Posted on

An Interview with Paul Ingraham

A few years ago, I came across a website that has become one of my favorites. It’s at www.PainScience.com, and the writer behind it is Paul Ingraham.

Ingraham is a former Registered Massage Therapist from Vancouver, Canada. He practiced for ten years in downtown Vancouver, taking as many difficult chronic pain cases as he could. Since 2009, he has been the assistant editor for ScienceBasedMedicine.org. I recently had the chance to ask him a few questions about his life and work:

LA: Paul, one of the reasons I find you so interesting is because we share the circumstance of formerly being into energy work, and all sorts of things along those lines that we no longer embrace. Was there a defining moment when you decided to leave that behind and become the skeptic you are today?

PI: It was a series of defining moments, a gradual process, many things chipping away at my faith. For instance, I had a colleague who I shared some beliefs with. We both did energy work and talked shop about it. For me it was more like art and poetry, while for him it was much more literal and real, like he thought he was a Jedi in training or something, and he shredded his credibility with increasingly bizarre belief and overconfidence — like healing over the phone — until I one day I thought, “Wow, way too far. That is just not quality thinking!”

There were many more little disappointments like that over the years. Some were bigger. I remember a workshop taught by someone I greatly admired. I went in beaming, but came out rolling my eyes — a whole day of fringe science and sloppy, self-serving “logic.”

When I started questioning this stuff publicly, I got hate mail, even about stuff I thought was no big deal to question. And that finished the job. Seeing a steady stream of incoherent arguments from unhinged true believers — never calm, never gracious, never “balanced” — finally turned me into an actual card-carrying skeptic. It took about a decade to go from true believer to doubter to curmudgeonly skeptical gadfly.

LA: For years, your website was known as SaveYourself.ca. What precipitated your recent name change?

PI: PainScience.com is more serious and dignified. And just more descriptive of what I do.

I never really cared for the connotations of “save.” Some people immediately think of Jesus when they think of being saved. And I didn’t want to imply that anything I write can “save” anyone — it smacks of the same kind of unethical over-promising that I often criticize in health care.

PainScience fits great. It feels like putting on a nice suit after years of doing business in a Hawaiian shirt.
LA: I’ve seen a few snarky comments from people on the Internet concerning the fact that you’re not a scientist, but you write about science. What are your qualifications, and what do you say to your critics?

PI: Yes, that comes up a lot. And they’re half right: I am not a scientist! But of course hardly any science news and reporting comes directly from scientists, and it can’t, because scientists are busy doing their jobs. And hardly anyone outside of science actually reads scientific papers (least of all the kinds of people who complain that I’m not a scientist).

I am a writer, and my job is to understand and translate science as well as I possibly can — to be a liaison between scientists and clinicians and patients. It’s a tough job, but I care deeply about it and work my hind end off to do it right.

Information about the implications of science can and should only be judged on its own merits. It doesn’t matter who wrote it. Is it good? Is it reasonable and referenced?
LA: One thing I have always admired about your writing is that you provide footnotes for everything. How much time do you spend researching and preparing an article?

PI: It never ends! I never stop editing and upgrading articles, because science is a moving target. They need to change. This is a distinctive thing about PainScience.com: I don’t publish stuff and then just leave it there to rot on the server forever.

But a first draft of a typical 2500-word delve into a topic is usually about a 40-hour project, assuming I’m really going for it. The main way to distinguish yourself online these days is quality. You can’t just write a lot — you’ve got to write well. Serious polish. So I really get into making an article as good as I can possibly make it. It’s not unusual to thoroughly edit at least five or six times.
LA: Like my own blog, some of your articles have generated controversy and even gotten you some hate mail. Is there an article that stands out in your mind for that?

PI: By far the most hate-mail generating article I’ve ever published is Does Chiropractic Work? The modern version of it is more diplomatic and generates much less hate mail, while the original was somewhat snarky and made a lot of heads explode. But I still stand behind any statement I ever made there.

But the most interesting hate mail generator is this one: Trigger Point Doubts. It doesn’t generate a lot of hate mail, but some people just go bonkers when they think they’ve caught me in a contradiction. That is, criticizing “trigger points” while also selling a book about trigger points. Even though the article tackles this so-called contradiction head on. And of course it’s very intellectually healthy to question your own ideas. But I get mail from people who are just furious with me: they take me for a trigger point guru and then freak out when they find out I have concerns about trigger point science being half-assed.

