[Editor’s note: Paul Ingraham, former assistant editor of SMB, makes a welcome return — this time with a guest post!]
May you come to the attention of those in authority.
~ traditional curse
At the end of 2010, I quit my nice job as a Registered Massage Therapist, exasperated by common anti-scientific attitudes, ideas, and methods in that profession and disheartened by an attempt to take away my right to write about it. My professional regulator had spent two years conducting a bizarre “investigation” into my professionalism because I was criticizing chiropractic and massage therapy on my website.
Rather than stop writing, I left my career, and became a traitor to complementary and alternative medicine, a rare CAM apostate. There aren’t many of us, just a handful I know of. Most CAM practitioners do not doubt the value of what they do, let alone quit because of it.
Many years later, I am finally ready to tell the story. I have been greatly delayed, mainly because right at the climax of my career crisis, my wife had a spine-crushing, brain-scarring accident while travelling alone in Asia. All that drama permanently changed my priorities, and for a long time I didn’t want to pick at any scabs. But now I’m finally ready to explain how I got these interesting scars…
When the tone police have power
The pseudo-legal hassle I got into was of a sort that I didn’t even know existed until it was happening to me. It was like a nuisance lawsuit, but I was not sued. I was … regulated.
From 2007–2010 I was embroiled in negotiations to defend my professional reputation. The threat came from my professional regulator, the College of Massage Therapists of British Columbia. The CMT is a government agency charged with setting and enforcing professional standards for BC massage therapists, which are laudably high. The profession aspires to be paramedical here, and has made a lot of progress towards that goal. I trained full-time for three years to get my certification, an unusually large requirement — in most places in the world, the bar is set much lower. The stakes were high.
The CMTBC has the power to investigate and punish RMTs for professional misconduct, and of course that’s important. But the misconduct they charged me with was peculiar: they tried to discipline me for the tone of my writing about pseudoscience and quackery, on my popular self-help website, PainScience.com.
They had no complaints about my accuracy, mind you — they never questioned that. They just didn’t care for my tone.
I probably would never have left the profession of massage therapy if I’d felt safe criticizing treatments like therapeutic “touch” (actual touch not included) or craniosacral therapy (actual therapy not included). Unfortunately, the regulatory interest in my writing was both distasteful and extremely intimidating.
Chiropractic hate mail
I had already been getting hate mail from chiropractors for a few years when the real trouble started in the summer of 2007 with a pair of particularly harsh, detailed complaints from two different chiropractors. They were no different in spirit from any of the other hate mail I routinely received, but these letters were more thorough and sent directly to the CMT instead of me, triggering an investigation by its Inquiry Committee.
The chiropractors wanted to get me formally spanked, and the CMT appeared to be sympathetic and cooperative. The committee was chaired at that time by a homeopath, so her cooperation wasn’t surprising to me — I had also publicly criticized homeopathy.
The Inquiry Committee of the CMT should be mostly concerned with allegations of genuine medical seriousness or moral turpitude, such as unsafe treatment or “bad touching”. They had never before investigated anything even remotely like this, or anyone like me: a skeptic in their own camp, an ideological traitor.
“Unprofessional” = opinions we don’t like
The CMT started their investigation with the strange allegation that the tone of PainScience.com was “unprofessional”. Specifically, they accused me of breaking these by-laws, which dictated that registrants must:
- respect the honour, dignity and credibility of other professionals;
- promote harmonious working relationships with other professionals;
- refrain from undue criticism of the qualifications or the therapies provided by other Registrants or Licensed Practitioners;
It was their subjective, editorial opinion that my writing violated these by-laws. They believed my writing was disrespectful, unharmonious, and unduly critical of other professionals. But they never got more specific, and they never did assert that I was wrong about anything. They just didn’t like my tone.
And yet my tone was quite mild. Skeptical writing about alternative medicine (especially chiropractic) is often strongly worded indeed, while I was relatively polite. If I’d pulled my punches any more, I would hardly have been criticizing at all.
The back story: why was I writing critically about chiropractic and massage anyway?
I was a writer long before I was a massage therapist, and massage therapy started out for me as a sweet day job to support my writing habit: decent pay and a flexible schedule. I started writing about massage — because I always write about whatever I’m engrossed in — and by 2005 the self-help and educational articles I’d written for my clients were starting to attract readers from around the world. I saw potential to do some serious good and embraced the challenge of taking it further.
