05 May 2014

Healthcare: the last mainstream superstition


Have you ever taken a drug that you know for sure works, because you could feel the difference it made?

Unless you happen to be both a pharmaceutical researcher and a theoretical psychologist, you almost definitely answered "yes" to that question.

You thought back to pain pills you've taken, allergy medication, cold remedies, a round of antibiotics, and you experienced the change, you felt it working.  At least, you believe you felt it.

But you are mistaken.  Even if you really did feel something, it is not remotely near enough for you to use the phrase "know for sure".

It simply isn't humanly possible.

There are literally hundreds of steps that could introduce error into the process, from the complexity of biology, to the limitations of awareness, perception, and memory, from the placebo effect and the power of expectation, to dozens of cognitive biases and ways that the human mind is predictably irrational.

If you have been reading my blog a while, you have likely seen all of those links before, but if not - or if you never actually clicked on them and watched or read what they link to - it would be worth while to check them out - especially if you're one of those sort of people who has a body.  If you have ever been to a doctor, taken any form of medicine, ever been sick, ever been injured, or if there is any chance you might ever do any of those things in the future, it would be to your great benefit to read and understand the information at all of those links.

Unless you have read those, everything I write next will be a lot easier to write off and disregard, but for those who have seen them before, I don't want to be too repetitive.
So go click some links, spend a few hours learning, come back and read this here post some other time...


Oh, hi!
You're back I see.  That's some crazy stuff, right?  I'm totally not over it yet either.  But hey, this is the world we live in, we gotta work with what we got.

For some reason that I have never even heard a good theory on, American's are apparently far more prone to believing crazy stuff than most of the rest of the developed world.  We have a disproportionate amount of creationists, astrologists, people who believe in ghosts and ESP and faith healing and magnet healing, and "energy fields", people who deny global warming and embrace supply side economics, people who are opposed to vaccines and any form of genetic engineering.

The proportion of people who buy into any one of those examples, however, is less than half - anti-science ignorance is widespread, but it isn't quite mainstream.

There is one area though, where being anti-science is so prevalent that an entire industry is built up around it, and that's health care.

We have the term "alternative medicine".  That's a thing.
What is it an alternative to?  Well... any medicine which has independently and objectively been shown to be effective at treating whatever it is it claims to treat.
Because the term for something which actually works is just "medicine".

No other area of life has an equivalent.
There is no "alternative math", where people base calculations on numerology.
There isn't an "alternative chemistry" industry, which seeks to revive the forgotten wisdom of alchemy.

There is also not many other ways where going backwards is seen as a good thing.  Few people cook over a log fire instead of using natural gas or electricity, based on the fact that people cooked over open fires for thousands of years and therefor it must be better. Other than Richie Norris, no one suggests we should go back to living in teepees. Nobody is seriously advocating we replace telephones with smoke signals or email with pony express riders for long-distance communication.
Health care is the one area where a very significant portion of the population sees ignoring all the progress science has made in understanding how things work as being a good thing.

Of course no one consciously thinks of it that way.  The term is "traditional", not "obsolete".  The reasoning is that people did things a certain way for a really long time, therefor it must be valid.  Presumably if it didn't work people would have given it up by now. 

But we are selective in which invalidated treatments we keep.  Pretty much no one advocates bloodletting, but there are many who take sticking needles in the skin as a serious form of health care.  We are done with trepanation, but you can get health insurance to pay for vertebral subluxation treatments.  Few people think exorcism will cure anything, but, somehow, homeopathy still exists - its silly to even investigate it, because its just water.  There is literally no active ingredient in most homeopathic remedies.   Belief in the four humors is past tense, but there is no challenge in finding people who believe in mysterious "energy fields" around living things.

Don't get me wrong - there really are energy fields.  But they aren't mysterious.  Humans have figured this stuff out.  There are 4 types of force in the universe: 2 types of nuclear force, gravity, and electromagnetism. We all know how gravity works - heavy stuff pulls toward other heavy stuff.  In our daily experience the planet is by far the heaviest thing around, so that means everything gets pulled toward Earth.  Nuclear forces keep all matter together, but we really only interact with it in bombs and power plants.  That leaves electromagnetism, which is fully understood by science, but isn't quite common knowledge yet.

