bullshit
Subluxation is … a displacement of two or more bones whose articular surfaces have lost, wholly or in part, their natural connection. (D. D. Palmer, 1910)
The definition of ‘subluxation’ as used by chiropractors differs from that in conventional medicine where it describes a partial dislocation of the bony surfaces of a joint readily visible via an X-ray. Crucially, a subluxation, as understood in conventional medicine, is not the cause of disease. Spinal subluxations, according to medical terminology, are possible only if anatomical structures are seriously disrupted.
Subluxation, as chiropractors understand the term, has been central to chiropractic from its very beginning. Despite its central role in chiropractic, its definition is far from clear and has changed significantly over time.
DD Palmer (the guy who invented chiropractic) was extremely vague about most of his ideas. Yet, he remained steadfast about his claims that 95% of all diseases were due to subluxations of the spine, that subluxations hindered the flow of the ‘innate intelligence’ which controlled the vital functions of the body. Innate intelligence or ‘inate’, he believed, operated through the nerves, and subluxated vertebra caused pinched nerves, which in turn blocked the flow of the innate and thus led to abnormal function of our organs. For Palmer and his followers, subluxation is the sole or at least the main cause of all diseases (or dis-eases, as Palmer preferred).
Almost exactly 4 years ago, I published this post:
Is chiropractic subluxation a notion of the past? SADLY NOT!
In it, I provided evidence that – contrary to what we are often told – chiropractors remain fond of the subluxation nonsense they leant in school. This can be shown by the frequency by which chiropractors advertise on Twitter the concept of chiropractic subluxation.
Today, I had another look. The question I asked myself was: has the promotion of the obsolete subluxation concept by chiropractors subsided?
The findings did not surprise me.
Even a quick glance reveals that there is still a plethora of advertising going on that uses the subluxation myth. Many chiros use imaginative artwork to get their misleading message across. Below is a small selection.
Yes, I know, this little display is not very scientific. In fact, it is a mere impression and does not intend to be anything else. So, let’s look at some more scientific data on this subject. Here are the last 2 paragraphs from the chapter on subluxation in my recent book on chiropractic:
A 2018 survey determined how many chiropractic institutions worldwide still use the term in their curricula.[1] Forty-six chiropractic programmes (18 from US and 28 non-US) participated. The term subluxation was found in all but two US course catalogues. Remarkably, between 2011 and 2017, the use of subluxation in US courses even increased. Similarly, a survey of 7455 US students of chiropractic showed that 61% of them agreed or strongly agreed that the emphasis of chiropractic intervention is to eliminate vertebral subluxations/vertebral subluxation complexes.[2]
Even though chiropractic subluxation is at the heart of chiropractic, its definition remains nebulous and its very existence seems doubtful. But doubt is not what chiropractors want. Without subluxation, spinal manipulation seems questionable – and this will be the theme of the next chapter.
[1] https://chiromt.biomedcentral.com/articles/10.1186/s12998-018-0191-1
[2] https://www.ncbi.nlm.nih.gov/pubmed/25646145
In a nutshell: chiros cannot give up the concept of subluxation because, if they did, they would be physios except with a much narrower focus.
I recently came across this paper by Prof. Dr. Chad E. Cook, a physical therapist, PhD, a Fellow of the American Physical Therapy Association (FAPTA), and a professor as well as director of clinical research in the Department of Orthopaedics, Department of Population Health Sciences at the Duke Clinical Research Institute at Duke University in North Carolina, USA. The paper is entitled ‘The Demonization of Manual Therapy‘.
Cook introduced the subject by stating: “In medicine, when we do not understand or when we dislike something, we demonize it. Well-known examples throughout history include the initial ridicule of antiseptic handwashing, percutaneous transluminal coronary angioplasty (i. e., balloon angioplasty), the relationships between viruses and cancer, the contribution of bacteria in the development of ulcers, and the role of heredity in the development of disease. In each example, naysayers attempted to discredit the use of each of the concepts, despite having no evidence to support their claims. The goal in each of the aforementioned topics: demonize the concept.”
Cook then discussed 8 ‘demonizations’ of manual therapy. Number 7 is entitled “Causes as Much Harm as Help“. Here is this section in full:
By definition, harms include adverse reactions (e. g., side effects of treatments), and other undesirable consequences of health care products and services. Harms can be classified as “none”, minor, moderate, serious and severe [67]. Most interventions have some harms, typically minor, which are defined as a non-life-threatening, temporary harm that may or may not require efforts to assess for a change in a patient’s condition such as monitoring [67].