LA: Painscience.com gets about 30,000 hits a day. I notice there’s no advertising on your site, but my guess is you’ve been offered plenty of deals; is that so? What’s your reason for running an ad-free site?

PI: I just like it better. Classier. Different than most of the rest of the internet. And I can generate enough revenue with e-book sales.

LA: You’ve written quite a few e-books. What is the focus of those?

PI: So far I have written eight books about eight musculoskeletal pain problems that are often puzzling and stubborn, like patellofemoral pain or chronic low back pain. The goal of the books is to explore the puzzle with the reader, who can be a patient or a professional: to dive into the interesting mysteries and try to figure out what works, what doesn’t, and why. My goal is to simply teach the reader as much as I possibly can about the condition. In the absence of proven treatments, good information is the next best thing.

LA: What’s the most gratifying thing about what you do?

PI: Oh, that’s easy: email from people who like my sense of humour! Best people in the world! Or librarians who recognize the mad genius of my bibliography.

But seriously, of course it’s the readers who feel that something they learned from me has really helped them. I do love that. That’s the whole point.

LA: Is there anything you haven’t accomplished yet that you plan to do? What’s next for Paul Ingraham?

PI: Lots! It’s taken me a few years to get PainScience.com going and prove that it can pay the bills. I’ve had to do a lot of technology work to get it to that point, which often distracted me from writing in a big way. Now it’s time to get back to the writing, and lots of it, both professional and personal. I’d like to get going on my first novel. And some other technology business projects with a genius buddy of mine, for the diversification and fun of it. Going to be a busy couple decades!

Posted on

The Snake Oil Medicine Show

There’s nothing earth-shaking in the world of massage politics on my radar this week, so I’m just going to make a few observations. I know that I am about to step on more than a few toes here, but it must be said.

I’ve got a few thousand massage therapists in my social networks (FB, LinkedIn, Twitter, Google +). In the mornings, when I’m drinking my coffee, I visit those sites and scroll through to see what people are up to. I like to read that people are having success with their clients, enjoying their work, being active in their communities, growing their businesses, volunteering, and a lot of wonderful things that massage therapists do.

What I don’t like to see is what I call the Snake Oil Medicine Show. There’s a popular band here in NC by that name, so I’m stealing it for this blog. According to Wikipedia: The phrase snake oil is a derogatory term used to describe quackery, the promotion of fraudulent or unproven medical practices. The expression is also applied metaphorically to any product with questionable and/or unverifiable quality or benefit. By extension, the term “snake oil salesman” may be applied to someone who sells fraudulent goods, or who is a fraud himself.

There are a lot of products (and practices) out there that have no proven benefits at all, and many that have in fact been proven not to have any benefits. Massage therapists seem to be particularly gullible to falling into the trap of not only using them personally, but also promoting them and selling them to their clients. I don’t know the real reason behind this phenomenon, but I can guess at several: 1) The therapist is not interested in scientific evidence and buys into the hype on the product’s website. 2) The therapist is desperately looking for something to bring in additional income. 3) The therapist has a genuine desire to help people, and truly believes the wild claims made by whatever company is selling the product, and thinks that it’s a duty to share it with clients.

If you’ve been following me for any length of time, you know that I am interested in the evidence-informed practice of massage, and that I’ve been on a mission to bust the myths of massage. This problem goes beyond that; and if I tried to bust every unscrupulous product out there, I’d never have the time to write about anything else. There are a lot of “quackery” websites on the Internet that have done most of the work for me….if only people would read and believe. But the fact is, you can hit some people over the head with scientific evidence, and they’re not going to believe it.  They’re too attached to that “detox” machine, or that dietary supplement, or that special water or whatever it is that they’re selling. Paul Ingraham, one of my favorite writers on the Internet, has written about a lot of these things (see www.saveyourself.ca) Dr. Stephen Barrett has had his Quackwatch site up for years (www.quackwatch.org). Another favorite of mine is a water myth website, found at www.chem1.com/CQ/

I’m not a scientist, or a very technical-minded person. Fortunately, I have some friends and acquaintances who are. I have often asked them “Can you explain to me how ____ works?” The usual answer to this question is “It doesn’t.”

As I said at the beginning, I’m about to step on some toes here, but then again, I do that on a regular basis, so what the heck. Here are the facts on detox foot baths, and may I say, yes, I have in fact used one myself in years gone by:

There is no way an electric current passing through a part of your body can distinguish between “good” molecules and “bad” molecules (“toxins”), most of which are electrically neutral anyway.

