I deal with a lot of controversial subject matter on this website. I debunk and criticize many products, services, and ideas. Each one of them is someone’s cherished belief, and many are the basis for an entire career. And so I get complaints. A lot of complaints (some of them pretty vicious). Many people think I’m too “negative” or that I must “hate” nice things like massage. I am regularly publicly vilified. I often stumble on conversations between strangers on Facebook about what a miserable jerk I must be. A few years ago, accusations of negativity were taken as far as formal charges of professional misconduct — which would have been laughable, if it hadn’t been so serious.
Why do I do it? Why is PainScience.com so negative? (It’s not.) Why do I do so much debunking and criticism? (Pesky ethics.) Is doing that even actually negative? (Nope.) Do I ever report good news? (Yep.) How is my approach helping ordinary people in pain? (It saves them time and money.) And do I really hate massage? (Don’t be absurd.)
There is a crack in everything
That’s how the light gets in.
Leonard Cohen, Anthem
I plead “not guilty” — but the accusation of negativity wouldn’t matter even if it was true. What does matter is the truth, even when it’s ugly and disappointing, which it often is. I have many reasons for doing what I do, but I only need this one: I value integrity in health care for its own sake. Even if a health myth is relatively harmless, I’ll bust it just for the dishonesty. And if it actually hurts innocent people who are already in pain? If it wastes their time, or their money? Or distracts them from proper health care? Well, then I’m definitely going to bust it.
I realize myth busting and idealistic critical analysis can seem negative, but I believe it’s actually the most positive thing anyone can do: it is a noble and exciting good cause to strive for truth and excellence in health care, and to defend patients from false hope, fraud, and worse.
Working on PainScience.com never feels negative to me. I have fun taking health care seriously. I am a natural contrarian, curmudgeon, and satirist. And I do report plenty of good news, and some treatments for common painful problems are indeed well worth trying. For instance, my prominent Pain & Injury Survival Tips page offers dozens of useful examples.
Our judgments about the world are all that we can control, but also all that we need to control in order to be happy; tranquility results from replacing our irrational judgments with rational ones.
Oliver Burkeman, The Antidote: Happiness for People Who Can't Stand Positive Thinking
That pretty much covers it, but — as usual on this website — a much longer discussion follows, for those who want it. Ahead is a compilation of my writings on negativity over the years. The highlights:
I am actually a big fan of several things (despite my well-earned reputation for curmudgeonly skepticism about nearly everything else).
Angry massage therapists: please, do you have any idea how much free advertising I’m giving you? This website promotes massage to more people than 10,000 little brochure websites and blogs for your clinics. Seriously. Do you know how people write to me constantly asking for referrals to a good massage therapist? No matter where they are in the world? No matter how implausible it is that I would know anyone in their area? It’s a deluge.
My writing does not make people reject massage therapy or chiropractic — it just makes them want a good massage therapist or chiropractor. My writing does not make people reject massage therapy — it just makes them want a good massage therapist. Because I enthusiastically endorse trigger point therapy on a massive scale, for instance. (Despite the problems with trigger point science.)
I’m also rather fond of stretching, despite the fact that it doesn’t do much of what people think. I think that exercise is the closest thing there is to a miracle cure, and I have many articles about various forms of therapeutic exercise, especially strength training (and especially done just right for patellofemoral pain — something evidence changed my mind about, by the way). And I like Voltaren® — a decent medicine. I endorse icing and heating — if you know the difference. I think there are good ways of dealing with insomnia — which is extremely relevant to chronic pain. I’m particularly bullish on the value of vitamin D supplementation for chronic pain patients.
And so on and on. There are dozens more examples. The only people who accuse me of negativity are the people who don’t like my opinion about what they like.
Those who don’t stay current with the literature think my perspective is contrarian.
Christopher Johnson, PT, www.Head2ToeSystems.com
In her book Smile or Die, Barbara Erenreich describes a cult of optimism that has sprung up around breast cancer: “cheerfulness, up to and including delusion and false hope, has a recognized place in medicine.” Indeed, blind faith in the power of positive thinking1 has become so fashionable and ingrained that “being ‘positive’ seems to us not only normal but normative — the way you should be,” and anything else is frowned upon.
