Sunday, September 14, 2014

Accepting, rejecting, or ignoring ideas. (Part 2)

Part 2, How do we know what we know?

In a recent video making the rounds on social media, we see a "non-conventional" view of how the solar system and the universe work.  Despite the many errors in word choice (vortex rather than helix, universe rather than solar system) the quality of the animation looks very professional.  In this video, the planets are seen being dragged behind the sun as it races, corkscrews, and bobs around the universe.  This video is now approaching 2 million views, and climbing.  Nevermind that the information presented is false, it is very compelling.The second video by the same author doubles down and builds upon these misconceptions.  This is a great example of all the concepts I want to talk about in this blog.

It's Wrong?  Says you!


If you've read previous entries, it should go without saying that I'm not going to ask you to take my word for it when I say this video is inaccurate.  If I did that, I would be presenting even weaker evidence than the video in question.  At least he has a very pretty 3d animated demonstration. 

But wait, the model he is trying to dispute has gorgeous 3d models too!  It also has a long history of accurate predictions.  It also has consistently observable effects, like the positions of space probes, placement of stars outside the milky way, and events like planetary transits across the sun.  To convey this, let us consult an expert.  What would an astronomer say about this video?
It’s wrong. And not just superficially; it’s deeply wrong, based on a very wrong premise. While there are some useful visualizations in it, I caution people to take it with a galaxy-sized grain of salt.

 What was that saying about extraordinary claims again?


How much evidence would be required to unseat the sun as the center of our solar syst...err... group of planets?  At the very least, you would need a model that functionally explains all the observations we can make with the naked-eye.  This one fails that very first test.

But, because the internet levels the credibility playing field to a certain extent, it is important to look at new information from a critical thinking standpoint too.  I'm not an astrophysicist and you probably aren't either.  Assuming that you didn't know anything about the universe or gravity, you could still debunk the video by simple questioning. 

  1. Who backs the new point of view? (A small group with religious fervor about spirals, shamans, and energy that is actively looking to recruit new followers)
  2. Who has the opposing point of view? (NASA, Astrophysicists, Astronomers, Academic types: people who use knowledge of the subject to make predictions. and gain nothing from you believing them or not.)
  3. Which side presents a more complete case? (Hundreds of years of increasingly accurate predictions starting with Galileo. Everyone from Newton and continuing through Einstein all the way to the modern era of space telescopes and manned space stations vs. two videos based on a theoretical model posited by an herbalist/botanist)
  4. Which side has reliable experiments behind them?  (This is getting pretty obvious, isn't it?)

Sidenote: I will continue to add thoughts as time allows.  I've taken on a full-time load of classes, so I've let this blog go to the backburner.

Friday, June 13, 2014

Accepting, rejecting, or ignoring ideas. (Part 1)

Ever heard of Reflexology? Of course you have, you press on areas of the feet, hands, or ears and somehow, "reflexively," areas of the body are stimulated or healed. You've probably even seen these little pictures:

This represents a homunculus (or little person) on your hands and feet. If you squint your eyes, and use imagination, you might be able to see how they look person shaped. 

Many LMTs are remarkably bad at basic discernment. We seem, as a culture, to be willing to embrace anything "alternative" unquestioningly. That is why so many of us end up allied with the pseudosciences, health fads, mysticism, and thus kept at arm's length from the medical field. But we are only a single rung on the ladder of poor judgment. This is an epidemic.

I'm not going to tell you that Reflexology is all nonsense... I certainly could, but not today.  I'm instead going to tell you about a different homunculus

This One

"Recently, as a result of my developmental studies on human embryos, I have discovered a new version of reflexology, which identifies a homunculus represented in the human body, over the area of the buttocks. The homunculus is inverted, such that the head is represented in the inferior position, the left buttock corresponds to the right hand side of the body, and the lateral aspect is represented medially. As with reflexology, the “map” responds to needling, as in acupuncture, and to gentle suction, such as cupping. In my studies, responses are stronger and of more therapeutic value than those of auricular or conventional reflexology. In some cases, the map can be used for diagnostic purposes.
When John McLachlan, professor of medical education at Durham University in the U.K., submitted this hoax to the Jerusalem International Conference on Integrative Medicine, instead of being rejected or asked to produce evidence, he was accepted and asked to give a lecture at the conference.

