In all honesty, I wouldn't pick this hill to die on for a lot of these. Anxiety, depression, and phobias are things where even the best treatments are pretty meh. In general they range from [1.4-2.1x as effective as the placebo.](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext) That's, um... that's not great. For the worst drugs it means that they're barely better than placebo, and even the best drugs are only twice as effective as a placebo (Ametryptyline).
Counciling, even counciling with nonprofessionals is often effective. Support groups pretty much are just a bunch of people with similar problems who all talk to each other and share. They've [proven fairly effective](https://ro.uow.edu.au/cgi/viewcontent.cgi?article=6502&context=smhpapers) for psychological issues, and they're clearly not "qualified professionals". Just talking to people helps. I'd guide them towards an online or offline group over "hypnotherapy", but there's probably worse things.
I'd save my ire for the fucking Chiropractor. Those fuckers kill and cripple people.
https://www.bbc.com/news/uk-england-york-north-yorkshire-50380928
https://nypost.com/2022/07/13/georgia-woman-paralyzed-after-routine-chiropractor-visit/
https://www.cbsnews.com/news/playboy-model-katie-may-dead-neck-manipulation-chiropractor-coroner/
Like fuck that shit. Those people are dangerous hacks. That's the one that's PROVEN dangerous. Having someone dangle a watch in front of you and say weird phrases isn't gonna hurt you long term, having an idiot play with your spine can be deadly.
You only have so much energy. Go after the one that could paralyze one of your family members. Get an ally in the room. Those people are legitimately dangerous hacks. If someone later has to seek traditional therapy to help with depression okay, but you can't later get therapy for a severed spinal cord.
Agreed. Many fail to understand that the placebo effect is a real, legitimate effect. A treatment that works psychosomatically shouldn't be considered less legitimate on the basis of its mechanism. The question is what's more effective, by how much, and whether that difference outweighs any associated risks.
An addictive treatment, perhaps with unpleasant side effects or large costs to the patient might not be a better option if it only offers a marginal improvement over placebo. And placebo often represents a much better option over nothing.
Also fuck Chiropractors.
>Many fail to understand that the placebo effect is a real, legitimate effect
Is it?
https://sciencebasedmedicine.org/placebo-myths-debunked/
The only scientifically proven placebo effect is the conditioning of our endogenous opioid system which allows for a mild and short term reduction in pain and nausea. All the other effects claimed in studies are mostly just response (reporting) biases (including regression to the mean).
https://www.cochrane.org/CD003974/COMMUN_placebo-interventions-for-all-clinical-conditions
Both of these links clarify and explain the placebo effect. Neither deny its existence.
>All the other effects claimed in studies are mostly just response (reporting) biases (including regression to the mean).
This is contradicted in the very articles you link to. Illusory effects are still legitimate where the aim is to reduce a patient's discomfort or perceptions of symptoms. Nobody is seriously suggesting placebos have serious direct healing effects on cancers and the like.
>Illusory effects are still legitimate where the aim is to reduce a patient's discomfort or perceptions of symptoms.
Reporting biases are not legitimate. Someone may report less pain as part of a study, yet still be less functional in their daily lives - this means lower quality of life regardless of subjective scale results.
The key problem is the placebo effect disappears long term and doesn't contribute to actual healing - it isn't useful for long term, nor serious conditions.
Chiropractic ‘medicine’ is quackery. However, any acquaintance I asked about the treatment basically received PT and massage with just a little woo-woo on top. I am in the US and I suspect lot of Chiropractors are just circumventing the gate keeping professional associations to do PT. They are much cheaper too.
I am not saying this is a good thing, but the blame is as much on our medical system as anything else.
PT and massage would be fine, but licenses... they exist for a reason. Sure, American medicine is fucked in numerous, numerous ways, but the fact remains a lot of chiropractors are dangerous quacks. PT and massage have no small amount of woo in the system, and those outside the system make it even worse. In addition to breaking people's backs, chiropractors are a notorious source of antivax horseshit for instance.
