Eternal Struggle Posts Series on pseudoscience, "energy medicine", and MFR

I gathered all the entries on MFR, pseudoscience and "energy medicine" together in this one link. I started out with the post, Hurray! New Flimflam Busters, which belongs in the Eternal Struggles series even though it isn't named as such. It introduces a blog called Science Based Medicine, "Exploring issues and controversies in the relationship between science and medicine", from which I have gleaned at least one quote; several times I've linked one of the authors, Harriet Hall's review of Oschman's "energy medicine" book on the Quackfiles site.

In Eternal Struggles I I introduce the reader to the branch of PT that promotes pseudoscience to explain and support a treatment technique, known as myofascial release, that its main proponent John F. Barnes lifted from osteopathy, claimed for himself, and has taught for decades.

Eternal Struggles I through IX, and then XI, all examine a long thread on a evidence-based PT forum which has to do with revealing the thinking of the people and teachers in the branch of PT in question. Excerpts taken from a post in which one of the main teachers of this dubious hypothesis, who teaches it at university level, are deconstructed by comparing and contrasting them to excerpts taken from Rory Coker's article, Distinguishing Science From Pseudoscience at the Quackwatch site.
Post X is about a separate but related discussion also on the EIM group blog.

The list of entries in this series:
Eternal Struggles I
Eternal Struggles II
Eternal Struggles III
Eternal Struggles IV
Eternal Struggles V
Eternal Struggles VI
Eternal Struggles VII
Eternal Struggles VIII
Eternal Struggles IX
Eternal Struggles X
Eternal Struggles XI

July 18/'08
I'm back in this post to add a new link, which I think I'll call "Eternal Struggles - an even dozen."
It's a recent post by Jason Silvernail, highlighting some of the "sturm und drang" that makes the JFBMFR group seem more like an encounter group than a manual therapy group. I think Jason is right - the group is starting to sound like more of a cult than anything else. It is quite disturbing to read through, but informative.

August 16/08
I'm back in here to add a postscript. Two days ago John Barnes had a lawyer send around a letter naming five PTs who would be sued if they didn't remove their posts, which he had decided were defamatory, from the internet. The posts have been removed. So anyone who reads this series will find that the links are empty or near empty. Too bad - they were great threads that spelled things out pretty well.

This is a fine example of egomania IMO - if you have no science to back your claims you can always threaten to sue those who point that out. He has made a huge amount of money peddling his pseudoscientific wares to those who love a straight diet of dopamemes, and now he can use it to bludgeon other members of the profession into silence. Is this the American Way? Try to stifle free speech? I've never been so happy to be a Canadian PT as I am tonight (because we don't operate this way in Canada, not over stuff like this anyway..), and I've never felt more sympathy for those targeted. This does NOTHING for JFB's credibility - he won't discuss his.. um, "work" on a science-based level (mostly because it doesn't have any), and he won't engage with people in an ordinary collegial way - instead he stays silent then slaps down lawsuits through third parties. Is this not cowardly behaviour?

Update: August 27/08
Here is a link to Jason's latest post, Myofascial Release Posts Retracted

Ancestors

I came across a link to this article by Lynn Margulis, The Germs of Life, published in Orion magazine, about microbial ancestors, how the roles they have played in our evolution and still play in our ecosystems are becoming better understood.

1. "Bacterial nitrogen fixation enriches the soil at no cost to us."

2. "..the photosynthesis that excretes oxygen and makes food for all life is carried out by the blue-green bacteria called cyanobacteria—both the free-living kind and those that became chloroplasts in the cells of algae and plants."

3. Even disease-causing bacteria play a role in overall systems health - e.g., anthrax bacteria prevent overgrazing/kill grazers, saving the soil so it can grow new crops.

4. Bacteria in our gut tubes provide essential vitamins, assist digestion.

5. Bacteria in our orifices enhance metabolism, block opportunistic infection (like yeast), help our immune system sustain itself.

6. Mitochondria along with other cell "parts", perhaps,(such as cilia) evolved from various "communities" of different species of bacteria-like life which cooperated for survival, learned to live in "community."

7. Cilia are a feature of many of the sensory cells of the nervous system.

8. Everything social we do as humans, bacteria already invented long before. Humans will go extinct long before bacteria and other microbes do.

Cory's new blog: Forward Motion

Cory Blickenstaff, who has joined Matthias Weinberger and I on the Neurotonics PT team blog, has just launched his own blog and website, Forward Motion. I've included a permanent link on the right, in the PT blog menu. It's a very attractive, easy-to-read site, with spiffy dropdown menus. Good work Cory. I look forward to reading all your thoughts.

Eternal Struggles XI: "Pseudoscientists invent their own vocabulary"

From the Coker article:

"Pseudoscientists invent their own vocabulary in which many terms lack precise or unambiguous definitions, and some have no definition at all.
Listeners are often forced to interpret the statements according to their own preconceptions. What, for for example, is "biocosmic energy?" Or a "psychotronic amplification system?" Pseudoscientists often attempt to imitate the jargon of scientific and technical fields by spouting gibberish that sounds scientific and technical. Quack "healers" would be lost without the term "energy," but their use of the term has nothing whatsoever to do with the concept of energy used by physicists."