The skin is impermeable to all but a few chemical substances; there is no evidence that any that are found inside the body can pass through the skin to the outside, with or without the help of an electric current.

All but a very few of the “toxins” produced as metabolic products are colorless— suggesting that what you see during these “treatments” is put there for show.

You can in fact put a zucchini, or nothing at all, in the foot bath, and the water will still turn color. I have personally witnessed this happening. Then we’ve got the “alkaline water” products, including a well-known MLM company that sells filters for about $4000 bucks. That’s a European vacation, folks. Not only that, but the actual components of that water filter can be purchased at any home improvement or hardware store for about $35. Here are the straight facts on that, and YES, THIS IS WRITTEN BY A CHEMIST:

“Ionized water” is nothing more than sales fiction; the term is meaningless to chemists.

Pure water (that is, water containing no dissolved ions) is too unconductive to undergo signficant electrolysis by “water ionizer” devices.
Pure water can never be alkaline or acidic, nor can it be made so by electrolysis. Alkaline water must contain metallic ions of some kind — most commonly, sodium, calcium or magnesium.

The idea that one must consume alkaline water to neutralize the effects of acidic foods is ridiculous; we get rid of excess acid by exhaling carbon dioxide.

If you do drink alkaline water, its alkalinity is quickly removed by the highly acidic gastric fluid in the stomach.

Uptake of water occurs mainly in the intestine, not in the stomach. But when stomach contents enter the intestine, they are neutralized and made alkaline by the pancreatic secretions — so all the water you drink eventually becomes alkaline anyway.

The claims about the health benefits of drinking alkaline water are not supported by credible scientific evidence.

“Ionized”/alkaline water is falsely claimed to be an anti-oxidant. It is actually an oxidizing agent, as can be seen by its ability to decolorize iodine (see video).

There is nothing wrong with drinking slightly acidic waters such as rainwater. “Body pH” is a meaningless concept; different parts of the body (and even of individual cells) can have widely different pH values. The pH of drinking water has zero effect on that of the blood or of the body’s cells.

If you really want to de-acidify your stomach (at the possible cost of interfering with protein digestion), why spend hundreds of dollars for an electrolysis device when you can take calcium-magnesium pills, Alka-Seltzer or Milk of Magnesia?

Electrolysis devices are generally worthless for treating water for health enhancement, removal of common impurities, disinfection, and scale control. Claims that “ionized” waters are antioxidants are untrue; hypochlorites (present in most such waters) are in fact oxidizing agents.

Claims that “water ionizers are approved for use in Japanese hospitals” are misleading: these “approvals” merely attest to the machines’ safety — that they will not electrocute you! My understanding is that the Japanese Health Ministry is highly critical of therapeutic claims made for alkaline water.

And yes, I have also drank alkaline water…several clients and a part-time staff member insisted on my trying it, and I did, but I can’t say it did anything for me that regular water wouldn’t have done.

What about the Chi machine? Actually, I used to house sit for a friend who had a Chi machine, and I would lie down in the floor and use it every time I was at her house. I personally found it very relaxing, and it felt good. In fact I would usually zone out and have a little nap while the machine was running. However, the big claim made about it is that it “maximizes the body’s natural absorption of oxygen.” Really? It’s shaking your ankles back and forth. How is that doing anything to maximize the absorption of oxygen? Can’t I just lie down and shake my own ankles and do the same thing without spending that $399? The websites touting the Chi machine go on about how cancer can’t survive when you’re fully oxygenated, disease can’t get you, parasites will disappear, and all illness will leave your body if you just have enough oxygen. The way I see it, I’m breathing, so I must have enough oxygen. How much more do I need? Am I going to breathe MORE if I shake my ankles every day? I don’t think so.

Shall I go on? There are so many dubious products out there, I could stop writing about the politics of massage altogether and have enough fodder to go on for years, but I’m going to stop here, for now. I’m sure those of you who sell the heck out of these machines will write in and tell me what a moron I am. Maybe ONE of you will perform a thorough scientific examination of the facts and decide that you’ve been hoodwinked into spending a few hundred, or a few thousand, dollars on something that doesn’t work, and you’ll quit trying to sell it to your clients. That would be nice.

References:

Foot bath

Alkaline Water

Chi machine

 

Posted on

Kudos, and a Few Thumps on the Head

The year is winding down; all the award shows have been on television lately, and I’d like to give out a few of my own, along with a thump or two on the head of those who need it. Call me a critic! These are my opinions only and should not be construed as the opinion of anyone else.