Brief digression for a general science lesson:

Almost everything we commonly think of as "energy" is some form of electromagnatism.  Electricity, obviously.  And magnets.  The entire planet is covered in a giant magnet field, which is why compasses point North.  You can actually see it at the poles, in the form of the Northern (and Southern) Lights

If you can remember back to high school science class, you may realize the close relationship between electricity and magnets: wrap a live wire around a piece of iron, you have an electromagnet.  Move a magnet back and forth inside of a coil of wire, it generates electricity.  That relationship is how every electric generator and every electric motor works.
Then there are electromagnetic waves.  Sounds fancy and sciency, right?  Its just the technical term for "light".  It's all light waves.  Like, the stuff you can see with your eyes, blue and purple and green.
All the different colors of light are arranged in order of how big the light wave is: purple has a small light wave, red has a big one.  That's why rainbows in the sky are in the order they are in.  You can't see it, but the rainbow keeps going, in both directions.  Above purple is ultraviolet (Latin, for "above violet" - hey, what do ya know about that!).  We can't see it with our eyes, but it is there.  If you happened to be a bee, you would see it.  Below red is infrared ("below red") light.  Again, our eyes can't see it, but it is there.  If you put a thermometer just below the red light coming off of a prism, you will see it gets hotter as you go down from purple toward red, and gets even hotter just below red.  Infrared light is where heat lamps get their heat, and it's what night vision goggles see.
But it doesn't stop there.
Microwaves, TV and radio signals, cell phone signals, x-rays, WI FI, radar, it is all light.  A microwave is just a color.  One which the human eye can't see, but the only difference between microwaves and blue is the size of the wave.  All an antenna is is a mechanical eyeball.  A radio sees radiowaves just like your eye sees green.

Even if you personally don't fully understand all the details, realize that it isn't a mystery, all this is very well understood.  It isn't even all that complex.  We know how energy works.  If there is a "life force", it is within the forces that exist in the universe.  And in fact, our nervous system runs on electricity.  Our thoughts, our movements, every part of being alive, it is all powered by chemical energy, adenosine triphosphate breaking down to adenosine diphosphate, and releasing electrically charged ions that can do work in the process.  If you click that last link and try to read it, unless you happen to have been a molecular biology major, chances are most of it is hard to follow.  The important thing to realize is that, as insanely complex as living things are, we have an amazingly high amount of this stuff figured out.
Very few of us fully understand all the details of electronics and computers, down to both the resistor, capacitor and transistor level of the hardware and the line by line code of the software, but we all accept that it is understood, that it works, and we don't reject laptops and cellphones in favor of mysticism, ancient or modern, Eastern or Western. 

So I was wondering, why do we reject everything biology has learned in favor of tradition?  Why, when science understands biology so well, does such a huge proportion of the population choose to deliberately seek out health care practices and practitioners which explicitly reject the most basic principal of science: "check that you're right"?

I have a few theories.
I suspect the theories are all right, to one degree or another, and they all work together and reinforce each other.

-As complex as computers and airplanes and GPS and every other area of technology is, as complex as meteorology and geology and astronomy are, all of it pales in comparison to molecular biology.

Take this example:

That is fucking mind blowing!  I can barely keep up, but it is... how do you even put it into words?  All those things are going on inside of your body, right now.  And it's just one tiny set of many examples of cellular processes.  There are thousands more like it, and some set of those thousands are happening in every one of your 100 trillion cells 24 hours a day, from conception until several minutes after death.
It is totally overwhelming.
Wouldn't it be nice if it could all be simplified to something a person can wrap their mind around, like "life force", or "positive energy" or "qi"?  Wouldn't it be nice if, instead of having to understand all that amazingly wonderful reality, all health could just be a function of, say, eating the right things or of spinal alignment?