There are harms associated with a manual therapy intervention, but they are generally benign (minor). Up to 20 –40 % of individuals will report adverse events after the application of manual therapy. The most common adverse events were soreness in muscles, increased pain, stiffness and tiredness [68]. There are rare occasions of several harms associated with manual therapy and these include spinal or neurological problems as well as cervical arterial strokes [9]. It is critical to emphasize how rare these events are; serious adverse event incidence estimates ranged from 1 per 2 million manipulations to 13 per 10,000 patients [69].
Cook then concludes that “manual therapy has been inappropriately demonized over the last decade and has been associated with inaccurate assumptions and false speculations that many clinicians have acquired over the last decade. This paper critically analyzed eight of the most common assumptions that have belabored manual therapy and identified notable errors in seven of the eight. It is my hope that the physiotherapy community will carefully re-evaluate its stance on manual therapy and consider a more evidence-based approach for the betterment of our patients.
REFERENCES
[9] Ernst E. Adverse effects of spinal manipulation: a systematic review. J R Soc Med 2007; 100: 330–338.doi:10.1177/014107680710000716 [68] Paanalahti K, Holm LW, Nordin M et al. Adverse events after manual therapy among patients seeking care for neck and/or back pain: a randomized controlled trial. BMC Musculoskelet Disord 2014; 15: 77. doi:10.1186/1471-2474-15-77 [69] Swait G, Finch R. What are the risks of manual treatment of the spine? A scoping review for clinicians. Chiropr Man Therap 2017; 25: 37. doi:10.1186/s12998-017-0168-5
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Here are a few things that I find odd or wrong with Cook’s text:
- The term ‘demonizing’ seems to be a poor choice. The historical examples chosen by Cook were not cases of demonization. They were mostly instances where new discoveries did not fit into the thinking of the time and therefore took a long time to get accepted. They also show that sooner or later, sound evidence always prevails. Lastly, they suggest that speeding up this process via the concept of evidence-based medicine is a good idea.
- Cook then introduces the principle of risk/benefit balance by entitling the cited section “Causes as Much Harm as Help“. Oddly, however, he only discusses the risks of manual therapies and omits the benefit side of the equation.
- This omission is all the more puzzling since he quotes my paper (his reference [9]) states that “the effectiveness of spinal manipulation for most indications is less than convincing.5 A risk-benefit evaluation is therefore unlikely to generate positive results: with uncertain effectiveness and finite risks, the balance cannot be positive.”
- In discussing the risks, he seems to assume that all manual therapies are similar. This is clearly not true. Massage therapies have a very low risk, while this cannot be said of spinal manipulations.
- The harms mentioned by Cook seem to be those of spinal manipulation and not those of all types of manual therapy.
- Cook states that “up to 20 –40 % of individuals will report adverse events after the application of manual therapy.” Yet, the reference he uses in support of this statement is a clinical trial that reported an adverse effect rate of 51%.
- Cook then states that “there are rare occasions of several harms associated with manual therapy and these include spinal or neurological problems as well as cervical arterial strokes.” In support, he quotes one of my papers. In it, I emphasize that “the incidence of such events is unknown.” Cook not only ignores this fact but states in the following sentence that “it is critical to emphasize how rare these events are…”
Cook concludes that “manual therapy has been inappropriately demonized over the last decade and has been associated with inaccurate assumptions and false speculations …” He confuses, I think, demonization with critical assessment.
Cook’s defence of manual therapy is clumsy, inaccurate, ill-conceived, misleading and often borders on the ridiculous. In the age of evidence-based medicine, therapies are not ‘demonized’ but evaluated on the basis of their effectiveness and safety. Manual therapies are too diverse to do this wholesale. They range from various massage techniques, some of which have a positive risk/benefit balance, to high-velocity, low-amplitude thrusts, for which the risks do not demonstrably outweigh the benefits.
Harry G Frankfurt published his delightful booklet ‘ON BULLSHIT‘ in 2005 (in case you don’t know it, I highly recommend you read it). Since then, the term ‘bullshit’ has become accepted terminology even in polite discourse. But what exactly is bullshit? Frankfurt explains that is something between a lie and a bluff, perhaps more like the latter than the former.
Not least due to Frankfurt’s book, there is today plenty of research on the subject of bullshit. As much of it relates to so-called alternative medicine (SCAM), allow me to present here just 5 of the most recent papers on bullshit.
Navigating social systems efficiently is critical to our species. Humans appear endowed with a cognitive system that has formed to meet the unique challenges that emerge for highly social species. Bullshitting, communication characterised by an intent to be convincing or impressive without concern for truth, is ubiquitous within human societies. Across two studies (N = 1,017), we assess participants’ ability to produce satisfying and seemingly accurate bullshit as an honest signal of their intelligence. We find that bullshit ability is associated with an individual’s intelligence and individuals capable of producing more satisfying bullshit are judged by second-hand observers to be more intelligent. We interpret these results as adding evidence for intelligence being geared towards the navigation of social systems. The ability to produce satisfying bullshit may serve to assist individuals in negotiating their social world, both as an energetically efficient strategy for impressing others and as an honest signal of intelligence.