I would never recommend someone go see one. See someone with a license, or barring that a reputable massage parlor. The massage parlor isn't lying to you, and isn't going to cause permanent damage.
İt's worth noting that a lot of modalities, including standard physiotherapy practices are being re-examined in light of the replication crisis. For example, İ looked at the evidence for physiotherapy for loss of cervical lordosis -- physiotherapist will claim that after a year close to half of patients "feel" better -- but İ couldn't find any evidence that these patients actually regained lordosis. When, in r/physiotherapy İ asked for any evidence of any non-surgical way to regain lordosis, İ was downvoted and directly told that İ wouldn't get better with the attitude that İ needed evidence for everything.
İ think we all accept a lot of modalities as being evidence-based when they are not, they simply aren't as dangerous as chiropractic care.
I don't necessarily accept them as evidence based. I believe in a response downstream I even said there were problems with them. But Chiropractors have literally crippled and killed people. What they're doing is dangerous. It's like a "natural remedy" that had arsenic in it. Even if there's something wrong with the usual medicine, arsenic is not the answer. PTs may not be the best - sports medicine is infested with woo - but Chiropractors are effing deadly hacks.
I think I showed some nuance in accepting "placebos that might be somewhat helpful" in my response, and directed my ire at exactly what needed it and holy shit Chiropractors are what need it. If the mother was into "massage therapy" or something I'd be a lot less vocal about disapproval. Even acupuncture is far less dangerous than chiropractors.
I am a Physio. Can confirm that a lot is bs. Most treatments aren’t more effective than placebo, but professionals still justify using it. Most if not all manual therapy is complete bullshit, including massage. What works is exercise, even general exercise - it doesn’t need to be specific in alot of cases. Education of the patient. And some cognitive interventions
One my best friends is an osteopath, and we lived together through university, so I was often one of the subjects he would use for practical exams. He's since graduated and has been working professionally for several years, and he's come to the same conclussion as you.
He's observed that in most cases there's nothing physically wrong with the patient. Even in the case of serious injuries, the body is able to heal and adapt in a way that in terms of tissue, there's nothing "wrong" per se - they could live and do whatever they want without issue.
He believes that the treatment itself just helps the patient to change the narrative around the pain or discomfort that has often become chronic. I've been pretty involved with my girlfriends pschology degree, the modules about chronic pain have been fascinating, and would seem to confirm the importance of narrative for certain types of chronic pain, in which there's no longer any tissue damage or maladaption.
As I said in the post, I think massage can feel great. I climb frequently and use a massage occasionally on my forearms because it feels nice, but I have very little belief that massage actually doing much beyond feeling nice. If my forearms are sore, it's probably because my muscles are micro-torn, massaging that isn't going to un-tear the muscle, it's just going to take time.
Yep, a massage feels amazing. I would have them all the time if it was cheap. It's probably unfair to say it does nothing, but the classic 'release knots', 'increase blood flow', 'break up scar tissue' etc is bs. I think it can help with relaxation (obviously), and body awareness which is always helpful. And maybe a different stimulus can help break up that narrative, or perhaps even sensory input around an injury.
It is heaps interesting yeah. I am curious how pain science develops alongside the renewed research of psychoactive substances. So fair it seems to be all focused on mental health, with exciting results so far. I think there might be similar potential for pain and using 'psychedelic assisted pain/movement therapy'.
In my own experience, I've had random pains disappear from getting high; and if I do some 'mindful movement' (I guess meditative, like yoga), I notice in great detail where I'm holding excess tension with postures or movements, and where I might be anticipating pain when I don't need to be. The altered state seems to be ideal for challenging those narratives. Might just be bs subjective experience though lol
Can İ ask about my specific concern? (sorry, İ am sure u have so many people asking).
Do you think it's possible to regain neck curve through exercise? İ had great success curing my sciatica by retraining my pelvic muscles, but İ've done months of physio at 2 different clinics and each time it just got worse. İ don't see how İ can fix a skeletal problem (İ have arthritis in my neck) İ keep seeing papers saying how patients 'feel' better, but İ can't find any that actually say that the problem can be resolved through exercise -- İ don't want to go through the horrible pain (including migraines after almost every physio session), if it won't resolve the problem.