These weren't LMTs, they were doctors.  Most of the names on the list end with PhD.  And they wanted to hear about this new miracle reflexology map located "over the area of the buttocks" that responds to "gentle suction."  They were basically being told to kiss their patient's asses.

Much of this blog is about what is and isn't reasonable or perhaps, what works and what doesn't work. Sorting that out via discernment and judgment is increasingly difficult even though knowledge is more and more accessible. This problem has always interested me. How is it that bad ideas flourish and really good ones never take hold?

The whole of human knowledge is accessible to you right now. Want to know the main export from the Democratic Republic of Congo? Just look it up on one of many available platforms right in front of you. Turns out it is minerals, cobalt and copper and such. When I was hand-writing reports in elementary school, that would have required a trip to the library. Information has certainly become plentiful, but is all that information helpful?

What happens when misleading information, intentionally incorrect information, or naive wishful thinking present themselves as knowledge? Every conspiracy, every hoax, every email forward chain, and especially everything Dr. Oz says, will be passed around endlessly on the web. Believe that Autism is caused by gluten? There is a community for you, complete with false promises and product lines despite evidence to the contrary. Believe that 9/11 was a conspiracy? There is a community for you. Believe that reptile-like aliens are taking over positions of power in the government? Yep, that exists too.

How does one separate the good ideas from misinformation?

Part 2, coming soon.

Monday, March 17, 2014

The Lost Art of Listening

(I wrote this piece for a local medical journal, I thought I'd share it here too)

The teacher who sticks rigidly to a text book and rarely entertains deviation from the lesson plan isn’t the one that inspires students.  The stalwart disciplinarian who refuses to hear questions rarely gains the favor of subordinates.  We want to inspire others to take responsibility for themselves, and that inspiration comes mostly from understanding and intuition.  Paula Denton wrote a piece for the Virginia Journal of Education called The Power of Listening.  It was written for teachers, but its lessons are easy to apply to my clinic: 

“To be known and understood is a basic human need. When we fulfill that need for students (or patients), they feel a sense of belonging and significance… “

Which brings me to my practice of massage therapy.  Patients love feeling physically better and having their needs anticipated, but above everything else, they want to be listened to. That is often what brought them to me in the first place. 

In his insightful TED talk, Abraham Verghese MD., Professor of Medicine and Senior Associate Chair for the Theory and Practice of Medicine at Stanford University, talks about the most frequent complaint he hears about doctors, 
it is amazing how often you hear, "(S)he never touched me!" or, ". . . never laid a hand on me!" or "never looked at me" or "never listened" or "was too busy looking at the computer screen.""
His main point is that when doctors spend time trying to create a virtual model of the patient, they forget to see the actual person sitting in the room.  Although that doesn’t happen in my field, the opposite problem occurs regularly.  Patients are brought into a room without a proper interview and given a generic massage routine which addresses none of their specific complaints.

As with many complementary and alternative therapies, massage therapists spend the majority of their time with a patient one-on-one.  We are in a wonderful position to help people, and have the time necessary to listen carefully.  People often seek alternative health practices simply because they want to be treated this way.  When I see a patient for the first time, the interview and intake procedure can take 20 minutes or longer, because I listen to everything they have to say about their pain and ask all the necessary questions to understand their goals.  Time to express their complaints with my undivided attention gets nearly as many positive comments as the massage gets.

Listening isn’t easy.  

There is a misconception that if you sit quietly while someone speaks, you have met all the requirements for listening.  

Being present, with open ears, is just the beginning.  

When someone speaks to us they are trying to tell us many things.  Besides the basic message in the words themselves, there is subtext in why they chose the words they use, the expressions both in the face and the tone of voice, and body posture.  Most of these messages are lost on the active listener.  Really listening to someone for more than a few minutes is much more challenging than it sounds.  Most of the time, in conversation our brain is busy anticipating the next chance to speak.  When with a patient, we want simple clear answers to tick boxes either on a chart or in our minds.  Our own thoughts, agenda, point of view, and expectations can seep in and drown out hearing the whole message.  

In a busy environment--with computer whirring, charts with empty spaces, missed calls and texts, anticipation of several more appointments today--focusing on the task of eye-contact and evaluation of words as they are being actively spoken can seem next to impossible.  To combat this there is no computer in my treatment room, there is also no phone, and virtually no other distractions from the patient.  I don’t even write down much of what is said until after the interview is over, just quick notes to keep track.  Even with all these modifications, I still have to actively quiet my mind to avoid categorizing problems prematurely.  My scope is fairly small, and even so, a missed detail can be the difference between an effective intervention, and a null result.