As punishment of the sin of speaking frankly about bad news and disappointing realities, I get a more or less constant supply of hate mail (and comments on social media), about 3 juicy messages per week, dripping with loathing. For instance, a massage therapist wanted me to know:
Briefly, specifically, and clearly.....you are a douche.
Not at all specific really, but clear in a way, and, yes, mercifully brief. And not a word about any subject other than me. (This is the nature of all hate mail: personal insult instead of discussion of ideas, intelligent or otherwise.) That one was generic hate, but my so-called negativity is a strong theme — the main theme — in most of these missives. Here’s a typical example from YouTube, responding to one of my videos, where comments are particularly articulate. I’m not making this up.
i think its so wrong to give out all that nagative response to people who are in pain and desperate for a cure an d some pain relieve! lots of us have't got loads of money to go and see expensive physios! every week! so why don't you get some bonfide people on a video and show us your miracle cure? or your going to share that to the good of man kind.... naarrrr didn't think so.!
Many such complaints come from people selling treatments and therapy for a living — a coincidence, I’m sure!
Much of what people perceive as “nagativity” is just the harshness of reality. People tend to shoot the messenger. It is simply not possible to criticize anything that people believe in or sell without provoking a little outrage. In The Science of Why We Don't Believe Science, Chris Mooney wrote:
Given the power of our prior beliefs to skew how we respond to new information, one thing is becoming clear: If you want someone to accept new evidence, make sure to present it to them in a context that doesn’t trigger a defensive, emotional reaction. … We apply fight-or-flight reflexes not only to predators, but to data itself.
Comedian Chris Rock gets to the same point quicker:
Knowledge is like Kryptonite to the ignorant.
I do everything I can to be negative as nicely as I can (without sucking the life out of my writing). For instance, the words “myth busting” have a good-natured tone that can defuse some emotional defensiveness. That’s why the show Myth Busters is called Myth Busters. (I don’t think they’d have gotten far if they’d called the show “The Critical Analysis Hour.”)
Or I’ll use a word like “bollocks,” which has a delicious duality to it: strongly judgemental and yet more whimsical and less harsh than “bullshit” or “what a load of #%$&@ crap.” Bollocks is a cranky panda, bullshit is a mean bear.
Facts are stubborn things; and whatever may be our wishes, our inclinations, or the dictates of our passion, they cannot alter the state of facts and evidence.
I use many defusing strategies. But as I dial up the diplomacy, I can only reduce the severity of the reaction. There will always be a few people who are still horrified by my impertinence. As my caution increases, I gain some things and lose others. For instance, my kindest approach might score me some points with moderates and lessen the umbrage of a few on the far side of the fence, while simultaneously disappointing and annoying some of my mentors and allies because I’ve been merely “negative” instead of downright harsh!
If your knickers are getting twisted over something I’ve written, it probably wasn’t meant for you. There are many contexts and reasons for mythbusting and debunking, and persuasion certainly isn’t the only goal. Often in my writing I’m not really trying to persuade anyone at all: my goal is often to arm like-minded colleagues and patients with more and better information.
For example, a very snarky podcast episode about quackery in general, but especially homeopathy: the tone of their criticisms will put any homeopathy true believer on the defensive, in a big way. There’s no way it would have convinced them of anything (except that they were under siege). But the show wasn’t for them, obviously, it was for people like me: preaching to the converted.
Sometimes I do that. Sometimes it’s important to do that.2
The behaviours that make us human are not professional. Honesty, frankness, humour, emotionality, embracing the moment, speaking up for what you believe, affection, sincerity. Quoting extremely offensive trolls. These are all things that will make some people love you and others hate you. When you get more attention, these aspects of your personality fuel the inevitable backlash. As your audience grows, the chance of any given action triggering criticism asymptotically approaches 100%.
Allen Pike, “Unprofessionalism”
As often as possible, I report on treatments that work and the ideas that make sense, but the next best thing is to warn consumers away from the many ones that don’t — to try to spare patients the insult of wasted time, drained wallets and unnecessary or excessive risks. And there is so much dodgy, over-hyped nonsense in the world of freelance therapy and alternative medicine that you can’t discuss the topic for five minutes without tripping over twice that many myths.
