I’ve produced for PainScience.com: tens of thousands of hours of scholarship and writing, which is not only an exotic accomplishment in the profession, but an idealistic service to my profession and to readers around the world.
Not worth one credit!
It doesn’t appear that the CMTBC has much respect for academic study and scholarship.6 I realize it’s partly just a red tape thing, and there’s obviously some par-for-the-course failure to keep up with the times and recognize how important internet publishing has become. But I made these points and others to them, and it was like talking to a brick wall: the CMTBC wasn’t just saying “no credits,” they were actually saying “no discussion.” The chair of the committee responsible mostly just seemed irritated that I was daring to doubt the wisdom of her committee’s decision. I tried to have an amiable chat with her about it, but she was having none of it.
Is it really unreasonable to ask a regulatory body to recognize earnest independent scholarship as evidence of competency and continuing education?
Not only is it reasonable, it’s actually how other professions regulate. For instance, the physiotherapists of BC are actually required to report on their personal efforts to continue their academic education: that’s one of the ways that they measure competency! And that’s standard for many other professions.
Not in massage therapy in BC. Here, my constant scholarship over a decade was considered completely irrelevant to my continuing education requirements.
I worked on my own terms in a home office, as much or as little as I wanted for $100-$150/hour, for years. I had many fiercely loyal clients, regulars that dominated my schedule so much that it was hard to see new clients — but I did, because I was interested in clinical challenges. The waiting list was kind of a joke by the end; a few times I took on clients who had been waiting over a year. Many clients offered to double or even triple my high regular rate, or to travel from other cities. I had little use for that — who needs that kind of pressure?
I was successful mainly because I was a conspicuous rationalist and a relentless troubleshooter. I treated every client to both a fantastic sensory experience and I did everything in my power to help them understand and solve tricky pain problems, often going to extraordinary lengths after appointments to support, educate and brainstorm. So despite the impressive “$100-150/hour” rate — which is what clients actually paid — my real hourly rate was always more like $30-40/hour.BACK TO TEXT