When the CMT Inquiry Committee’s investigation began, my writing about health science was amateurish compared to my standards now, but even then it was rigorous and idealistic. I had footnotes and everything. My work was focused on patient education and showed plenty of respect for science. Bizarrely, I had even invested in custom-built software that facilitated referencing on my website, a $2,500 project requisitioned before I had any real income from writing. I was serious about upping my science journalism game.
And my interest in science and skepticism was fresh. I was a recently retired flake. Sagan’s Demon-Haunted World had inspired me to abandon a lot of beliefs, and I was full of zeal for my new way of life. I had written some rants about the sorry state of online information about musculoskeletal health and the manual therapies.
The most notable of those was an article critical of chiropractic, in which I wise-cracked about “crack addiction.” I do not deny that I was a little sassy — I was a budding skeptic, and there were a lot of things I wanted to make fun of back then. But it was pretty tame stuff.
“Crack addiction” and other offensive phrasings
The words “crack addiction” became my equivalent of Simon Singh’s infamous choice of the word “bogus,” referring to chiropractic therapy for children. It was one of three supposedly unprofessional phrases that the CMT inquiry committee originally cited. But, unlike Singh’s clearly scathing use of “bogus,” I had referred to “crack addiction” almost affectionately. It was clear in context that I was not actually knocking “crack addiction” per se, just identifying a major factor in the appeal of chiropractic adjustment. Here is the original text:
Nearly every fan of chiropractic is a “crack addict,” I’ve noticed. I enjoy joint cracking myself. I get real relief from a good joint crack, and I seek chiropractic adjustment from time to time. But I do try to promote a realistic view of what cracking can and cannot do. Although cracking can be made to sound more respectable by calling it “spinal adjustment,” and even though scientific research has shown that it does have some therapeutic benefits, it is fairly clear that crack addiction is the only reason that chiropractic survives as a profession. You can sell joint cracking. People want to be cracked!
Pretty harsh! The way I said that it has some therapeutic benefits that I seek out and pay for myself? Oooh, burn!
The only other phrases the IC ever specifically mentioned were:
- chiropractic is “a bit of a one-trick pony” (referring to the crack addiction thing, and how spinal manipulation dominates chiropractic)
- honesty is “in short supply among chiropractors” (referring to infamously aggressive chiropractic sales tactics, which are so excessive that even many chiropractors repudiate them)
Those were much more obviously negative and critical statements. But “unprofessional”? Worthy of censorship and censure?
For more than two years, the CMT escalated their case, always emphasizing and reiterating their concern about the “tone” and quality of my writing, but without further examples or more substantiating complaints. They simply believed that I had stated my opinions too colourfully, or something, and tried to penalize me for it.
Attack of the 50-foot committee!
Professional regulators have substantial power over their registrants. Getting investigated is like having your crotch sniffed by a huge, growling dog — a dog that can destroy your career. Regulatory law is a dark alley where you can get legally mugged and no one can hear you scream, and they wouldn’t have the jurisdiction to help you even if they did.
Regulators normally do not have any reason to investigate the professionals they certify unless there’s truly something wicked going on. But if they do investigate you, and if it’s unjust or motivated by internal politics or ideology … well, then you can have a serious problem. I’m aware of a case much like my own, concerning well-known potty-mouthed skeptical physiotherapist, Adam Meakins, whose paint-peeling rants about similar topics also attracted an accusation of professional misconduct. But while his case was wrapped up quite speedily, mine just kept going.
In the summer of 2008, the committee demanded a public reprimand as well as deletions and changes on my website (which I would define as censorship). Resistance would have been futile and disastrously expensive.
Initially the committee’s investigation was only a disconcerting oddity. Despite their power over me, the complaint was about a relatively trivial matter. The idea of a disciplinary hearing was scary, but it was also remote and improbable. A volunteer lawyer advised me to take it on the chin and consent to their proposal — that I agree with their judgement that my writing was unprofessional, a fact that would publicized (like the results of all Inquiry Committee investigations). In her opinion, if I threw the big mean dog a bone, it would probably leave me alone. So I threw it a bone.
But it did not leave me alone. Instead, it started snarling and barking. The Inquiry Committee raised the stakes.
The report on a website disloyal to CAM
All was quiet for months after I consented to a wrist slap. I thought the ordeal was over. Instead it kicked into a higher gear when I found an envelope full of trouble in my mailbox. The CMT had hired a professor from the University of British Columbia to review my website.