Research into both receptivity to falling for bullshit and the propensity to produce it have recently emerged as active, independent areas of inquiry into the spread of misleading information. However, it remains unclear whether those who frequently produce bullshit are inoculated from its influence. For example, both bullshit receptivity and bullshitting frequency are negatively related to cognitive ability and aspects of analytic thinking style, suggesting that those who frequently engage in bullshitting may be more likely to fall for bullshit. However, separate research suggests that individuals who frequently engage in deception are better at detecting it, thus leading to the possibility that frequent bullshitters may be less likely to fall for bullshit. Here, we present three studies (N = 826) attempting to distinguish between these competing hypotheses, finding that frequency of persuasive bullshitting (i.e., bullshitting intended to impress or persuade others) positively predicts susceptibility to various types of misleading information and that this association is robust to individual differences in cognitive ability and analytic cognitive style.
Recent psychological research has identified important individual differences associated with receptivity to bullshit, which has greatly enhanced our understanding of the processes behind susceptibility to pseudo-profound or otherwise misleading information. However, the bulk of this research attention has focused on cognitive and dispositional factors related to bullshit (the product), while largely overlooking the influences behind bullshitting (the act). Here, we present results from four studies focusing on the construction and validation of a new, reliable scale measuring the frequency with which individuals engage in two types of bullshitting (persuasive and evasive) in everyday situations. Overall, bullshitting frequency was negatively associated with sincerity, honesty, cognitive ability, open-minded cognition, and self-regard. Additionally, the Bullshitting Frequency Scale was found to reliably measure constructs that are (1) distinct from lying and (2) significantly related to performance on overclaiming and social decision tasks. These results represent an important step forward by demonstrating the utility of the Bullshitting Frequency Scale as well as highlighting certain individual differences that may play important roles in the extent to which individuals engage in everyday bullshitting.
Although generally viewed as a common and undesirable social behaviour, very little is known about the nature of bullshitting (i.e., communicating with little to no regard for evidence or truth; Raritan Q Rev 6, 1986, 81); its consequences; and its potential communicative utility. Specifically, it is hypothesized that bullshitting may be may be relatively influential under specified conditions. Experiment 1 participants were exposed to a traditional persuasion paradigm, receiving either strong or weak arguments in either an evidence-based or bullshit frame. Experiment 2 also incorporated a manipulation of a peripheral route cue (i.e., source attractiveness). Findings demonstrate that bullshitting can be an effective means of influence when arguments are weak, yet undermine persuasive attempts when arguments are strong. Results also suggest that bullshit frames may cue peripheral route processing of persuasive information relative to evidence-based frames that appear to cue central route processing. Results are discussed in light of social perception and attitude change.
Objective: Fake news represents a particularly egregious and direct avenue by which inaccurate beliefs have been propagated via social media. We investigate the psychological profile of individuals who fall prey to fake news.
Method: We recruited 1,606 participants from Amazon’s Mechanical Turk for three online surveys.
Results: The tendency to ascribe profundity to randomly generated sentences-pseudo-profound bullshit receptivity-correlates positively with perceptions of fake news accuracy, and negatively with the ability to differentiate between fake and real news (media truth discernment). Relatedly, individuals who overclaim their level of knowledge also judge fake news to be more accurate. We also extend previous research indicating that analytic thinking correlates negatively with perceived accuracy by showing that this relationship is not moderated by the presence/absence of the headline’s source (which has no effect on accuracy), or by familiarity with the headlines (which correlates positively with perceived accuracy of fake and real news).
Conclusion: Our results suggest that belief in fake news may be driven, to some extent, by a general tendency to be overly accepting of weak claims. This tendency, which we refer to as reflexive open-mindedness, may be partly responsible for the prevalence of epistemically suspect beliefs writ large.
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Yes, bullshit seems to be an active area of research. And rightly so! There is so much of it about. Those who regularly read the comments sections of this blog will probably agree with some of the writing above. The statement that ‘bullshitting can be an effective means of influence when arguments are weak’ rang particularly true, I thought. ‘Communication characterised by an intent to be convincing or impressive without concern for truth’ might perhaps also remind us of a few notorious commentators on this blog.
In any case, I am relieved to know that research into bullshit is buoyant – there clearly is a need to better understand the phenomenon. I for one intend to use this terminology more frequently in the future.