We tend to think of the body like a complicated machine.  When a machine breaks, there is always some specific part that needs fixing or replacing - make the right adjustment, everything is as it should be.
But living things are really nothing at all like machines.  Metabolism is not like burning fuel.  Our joints are not hinges or pivots.  We are more like a bag of soup.  A bag of soup with a frame - but the joints of the frame, instead of being held together by pins, they are held together by strong rubber bands and cushioned by mushy padding.  We are more like a wobbly marionette than a rigid robot.

If the human body is essentially a big chemical bag of soup, and our skeleton is held together by stretchy bendy tendons and ligaments, that rather undermines the entire concept of body "alignment".  What exactly is it being aligned with, and what stops it from lining up "right" on its own?  This doesn't just undermine chiropracty - it undermines most of medical massage, orthopaedic surgery, sports physiology, and physical therapy.
The idea that manipulating body parts, putting them in the "correct" position, stems from thinking of the body as mechanical, when in fact it is fluid and flexible and far more complex than any machine ever built.

Another possible reason for the popularity of anti-science in healthcare, aside from being far more complex than any other area of potential human knowledge, biology and medicine is far more personal.  Nobody is ever going to interact with a neutrino.  Understanding the Higgs Boson doesn't affect your daily life in anyway.  So it's fairly easy to accept that some other people, for whom that is their specialty, know what that stuff is, and you can just trust them on it.  Since everyone has a body, and the health of it is arguably the single most important thing in your life, everyone has incentive to want to know what the hell is going on.

 An answer - any answer - always feels better than "I don't know".  It just feels terrible to have a vague ambiguous open-ended question; especially if it's something with a real effect on day to day life, like a disability, illness, or pain.
And an answer we can't comprehend sometimes feels as bad as no answer at all.  
It is an unfortunate side effect of how human psychology works that we feel better having a concrete - but wrong - answer than having one that is accurate, but confusing.
And compounding that, the complexity of molecular biology is so great that, even as much as scientists do know, there is still a huge amount they don't - so in addition to the real answers being confusing, sometimes nobody has an answer at all.

If 10 doctors and specialists say "we don't know", and then one seems confident that they have the answer, we are inclined to accept that last answer, even if we might not have accepted the claim otherwise, because there is nothing better being offered.  But sometimes "nobody really knows" is the most honest answer.  When things are really complex and/or controversial, a professional's confidence should make you less trusting of their opinion, not more.  That confidence is coming from faith.  Faith is the antithesis of science.  It means just making something up, and deciding it's right, without doing the work to double check.

Very closely related to the last reason, it always feels better to do something than to do nothing.  People say that explicitly in times of desperation: "I can't just sit back and do nothing".  But sometimes nothing anyone does will help.  Sometimes doing anything makes it worse.  In the game of soccer, when one team kicks a penalty shot, the statistics say that the goalie has the best chance of blocking the ball if he just stays in the center.  The kick is so fast it is humanly impossible to predict which way it will go.  But almost every goalie, every time, will dive either left or right, and game after game, the kicker scores a goal because the goalie dives out of the way, just because the goalie felt he had to DO something. Because if he just stood there and missed, he would feel like an idiot.

But the truth is:

Living things have been figuring out how to exist for 3 billion years.  

Without any form of medicine.  

Not modern science based, not alternative tradition based.  

Not any kind.  

Any living thing that hasn't figured out how to heal itself, how to naturally be in optimal alignment, how to get the correct nutrients via appetite, repair its own cellular damage, and generally optimize its own health, went extinct long before humans existed.

Every single day, even without injury or illness, your body creates 300 billion new cells, to replace old worn out ones.  You may have heard the claim that the entire body is replaced every 7-10 years.  It isn't exactly right - different body parts renew at different rates.  Some take 16 years.  Some are replaced every few days.  But, aside from brain cells, your entire body really does replace itself on an ongoing basis.

This is how you heal after injury.  Give the body enough time, and it will replace damaged cells, without you doing anything at all.
Our immune system is more powerful and effective than any drug or remedy humans have ever invented - in fact, the single biggest medical innovation of all time - the vaccine - isn't actually a medicine at all, it is just a way to teach the body's natural immune system how to do its job a little better.