When you’re paying for the tune you want to hear, that’s a “jukebox” report. In a two-page opinion letter and much longer analysis of my many citations, the professor gave the CMT a (presumably expensive) academic opinion that my writing was “insulting and derogatory” and that it was my intent to “do harm to other health professionals.” A thought crime, an accusation based on speculation about my intentions. The CMT used the report as a justification to demand extensive changes to my website that were still unspecified, despite the detailed report.
A few observations about the report:
- It was mostly padding. Half the wordage was an essay on “good science.”
- Most of the remainder was an analysis of the wrong website.
- The context of my citations was ignored. For instance, several sources were judged to be “poor quality” without acknowledging they had been cited as examples of poor quality evidence.
- Other sources — skeptical sources, like QuackWatch.org — were denounced for blatantly ideological reasons.
- My website was accused of being “insulting” — a major feature of the conclusions — and yet only a single minor example was given. But that example didn’t exist!
How much did that report cost the CMT? And what if they demanded that I pay for it? They had invested in this fight, and I had no idea how much further they might be prepared to go. The CMT proposed that I “accept” the professor’s report and “amend” my website within 60 days, with no specific suggestions.
If my website had been a book, they would have proposed a burning. It had obviously been a tactical error to consent to their proposal the previous summer. It was time to fight back.
Meet the skeptics!
I reached out to the Vancouver skeptical community. I jetted off to The Amaz!ng Meeting in 2009 and introduced myself to the SBM bloggers. At an amazing Skepchick party, Dr. Novella and I discussed how I could effectively help him out with his many projects, which is the origin story for my role as the assistant editor of this here blog from 2010 to 2016.
My predicament was kind of hot for a while. Everybody at TAM wanted to chat with the massage guy who was in trouble with his regulator. Upon my return, I went to my first Skeptics in the Pub event, and was introduced to Dr. Rob Tarzwell (now impressively both a psychiatrist and a nuclear medicine specialist).
“We have to talk,” Dr. Tarzwell said. “You really need me. And I want to help.”
He was the first of three local heavy hitters that enthusiastically came to my defense. I was also aided by Dr. Dale Beyerstein (brother of the late Barry Beyerstein, much missed by skeptics). A medical ethicist, Dr. Beyerstein identified legal and ethical flaws with the allegations against me. Finally, I also got support from Dr. Jonathan Berkowitz, a UBC statistician specializing in medical research, and a distinguished teacher of statistics, research design, and critical appraisal in medicine.
I had assembled a dream team of supporters, and all three wrote beefy letters of support. This is what skeptics will do for you. Because they care. And, as impressive my support already was, it seemed like it would have been easy to get more.
I sent another letter off to the CMT, attaching my letters of support. The CMT did not reply.
Despite robust support from three credible experts, the situation was still delicate. The CMT had already shown that there were no clear limits to how hard they would press their case. I had to play one more card: I had to let the CMT know that they were going to get a public relations black eye if they didn’t start compromising.
So I went on the radio. Just a little bit.
I was a guest on Desiree Schell’s excellent show, Skeptically Speaking (now Science for the People). I asked listeners to contact the CMT and express their support for PainScience.com, and their concern that I was being accused of professional misconduct for silly reasons. They did. The chair of the disciplinary committee — the homeopath, remember? — immediately wrote back to them, demanding to know how they had heard about my case.
The CMT had probably never faced a public relations kerfuffle like this. I took satisfaction in imagining the institutional consternation I caused. It couldn’t begin to make up for the personal stress I had endured since 2007, but it was something, and I savoured it.
Victory and fresh hell
I didn’t hear from the CMT again for months, and their next letter was conciliatory compared to all their previous correspondence. Reading between the lines of this much more cautious note, it seemed to say, “If you stop making a stink, we’ll back off.”
For the first time in years, I started to relax a little bit. But that didn’t last long. Just one week later, my wife had a horrific car accident while travelling alone in Laos, injuring her brain seriously, smashing her spine, and much else — proof that life (as well as history) is just one damned thing after another. Writing from a sweltering hospital room in a small town in northern Thailand, my wife lying beside me with a crushed spine, I told the CMT that I considered the matter resolved, and in any case I’d quit the profession and was indefinitely distracted by a medical emergency. Reading between my lines: “Buzz off — I have real problems to worry about now.”
I never heard from them again.