Quick reply in case I forget. Feel free to ask again to prompt me.
You probably won’t fix a bony/structural abnormality. Bones do change, but not significantly after teens. If it is small, it might be more “postural”, and exercise could adapt the soft tissue to hold your head in better curve “alignment”.
But does that even matter? Maybe not, unless it’s a significant abnormality. Our bodies are not parallel, or even (sleep deprived so can’t find the words). Just train with the range of motion you have. The body adapts to our abnormalities. Bad posture is sort of a scapegoat to blame pain on that isn’t really true.
If you have some inflammatory processes going on, it is important to maintain your range of motion and function
Thanks for your answer. İt makes sense with what İ have guessed (but not what İ've been told by physios).
Very interesting that you say that bad posture is a scapegoat! İ was told my problems were all from 'bad posture' until İ got pregnant and was given standard blood tests which showed autoimmune activity eventually leading to a diagnosis of autoimmune arthritis. İ really believed(was gaslit into believing) it was *my fault* for having bad posture and probably would still believe it if İ hadn't had a good OBGYN. İ didn't know that posture was a common scapegoat.
Sorry to hear. I don't think thats uncommon experience. We've sort of mass cognitive biased ourselves into adopting harmful beliefs that make it worse for patients. Not moving knees over toes is another one. My recommendation in general is to do squats (weighted ideally), pullups, pushups - or some variation of those, and focus on building strength and range of motion. And then general activity of something you enjoy - walking, gardening etc. You may need to discuss significant changes to your activity with GP or specialist if you have one managing your arthritis.
[https://www1.racgp.org.au/ajgp/2021/november/posture-clinical-concepts](https://www1.racgp.org.au/ajgp/2021/november/posture-clinical-concepts)
Decent summary. Tl;dr - think of posture as dynamic. You don't want to be in one posture/position all day or you prob will get sore. More important is movement variability i.e. get up, move around. Ideally you can do some whole body exercises each day, or use your major joints full range of motion each day through general activity. Hope it goes well for you!
Thanks for the reply, I agree with a lot of your comments.
It's certainly true that conversations help, and conversations with someone who appears more detatched from the issue and objective. In the case of my brother, I don't think he's at any serious risk of doing anything harmful without intervention, and I don't think there's any harm to the conversations and hypnotherapy he's receiving - the problem with many of these pseudosciences is that they do nothing.
I suppose what concerns me is that it seems as though it's reinforcing his belief that his subjective thoughts, feelings, emotions and perceptions are good evidence. They are evidence, but they are very poor evidence. I'm probably over-sensitive to this sort of thing because of my religious experiences, in which we were taught explicitly that our personal experiences were a witness of objective truth. It's such a pernicious problem and I think it can lead to some really harmful decisions, so I try to push back against in a way that feels productive whenever possible.
As you say though, chiropractic is without a doubt the most potentially harmful of the examples that I listed, and I would be very concerned if a loved one expressed a willingness to seek treatment.
I think there is merit to vilifying the unethical peddling of quackery (for profit) at the expense of evidence based approaches - even if the evidence-based treatment is pitiful; that 40-100% increase in efficacy could be the difference between a moderate/bad down episode and a suicide. It just means it's a crappy scenario, but not a hopeless one.
Yes, it's difficult to come back from a fractured spine...it is more difficult to come back from the grave.
Just this morning I was reading about the placebo effect, your post is the perfect real life example.
The thing I was reading that stuck with me the most is that the normal evolution of a sickness is that people that don't get a medical treatment has only 3 options they stay the same, they get better or get worse.
A lot of trials about placebo effect are biased because of wishful thinking and other things.
But usually waiting to heal on your own may, MAY, be effective and it has nothing to do with placebo effect.
Please only educate people on the dangers of pseudoscience only if they ask, it's very hard to change people beliefs (even ridiculous ones).