And so my website has steadily filled up with debunking over the years. I didn’t plan it that way. I just had the misfortune to develop a strong interest in a field that turns out to be polluted with vastly more myths than truths. Oops.
Here’s something I’m pretty sure about, ethical bedrock: lying is a bad thing. It is obviously unacceptable to directly deceive patients in any context or for any reason … not even for the “power” of a placebo, which is a common justification (and yet another myth3). The ethical responsibility goes deeper than simply not lying. If my entire website is trying to answer the question “what works?” then I must answer as honestly as I can.
Unfortunately, the honest answers are often disappointing. Truly good solutions for people in pain are tragically few.
It doesn’t even occur to most people that there may just not be any good, reliable solution to their painful problems. Modern, wealthy humans are generally a pretty spoiled bunch. Many of us expect that there “should” be a product for every whim and a solution for every health problem (other than horrible, incurable diseases).
Now where would they get an idea like that?
The promise of “results” is a major culprit: promises made by countless health care freelancers, working for private fees or insurance reimbursements, usually earnest and well-intentioned. By definition, quacks are guilty of selling more hope than help, but over-promising also happens frequently in more mainstream offices, thanks to ordinary ignorance, overconfidence, and ego. The public eats it up and learns to assume that there “must” be a solution out there somewhere — if not from therapist A, then surely from therapist B, who charges a lot more but “must be worth it.”
I know that this is a problem because I butt heads with it every day…
YouTube commenters are not exactly a classy bunch (understatement4). By far the most common feedback I get on my YouTube “Myth” videos about iliotibial band syndrome are demands for nonexistent answers. A few of the demands are polite but desperate, but most are angry, and some seem deranged. The entitlement issues drip like thick snot from most comments. All errors and profanity reproduced exactly as typed by the barely-literate commenter:
.now let me ask this fraud .. how does all this information help a person in pain you fraud..
if you really cared you would've made a video showing us how to fix the problem not to mention you are not a doctor you have no credentials so save this bull shit please and stop sending me videos [I don’t send any videos to anyone; I have no idea why he thinks I sent him something. ~ Paul]
ok, so now we know what doesn't work (i've tried all these myths and indeed they don't work), now what DOES WORK
Then how do we fucking fix it. Lol!
Fucking faggot ass piece of shit you know how many people suffer from this and you dont want to tell us how to fix it! you fucking devil!!!!!!!!!!!!! go die!!!!!!!!
(The last one was toxic even for YouTube.)
A strong common denominator here is the assumption that there actually is an answer, and I’m just holding out on them because I’m greedy. Ironically, they are actually quite skeptical and cynical — like me! If I’d told them what they wanted to hear (“The Answer”), they would have no complaint and probably would have bought it. Perhaps literally!
There is no “cure.” There is no specific method or series of logical steps that will reliably cure any kind of chronic pain problem (and least of all the tough ones I write books about). That’s the point, really — when someone is selling The Answer, it’s bogus by definition. There’s only a range of imperfect options, even the best of which are a bit iffy. I promise to review the options — not endorse them. And if the options are disappointing, it’s reality that’s disappointing — not my review. They have theirs pros and cons. Some almost entirely ridiculous. What options to try depends on the case, the medical details, and even humble logistics (what the client can afford, what they have the time or freedom to try). To select from your options intelligently, you have to understand the condition and the options quite well.
That’s why I write: not to sell “the answer,” but to give desperate patients a realistic and thorough tour of their options. That’s all there is. That’s all anyone ethical can do. I promise to review treatment options — not endorse them. And if the options are disappointing, it’s reality that’s disappointing — not my review.
I clearly recall that, when I started writing my IT band syndrome book, I had no idea that it could possibly be “controversial.” That seems laughably naïve now. Unethical and overconfident cure mongers constantly fan the flames of hope and “belief,” and the result is an infinite poopstorm of disappointment and frustration with anyone who won’t join in the chorus of empty promises.
P.S. The expectations problem cuts both ways. A humble therapist may try to manage expectations, while the client barges ahead with desperate hope for results. Sometimes humility paradoxically makes the problem even worse: “Wow, you’re talented and humble: you must be even better than I thought!”