Jason's first EIM thread has accumulated 86 replies to date. We return to it now.

Carol Davis' final remarks:

"I have been a proud member of the American Physical Therapy Association since 1967. I have worked diligently to help move the profession forward to the clincal doctoral level. I have continued treating patients all throughout my academic career, and my outcomes using myofascial release are extremely positive. I have three case studies conducted with my students in process to submit to peer reviewed journals, two of which I have presented at Combined Sections meetings in the past. Case studies are the lowest level of evidence we have in systematically trying to explain what is happening when we treat, but it is a start, a way to keep sorting through the outcomes we see with our patients that help them to improve their function and decrease their pain. That is my commitment."

In the blog Science-Based Medicine, an recent entry Collision of Incompatibles appears. The topic of CAM as "anomalous medicine" is proposed. Reading through the 50+ replies is an instructive exercise. On Jan. 20/08, in reference to CAM studies, Harriet Hall includes in one of her replies:

"These studies are prime examples of what I call Tooth Fairy science. You can study how much money is found under the pillow if you leave the tooth in a baggie compared to leaving it in a Kleenex. You can study how much money children in different socioeconomic groups get. You can study whether the money for the first tooth is the same as for the last tooth. You can get all kinds of statistically significant results. You could publish those results as telling us important information about the Tooth Fairy. But that research would be worthless, because you have not established that the Tooth Fairy is real, and you are not actually testing what you think you are testing."

My bolds.

In all fairness to Carol Davis & co., most PT studies likely fall into this Tooth Fairy category in that most are about establishing efficacy rather than understanding or worrying over why or how or linking findings to the deconstruction of one hypothesis or another - PT "science" is still an infant. But investigators could at least base their work on what other fields of science have already established. Lack of evidence to support energy medicine and vitalism is the equivalent of an impassable cliff. Why not take advantage of any actual scientific trails through the woods? For example, there is ample neuroscience to wade through and base our own science projects upon. Occam's Razor (chainsaw) is for slicing down "unnecessary hypotheses." Davis misuses our collective scientific resources/wastes scientific (real, biological, ATP) "energy"/wears out the chainsaw trying to cut through rock and making ladders to try to climb up the cliff.

This concludes comment on Davis and her EIM reply. The "Eternal Sruggles" series of posts on pseudoscience within physiotherapy is now complete. Thank you for your attention.

Eternal Stuggles X

This post is an easy one - I'm going to point the reader in the direction of Jason Silvernail, who has put up a second post on EIM, called Myofascial Release Madness #2: Energy Medicine.

An excerpt:

"A big part of the theoretical explanation for Myofascial Release involves the concept of Energy Medicine (EM). In addition to MFR, approaches as diverse as traditional acupuncture, reiki, acupressure, therapeutic touch, Qi Gung, and the vitalistic chiropractic subluxation theory (among others) also rely on aspects of EM... (Beyerstein paper, Distinguishing Science from Pseudoscience) ...There are many good reasons why any science-based clinician should reject the concepts of EM as an explanatory model. Put simply, EM is just another variant of the "vitalistic" philosophy which states that there is a flow of a kind of bioenergy in the human body, and that obstructions or poor flow of this energy is responsible for many diseases and conditions. The NIHs National Center for Complementary and Alternative Medicine page on EM is here.

Lately a book by author James Oschman on EM has created a stir for those who support energetic medicine concepts. Dr Harriet Hall MD has a great review of this book in Skeptic magazine (volume 11, no 3), which you can read online here at the "Confessions of a Quackbuster" blog.

What does this energy flow have to do with Myofascial Release (MFR)? Well, here is Mr. John F. Barnes himself describing it on his blog:

"However, what about the enormously powerful influence of the billions upon billions of micro-tubules of the fascial system that carry fluid, information and energy that act as tributaries into the major rivers? [by rivers he refers to qi acupuncture meridians here]

Myofascial restrictions block the flow of the meridians and the tributaries causing major problems such as pain, physiological dysfunction and disharmony.

Myofascial Release is important in that it can ease the crushing pressure caused by Myofascial restrictions, opening up the meridians and the tributaries (micro-tubules) for maximum flow of the bio-energy of the mind/body, which allows for a return of function and healing."

And here:

"This trapped potential energy can be freed by Myofascial Release converted into kinetic energy freeing the mind/body’s vibrational level to return to normal."

Unfortunately for those espousing EM, this supposed bioenergy has never been demonstrated to exist, as both Dr Hall's review and the NCCAM paper explain. There are rational explanations for the effects seen in the clinic for manual therapy. Energetic medicine and bioenergy fields are not one of them."

I couldn't agree more. Concepts such as EM are like waking dreams - they make no sense. They are conceptual hallucinations. They are not scientific. They are based on nothing at all. They do not further knowledge. Trials that are done to support them end up supporting nothing, because those who conduct them fail to apply Occam's Razor, which is an "admonition against unnecessary hypotheses." There is no need to create a mythical "second nervous system" to explain one's treatment effects. There already exists a perfectly good real one, comprised of several generations of ectodermal derivatives, already complex and mysterious enough to produce awe sufficient for everyone, if they bothered to read.