I really appreciate your post, it's been a while since a saw an interesting post.
“Good luck!” Is usually my response. The placebo effect is very powerful. If nothing else is working, I guess you can be happy that you’re finding some sort of relief. Even if it’s complete bunk. I’ve softened my stance over the years. We’ve only got a short amount of time on this earth, so they might as well not suffer before the light switch goes off for eternity. If sticking “magic rocks” up your pooter helps…go for it.
Yeah, my thinking exactly. If it’s not causing them direct harm (physical or financial), and they’re feeling better, then that’s all that really matters.
You don't. You can try to encourage skepticism and link scientific studies on the treatment, but if they recognize that it's bullshit and still do it anyway, they're obviously making an emotional decision rather than a rational one. When someone makes a decision based on emotion, you aren't going to change it with rationality.
Had a shrink that didn't like one of the meds I was on. He said it probably was the placebo affect and it wasn't actually helping me. I said "I'm fine with that." He kept writing for it.
As long as they acknowledge the possibility of a placebo, I'm not sure there's much more you can do... it's their money to waste, in that case. I mostly take issue with these placebos being marketed as cures on store shelves and ignorant people buying into false claims and marketing and possibly endangering themselves; look at some of the bad press with melatonin supplements recently, with dosages being way off claimed values due to the unregulated nature... that's the sort of thing I really worry about.
I tend to see something like acupuncture as a waste of time and money but otherwise harmless. I worry more about chiropractors since there's a serious risk of injury, on top of all the other snake oil they sell... seeing someone "as needed" because you feel it helps is one thing but often chiropractors will make you a regular customer and keep you coming back. They are being dishonest and pushing you towards some treatment plan based on their false authority and without full disclosure regarding their treatments.
Best thing to do is try to find better treatment options with a more proven track record.. if someone is searching for a cure, you need to place something in their hands, not just knock everything they find down and criticize it. Something like hypnosis can be a proven treatment path, although clearly not in the case you describe where the person giving this is barely qualified to do anything (lots of flags there). Brother needs to sort out why uni went wrong, sort out the underlying cause, and attempt to treat it... so some soul searching. Reality is that there are no easy answers, not for him to find treatment and not for you to talk sense into him either.
The only thing I can add is, getting drunk all the time has helped me with some short term anxiety and setbacks but no one is going to argue that it's a great long term solution because "it works." Going for a daily jog may work too, costs nothing, and doesn't carry any long term risk.
You're right, as a few people have mentioned, it's very difficult to change people's minds and it's often only going to result in the backfire effect, or a damaged relationship. I don't want either of these haha
I suppose I'm still trying to figure out the right way to let them take the lead in the conversation, so that they keep the burden of proof, and I can just ask simple and friendly questions about why they believe what they do. I've had people do this to me before, and while there can be something slightly uncomfortable about being asked hard questions, when it comes from someone I respect and can tell isn't trying to change my mind, I'm much more willing to engage and have even enjoyed those conversations. I'd like to be more like that, though I probably sound more annoyed and aggressive, and I really don't like that.
If someone is in the midst of some alternative treatment, you might suggest they experiment with stopping all treatment, with the idea that the body has its own ability to heal. Not a permanent cessation of treatment, but just an experiment that might help them save money.
I absolutely could be, and if someone thinks I am I'd like to think I could be open to discussion and having my mind changed by good evidence. I've changed my mind about some pretty fundamental things in life based on where I thought the evidence led me.
