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Shooting the messenger’s website

 •  • 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.

I’m used to criticism, good and bad, and I have been frequently accused of amateurism, negativity, and bias — all of which I responded to long ago. I have also changed: anyone who has followed my writing since the beginning will tell you that the honey/vinegar ratio is much sweeter than it once was. Although I am still hard on pseudoscience, I’m much more willing to “teach the controversy” than I used to be … if I think the controversy is legit, and not a manufactroversy.

Diplomacy only works so well though, and I still get directly insulted a lot. Over the years, I have received hundreds of emails of the “your [sic] a looser [sic]” variety, often with a helpful suggestion to suck on something. Even the more grown-up insults are still classic ad hominem attacks: shooting the messenger, attacking my character instead of my argument, going after me rather than anything I’ve written. People assault messengers when they don’t like the message and/or don’t know how to attack the message.

Lately I’ve seen a rash of criticisms not of me, but of my website, of itself: not of its substance, but its style and format, especially denigrating it as “just a blog.” If I see that one more time, my eyes are going to roll right out of my head. It’s not a new angle of attack, but it does seem to be on the rise, maybe in sync with the rise of the site itself: maybe the bigger it gets, the more the domain seems like the target, rather than the guy who’s building it?

People who link to my articles in a Facebook thread often see these red herrings, and may not be sure how to handle them (or whether to bother, because it’s just a pain in the ass). So I wrote this for them (and for myself, for the ventings). Maybe it will be fun/handy to use these rebuttals to five common dumb reactions to linking to my site. For the record …

1. “It’s just a blog.”

People who denigrate as a “blog” are wrong on two counts: it’s not a blog, and it wouldn’t matter if it was. All information should be judged on its own merits, not the publication format (or anything else). Anyone who calls my site a blog clearly isn’t actually familiar with it, or with blogging. has a blog (you’re reading it), but it’s only a small fraction of the site: most pages here are regularly revised, expanded, and updated. I’ve been involved in web development for 25 years now, and I have yet to see any blog come anywhere close to that level of active maintenance. is much more like a library of constantly evolving position papers than a series of dated, ephemeral “posts.”

Not that there’s anything wrong with blogs! Or, more precisely, not that there’s anything stopping them from being great. Sure, many popular ones have always been awful.•••There’s always been a stigma against them because they led to a explosion of low-quality content, especially about health care, one of the biggest blog categories with a serious Dunning-Kruger Effect (Wikipedia) problem. But nothing about blogging prevents excellence, and blogs have become important in science, participating meaningfully in debate, an informal extension of peer review, or even setting the bar higher: see Five reasons blog posts are of higher scientific quality than journal articles.

2. “Comments aren’t allowed on”

Comments can have value, and they are an important part of some websites, but they don’t make or break content quality by a long shot. Many modern websites have abandoned comments as the bag of hurt that they are, and I never even considered them in the first place, because trolls: my subject matter attracts way too many of them. If I allowed them, would be inundated with cranky commenting and flagrant flaming. If I would have to routinely (a) censor half of it, (b) ignore it all, and/or (c) respond and educate extensively and yet mostly in vain … none of which are appealing or a good use of my time, which is far better spent creating good content.

3. “Other articles on are used as sources.”

The horror! I do that when a separate article I’ve written will provide more detail and especially more primary citations on a sub-topic than I can cram into the current page. The article I’m citing usually has many of its own external citations. In other words, my self-referencing is supplementary and elaborative. Wherever “citation needed” is directly relevant to the current page, I will cite primary sources, often many of them. But I will also link to other articles I’ve written if they provide more detailed arguments and referencing than I want to include on the same page.egFor instance, if I’m working on an article about an aspect of massage therapy and I state that “the importance of biomechanical factors has been exaggerated,” I support it by linking to another article I wrote that cites dozens of relevant primary sources. I’m not self-referencing because of a lack of primary sources to support my claim, but the opposite: I’m doing it because there are too many of them sources and they have already been analyzed and cited ad nauseam elsewhere. This is not a bad thing!

Ironic that gets criticized for doing exactly the single same thing, in the same way, for the same reasons as the single most trusted website on the internet: Wikipedia! On Wikipedia, the most relevant primary sources are cited in footnotes, but many inline links are also provided to related topics. The resemblance isn’t superficial: I have been imitating Wikipedia in this regard all along.

4. “ isn’t peer-reviewed.”

No, it’s not — and so what? Lots of good sources of information aren’t peer reviewed, and plenty of garbage is. Although an essential feature of scientific publishing, peer review is merely one factor among dozens that determine the quality of content. It is highly fallible because — news flash — peers are people. I have seen peer reviewers make daft arguments, or fail to comment on obvious problems. Some amazingly bad papers sail through peer review.

A lack of peer review is hardly a deal-breaker. Asserting that we should never cite anything that isn’t peer review is laughable amateurism. The world is more complex than that, and independent critical analysis clearly has a place in it. Blogging has had a major positive impact on science in the last ten years.

Most of the people who make this accusation probably don’t actually read much peer-reviewed content, and have undoubtedly praised other non-peer-reviewed sources like mine — just the ones they agree with.

Bias is an over-rated sin & objectivity is an over-rated fantasy, a pretentious delusion.

5. “ is biased.”

Although often stated as a criticism of the site, this ad hom is actually about me personally: it’s my bias that is at issue. And of course I am biased — everyone is. I’ve always been clear about that, and I make all kinds of obvious efforts to advertise, tame it, and limit the harm it can do. I have an extensive public record of acknowledging my mistakes (example) and changing my mind when presented with new evidence, even when I really don’t like it. Scientific papers that challenge my biases are actually highlighted in my bibliographic database. egFor instance, right now I take the evidence-based position that orthotics are not helpful for back pain, but there’s a paper in my bibliography that shows the opposite, and it has no obvious flaws. I sincerely wish it would just disappear, mostly to spare me the work of revising everything I’ve written on the topic! Instead of deleting it, I’m going to cite it, and acknowledge that it clearly undermines my position.

Bias is an over-rated sin, and objectivity is an over-rated fantasy, a pretentious delusion. We should never trust anyone who claims to be objective. Instead of expecting that, look for someone with a “view from somewhere” (Rosen) from someone who isn’t afraid to disclose and own where they are coming from. The ideal is not to be unbiased, but to be biased with integrity.

Egregious bias is clearly present in a high percentage of peer-reviewed scientific papers. Subtle, insidious bias is basically everywhere. You can wish for unbiased content, but good luck finding it.

I get good criticism quite regularly — and I don’t just mean the criticism I agree with. But all these criticisms are useless. In summary:

  • isn’t a blog and it wouldn’t matter if it was. Good blogs matter!
  • All self-referencing on is supplementary. Extensive primary sources are provided where it counts the most.
  • Comments have nothing to do with the quality of most websites. readers can (and do!) provide influential input by other means (email, social media).
  • Bias is unavoidable; it’s better to be open about a bias than try to pretend not to have one.
  • Regardless, the credibility of the site or the author is irrelevant to the validity of the content.

Feel free to copy and paste as needed. 😉

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