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Not even wrong claims, and why pain “cures” are impossible in principle

 •  • by Paul Ingraham
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 PainScience.com: a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Many bogus claims in musculoskeletal medicine suffer from the “not even wrong” problem. That odd phrase describes a claim that seems scientific but is based on such bogus reasoning or imaginative/irrelevant premises that it can’t be clearly or easily corrected, even though it’s utter nonsense. Because it’s such utter nonsense. It’s like trying to clean up a really terrible mess; the worse the mess, the harder it is to know where to even start.

Consider this doozy of claim, that laser therapy “kickstarts photosynthesis in human cells”! That’s not a joke. Someone actually thinks that. First of all, let’s just take a moment to rest our faces in our palms …

Photo of a classy statue doing a “facepalm” of disbelief.

Now that we’ve gotten that over with … human cells are incapable of photosynthesis. Saying that lasers can stimulate human photosynthesis is like hoping they’ll add nuclear fusion to your car. But that response is a contradiction, not a real argument. How do you argue that human cells can’t do photosynthesis? It’s difficult, because it’s a technically unfalsifiable premise: no one can “prove” that human cells are incapable of photosynthesis, because we haven’t tested all of them. You never know what you might find tomorrow!

There is no clear, easy path to undertanding how absurd that premise is. You just have to go to biology school long to understand that discovering human photosynthesis is less likely than a gravity failure.

Testing and debunking the ridiculous is more trouble than it’s worth

Scientists rarely test not-even-wrong claims rigorously because their biological plausibility ranges from poor to bonkers. Some are testable in principle, but no scientist has ever bothered or likely ever will, and this makes simple refutation-by-citation impossible.

Rigorous debunking of not-even-wrong claims can only be achieved by explaining why they are ridiculous, but refutation-by-education requires a huge rhetorical effort. “A lie travels around the globe while the truth is putting on its shoes.”

For instance, it is possible to test an alleged perpetual motion machine, but you don’t need to if you understand the 1st and 2nd laws of thermodynamics. But grokking those is kinda hard!

Bringing this back to pain

Similarly, all pain cure claims are at odds with a “law” of pain science:

Chronic pain is too complex an experience for any one treatment approach to ever be consistently and impressively effective.

Every stitch of pain science, many lines of evidence for decades (consilience), has shown that chronic pain is extremely multifactorial, and especially affected by mental state. Therefore it is impossible in principle for any treatment to reliably relieve the majority of a person’s pain: there are too many uncontrollable factors that affect the outcome. The unstated premise of every pain cure claim is that it’s possible for one thing to work very well most of the time, and that premise is both silly and yet awkwardly unfalsifiable. And it gets worse …

Ironically, the very complexity of pain, it’s susceptibility to many factors, also makes it possible for some people to experience dramatic relief … and often with the help of the optimism powered by a new treatment they’ve just tried. And so the world is full of pain cure stories! Which makes it seem a lot like pain cures are possible.

But the explanation for the relief is usually wrong … and it won’t work for the next guy. Relief is possible for individuals, but they are idiosyncratic miracles that cannot be mass produced — and if you can’t bottle it, it’s not a “pain cure.”

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