Certainly if you have cancer, or a severe bacterial infection, a compound fracture, diabetes or appendicitis, modern health care can mean the difference between loss of life or limb, and a full recovery.  But for the vast majority of ailments, both physical injury and pathogen, the best possible thing you can do is support your own general health: stay physically fit (balance intense exercise with sufficient rest and recovery), get enough nutrients and calories (but not too many calories), get enough sleep (every night!), and keep emotional stress to a minimum (which, believe it or not, has very little to do with your life circumstances.  It is almost entirely about your outlook).
These four lifestyle choices: exercise, nutrition, sleep, and optimism, correlate far more strongly to overall health than access to any particular form of health care or treatment, more even than access to any form of healthcare at all.

Because of the evolutionary process, because of living cell's incredible ability to repair damage to itself and destroy infections,

Almost every medical problem will heal itself, all on its own.

 With no treatment, just time and nutrition and rest.

And that means that if you take or do any form of "treatment" long enough, it will seem like it "worked", just because your body was repairing itself all along, and you happened to be doing this other stuff at the same time. You end up better, so everyone assumes they got better because of the treatment.  But you probably would have gotten better anyway.  

That is without even considering the placebo effect.

The human body generally fights off a cold in barely over a week, with no drugs or remedy of any kind.

Say you start feeling symptoms a day or two after you first catch it, the next day you start taking a remedy, and then a couple days later the cold is mostly subsided.  People will almost universally assume that the remedy cured the cold, but it didn't do anything.  There is no substance that can reduce the length of a cold. Anything which reduces symptoms (like a fever reducer) will increase the length of the cold, because the medicine isn't fighting the virus, it is fighting your own body's natural response to the virus.

But as a single individual there is no way for you to test taking the remedy and not taking it side-by-side to see which gets you better faster.  You have to either take it or not take it.

This is the whole reason clinical trials and studies were invented in the first place. 

And then people figured out that just being in the trial made people get better, because of the placebo effect, and they had to introduce the double blind placebo trial.

Placebos genuinely make people feel better - and that has much more significance than you realize.  It affects you more than you ever realized, and more than you want to admit.  This is why you got my first question, in the opening line to this essay, wrong. You can not know a medicine, or any medical procedure is working because you "feel" it working, because there is no possible way you can control for the placebo effect in your own personal first hand experience. 
It is not humanly possible for anyone to answer "yes" to that question and be right. Read about it at the link below:

Investigation into the placebo effect

I know, you already know about placebos.
Remember that question I opened this blog post with?

"Have you ever taken a drug that you know for sure works, because you could feel the difference it made?"

If you answered "yes" to that question (and admit it, you did), then you don't really understand the significance of the placebo effect.  You may understand, intellectually, that it happens, but there is a disconnect, a cognitive dissonance, where you think you are an exception.  You think you can feel the difference a drug or physical therapy makes objectively. Placebos seem like a fascinating phenomenon that affects other people.  Millions and millions of other people.

Even if you accept that, for example, you don't always know all of your subconscious motivations for your behavior, everyone thinks they can "know" their own physical body objectively.

But believing that is just as ridiculous as thinking you can "tell" from the moment of conception that you are pregnant (it takes between one and two weeks for the egg to implant, so there is no change to feel before then), or that you can "feel" when somebody is looking at you, (you can't).

You, my dear reader, are a human.  You have all the limitations that all humans have.
There is so much more to the placebo effect than we normally think about.  The placebo effect is deep.  Fascinating.  And extremely important, extremely relevant to daily life as living creatures.  I would highly recommend reading  some more about it - for example this and this and this.  It should be required for any person who has a body.