Maybe this is what I should do with my life, write a book about the nervous system for non-science-based human primate social groomers.

Eternal Struggles IX: "Pseudoscience begins with an emotionally appealing but implausible hypothesis which only looks for items to support it"

From the Coker article:

"Pseudoscience begins with a hypothesis — usually one which is appealing emotionally, and spectacularly implausible — and then looks only for items which appear to support it.
Conflicting evidence is ignored. Generally speaking, the aim of pseudoscience is to rationalize strongly held beliefs, rather than to investigate or to test alternative possibilities. Pseudoscience specializes in jumping to "congenial conclusions," grinding ideological axes, appealing to preconceived ideas and to widespread misunderstandings."

More from Carol Davis's post on the EIM thread (I have added links into her text):

"This blog group obviously defines the higher levels of Sackett to be the only acceptable evidence for efficacy, and I understand the reason why you would want to remain there.
However,if you want to question the science behind complementary therapies, (basic science or research outcomes), you need to question the NIH. In 1997 the NIH held a consensus conference on the evidence for acupuncture and not only publically agreed that well designed peer reviewed research revealed that acupuncture was providing positive outcomes in certain cases, but that there was a level of credibility to the concept of a "flow" that needed to be investigated further by approaches other than the randomized controlled trial.
If you want to question the science behind complementary therapies in rehabilitation, question the positive results of Tai chi on balance conducted as part of the multisite FIXCIT trials at Emory University headed up by Dr. Stephen Wolf.
If you want to question why a research one university has hired and tenured a professor who teaches about complementary therapies in rehabilitation, question the administrators of Harvard Med, Duke, Princeton, USC, Stanford, and a host of other schools which proudly publish from their medical schools in the several peer reviewed journals that now exist, and offer annual continuing education on these topics.

This train has left the station folks, and we can engage in wonderful discussion about what we believe, what we know as fact and what we can prove with regard to the science behind complementary therapies. But to ignore or dismiss the contribution of quantum physics to this discussion is to turn a blind eye to exciting and quite plausable hypotheses that accompany the facts of what we observe is happening at a celluar level. I say "observe" based on the work of outstanding scientists, at Harvard, Duke, Princeton and, yes, the NIH, NCCAM - National Center for Complementary and Alternative Medicine."

Just in case anyone reading this missed it, here it is again:

"But to ignore or dismiss the contribution of quantum physics to this discussion is to turn a blind eye to exciting and quite plausable hypotheses that accompany the facts of what we observe is happening at a celluar level."

There is a whole system in there, in the body, that Davis repeatedly ignores in favor of jumping to the molecular level of existence. That system is the excitable nervous system. This truly sounds like she would prefer to ignore the obvious in favor of the glamorous, or the mysterious, or the pre-packaged, pre-digested pseudoscientific memeplexes that float around out there in our sad, tattered postmodern dumbed-down world where all ideas are considered equal (especially on TV) no matter how absurd or anti-science or inappropriately outside their own domain they may be.

Honestly, I have no problem with research of tai chi or anything else. Fine. It's easy (at least it SHOULD be..)to separate -

1. the "thing" itself, some intervention used by humans on themselves or each other, from..
2. its historical underpinnings, the set of ideas, the theory that accumulated around it and was used to "explain" it.

If the thing turns out to work, it does not follow therefore that the THEORY was correct.

To provide contrast, here is a paper in which the author did a tremendous job of providing support for his particular theory from several different domains without ignoring the nervous system or shmushing domains together or violating any of them in any sort of annoying way, takes care to not deliberately insult the intelligence of any of the specialists who might work in any of those domains:
Minds, Brains & Catalysis: A theory of cognition grounded in metabolism (...by Chris Davia). In particular, check out his section titled Life as Catalysis - he keeps different scalar categories of energy dissipation separated with firm black lines, so that his model looks like a patchwork quilt.

Eternal Struggles VIII: "Pseudoscience always avoids putting its claims to a meaningful test"

From the Coker article:

"Pseudoscience always avoids putting its claims to a meaningful test.
Pseudoscientists never carry out careful, methodical experiments themselves—and they also generally ignore results of those carried out by scientists. Pseudoscientists also never follow up. If one pseudoscientist claims to have done an experiment (such as the "lost" biorhythm studies of Hermann Swoboda that are alleged basis of the modern pseudoscience of biorhythms), no other pseudoscientist ever tries to duplicate it or to check him, even when the original results are missing or questionable! Further, where a pseudoscientist claims to have done an experiment with a remarkable result, he himself never repeats it to check his results and procedures. This is in extreme contrast with science, where crucial experiments are repeated by scientists all over the world with ever-increasing precision."