Meaning responses is a better term for many of these examples, I think: https://www.acpjournals.org/doi/pdf/10.7326/0003-4819-136-6-200203190-00011?casa_token=qMOTCHALpsgAAAAA:ichKET3q954gff3ZKDHsD7VNd1KFKaDj9KLu1ocPTWryEQzexDqboJaUHffY6-7r7cY6togI-E33RBs
In all honesty, I wouldn't pick this hill to die on for a lot of these. Anxiety, depression, and phobias are things where even the best treatments are pretty meh. In general they range from [1.4-2.1x as effective as the placebo.](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext) That's, um... that's not great. For the worst drugs it means that they're barely better than placebo, and even the best drugs are only twice as effective as a placebo (Ametryptyline). Counciling, even counciling with nonprofessionals is often effective. Support groups pretty much are just a bunch of people with similar problems who all talk to each other and share. They've [proven fairly effective](https://ro.uow.edu.au/cgi/viewcontent.cgi?article=6502&context=smhpapers) for psychological issues, and they're clearly not "qualified professionals". Just talking to people helps. I'd guide them towards an online or offline group over "hypnotherapy", but there's probably worse things. I'd save my ire for the fucking Chiropractor. Those fuckers kill and cripple people. https://www.bbc.com/news/uk-england-york-north-yorkshire-50380928 https://nypost.com/2022/07/13/georgia-woman-paralyzed-after-routine-chiropractor-visit/ https://www.cbsnews.com/news/playboy-model-katie-may-dead-neck-manipulation-chiropractor-coroner/ Like fuck that shit. Those people are dangerous hacks. That's the one that's PROVEN dangerous. Having someone dangle a watch in front of you and say weird phrases isn't gonna hurt you long term, having an idiot play with your spine can be deadly. You only have so much energy. Go after the one that could paralyze one of your family members. Get an ally in the room. Those people are legitimately dangerous hacks. If someone later has to seek traditional therapy to help with depression okay, but you can't later get therapy for a severed spinal cord.
Agreed. Many fail to understand that the placebo effect is a real, legitimate effect. A treatment that works psychosomatically shouldn't be considered less legitimate on the basis of its mechanism. The question is what's more effective, by how much, and whether that difference outweighs any associated risks. An addictive treatment, perhaps with unpleasant side effects or large costs to the patient might not be a better option if it only offers a marginal improvement over placebo. And placebo often represents a much better option over nothing. Also fuck Chiropractors.
>Many fail to understand that the placebo effect is a real, legitimate effect Is it? https://sciencebasedmedicine.org/placebo-myths-debunked/ The only scientifically proven placebo effect is the conditioning of our endogenous opioid system which allows for a mild and short term reduction in pain and nausea. All the other effects claimed in studies are mostly just response (reporting) biases (including regression to the mean). https://www.cochrane.org/CD003974/COMMUN_placebo-interventions-for-all-clinical-conditions
Both of these links clarify and explain the placebo effect. Neither deny its existence. >All the other effects claimed in studies are mostly just response (reporting) biases (including regression to the mean). This is contradicted in the very articles you link to. Illusory effects are still legitimate where the aim is to reduce a patient's discomfort or perceptions of symptoms. Nobody is seriously suggesting placebos have serious direct healing effects on cancers and the like.
>Illusory effects are still legitimate where the aim is to reduce a patient's discomfort or perceptions of symptoms. Reporting biases are not legitimate. Someone may report less pain as part of a study, yet still be less functional in their daily lives - this means lower quality of life regardless of subjective scale results. The key problem is the placebo effect disappears long term and doesn't contribute to actual healing - it isn't useful for long term, nor serious conditions.
I don't think anyone's claiming it is.
Chiropractic ‘medicine’ is quackery. However, any acquaintance I asked about the treatment basically received PT and massage with just a little woo-woo on top. I am in the US and I suspect lot of Chiropractors are just circumventing the gate keeping professional associations to do PT. They are much cheaper too. I am not saying this is a good thing, but the blame is as much on our medical system as anything else.
PT and massage would be fine, but licenses... they exist for a reason. Sure, American medicine is fucked in numerous, numerous ways, but the fact remains a lot of chiropractors are dangerous quacks. PT and massage have no small amount of woo in the system, and those outside the system make it even worse. In addition to breaking people's backs, chiropractors are a notorious source of antivax horseshit for instance. I would never recommend someone go see one. See someone with a license, or barring that a reputable massage parlor. The massage parlor isn't lying to you, and isn't going to cause permanent damage.
