Tuesday, April 16, 2013

The Bridge Is Smoking, But It Hasn't Yet Been Burned.

After showing this comic to my wife, I've realized I should explain why it is funny.  The comic illustrates a common statistical error and how the media portray very dismal results.  P Value is a measure of how sure you are that a particular result isn't just chance.  So if you test 20 different colors of jelly beans, then each color is only 5% of your accumulated results.  A 5% chance of coincidence on 5% of the results is 100% chance of coincidence.
Permanent link to this comic: http://xkcd.com/882/
 (If you aren't smiling, hold your mouse over the image for an explanation)

Being a Massage Therapist and a science enthusiast is a very difficult position.  It isn't inherently contradictory, as there is nothing intrinsic to massage that flies in the face of science; rather it is tradition and history that drives a wedge between the two fields.  And if this discussion on LinkedIn is any indicator, that wedge is large, heavy, and very hard to shift.  For those who can't see this discussion, here is what it looks like:

The end result of the discussion, thus far, is some feel you can say nothing at all about massage scientifically, some feel that science is just another religion, some feel that they have quantum-healing-energy-superpowers, and some feel that we should, in fact, look at the research before we tell a patient what massage can and cannot do.

In other words, there is no real consensus.  This answer would be obvious in any other field; LMTs are unsure whether evidence is important in evaluating what is and isn't fiction.

My position on this is in two parts.

  1.  The first part of me knows that there is no valid reason to avoid looking at the science.  You can say it is difficult, or you can say it is biased, or you can claim that your own personal evidence is better than anything that science can offer.  All of these explanations, when talked out to their logical conclusion fall flat.  
    • I am too busy, it is too hard: If you are offering massage, you have an obligation to understand how it works. Do you have any business ethics?  I would never offer my patients something if I couldn't explain why it is worth spending their hard earned money on.  This is just laziness and apathy.  If you can't understand something, ask someone in the field to explain it.
    • The Big Pharma Conspiracy: You think all scientists and doctors are conspiring to hide the truth and invalidate what would actually heal people?  Okay, then you have to back that assertion up with evidence.  A conspiracy of this magnitude would require complicity of nearly every major university, hospital, medical journal, and researcher.  If that is your perspective on the world, you seem to be living in The Truman Show. For that matter, how do you know the conspiracy theorists learned from weren't a part of a conspiracy to keep you ignorant?  As Christopher Hitchens said, "That which can be asserted without evidence, can be dismissed without evidence."
    • I make my own evidence: If you believe your personal anecdotes are better than all the scientific research, ask yourself if it is:
      • reviewed by peer-experts?
      • checked for human error, effect size, chance of coincidence?
      • evaluated for significance against placebo?
      • replicated by other experts?
      • checked against similar reports?
      • controlled and measured carefully? 
  2. The second part of me knows that a huge amount of this is faith-based. Some people speak about quantum physics, fascia, or consciousness in hushed tones. To them, there will never be enough evidence to overturn their desire to live in a particular version of the universe. One where their thoughts become things, their intentions produce results, and stuffy guys in lab coats are flummoxed by their deeper understanding of the world.
    • Quantum Physics is mysterious, and hard to understand:  For this reason gurus have grabbed on to it, and used it to assert fiction.  A simple look at Wikipedia can offer the explanation for most of these misinterpretations
      • The Observer Effect: ever check your tire pressure with a pressure gauge, and in doing so let out some air?  That drop in air pressure, the one caused by poking the pin inside the valve stem, that is the "mysterious" observer effect.
      • Particles don't follow Newtonian Physics: True, because particles are too small to be effected by those laws, but thoughts, intentions, emotions, and the like are not that small, and neither is anything you will ever experience with your senses.
      • Everything is energy:  Not really, everything is MADE of energetic particles.  For perspective on the difference, ask yourself this: can I breathe under water?  Water is made of Hydrogen and Oxygen, you can breathe hydrogen and oxygen, but you can't breathe water.  This is called the Fallacy of Composition.
    • Fascia is everywhere in the body: It is the container that holds organs, muscles, nerves, and vascular tissues.  This is often misconstrued to mean that fascia does all things.
    • Consciousness is an extremely slippery subject:  How would we measure something from the inside out?  But that doesn't mean that you can say anything you want about it and be right.  Also, we don't have to know everything about something to know something about it.
      • Deepak Chopra said so: This is called the Appeal to Authority.  He is a very intelligent man, but he isn't infallible.  He is only human.  His opinions are often anti-science, and he is always selling something to improve your quantum-spiritual-well-being. 
      • The Law of Attraction:  It's a LAW right?  It sounds sciencey!  Too bad this isn't actual science, but a construct of New Age Philosophy. One which lacks the values of any physical science law, it can not be verified nor falsified. It also ignores a simpler and thus more plausible explanation. 