From the EIM thread, Davis' next statement:

"The outcomes of some complementary therapies lend themselves for study by way of the randomized controlled trial. Manual therapies often do not, as the bioenergetic aspect of what is happening at the cellular level is impossible to confirm with repetition, or validate without a doubt as we lack the technology so far. But that technology is advancing as we speak, and scientists are using it and writing about it in greater numbers. And I continue to study it, and write about it in an effort to help translate it to the practice of rehabilitation.
So we who practice the manual energy - based therapies have to content ourselves with living in the world of basic science hypotheses right now, as we try to explain what we feel is happening under our hands. This includes, of course, joint mobilization."

I think she is actually suggesting that before PTs even begin to understand or study our hands-on applications, we will have to embrace a "bioenergetic" interpretation of it - then we'll have to wait around for the "technology" supporting it to advance. I think she truly considers herself to be a PT leader, marching toward understanding, followed blindly by multitudes of us ordinary PT human primate social groomers who rely on someone like her to think on our behalf. She will continue to dig deep into the Oschman line of thought, preparing for the day when enlightenment will finally reach the science community also, whereupon we'll be provided with "technology" sufficient to study our rehab methods, what she "feels" under her "hands", and all the Oschman lines of thinking will be shown to have been correct all along.

Of course, lest we forget, she actually has received awards from the APTA. So I guess that proves she is a true leader, right?

Note the complete lack of reference to anything to do with the nervous system or how it functions, or how some of it is a sensitive physical peripheral system. Not a word. Not even one.

Eternal Struggles VII: "Pseudoscience argues from ignorance, an elementary fallacy"

From the Coker article:

"Pseudoscience argues from ignorance, an elementary fallacy.
Many pseudoscientists base their claims on incompleteness of information about nature, rather than on what is known at present. But no claim can possibly be supported by lack of information. The fact that people don't recognize what they see in the sky means only that they don't recognize what they saw. This fact is not evidence that flying saucers are from outer space. The statement "Science cannot explain" is common in pseudoscience literature. In many cases, science has no interest in the supposed phenomena because there is no evidence it exists; in other cases, the scientific explanation is well known and well established, but the pseudoscientist doesn't know this or deliberately ignores it to create mystery."

My bolds.

Carol Davis says in her next paragraph in the EIM thread:

"Some of you say all that we observe can be easily explained by understanding basic Newtonian physics and cellular physiology. But some very compelling questions cannot be explained so easily, and certain patient responses cannot easily be dismissed as "ouliers" to the normal bell curve of responses. For example, the thousands of recorded cases of the spontaneous remission of space invading tumors, or where the extra energy comes from when given off in a muscle contraction (greater than is produced by the mitochondria of the cell), like how in the world can a person hit a baseball coming at them at over 90 miles an hour when the speed of neural transmission is far less than is needed with those conditions?"

Let's move on to the deconstruction of Davis' thoughts.

1. ENERGY TRANSFORMATION:
I have some thoughts on this.. points to make.. I confess my own knowledge base has a lot of gap and distortion, but it seems to me that biology is based on ordinary physics (thermodynamic considerations about energy transformation) and that cellular physiology concerns itself with how the body produces new combinations of substances that are life supporting. It also seems to me that our own profession, PT, which concerns itself with human interaction and the strategic application of outside forces to the body by person A (the "therapist") to help the nervous system of person B (the "patient"), to effect change for the better from the patient's perspective, is safe in relying on ordinary science to help it along, help it do its job.

About tumors, I know nothing, so choose to say nothing.

One of the best books I have ever read on the topic of energy transformation that did not insult my intelligence was Into the Cool: Energy Flow, Thermodynamics and Life, by Eric Schneider and Dorion Sagan. Much of it is available to read online through the link I've provided. So easy.

2. SPEED OF NEURAL TRANSMISSION:
My understanding is that actual, ordinary neural transmission speeds vary depending on fibre size, length etc, but that important stuff, like avoiding or connecting with an object hurtling toward one at 90 mph is managed by the nervous system at a rate of about 270 mph, which seems fast enough to me. I found a (reasonably good I think) paper (I think it's a book chapter) by googling (so it would seem that it is free access), called Excitable Tissue. It discusses the voluntary nervous system, which, we should remember, is as much under the control of vision as it is of the sort of kinesthetic sensation referred to in the paper.

Eternal Struggles VI: "Pseudoscience makes extraordinary claims"

From the Coker article:

"Pseudoscience makes extraordinary claims and advances fantastic theories that contradict what is known about nature."

Professor Davis came on the EIM blog yesterday to defend her teaching choices. I will bring her response here a bit at a time and comment on each point she makes. There are so many points to comment on that it may take awhile just to deconstruct this single post from her. But I will take it as far as I have the stamina to.

Here is sentence one:

"The science of energy medicine, or bioenergetics is quite a huge shift from traditional science based on Newtonian physics, and thus is hard to understand and harder to believe. However, it is a major challenge to explain what we observe happening when we apply complementary therapies, whether it be Yoga, or Pilates, or Tai chi or massage or myofascial release."

1. ENERGY MEDICINE:
Here is a wikipedia entry for an NIH definition of "energy medicine". Note that there are two kinds, veritable and putative. "Veritable" would include things like light therapy, something in the realm of regular physics. "Putative", on the other hand, is "based on the supposition that illness results from disturbances in (undetectable or unquantifiable) energies and energy fields and can be addressed via interventions into those energies and energy fields."