You would think every single medical professional, in any field, would know this stuff, but the unfortunate reality is that doctors aren't remotely scientists in any sense of the word.  Not just the "alternative" folk, but regular, med school graduating, AMA member, licensed professional doctors.  They are largely guessing.  They don't keep up on research.  They get influenced by the pharmaceutical and medical device industries, and by what school they happened to go to and what their co-workers happen to beileve:


Read it.  It's scary stuff. You should not 'trust' your doctor.  Doctors are just people, and they make all the same normal mistakes that all humans make.  Question them.  Get a second opinion, from a doctor in a totally different field.  Get a third opinion.  Take advantage of the age of the internet and do some research on your own.  Try to prove them wrong, even if you suspect they are right.  Every good scientist sets out to prove her own hypothesis wrong before publishing, because it's in searching for contrary data that confirmation bias is undermined.  Its easy to find what you are looking for, but finding what you are looking for is poor evidence that you are actually right.  Search for what you aren't looking for.

We tend to assume, maybe because of all the training they get, maybe because of the white coats, that doctors are like scientists for health, but they aren't.

If a molecular biologist is like an engineer, a doctor is like a mechanic.
The engineer designs brand new inventions, and to do that they have to have extensive understanding of materials science, newtonian physics, mechanics, and advanced mathematics.  The mechanic only needs to understand enough mechanics to figure out how the thing the engineer designed is supposed to work, in order to fix it when it breaks.  It is an important job (its MY job!), but you shouldn't assume a mechanic understands all of the how and why of which materials were chosen or why they were put together just so.  
Similarly, while science at large has figured out a myriad of metabolic pathways, enzymatic processes, and all of the other stuff going on behind the scenes within the human body, doctors tend to only scratch the surface enough to diagnose a few particular problems, and suggest possible ways to help correct them.

A doctor is a mechanic for the body.

Like mechanics, they often seem to believe they know more than they really do, like mechanics they often diagnose based on "intuition", and they frequently stray from their specialty (or are quick to see every illness as somehow related to their particular specialty).  Given how complex life is, any doctor who finds a simple cause and effect relationship should be at least a little suspect. Given how much there is left for science to learn about how everything works, the more confident a doctor is, the less you should trust them.  Think of them more like weather forecasters - they have more training and equipment than you, so they can give you a better prediction than you can make on your own, but everything they say has a percentage likelihood of being wrong.  The best doctors know this, and they will be upfront with you about it.  Never discount a medical professional for saying "probably" or "I don't know".  That is usually the most honest possible answer, and when it comes to your health, an ambiguous truth will at least not do as much damage as a confident mistake can.

All that uncertainty makes people turn away from modern medicine, and to "alternative" medicine, but that's even worse.  Much much worse.  By definition, alternative medicine is anything which has been already proven in tests to NOT work.

People are drawn to the easy answers, to the alternative health care provider's sense of certainty, to their rejection of "artificial" pharmaceuticals in favor of "natural" treatments - never mind that drugs are derived of naturally occurring compounds, that plenty of herbs are bad for you or even deadly, that cooking food is a process of chemistry, or that the living cell is the most powerful, most complex chemical factory that has ever existed.

Some people suggest never eating anything with an ingredient list you don't recognize and can't pronounce.
You want to see a list of scary looking chemicals?

  • oligosaccharides
    pantothenic acid
    lipoprotein lipase
    inactivated alkaline phosphatase
    C16:0 ß-hydroxy fatty acids
    conjugated linoleic acid*
    blood serum albumin
    high proline micelle

Gross, huh?  You would never want to eat that weird crap.  Probably something Pfizer created, or Monsanto maybe.


Those are all chemicals that are naturally present in milk.

*(which is a TRANSfat omg!!!!!!!! - but wait, aren't transfats all man-made and added by the evil food industry????  What's that?  Some transfats are naturally occurring? How can that be, when everything natural is good and healthy, and all transfats are created by evil corporations??)

A chemical is anything that is made of matter.  In other words, everything.  Everything you eat and drink is made of chemicals.  You are made of chemicals.  Everything you can see or touch or smell is made of chemicals. Nothing exists that isn't chemicals.  This is not just semantics.  Whenever anyone says anything about "chemicals" meaning something "unnatural" or toxic or synthetic or whatever, its coming from ignorance of science.