So what does that leave us with?  Can we leap over this divide and find a space where those of us who want to help others can do so without trying to sell them our philisophical or religious values? Can someone who is deeply entrenched in ancient tradition still reach out to science for explanations without judgement?

The Dalai Lama thinks so. "If science proves some belief of Buddhism wrong, then Buddhism will have to change. In my view, science and Buddhism share a search for the truth and for understanding reality."

Who am I to disagree?

Wednesday, April 10, 2013

Can we talk about Cognitive Dissonance?

Other links regarding bias and dissonance:
The limits of reason
Treacherous Trio: confirmation bias, cognitive dissonance, and motivated reasoning

In a perfect world, one which we all wish to inhabit, humans are rational creatures. To make decisions, we rely on the best evidence from the most accurate sources, and choose the most prudent course of action. When confronted with the fact that something we previously believed was untrue, we throw our hands up and say, "I don't mind being wrong; that is how you learn stuff."

I don't think I have to tell you that we don't live in that world. I posted this image on facebook:

I can never know how many people looked at it, found it challenging, and then quickly found something else to look at.  I do know that it made at least one friend disgusted, uncomfortable, and even angry.  Driving him to question my education, accuse me of evangelizing science, and to ultimately abandon discussing the topic in favor of personal attacks and insults. 

When a little while later the same image appeared on The Scientist and IFLS... The reactions were very similar to what I experienced.  Most people expressed anger and outrage that whatever thing within the diagram they personally believed in was 100% real and anyone questioning it was stupid to do so.

So what is it about an image like this that causes such a visceral reaction? Why is it when people like Paul Ingraham, Alice Sanvito, and Ravensara Travillian bring research and accurate information to the public about massage they are met with personal attacks, insults, and outright derision?

Saveyourself.ca's own Venn Diagram

The answer is cognitive dissonance. Research has shown that "the primary causal agent for misperception is not the presence or absence of correct information but a respondent’s willingness to believe particular kinds of information" and that we are "...responding to information defensively, accepting and seeking out confirming information, while ignoring, discrediting the source of, or arguing against the substance of contrary information (DiMaggio 1997; Kunda 1990; Lodge and Tabor 2000)."

There is no way to turn off this bias, and it is a very strong motivator.  In evolutionary terms, it benefits our survival to feel secure in an orderly universe, and not experience doubt of our beliefs.  Like pain, the uneasy feeling we get when confronted with contradictory evidence is the brain's alarm and defense system.  One part of your brain is telling another part, "You better not go there, it will shake things up too much!"  Also, like pain, you need slow and graded exposure over time to change an existing state.  Old, deeply rooted, or cherished beliefs will not go out without a fight.

To tie this into massage, because this is a massage blog, when you hear any of the following:

Massage removes toxins -- Nope
Your pain is caused by Lactic Acid, massage removes it -- Nope and more Nope
Massage increases blood flow to the muscles -- Nope... No, but it does increase skin circulation
You need to heal your energy -- All kinds of Nope  Two  Three  Four
I'm going to stretch your fascia -- Not likely
Always massage toward the heart -- see Laura Allen link
Don't massage pregnant women in the first trimester -- see Laura Allen link
Don't touch the ankles of pregnant women -- see Laura Allen link
Don't massage cancer patients -- Wrong

More Massage Myths By Laura Allen
3 massage myths you should stop repeating by Sarah Cafiero

Remember that these things are beliefs, not facts.  You may do well to mention, delicately, that the best evidence we have shows exactly the opposite.  Do not, however, expect to be greeted warmly or to change minds.  You can lead a horse to water, but you can't make it drink.  Likewise, you can lead a human to knowledge, but you can't make it think.

One last myth worth mentioning, because it has some tragic consequences.

Vaccines cause autism  -- NoNope -  Still NoAnd we lied in the first place.

Sunday, April 7, 2013

TED Talks For You, Understand Pain Better (Part 1)

For a massage therapist and massage patients, understanding pain is absolutely essential. Reading books and research papers is not for everyone, and that is what makes TED such a great concept. Here are some quick and interesting videos to help you get a better grasp on the often head-scratching reality of pain.

Pain is an output from the preconscious brain, not an input from the tissues:

The amount of pain is not always related to the amount of damage:

Pain is subjective, personal, and complicated. (and massage works to decrease it):

... and for bonus, here is Radiolab's interesting podcast on understanding pain:

8 Random Things Everyone Should Know About Massage

I try to never miss an entire year on my blog, so here is one post for 2018: a list of concepts I think everyone should know before receivin...