Oschman's book "Energy Medicine", which Davis continually refers to, tries to justify hanging on to concepts that are long past their due date. (See Harriet Hall's review of his book.)

2. BIOENERGETICS:
There appears to be no sturdy definition for "bioenergetics."
I'm fairly confident that Davis is leaning away from a medical definition of the term, which is "the study of the energy transformations in living organisms" (like metabolism, etc.), and toward vitalist definitions based on belief systems.

3. CATEGORY ERROR:
I don't know how yoga or Pilates or Tai Chi belong in the same category as massage and MFR. The first three involve active movement by an autonomous human, while the latter two involve the patient lying still and a practitioner applying some mechanical forces into the body/nervous system. I beg to differ with the idea that "it is a major challenge to explain what we observe happening" - that's the easy part...

4. TREATMENT CONSTRUCT:
... What is harder is to know what someone thinks they are doing when they practice the first three items she lists or are applying the second two items to another person/patient. A practitioner involved in treating another usually has developed one kind of treatment construct or another. Professor Davis seems to think that her strange treatment construct is a better one to teach to innocent PT students than ones that are based on ordinary biology, anatomy, neuroscience. She doesn't seem to get that this is what is being disagreed with.

Eternal Struggles V: "Pseudoscience "research" is invariably sloppy"

From the Coker article:

"Pseudoscience "research" is invariably sloppy".

"Pseudoscientists clip newspaper reports, collect hearsay, cite other pseudoscience books, and pore over ancient religious or mythological works. They rarely or never make an independent investigation to check their sources."

There is a thread about Barnes' version of MFR going on the Evidence In Motion blog, called "Myofascial Release - Time to Stop the Madness?"

One of the posters, John Ware, actually contacted Carol Davies at U. Miami to ask her to defend her particular slant on PT education - she "requires" that PT students buy the textbook she wrote - which she declares is "evidence-based" no less.

She replied that she wouldn't discuss the matter until the PT who invited her had read through Oschman's book. From his post on the matter:

"I have more than once personally invited Dr. Davis to come to this forum or the soma simple site to discuss and defend her embracing these questionable concepts. She has refused to continue to discuss the issue with me at all until I read James Oschman's book on "energy medicine." Apparently, this is considered an authoritative text by the Barnesians merely because it has the word "science" in the title and banters quantum theory jargon around. When I replied that I had read a review by Harriet Hall, MD that thoroughly and convinclingly discredited any scientific basis for Oschman's book, she discounted Dr. Hall as an "avowed cynic." Now, why anyone would confess to being a cynic when they are in the business of reviewing purportedly scientific writings, I have no idea."

This seems like pseudoscientific red flag #2 cop-out to me.

One interest I have in all this is how the university she teaches at lets her get away with this apparent conflict of interest, not to mention the exertion of apparently next to no quality control over the intellectual product that it graduates. Here is a position paper on the matter, produced by the American Association of University Professors. Perhaps Davis is not a member. Perhaps U. Miami is not affiliated.

This bothers me - it is MY profession, the same one I belong to - that is being affected by graduates that have passed through her..um, particular version of "PT education."

Eternal Struggles IV: "Pseudoscience displays an indifference to facts."

From the Coker article:

"Pseudoscience displays an indifference to facts."

I looked around the internet for links to bring that show the history of myofascial release, and sadly there is next to nothing out there. This wikipedia link is pretty good, probably the least misleading of any of the 48,000+ links google provides when one types in 'history myofascial release'. Myofascial release's origins are with osteopathic manipulative medicine, not with PT as such, or rolfing, or massage, although individuals in all of these "fields" would claim it as part of their own professional "toolbox". It is, like many other treatment interventions, including "manipulation", a world unto itself, taught by most as a simple set of hands-on tools, a label given to a specific form of kinesthetic awarenesses (see paragraph 4 here).

There appears to never have been any real proprietary context for this collection of kinesthetic contributions to human primate social grooming until Barnes came along. For example, Rolf did something like myofascial release which later became referred to as "Rolfing" whereas Barnes took the set of techniques along with the name it had acquired, clothed it in his own collection of strange constructs to "explain" how it works, branded it to try to make "MFR" synonymous with himself - probably to "sell" it easier. This is something done routinely in chiropractic, in my opinion a particularly odious proclivity... but wait, we haven't even gotten to the pseudoscience part of all this yet.

The FACT (toward which indifference is being displayed by Barnes et al.) is, (hello?) there is a peripheral nervous system inherent in skin and body that reads exteroceptive contact and reports it to the CNS, which acts (or doesn't) upon said exteroceptive information. This is a giant fact that should not be ignored, especially by someone who is supposedly a PT. To ignore this fact in such a blatant manner is intellectually unconscionable. To deliberately prefer to spread notions about "quantum shift", etc., instead, as a PT, is to radically undermine the PT profession itself, in my opinion. For the profession itself to ignore such shenanigans without protest is, at the very least, self-destructive.