What is the real difference between a drug made in a factory by a pharmaceutical company and an "all natural" remedy?
There are laws requiring the drug company to extensively test their product for effectiveness and side-effects before they are allowed to sell it, while anything not officially classified as a drug has almost no regulations and  no testing standards.

So far I've listed a bunch of reasons why people might be even more prone to accept superstition in the realm of healthcare than any other area, but I have found, when discussing this with people in the past, that people are particularly resistant to hearing contradictory evidence to their medical treatments, not just intellectually, but emotionally.

I think, beyond just the normal ways the human mind is always irrational, there are a couple other specific reasons why this is a sticky one:

 - Personal relationships.
This seems to be one of the biggest reasons that alternative medicine is still so popular, despite being proven not to work over and over again.  Its not just that everyone is superstitious.  It's that mainstream medicine has been so totally enveloped by capitalism that doctors don't have time to treat their patients like people.  Which makes people prefer to gravitate to those who actually do treat them like people.
Compounded by the fact that such a huge amount of physical illness really is closely tied in with the mental and emotional (up to 90% of all doctor visits are for "conditions" caused by plain old emotional stress); sometimes the alternative practitioner really does get better results - just not because of their actual treatments.
The results are despite the treatments; they are because of the emotional connection they build with the patient.  
So, of course, when someone challenges the validity of the alternative "treatment", the patient will naturally immediately feel this is an attack on their own personal doctor.  Their own personal doctor is a good person!  S/he is honest and caring and hard working, s/he has a real medical degree and 3 decades of experience and has helped 1000s of people! 
Questioning their belief is seen as a character attack. Even though the same person might dispute a particular religion even while they have close personal friends or relatives who hold that religion, or dispute an economic theory without feeling it is an attack on all who believe it.
It is not a statement on the integrity of any individual.  Doctors are human.  Humans make mistakes. Alternative medicine practitioners believe wholeheartedly, they get invested in their own mistakes and suffer confirmation bias and the backfire effect and all the rest.  That doesn't make them bad people.  It doesn't make them all con-men and tricksters.  Most, certainly the vast majority, are totally sincere. Just like priests and monks are sincere. Just like the billions of people who believe in a particular religion, the strength of conviction doesn't mean they are right.

 - People always hate to be mistaken, but they especially feel bad about it if they have spent significant time or money, investing in something that turns out to be wrong.
Nobody likes to feel stupid, and we especially hate feeling like suckers.  So, instead of correcting the view later once we have more information, we usually ignore the new information, or look for a way to justify the old belief.

 - If it feels like it's working, then most people feel it's safer to just keep doing it than to stop (and risk relapse.)
If you read some of the links on placebo, there are lots of examples of people asking to continue their treatment even after they are told it was fake!  They KNEW the drug wasn't helping, but they were afraid to change the conditions that led to feeling better.  It's an extreme example of the natural human faulty reasoning of post hoc ergo prompter hoc which is the basis of most forms of superstition.  If humans do that even when they know for sure the drug was a fake, it shouldn't be much of a surprise that people will cling to treatments that, as far as they know, might actually be working - even if that "might" is just based on not knowing enough biology and related science to objectively evaluate it.

Between the fact that the body heals itself regardless of what we do the vast majority of the time, and the fact that the placebo effect makes us feel better if we do or take anything that we are told will help, it is no wonder that every form of alternative healing seems to work to those who seek it out.

The treatments always seem to "work" in that the person gets better - or, at least, feels better temporarily.

Of course, there is a huge difference between feeling better for a little while, and actually getting better.  
This is when it really gets me - when the "treatment" isn't even supposedly a cure, when the "treatment" is supposed to continue indefinitely.   I have no numbers to back this up, so maybe I'm wrong, but from personal observation, alternative health care providers seem to much more frequently prescribe "treatments" to patients which are supposed to be regular, and for a lifetime.
I think most of the medical folk who prescribe such things are sincere, but it is certainly convenient that their cures require a lifelong prescription - and the accompanying lifetime of payments.