More importantly, I don’t want to be another example in a long line of, “I saw so-and-so and he didn’t even listen to me.”  Most of my patients have these stories in common.  It is not unusual for a primary care physician to send a patient home having never touched them and barely talked to them, usually recommending large doses of ibuprofen or naproxen, if anything is recommended at all.  If they come back, they are sent to a physical therapist who doesn’t touch them or listen to them before sending them off to do painful exercises with an assistant who urges them to ignore the pain and stick with it.  When results from this are less than stellar, should anyone be surprised?

Anti-inflammatory medicine may have been the right call, the exercises may have been exactly the right ones, but the patient didn’t feel satisfied with encounter with his/her clinician, so compliance is minimal.  It is human nature to take the advice of someone we like or respect.  A 2010 Harvard Medical School study showed that about 20 percent of first-time prescriptions are never filled.  That number drops even lower when we look at advice given without a written script.  OTC medicines aren’t taken seriously and take home exercises, in my experience, are very rarely done properly. 

It is admittedly easier to get patients to stick to a massage regiment. Despite the expense, massage is pleasant, feels significant and specific when done properly, and gets quick short-term results. During that time, if I can convince them to dust off the PT’s orders, or follow the regiment their doctor recommended, the results only improve.

Sunday, February 2, 2014

This is not a New Year's Resolution post.

I recently got serious about taking off the baby weight.  


When my wife and I got pregnant last year, we stopped exercising almost entirely.  My priorities shifted and I completely let myself go to focus on taking care of my wife, my business, my house, my pets, anything other than my physical health.  I made sure to cook healthy meals, but I also followed those meals with huge helpings of ice cream and cookies and cakes and...  you get the idea.

When my daughter arrived, my excuses rapidly disappeared. It was time for me to look at what I could do to reverse the damage done.

"Dad, there is no easy way to tell you this: you're fat."
Starting this new year I am about 25 lbs. heavier than last year.  I still have my gym membership, because we kept paying for it, like tithing to assuage guilt.  That only leaves the matter of what to do and how to get started.  For me, that answer came from trading massage sessions for personal training sessions from a certified trainer/massage therapist friend of mine.  I'm about 3 weeks in, so wish me luck.  By this time next year, I hope to be writing a victory blog.

What does this have to do with massage?


The universe is full of irony, it should come as no surprise that as I'm starting to get back in the saddle (trotting toward physical fitness) that I should start to encounter a huge uptick in avid athletic types.  CrossFit competing, marathon running, workout slaying types have helped to illustrate two very key things about my journey back.
  1. I have a long way to go.  Determination, discipline, and motivation will be necessary.
  2.  Injuries can quickly derail even the most motivated, disciplined, and determined.
There are a million different ways of staying mentally committed to your goals, and thousands of books and websites to help you along the way.  Find one, and if it doesn't work, just move on to the next.  Contrary to all the claims, there is no perfect program, routine, or diet.  You will need something to keep you on track though.  People fail far more often than they succeed when it comes to weight and health goals.

The same may be true for injury prevention, but that is needlessly complicated.  My one piece of advice?  Listen to your body.  If you have to "work through the pain" or ignore injuries to keep up with your goals, you are hurting your goals in the long run.  Injuries are avoidable, but one probably will happen.  You have to have a plan to deal with that injury.  Chronic pain may also happen, especially if you do insist on working through the pain.  Ignore any pain that has lingered longer than 3 months at your own peril.  Pain is a messenger, but it doesn't have to be a harbinger.

Massage can help maintain, even improve your performance.


There is plenty of science out there showing massage to be helpful within active and athletic populations.  It is certainly more beneficial than the supplements these folks often take, especially since one-third of supplements tested contained none of the plant extracts indicated on the product label.  Even when the right product is in the bottle, is there any evidence that it works as it claims?  Probably not.  One,  Two,  Three,  Four,  Five...  You get the idea.

It is no accident that my personal trainer is also a licensed massage therapist.  If your trainer isn't, find a licensed massage therapist that works with athletes.  A large number of NBA, NHL, MLB, as well as Olympic teams, have massage therapists on staff; along with the very best in physical therapists, trainers, and orthopedic surgeons on call.  It just makes sense to have that base covered.

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