Detailed guides to painful problems, treatments & more

Mechanism masturbation: wishful thinking about why treatments work

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Jonathan Jarry (@CrackedScience) with a hot 🔥 tweet:

“There is a fascinating phenomenon in the CAM literature we could call ‘mechanism masturbation’ where the authors, faced with the tiniest of positive signals in a small study, write paragraph after paragraph hypothesizing how, mechanistically, watermelon seeds might cure schizophrenia.”

Musculoskeletal and pain research is particularly rotten with “mechanism masturbation” — often because it’s just all there is. There’s no good clinical trial data, so we get wishful thinking instead. The best example is surely the entire fascia craze, which is based almost entirely on overheated extrapolation from basic research about how fascia might be relevant to therapy (while failing to ever actually show that it is relevant). But you see lots of “mechanism masturbation” for nearly all popular treatments: laser therapy, shockwave ultrasound, scraping massage, therapy taping, spinal manipulation, platelet-rich plasma, transcutaneous electrical nerve stimulation (TENS)all that “literature” is just rotten with cart-before-horse speculation about how they how they could work, might work, should work, maybe work… when all the clinical trials show that they don’t actually work, or not very well.

Jonathan’s satirical example really nails the flavour of “research” like this:

“It might interfere with the hypothalamic-pituitary-adrenal axis.... One of its compounds does bind to alpha receptors in this cell type.... Could play a role in this cascade... Anyway, preliminary results from n = 6. More studies needed!”

Yes, that definitely reads like about a thousand papers I’ve wasted my time reading over the last decade. I’m always looking for the rare scraps of basic science I can actually consider interesting/promising instead of more post-hoc rationalization for someone’s meal ticket. 🙄-

I’ve added the idea of “mechanism masturbation” to my article 13 Kinds of Bogus Citations: Classic ways to self-servingly screw up references to science, like “the sneaky reach” or “the uncheckable”. And Jonathan talks more about it in this interview for Adaptabilia.

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