If I could re-invent the physiotherapy profession, I would charge each member of it with the duty to safeguard it. Safeguarding would not consist of following a bunch of rules and training only one's hands to a set of predigested tasks: - No, it would be an ongoing interfacing process of backing up all treatment interventions with basic anatomical, physiological and biological knowledge, whatever the current best knowledge was, bearing in mind that science advances and therefore regular upgrades would be necessary to provide ongoing quality control. The medical profession does this to a large extent. My understanding is that this is what PT is supposed to be like.. but I would go a bit further and add that any member who refused to do this, who instead taught to other practitioners something else entirely, would, after a couple warnings, be expelled from the profession, have their license revoked. Then my profession would be one that stands up for itself, its future health, the healthy future for its membership, and the right of all patients treated by us to have explanations given to them that are straightforward and respect their intelligence.

Wow, just think: we could be a profession whose members help the public learn how to think rationally about their bodies and about pain. Of course, we have a lot of work to do on ourselves first with Occam's Chainsaw.

Eternal Struggles III

I want to bring a scholarly paper here, written by Barry Beyerstein in 1995: Distinguishing Science from Pseudoscience. At 50 pages long, it is an extensive read, and touches on most categories of this issue, covering many of them in detail. It will inform the reader well on the kinds of pseudoscience that exist, why they are pseudo, how all of us are susceptible from time to time, and how to defend one's own mind against it all - what the red flags look like so they can be spotted, in other words.

A moderator on Somasimple started a thread about Barry Beyerstein and has several more links to his work posted there. He was a prof at SFU, in BC, and a contributor to the magazine Skeptical Inquirer. He passed away suddenly last year.

While writing this and bringing a link to SFU here, I serendipitously found this media release from just a few weeks ago: Scientists find origin of electrical signals in nerve cells. Excellent. Congratulations, real scientists, and thank you.. you are helping clinicians like me figure out how to apply our treatment knowledge without resorting to pseudoscience.

Eternal Struggles II

In reference to Eternal Struggles:
Here is an excellent overview of pseudoscience by Rory Coker, Ph.D, on Quackwatch, (linked here on the right side of this page) entitled Distinguishing Science and Pseudoscience (2001).

Here is paragraph one:

"The word "pseudo" means fake. The surest way to spot a fake is to know as much as possible about the real thing — in this case, about science itself. Knowing science does not mean simply knowing scientific facts (such as the distance from earth to sun, the age of the earth, the distinction between mammal and reptile, etc.) It means understanding the nature of science — the criteria of evidence, the design of meaningful experiments, the weighing of possibilities, the testing of hypotheses, the establishment of theories, the many aspects of scientific methods that make it possible to draw reliable conclusions about the physical universe."

In other words, science is a verb, not a noun. I think Michael Shermer said that first, but I will borrow it here.

The whole spectrum of human primate social grooming must move on if it is to progress. I feel sometimes like my own profession (PT) is a felled tree of human primate social grooming floating down a river of evolutionary time, and I'm a survivor clinging to it, come what may; clinging seems better than any alternative I can see from here...no river banks in sight. It's movement, but passive, not active. A lot of the intellect within it is strictly potential, not actual. Furthermore, its branches snag easily, and if it were to get permanently caught in a jam, and the river level fluctuate (which river levels do) my tree raft through life would become completely submerged.

In my opinion the retention of all these goofy anti/pseudoscientific notions inherent, if not strictly within my profession, then within certain individuals who heavily lean toward profiting from its credentials and by teaching members of it, are like thick fluffy branches, getting caught on everything and threatening to stall the progress of the tree, drowning its passengers rather than floating them to wherever a beach might beckon, wherever the tree might be made (more usefully) into a canoe shaped by collective thought. Occam's Razor is an "admonition against unnecessary hypotheses". The field I'm in desperately requires Occam's Chainsaw.

I plan to go through the list in this quackwatch article and point out how MFR (a la Barnes, Davis) fits with most if not all of the points made. Then, in good scientific form, we shall let the (wood)chips fall where they may.

Eternal Struggles I

It's rare that I side with my orthopaedically-minded colleagues on anything much. I have an issue with their generalized lack of acknowledgment of the importance of nervous system considerations and apparent lack of interest in pain theory or pain treatment. They are the consummate "All-you-have-to-DO-is" people. They want to DO, not think (at least they don't want to be forced to think very hard...)

To them, it's easy you see, all body pain comes from joints. To tackle any perceived problem be it motor dysfunction or pain, "all-you-have-to-DO-is"... find the suspect joint and apply pressure to it in such a way that you passively move the joint surfaces upon each other and voilá, movement improves, pain leaves. Simple as that. Formulaic. Except for when it doesn't work out so easy, pain is not only not alleviated but even worsened by this cavalier approach. Pain is always the patient's problem, you see, never the practitioners'..

This is generally true of chiropractic as well - that segment which presumes to believe it is evidence-based.