Kudos to Rick Rosen for starting the Alliance for Massage Therapy Education, and to the organization for putting on one of the best meetings I’ve ever attended earlier this year, and for taking the initiative to set some standards for teaching massage. If you are involved in massage education and you haven’t joined yet, I suggest you quit procrastinating.

Kudos to the Massage Therapy Foundation for all the work they do in promoting research in the field, and in particular for offering classes in Teaching Research Literacy. And to Ruth Werner for being such a fabulous ambassador for the organization.

Kudos to the executive officers and chairs of the Alliance for Massage Therapy Education, the American Massage Therapy Association, Associated Bodywork & Massage Professionals, the Commission on Massage Therapy Accreditation, the Federation of State Massage Therapy Boards, the Massage Therapy Foundation, and the National Certification Board for Therapeutic Massage & Bodywork for coming together this year at the Leadership Summit, and particular kudos to Bob Benson of ABMP for taking the responsibility for making that happen.

Kudos to Paul Lindamood, former CEO of the NCBTMB, for doing such a great job in putting that organization’s finances back in order. I was very sorry to see him go.

Kudos to AMTA, in particular the Oregon Chapter, and Glenath Moyle, National President, for putting on one of the best conventions in my memory. Kudos also the the thousands of AMTA members who volunteer at their chapters and the national level.

Kudos to ABMP for their generosity in allowing everyone, regardless of what organization they belong to (or none at all) to read Massage & Bodywork Magazine online for free, and for providing the huge forum at www.massageprofessionals.com, which is also open to everyone.

Kudos to Facebook. Not only are they my favorite place to hang out online, they are also spending millions of dollars building their new data center in my hometown, and providing much-needed employment in a very economically depressed area.

Kudos to Dr. Christopher Moyer, Bodhi Haraldsson, Paul Ingraham, Ravensara Travillian, Alice Sanvito, Rose Chunco, and the other folks out there who keep beating the drum for Evidence-Based Practice of massage.

Kudos to Jan Schwartz, Whitney Lowe, and Judith McDaniel of Education Training and Solutions. They don’t toot their own horn enough about some of the excellent work they have done for the Massage Therapy Foundation, the World Skin Project, and in general advancing excellence in online education.

Kudos to Angie Patrick of Massage Warehouse for her tireless work in the Sanctuary and raising money through massage for the Massage Therapy Foundation, the Liddle Kidz Foundation, and other worthy causes.

Kudos to all the massage therapists in the trenches, who give of their time in performing community service and their income to support deserving populations and those who can’t afford massage. I know hundreds of them so I just can’t list them all here, but every day, someone is out there donating the awesome power of touch in hospices, abused women’s shelters, the VA hospitals, homeless shelters, and hospitals. Bless them all.

Kudos to all those teachers out there who have what I refer to as “a higher calling.” Those who are teaching hospice massage, cancer massage, pediatric massage…There are too many to name, but they are led to work with the sick, the dying, the special-needs. Bless them all, and those they teach.

Kudos to any massage school and/or instructor who is teaching their students to be research literate.

And now, a few thumps on the head. The names have been omitted so as not to put the magazines who publish my blog in danger of a lawsuit, but you know who you are:

A thump on the head to the therapists who say “I’m better than any doctor or chiropractor. I will heal you when they can’t.”

A thump on the head to the therapists who say “I don’t refer out to anybody. No one is as good as I am.”

A thump on the head to the therapists who say to their clients “You really need this  (expensive water filter, nutritional supplements, foot patches, juice by so-and-so) etc that I am selling.”

A thump on the head to the therapists who say “I don’t need continuing education. I already know everything there is to know.”

A thump on the head to the therapists who impose energy work on every client who gets on their table, as if it is some God-given right, when the client hasn’t asked for it, doesn’t want it or believe in it, and it hasn’t been discussed.

A thump on the head to the therapists who are telling their clients that massage is detoxifying them and that they need to drink a lot of water to flush out their toxins.

A thump on the head to the therapists on massage forums who can’t behave and can’t have civil discourse, and instead resort to name-calling and personal attacks.

A thump on the head to the therapists on Facebook who are identifying themselves as MTs and posting pictures of themselves that look like they belong in the centerfold of Hustler.

I could thump all day–and give kudos all day–but I’ll save some for a future blog.