Third holiday of the year, third sickness, so some free time to write a personal piece on a topic dear to my heart as we recover from our Danish Xmas (the 24th):
In the recent year, the content of this blog has found itself often in opposition to the mainstream scientific body of knowledge from the disciplines of medicine and exercise physiology.I have always claimed to be a “man of science” so this may appear an obvious contradiction. Is it opportunism on my part or am I just “jumping the latest wave”.
Long-time readers will be unsurprised to know that I remain committed to the scientific method – but this does not mean necessarily supporting the mainstream thinking of people educated from within the ranks of “scientific” professions. There is no good or bad science – it’s just a method with a set of principles – but there are good and bad ways of applying the scientific method and there are scientists who are good or bad at applying it.
Cutting through the definitions
Just so we can be sure we are all speaking about the same thing. Science has a few closely related meanings, the most common today being “a systematic approach to building and organising knowledge through testable explanations and predictions”.
Today, the term is often collated with the more specific meaning of “scientific method” – the techniques used to ensure findings are as objective as possible. This generally means letting reality speak for itself – supporting a theory when predictions are confirmed and challenging it when it is proven false.
In my view, the scientific community around injury prevention in sports have been neglectful in their pursuit of the former when it comes to current mainstream approaches and overly conservative and antagonistic when it comes to the latter. This imbalance is easily explained when you understand human psychology and once you accept that while scientific method is free of this bias, the human scientists are not.
WYSIATI and the shattering of scientific knowledge
Nobel prize winner Daniel Kahnemann introduces two concepts of how our brain forms thoughts in his book “Thinking fast, thinking slow” – and the dominant way he calls “System 1” – fast, automatic, frequent, emotional, stereotypic and subconscious.
What this system does is to use only existing knowledge that you have to associate new information you receive rather than creating new ones – so a child that has only ever seen straight lines will experience an octagon the first time they see a circle (they have no existing knowledge of “roundness”).
This is called “What You See Is All There Is” - meaning we are designed to jump to conclusions based on whatever knowledge we already have in memory. Scientists today have been placed in a particular insidious trap because their fields, especially in medicine, are growing so specialised that in order to master specialties (such as toxicology) you easily loose the big picture and often have no time for the sort of inter-disciplinary master ship held by “renaissance men”. We have few specialists with strong knowledge of biomechanics, physiology, neurology and their practical application for instance. To be a scientist often means having to learn lots and lots of data when we know that quality of data is more important than quantity.
Fields such as “Evolutionary medicine” which is a foundational discipline without which you cannot fully understand why the body acts as it does, do not even make it on the curriculum and we can assume that many of our doctors are unaware of its implications. This means that our doctors can act entirely correct based on the body of knowledge available to them – yet still make a choice that is essentially wrong for the patient because a critical piece of the puzzle is unavailable to them. Add long work hours and budget cuts across healthcare and we can assume many doctors are struggling to just keep up with new drugs coming out much less theories at the frontier of human knowledge.
The narrow spectrum of science today
"The smart way to keep people passive and obedient is to strictly limit the spectrum of acceptable opinion, but allow very lively debate within that spectrum - even encourage the more critical and dissident views. That gives people the sense that there's free thinking going on, while all the time the presuppositions of the system are being reinforced by the limits put on the range of the debate." - Noam Chomsky
“The establishment” (meaning whoever holds power and resources right now) will always seek to boil every matter down to “black” or “white” options when the real discussion may be “yellow”, “green”, “red”, “blue” and so forth. In a system dominated by corporations and economic elites this happens without the need for any conspiracy – its an entirely rational, self-generated and self-perpetuating system and if you are an injured runner you’ve been swept into it as well and so have your podiatrists, GPs, physiotherapists, surgeons and so on.
My Irish readers will notice that your government utilises this tactic every day when they narrow the political debate to whatever options are available under the assumptions they operate under (e.g. you cannot say no to the Troika, you have to cut, you have to pay off all the debts etc.). This happens in political debate in every country across the world – so you have a heated debate about “what should be cut” rather than “do we REALLY need to cut?" or “What should we do save the banks” rather than “how do we save the people” and so forth.
Examine the list of acceptable opinion about injury cure and prevention and you may get: anti-inflammatories,orthotics, surgery, stretching, footwear, rest, non-impact cross-training etc.This narrow spectrum of solutions are a simple result of WYSIATI – What You See Is All There Is combined with corporate forces influencing our scientists.
What get’s taught and debated is whatever serves the current interests of the system. Symptom relief serves the system, cures do not. Expensive products serve the system, teaching people how to take control of their own injuries do not. The system funds universities and one of the most effective ways to succeed in a system is to support prevailing views – and this is true of human social systems. Being “on the fringes” or “unreasonable” does not pay for the majority of people. Conform and flourish is rather the motto. This is a subconscious choice more than a conscious one – an existing authority tells you something, if you accept it your life get’s easier and accepting it makes sense because you’re getting it from authority. Incidentally, this is the antithesis of science.
Scientific behaviour revisited
Is it a coincidence that barefoot running and teaching running technique are being strongly opposed by the majority while mainstream methods (drugs, shoes, tape, stretching, etc.) are strongly supported and posited as the “reasonable” choice. That learning to eat well seemingly has less priority than learning how to medicate well? That spending money on expensive symptom relief hugs the discussion rather than simple educational programs for our children which would solve the majority of health problems permanently?
I will argue that if you were a stranger to this planet, having arrived off a spaceship, you would think our mainstream methods (casting our feet in strange looking rubber creations, taking a drug that sabotages one of the body’s defense mechanisms while creating muscle wastage or conducting an exercise that is uncomfortable, completely unproven and biomechanically unsound – yes I’m talking about shoes, NSAIDs and stretching) as insane while considering that running as we have evolved (barefoot) or seeking to reduce injury by ensuring our bodies function as naturally and efficiently as possible (teaching technique) are the sane methods.
But these methods seem sane once you take away the bigger picture and focus only on the myriad of research studies (all inconclusive of course) having been made on shoes, drugs et al. WYSIATI once again. This is not a mass cover-up from Big Pharma, the billion-dollar shoe industry or expensive private practice – it is simply “Chomsky’s law” in action – the system will perpetuate the values that support it and attempt to marginalise those who don’t.
So consider this when dealing with “the establishment”: innovation happens at the fringes. Everything that is mainstream today was once thought upon as unnecessary or even crazy (how did plasma screens, GPS, micro-waves, mobile phones etc. sound to you the first time you heard about it?). There are mountebanks and charlatans and you’ll need to apply your own common-sense and a degree of risk-taking to root them out. Medical science of the 16th century was looked upon as sophisticated and mature then but hundreds of years from now I can almost assure you they’ll look back at some of our practices the way we look a leeches today or as downright butchery.
What this means for runners and my own vision of 2013 I will write more on in a less “heavy-handed” article shortly. In the meantime, enjoy your Xmas!