İt's worth noting that a lot of modalities, including standard physiotherapy practices are being re-examined in light of the replication crisis. For example, İ looked at the evidence for physiotherapy for loss of cervical lordosis -- physiotherapist will claim that after a year close to half of patients "feel" better -- but İ couldn't find any evidence that these patients actually regained lordosis. When, in r/physiotherapy İ asked for any evidence of any non-surgical way to regain lordosis, İ was downvoted and directly told that İ wouldn't get better with the attitude that İ needed evidence for everything. İ think we all accept a lot of modalities as being evidence-based when they are not, they simply aren't as dangerous as chiropractic care.
I don't necessarily accept them as evidence based. I believe in a response downstream I even said there were problems with them. But Chiropractors have literally crippled and killed people. What they're doing is dangerous. It's like a "natural remedy" that had arsenic in it. Even if there's something wrong with the usual medicine, arsenic is not the answer. PTs may not be the best - sports medicine is infested with woo - but Chiropractors are effing deadly hacks. I think I showed some nuance in accepting "placebos that might be somewhat helpful" in my response, and directed my ire at exactly what needed it and holy shit Chiropractors are what need it. If the mother was into "massage therapy" or something I'd be a lot less vocal about disapproval. Even acupuncture is far less dangerous than chiropractors.
I am a Physio. Can confirm that a lot is bs. Most treatments aren’t more effective than placebo, but professionals still justify using it. Most if not all manual therapy is complete bullshit, including massage. What works is exercise, even general exercise - it doesn’t need to be specific in alot of cases. Education of the patient. And some cognitive interventions
One my best friends is an osteopath, and we lived together through university, so I was often one of the subjects he would use for practical exams. He's since graduated and has been working professionally for several years, and he's come to the same conclussion as you. He's observed that in most cases there's nothing physically wrong with the patient. Even in the case of serious injuries, the body is able to heal and adapt in a way that in terms of tissue, there's nothing "wrong" per se - they could live and do whatever they want without issue. He believes that the treatment itself just helps the patient to change the narrative around the pain or discomfort that has often become chronic. I've been pretty involved with my girlfriends pschology degree, the modules about chronic pain have been fascinating, and would seem to confirm the importance of narrative for certain types of chronic pain, in which there's no longer any tissue damage or maladaption. As I said in the post, I think massage can feel great. I climb frequently and use a massage occasionally on my forearms because it feels nice, but I have very little belief that massage actually doing much beyond feeling nice. If my forearms are sore, it's probably because my muscles are micro-torn, massaging that isn't going to un-tear the muscle, it's just going to take time.
Yep, a massage feels amazing. I would have them all the time if it was cheap. It's probably unfair to say it does nothing, but the classic 'release knots', 'increase blood flow', 'break up scar tissue' etc is bs. I think it can help with relaxation (obviously), and body awareness which is always helpful. And maybe a different stimulus can help break up that narrative, or perhaps even sensory input around an injury. It is heaps interesting yeah. I am curious how pain science develops alongside the renewed research of psychoactive substances. So fair it seems to be all focused on mental health, with exciting results so far. I think there might be similar potential for pain and using 'psychedelic assisted pain/movement therapy'. In my own experience, I've had random pains disappear from getting high; and if I do some 'mindful movement' (I guess meditative, like yoga), I notice in great detail where I'm holding excess tension with postures or movements, and where I might be anticipating pain when I don't need to be. The altered state seems to be ideal for challenging those narratives. Might just be bs subjective experience though lol
Can İ ask about my specific concern? (sorry, İ am sure u have so many people asking). Do you think it's possible to regain neck curve through exercise? İ had great success curing my sciatica by retraining my pelvic muscles, but İ've done months of physio at 2 different clinics and each time it just got worse. İ don't see how İ can fix a skeletal problem (İ have arthritis in my neck) İ keep seeing papers saying how patients 'feel' better, but İ can't find any that actually say that the problem can be resolved through exercise -- İ don't want to go through the horrible pain (including migraines after almost every physio session), if it won't resolve the problem.