This seems to be particularly prevalent among the various structuralists, and in particular following any large - but one-time - injury.  Remember when I pointed out that the entire body renews itself regularly?  Different bones heal at different rates, anywhere from 3 weeks to 3 months. Torn muscles, tendons, and ligaments, heal within 2 months, and even the most severe damage, that requiring surgery to reattach something torn all the way through, heals within 4 months.  If a person is being treated for an injury that occurred years ago, they aren't really being treated for that injury at all.  That injury has long since healed on its own.

Its important to keep in mind - even with a scientifically validated drug or surgery or other procedure, nothing that medical care can do can actually heal you.  Only the body can do that.  The best treatments serve to facilitate that healing, to remove any obstacles to healing.  Health is the body's default natural state.

I am beginning to suspect that in some of these cases the "cure" itself is actually prolonging the problem.

Sometimes this is by interfering with the body's natural self-healing. Sometimes they may make things worse by direct action - unintended drug interactions and side effects, or physical therapies that damage tissues.

In some cases the treatment may prolong injury in the same way that cold remedies do: they make the patient feel better (temporarily), and with their pain masked, they don't rest as much as they need to in order to allow the body to heal.  Contrariwise, oftentimes a person will be told to avoid use of a body part for so long that the muscles and tendons get weak and inflexible, which in turn makes them more prone to future injury.
The most obvious example of this is back injuries.  Someone who has ever strained their back tries to avoid ever doing anything that might stress it, and consequently the muscles bones tendons and ligaments of the lower core atrophy and get weaker and weaker, to the point where they are at much higher risk of injury than they would have been if they had taken the opposite approach, and engaged in a (careful, gradual) consistent program of progressive-load weight-bearing resistance training, and higher risk even then if they had just maintained normal everyday activities.

Most of the time the treatment itself is probably neutral, but the false diagnoses produces a "nocebo effect". They tell you something is wrong with you, they tell you to expect certain symptoms (unless you let them heal you), and you experience what you are expecting. They tell you the symptoms will recur within a certain amount of time, and because you are expecting it, you feel it. The nocebo effect is equally as strong as the placebo effect. You may recall from some of the links above how being told to expect certain negative side effects caused them intensely in patients of both fake drugs and fake acupuncture.
Anytime a health care provider tells you that the problem is something fundamentally wrong with you, or a natural tendency to go out of alignment, out of balance, to absorb negative energy, to build up toxins that need cleansing, whatever it is, the fact of having been told that will make you far more prone to feeling negative symptoms in the future - or to interpret minor unrelated things as being that sign you were waiting for - and that feels like it validates what you were told, and justifies giving them some more money (and time) to let them "heal" you.

I don't think the practitioner does this deliberately, any more than bloodletters and other dark age doctors who killed more of their patients than they helped did it deliberately.   But as a patient, we all owe it to ourselves not to put blind faith in an industry or ideology which has gotten so much wrong all throughout history, and whose track record even today is - debatable. At best.

I'm not trying to tell anyone else what to do or think or believe. 
I just feel a responsibility to share information I have had the privilege of having access to.
I can say, for myself, that I once was a fan of alternative medicine myself, but today I am skeptical of all forms of medicine. Before I take any medical advice, I need to know for myself the clinical trials that have been involved, the efficacy rate, the side-effects and complications, I need some references to independent research, (independent of anyone who is in anyway in the profit chain), and perhaps most of all, I have to understand the process, the cause and effect - how it works, and why.  Lucky for me - for all of us - we happen to live in an age where all of this information is available, for free, from the comfort of home.  For something which has such a profound impact on quality of life, it should be worth a few hours of research.

I think understanding the world at all requires a healthy level of skepticism, but most especially when it comes to health care.  For one thing, the stakes are particularly high.  For another, throughout the history of civilization, medical practice has gotten things wrong much more often than it has gotten them right.
Look at the 4 humors, or bloodletting, or leeches, exorcisms, lobotomies, and the hundreds of downright silly superstitions that nearly every culture has had at some point - so much stuff that we look back on now and think "what in the hell could those people possibly have been thinking?"

And yet, we are so filled with hubris that we never stop to think how, 100 years from now people will look back on us today and think the same thing.

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