Massage — love it or leave it!
I am widely regarded as an enemy of the massage therapy profession, because I write articles like this one. Surely this is absurd hyperbole? If anything, it’s an understatement. For years, a group of outraged colleagues actually tried to get me formally censored and censured for my “tone” on this website. That was a hell of a thing, and a story I will recount in detail in a book someday. As massage therapist Allissa Haines put it after getting a taste of this phenomenon herself, sometimes massage therapists are not very nice people. Unfortunately true.
I weep for the fragile ego of the massage therapy profession. It really cannot take criticism. Its knickers get in an awful twist. Every massage professional who chooses to publicly question popular beliefs and practices is going to get vilified and accused of “negativity.” The slightest sign of critical thinking will provoke hate mail, even threats, with ironic accusations of being “unprofessional.”5 Good grief.
Dear Massage Profession,
Grow a pair! Learn to take criticism, embrace self-improvement, abandon obsolete ideas.
And yet I personally love massage itself, and this website praises and celebrates massage, and earnestly recommends it to literally thousands of people every day, in dozens of popular articles on the topic, like this one. I have likely generated business for many of my critics! And countless more who would be critics if they’d ever heard of me. I am actually advertising massage globally, successfully. You’re welcome, massage therapy profession. That’ll be about $8 million, please. You can use PayPal.
The big worry I hear from massage therapists is that I am throwing the massage baby out with the bathwater. (I’ve heard that metaphor thousands of times now in this context.) But the good reputation of massage is quite secure, and there will always be someone — or 100 someones — to leap to defend it whenever and wherever I point out a problem. I am hopelessly out-numbered. Massage is quite safe from my so-called negativity.
So far I’ve mostly answered accusations of negativity from an ethical perspective. To recap, it’s the sad truth that the world of pain therapy is unusually polluted with bad ideas, and pain patients deserve either better treatments or, failing that, at least better information. So even if a health myth is just quaint and harmless, I’m still going to bust it. It’s an honour thing.
Now I will try to answer from a scientific perspective. This won’t hurt a bit. In fact, there’s literally “nothing” to it: the null hypothesis, one of the pillars of the scientific method, is that most hopeful theories about how things work amount to nothing when when carefully checked. Most test results are “negative.” Science is so negative!
Cynicism is baked deep into science. No one can possibly study the history of science — especially medical science — without becoming super-duper cynical. Many strange, bad ideas have come and gone over the centuries, for such outlandish reasons, and with such caustic consequences, that you can get whiplash switching between laughing and crying. The number of nakedly evil scams alone is just gobsmacking, but it’s dwarfed by the earnest delusions!
Sobering indeed, then, to realize that the treatment of pain is a bit of a medical backwater. While we’ve made huge strides on other fronts, pain treatment has languished in an almost primitive state.6
At the heart of every scam and delusion in the history of health care is a medical idea: a notion about what would help and why … which turned out to be wrong. How many of medical ideas in the history of medical brainstorming have turned out to be good ideas? Things that actually worked? Almost none. Maybe 1%. It’s a shockingly low number.
Indeed, almost all the ideas that we humans cook up about anything at all are flawed and turn out to be wrong. People are wrong-answer-generating machines. But we’re especially prone to wrongness in medicine, because disease and pain and suffering are so complex and scary. It’s all too easy to be wrong when you’re desperate.
It is the business of science to check those ideas carefully. And wrongness is so incredibly common that scientists have learned (the hard way) to just assume that an idea is wrong until proven otherwise. In 1935, that cynicism was given a name, which stuck and became An Official Science Thing. Ronald Fisher, a British geneticist, called it the null hypothesis — the assumption that an idea will amount to nothing when carefully checked.
The null hypothesis is basically cynicism wrapped up in a lab coat.
People had been noticing that most ideas crash and burn when tested long before it became a defining feature of the scientific method. I was always naturally inclined towards the null hypothesis. I was often its champion, defending it from believers in untested ideas, before I’d even heard of it.