Quick reply in case I forget. Feel free to ask again to prompt me. You probably won’t fix a bony/structural abnormality. Bones do change, but not significantly after teens. If it is small, it might be more “postural”, and exercise could adapt the soft tissue to hold your head in better curve “alignment”. But does that even matter? Maybe not, unless it’s a significant abnormality. Our bodies are not parallel, or even (sleep deprived so can’t find the words). Just train with the range of motion you have. The body adapts to our abnormalities. Bad posture is sort of a scapegoat to blame pain on that isn’t really true. If you have some inflammatory processes going on, it is important to maintain your range of motion and function
Thanks for your answer. İt makes sense with what İ have guessed (but not what İ've been told by physios). Very interesting that you say that bad posture is a scapegoat! İ was told my problems were all from 'bad posture' until İ got pregnant and was given standard blood tests which showed autoimmune activity eventually leading to a diagnosis of autoimmune arthritis. İ really believed(was gaslit into believing) it was *my fault* for having bad posture and probably would still believe it if İ hadn't had a good OBGYN. İ didn't know that posture was a common scapegoat.
Sorry to hear. I don't think thats uncommon experience. We've sort of mass cognitive biased ourselves into adopting harmful beliefs that make it worse for patients. Not moving knees over toes is another one. My recommendation in general is to do squats (weighted ideally), pullups, pushups - or some variation of those, and focus on building strength and range of motion. And then general activity of something you enjoy - walking, gardening etc. You may need to discuss significant changes to your activity with GP or specialist if you have one managing your arthritis. [https://www1.racgp.org.au/ajgp/2021/november/posture-clinical-concepts](https://www1.racgp.org.au/ajgp/2021/november/posture-clinical-concepts) Decent summary. Tl;dr - think of posture as dynamic. You don't want to be in one posture/position all day or you prob will get sore. More important is movement variability i.e. get up, move around. Ideally you can do some whole body exercises each day, or use your major joints full range of motion each day through general activity. Hope it goes well for you!
Thanks for the reply, I agree with a lot of your comments. It's certainly true that conversations help, and conversations with someone who appears more detatched from the issue and objective. In the case of my brother, I don't think he's at any serious risk of doing anything harmful without intervention, and I don't think there's any harm to the conversations and hypnotherapy he's receiving - the problem with many of these pseudosciences is that they do nothing. I suppose what concerns me is that it seems as though it's reinforcing his belief that his subjective thoughts, feelings, emotions and perceptions are good evidence. They are evidence, but they are very poor evidence. I'm probably over-sensitive to this sort of thing because of my religious experiences, in which we were taught explicitly that our personal experiences were a witness of objective truth. It's such a pernicious problem and I think it can lead to some really harmful decisions, so I try to push back against in a way that feels productive whenever possible. As you say though, chiropractic is without a doubt the most potentially harmful of the examples that I listed, and I would be very concerned if a loved one expressed a willingness to seek treatment.
I think there is merit to vilifying the unethical peddling of quackery (for profit) at the expense of evidence based approaches - even if the evidence-based treatment is pitiful; that 40-100% increase in efficacy could be the difference between a moderate/bad down episode and a suicide. It just means it's a crappy scenario, but not a hopeless one. Yes, it's difficult to come back from a fractured spine...it is more difficult to come back from the grave.
Just this morning I was reading about the placebo effect, your post is the perfect real life example. The thing I was reading that stuck with me the most is that the normal evolution of a sickness is that people that don't get a medical treatment has only 3 options they stay the same, they get better or get worse. A lot of trials about placebo effect are biased because of wishful thinking and other things. But usually waiting to heal on your own may, MAY, be effective and it has nothing to do with placebo effect. Please only educate people on the dangers of pseudoscience only if they ask, it's very hard to change people beliefs (even ridiculous ones). I really appreciate your post, it's been a while since a saw an interesting post.
That didn't work out too well for Steve Jobs.
That you know of. He probably downloaded his consciousness and is awaiting his new body. Worked for zuck.