This is what I like to refer to as training wheel mentality - intellectually neotenous dependence on a simplistic model that has been around so long and is so well-established that it will never come of age. Passed along and down through the ages mostly by workshops and various "schools" by manual therapy gurus in a direct transmission sort of way, this set of only-slightly-varied (and expensive to learn) ideas and behaviors has been a cash cow and a never-never land that the old boys of manual therapy (who, like Peter Pan, never grew up past these training-wheel ideas) created long, long ago - it has been perpetuated as an integrated meme-plex, the underpinnings of which are seldom examined and rarely if ever updated.

But I have digressed terribly. This post was not intended to be about my life-long allergic response to orthopaedic mentality. Let me begin again.

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Once in awhile, politics make strange bedfellows: Jason Silvernail started a thread on Evidence in Motion, a strong PT group weblog that promotes an orthopaedic approach to everything, "evidence-based" (in an ortho sort of way at least...)

Jason's thread exposes and shines a spotlight on a major blight on science within PT itself, namely the teaching empire that was built by John F. Barnes, successful over a number of decades now. Barnes borrowed a technique from osteopathy called myofascial release, and conflated into it his own interpretation of Oschman's strange ideas on "energy medicine". Read Harriet Hall's deconstructive review of the book "Energy Medicine", by James Oschman. Barnes also added in his own approach to "repressed memories" which he claims are "trapped in fascia" both of which he believes he can "release" by changing (yes, physically changing from a gel to a solute) fascia from outside the patient's body, with his hands, using some sort of mentally applied quantum physics possibly, while encouraging his patients to "remember" their buried emotional traumas. Practicing this would be bad enough, but he teaches this. He makes money selling this set of interwoven ideas to human primate social groomers who feel inadequate and want more information. His ideas take root in vulnerable minds and he gains a "following" of practitioners in whom it would seem he has not encouraged any critical clinical thinking - in fact it would appear that he actively discourages such a thing. He claims his version of MFR has scientific rationale - but it seems like just the same old "energy medicine" stuff to me.

"When two opposite points of view are expressed with equal intensity, the truth does not necessarily lie exactly halfway between them. It is possible for one side to be simply wrong." - Michael Shermer, "Wronger than Wrong", Sci Am 2006

I'm all for a good sound deconstruction of this Barnes approach that seems to have all but taken over PT, but for the (skeptical, bless their socks) ortho people. For one thing, it would be wonderful if someday careful hands-on work with the outer layers of people's bodies was not automatically assumed by the ortho people in the PT profession to directly fall into this category of what I hope to show is pseudo/anti-science. It would also be better for patients if my profession had taken steps to counter all crazy thinking like this, thinking that came into it holus-bolus along with soft tissue techniques and should have been decisively countered at the time, but wasn't. Never too late though. The time has come. Neuroscience has provided a much saner foundation on which to base treatment constructs.

It remains to be seen, however, if the profession is in good enough shape to take this reclamation job on. Apparently Carol Davis, a friend, someone who would appear to be a "disciple" of J.F. Barnes, and vibrational energist, teaches physical therapy students at U. of Miami and has written her own book called "Complementary Therapies In Rehabilitation". It contains every pseudo-and anti-scientific idea that ever came along with any of these therapies. Davis, according to her bio (see bottom of page) has been the recipient of an award by the APTA, which represents the American branch of the PT profession at a national level.

Here is her public letter to "John":

"Dear John:
I have been reading about the “new” science - the latest hypotheses concerning the effects of quantum physics on our mind/body - and I have come to recognize the central role that fascia plays in the process of health and healing and balance. What I have read from James Oschman’s work in Energy Medicine and Lynne McTaggert’s book, The Field, from a bioenergetic perspective, health is now being viewed as a balance of flows throughout the body that insures homeostasis through adequate immune response, endocrine function and other functions. According to Oschmsn,this balance seems to result from the flow of photons (sub atomic particles of light) all throughout the mind/body over the “living crystal matrix” of fascia. And fascia, the fascial web, actually is the superconductor of vibration, of energy flow. So it makes sense that myofascial release is the key to treating fascial restrictions that interfere with the conduction of the energy, the vibration of energy, of photons, that is responsible for health.
You say that, in proper treatment, myofascial release, by way of the piezoelectric effect from the pressure of the hands on the body, transforms potential energy into kinetic energy, and the polyglycoid ground substance of the fascia becomes less solid, more fluid. This hydrates the fascial cells, and the cells the fascia surrounds, so that they can vibrate once again for their own healing. So that they can conduct flow to the rest of the body/mind. Like taking your foot off the garden hose so the water can flow, the fascia “plumps up” again and the DNA of the cells it surrounds once again can vibrate off photons to regulate the cell it is within and also to communicate with other cells by way of photon or “light information” for the benefit of the entire being.
Fascia is central to the health of the living being, and myofascial release is the therapy that releases stuck fascia, and the energy that it has encapsulated, so that the person is free to move and think again without restrictions. This is a phenonmenal breakthrough in understanding the mechanism of action of the benefits of myofascial release. I have summarized this science in one chapter of the next edition (the third edition) of my book: Complementary Therapies in Rehabilitation, Evidence for Efficacy in Therapy, Prevention and Wellness. It is published by SLACK. Inc. and will be available mid 2008 from www.slackbooks.com. Janet Kahn, a well known leader in massage therapy, has a chapter on massage in it, and your chapter on myofascial release has the most updated research available.
John, here is my question — how does a myofascial release therapist best prepare oneself to do this work that is so critical for balance? Myofascial release is more than mechanical massage. As mfr therapists, we are vibrating for the health and balance of another, as well. How do we get our vibrations to be therapeutic for the good of our patients and clients?"