The null hypothesis is extremely powerful. It’s the winning hand. It’s the safe bet. Because most of the ideas humans cook up are deeply flawed, betting against them is where the smart money is, and betting against the null hypothesis is just throwing your money away. When in doubt, always pick the null hypothesis. Like a casino, it usually wins.
I’m starting to really groove on the elegance of the null hypothesis. It’s as pretty as Occam’s Razor. In fact, they’re cousins. Occam’s Razor says “bet on the simpler explanation.” The null hypothesis is the default “simpler explanation” — namely, that nothing significant is really going on here.
The legal principle “innocent until proven guilty” is a mirror image of the null hypothesis: treatments should be considered useless until proven effective. The burden of proof is on the pusher of the idea, and it’s a heavy burden. Treatments must work well and clearly to actually beat the null hypothesis. They must impress.
When a treatment is truly shown to be effective, it’s exciting! It makes headlines, and it should. But it’s also incredibly rare.
The null hypothesis is formidably reliable … but common, unsexy, and “negative.” It wins all the time, but it doesn’t make headlines doing it. Being the champion of sobering reality is a major drag, and the bane of my existence as a writer in this field. Do you think MythBusters would be popular busting myths without explosions? If it was mostly just a show of null hypothesis confirmations? Yaaaaawn.
Without explosions, one way tart up the triumphs of the null is to frame them as debunking. The comeuppance of a claim is always a source of minor thrills. Fortunately, because the null is so often confirmed, I get lots of chances to debunk.
People are constantly claiming premature victory over the null hypothesis. If a therapeutic benefit is so tenuous that it hangs on debates about p-values and effect sizes, then either it doesn’t exist at all, or it’s so trivial that it doesn't matter if it exists! And yet based on mere scraps of encouraging evidence, the believers will cry, “Eureka! It works!” And it makes headlines.
Not so fast.
This happens so much, and so egregiously, that it seems like the null hypothesis has almost been forgotten by a lot of modern researchers. Researchers should, in a sense, actually set out to prove the null hypothesis. As Cory Blickenstaff, Physical Therapist, put it, “Not doing so means you are trying to prove your pet theory, and in comes Mr. Bias.” It is clear that Mr. Bias has moved in and taken over a lot of research projects! In fact, this is a major point of one of the most famous scientific papers in recent history, by John Ioannidis, “Why Most Published Research Findings Are False.”7
The need to contradict this kind of nonsense is (literally) my full-time job, and the number one reason that I am “so negative” — because I am honour bound to point out that the null hypothesis probably has not been defeated.
The method of science, as stodgy and grumpy as it may seem, is far more important than the findings of science.
Do you ever wonder what will be left on the proverbial table for effective treatment?
Good question. I do wonder, I do! I’ve been studying a long time now, and I’ve gotten used to the fact that there seems to be more myth than medicine in the manual therapies. Sure, it can be a bit disheartening, but I recommend making lemonade out of it instead: it actually is quite inspiring that we are finally starting to make scientific headway in orthopedics. I have a theory that we’re in a bit of a Golden Age of manual therapy.
Generally speaking, the manual therapies have been infected with a whole lot of unjustified optimism and overconfidence for decades now. To get past that stage and into the future of good evidence-based care, there’s going to have to be a whole bunch of let downs, a whole lot of letting go of things that never really had any business being “conventional wisdom” in the first place. There will be growing pains.
But it’ll be good in the end.
And that’s a good place to end this article.
I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine.org for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.
— Added a minor funny note about hate e-mailers who can’t be bothered to specify what they are complaining about.
This intensely intellectual paper — it’s completely, hopelessly nerdy — became one of the most downloaded articles in the history of the Public Library of Science and was described by the Boston Globe as an instant cult classic. Despite the title, the paper does not, in fact, say that “science is wrong,” but something much less sinister: that it should take rather a lot of good quality and convergent scientific evidence before we can be reasonably sure of something, and he presents good evidence that a lot of so-called conclusions are premature, not as “ready for prime time” as we would hope. This is not the least bit surprising to good scientists, who never claimed in the first place that their results are infallible or that their conclusions are “true.”
I go into much more detail here: Ioannidis: Making Medical Science Look Bad Since 2005.BACK TO TEXT