Coda on quitting massage
I love massage. Its medical value may be unclear, but I’m comfortable with that — if it’s not biologically useful, it’s still “just” inherently pleasurable and relaxing, and I’m happy either way. I see a massage therapist regularly and it’s hard to imagine my life without that service. If every massage therapist was like mine — someone who never talks about chakras — I would have no gripe with the profession at all.
And indeed many massage therapists are like her, and many are busily trying to drag their profession into the 21st Century. They embrace evidence-based medicine, vigorously advocate for it on social media, avidly read this blog, and mine, and many other good sources that have cropped up over the years. Even as the CMT was investigating me, I got vigorous moral support and advice from the Massage Therapy Association of BC, which has a long history of promoting evidence-based practice.
And yet the profession is also deeply divided (much like chiropractic). The massage world is still rotten with faith-based treatments and flaky magical thinking, and what little interest in science you find is often shallow. Vitalism is rampant and many therapists indulge in overt quackery like Reiki and reflexology, but that’s only the most obvious nonsense, the tip of a far larger iceberg of health care amateurism and hair-raising ignorance, incompetence, and overconfidence. Practitioners earnestly keen on science and evidence-based practice are a depressingly small minority, and they are inevitably sneered at by many of their colleagues. Massage therapy has a deeply pseudoscientific character overall, defining itself mostly in opposition to science-based or “mainstream” health care, where rejection of science is actually celebrated by many practitioners, probably a majority.
And that is why I left: not just because I had a scrap with my regulator, but because I wasn’t comfortable in a profession so conflicted about science. It was getting awkward. I didn’t want to spend the rest of my career explaining to scientists and engineers and doctors that I was one of the pro-science massage therapists. Others like me have remained, of course, fighting to modernize the profession, and my hat is off to them — I do what I can to support them with my writing and publishing.
- This is one part of a three-part curse that is actually not actually “ancient Chinese,” but English or American. According to Wikipedia, “The Chinese language origin of the phrase, if it exists, has not been found, making its authenticity doubtful.” The other two parts of the curse are the more famous “may you live in interesting times” and “may you find what you are looking for.” ⤴
- Back then, in the late 2000s, it was SaveYourself.ca. I changed it to PainScience.com in late 2014. ⤴
- This was back when Simon Singh was being sued by the British Chiropractic Association. Today, in a world where Simon won (say that in the movie-trailer voice, very satisfying) I feel quite a bit safer from chiropractic litigiousness. But I sure didn’t feel safe back then. A chiropractor once even threatened to sue me for writing “chiropractors are litigious.” He didn’t see the irony. ⤴
- I was still a little foggy about research methods back then, and tended to cherry pick trial conclusions I liked the sound of, free of worries about things like P-hacking, but my bias was skeptical — I tended to cherry-pick “bad news” studies that showed no treatment effect — and I was at least clearly making an effort to cite, support, and ponder plausibility at a time when there were almost no other similar websites or blogs in existence, let alone rigorous ones. ⤴
- It would have triggered a formal disciplinary hearing — an expensive process, even more freakishly out of proportion to the seriousness of the issue than it already was. Suing a regulator is possible in theory but foolish in practice: the courts tend to strongly favour regulators. ⤴
- I had three websites at the time, and he reported on by far the smallest and least relevant. It did share a bibliography with PainScience.com, and that is mostly what the report analyzed. While the bibliography was relevant, the report damningly failed to discuss the content that referenced those citations, on the domain that actually mattered. ⤴
- The professor denounced QuackWatch.org as a bad source because it has a “known bias.” For the same reason, he also denounced Trick or Treatment, by Edzard Ernst and Simon Singh — an excellent book. Predictably, he found fault with any source that could be construed as skeptical or anti-quackery. ⤴
- As far as I can tell, he wasn’t even paraphrasing anything. It appeared to be invented. I guess it’s what the author imagined I might have said while in a drunken argument with him about alternative medicine at a dinner party. ⤴
- I remember asking Dr. Berkowitz, “What’s critical appraisal in medicine?” And he replied, “I study the credibility and validity of medical and health care information claims. In other words, I’m an expert in exactly what you need.” ⤴
- At the time, I had been in touch with Simon Singh, Drs. Novella, Barrett, Colquhoun, and other experts and skeptical celebrities. All were generous and interested. All offered assistance of one sort or another. The skeptical community had my back, in a big way. ⤴
- My interview starts at 13:30. ⤴