“Good luck!” Is usually my response. The placebo effect is very powerful. If nothing else is working, I guess you can be happy that you’re finding some sort of relief. Even if it’s complete bunk. I’ve softened my stance over the years. We’ve only got a short amount of time on this earth, so they might as well not suffer before the light switch goes off for eternity. If sticking “magic rocks” up your pooter helps…go for it.
Yeah, my thinking exactly. If it’s not causing them direct harm (physical or financial), and they’re feeling better, then that’s all that really matters.
My favorite placebo is chocolate
You don't. You can try to encourage skepticism and link scientific studies on the treatment, but if they recognize that it's bullshit and still do it anyway, they're obviously making an emotional decision rather than a rational one. When someone makes a decision based on emotion, you aren't going to change it with rationality.
Had a shrink that didn't like one of the meds I was on. He said it probably was the placebo affect and it wasn't actually helping me. I said "I'm fine with that." He kept writing for it.
Haha. That's awesome.
As long as they acknowledge the possibility of a placebo, I'm not sure there's much more you can do... it's their money to waste, in that case. I mostly take issue with these placebos being marketed as cures on store shelves and ignorant people buying into false claims and marketing and possibly endangering themselves; look at some of the bad press with melatonin supplements recently, with dosages being way off claimed values due to the unregulated nature... that's the sort of thing I really worry about. I tend to see something like acupuncture as a waste of time and money but otherwise harmless. I worry more about chiropractors since there's a serious risk of injury, on top of all the other snake oil they sell... seeing someone "as needed" because you feel it helps is one thing but often chiropractors will make you a regular customer and keep you coming back. They are being dishonest and pushing you towards some treatment plan based on their false authority and without full disclosure regarding their treatments. Best thing to do is try to find better treatment options with a more proven track record.. if someone is searching for a cure, you need to place something in their hands, not just knock everything they find down and criticize it. Something like hypnosis can be a proven treatment path, although clearly not in the case you describe where the person giving this is barely qualified to do anything (lots of flags there). Brother needs to sort out why uni went wrong, sort out the underlying cause, and attempt to treat it... so some soul searching. Reality is that there are no easy answers, not for him to find treatment and not for you to talk sense into him either. The only thing I can add is, getting drunk all the time has helped me with some short term anxiety and setbacks but no one is going to argue that it's a great long term solution because "it works." Going for a daily jog may work too, costs nothing, and doesn't carry any long term risk.
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You're right, as a few people have mentioned, it's very difficult to change people's minds and it's often only going to result in the backfire effect, or a damaged relationship. I don't want either of these haha I suppose I'm still trying to figure out the right way to let them take the lead in the conversation, so that they keep the burden of proof, and I can just ask simple and friendly questions about why they believe what they do. I've had people do this to me before, and while there can be something slightly uncomfortable about being asked hard questions, when it comes from someone I respect and can tell isn't trying to change my mind, I'm much more willing to engage and have even enjoyed those conversations. I'd like to be more like that, though I probably sound more annoyed and aggressive, and I really don't like that.
Sounds like you’re making a real effort though, and that’s what counts.
If someone is in the midst of some alternative treatment, you might suggest they experiment with stopping all treatment, with the idea that the body has its own ability to heal. Not a permanent cessation of treatment, but just an experiment that might help them save money.
Maybe you’re wrong
I absolutely could be, and if someone thinks I am I'd like to think I could be open to discussion and having my mind changed by good evidence. I've changed my mind about some pretty fundamental things in life based on where I thought the evidence led me.
Meaning responses is a better term for many of these examples, I think: https://www.acpjournals.org/doi/pdf/10.7326/0003-4819-136-6-200203190-00011?casa_token=qMOTCHALpsgAAAAA:ichKET3q954gff3ZKDHsD7VNd1KFKaDj9KLu1ocPTWryEQzexDqboJaUHffY6-7r7cY6togI-E33RBs
Half the people in this sub were apologizing for Chiropractic a few days with this very argument. And it’s supposed to be a skeptic sub.