In case the reader missed that last sentence:

"As mfr therapists, we are vibrating for the health and balance of another, as well. How do we get our vibrations to be therapeutic for the good of our patients and clients?"

How indeed. Wronger than wrong.

The national PT associations in countries are not set up to "police" the members of the profession to the extent that would be required to rootle out all this weird pseudoscientific thinking. Their job is to keep the profession glued together organizationally, give it some sort of public face, provide support to special interest groups within it. The only "quality control" exerted on the product (at least in Canada) is a set of standards to which the PT schools (all of which are based in universities and affiliated with medical schools) must adhere and an academic level which graduates must attain.

I have no idea what goes on at U. of Miami, but to allow this sort of,.. um, education to proceed unchecked within a university setting suggests to me that someone who should be awake and aware of what PT professors are transmitting must be sleeping at the wheel.

It looks like it will be up to individuals to protest all this craziness. I'm taking a blog stand today, with this post, against craziness in PT. See the new list to the right, of sites that debunk quackery. There is as yet no official site to name, expose and denounce quackery specific to PT, but this could change. Meanwhile, we'll see how the winds blow.

Hurray! New Flimflam Busters

A new blog has appeared in the blogosphere, called Science-Based Medicine. It looks like it's been up for just a few weeks. The authors include Steven Novella, Wallace Simpson, Harriet Hall, David Gorski, Kimball Atwood, mostly MDs, established skeptics and quack exposers. Their list of categories includes something called "energy medicine", something that seems to persistently creep into treatment constructs, and requires active resistance to keep exposed and at bay.

Embodied Cognition

Recently this news article was brought to my attention.

Excerpts:

a growing body of new research suggests that something more collaborative is going on - that we think not just with our brains, but with our bodies.

Being able to manipulate objects in a classroom helps children learn mathematics and spelling. Being able to gesture helps actors remember lines.

The greatest impact...has been in the field of neuroscience itself, where embodied cognition threatens age-old distinctions - not only between brain and body, but between perceiving and thinking, thinking and acting, even between reason and instinct - on which the traditional idea of the mind has been built.

what's going on inside the brain in large part may depend on what's going on in the body as a whole, and how that body is situated in its environment.

Motion is lotion, including mental lotion.

In other words, context is everything, not just for pain, for threat, but also for thinking and learning. This fits in well with ideas from Go Animal.

Mirror therapy for amputee phantom limb pain

Here is a recent news story about how mirror therapy is helping amputee soldiers with phantom limb pain.

Thank you, Ramachandran.

About Point 3...

I feel I must take apart Point 3 of the "consensus on pain" a bit.
Point 3 states:

3. A pain experience may be induced or amplified by both actual and potential threats.

Bear in mind that this point was agreed upon from the perspective of a group of human primate social groomers, who don't want our presence to be threatening, and who want to see our work, i.e., the manual therapy part of it, as beneficial, pain alleviating. We wanted to point out that ofttimes manual therapy (exteroceptive contact) constitutes a "threat" to parts of someone's nervous system. We (collectively) want practitioners to realize this, and learn to back off appropriately, make contact gently.

However, if we look at pain from the context of a person with chronic pain, out and about, making his or her way in the world, coping as best they can with pain, the statement would be different. It would be something along the lines of "A pain experience may be increased OR decreased in the face of a threat, potential or actual."

People often have this experience. For example, consider a parent who has chronic pain, looking after a toddler, out window shopping. Parent's attention becomes distracted for just a few seconds, long enough for the toddler to run off out into traffic. Parent looks up, doesn't see child, experiences panic (sympathetic nervous system response), eyes sharpen accordingly and start scanning, parent spots toddler off the sidewalk in street, sees red bus coming (YIKES!) and adrenalin immediately kicks in - parent forgets all about being in pain, doesn't even "feel" it in that moment. A greater threat to "survival" - a possibility one's child might be killed - has kicked in, pain channels/pathways go silent, the non-conscious brain takes over the body, galvanizing its imperative to make the parent run like the wind and scoop up that child before the bus arrives to where it is standing.

Once the adrenalin is gone, the pain returns, but the person will recall that for a brief period of time (that felt like hours), they were completely distracted from their perception of their "pain", and something else was able to take over their body, to do what was necessary in the moment. In other words, for those few moments, they were ostensibly "pain free", as their system dealt with the larger threat at hand.

Whether a pain experience is increased or decreased by a "threat" will depend entirely on context, just like pain itself does.

Therapists need to be able to both convey this intelligently, and develop sufficient therapeutic treatment boundaries so as to constitute as small an exteroceptive "threat" as possible to their patients.