Forget gurus, the cult of the evidence-based blogger has taken over ... 'Biased BLOG Bingo'

WARNING! This blog may contain traces of humour ... 

If you suffer a sense of humour deficit ... DO NOT READ ON!

Some time ago now, I had the pleasure of reading an excellent article by Will Self called ‘The awful cult of the talentless hipster has taken over’ … 

Whilst I didn’t necessarily agree with his diatribe entirely, I lapped up the trademark dour humour, empathised with his view and thoroughly enjoyed the read. Then in a bizarre moment of thought association, my mind turned to my own area of interest, Health Sciences and evidence based practice (Physiotherapy in particular) … though this undoubtedly pertains to medicine and all other areas of health care ... I began to ponder ‘the cult of the evidenced based blogger’, which now appears to pervade the zeitgeist of our increasingly confused World

Don’t get me wrong, our World is important (to us … and the people we care for, hopefully) as is the evidence. I like and respect (most) bloggers (cos’ they’re out there), I blog myself … But sometimes I begin to wonder about the whole process, or perhaps question the motives of the bloggers (myself included).

Bloggers and Twitterati, these days are ubiquitous; everyone seems to be having a go and some appear to be very authoritative. Yet blogging is a strange and precarious pastime/hobby/profession, which is both time and thought consuming. So, unless they are getting paid for it (some are … Will Self falls into that category), one would have to debate what motivates the ardent blogger. Shouldn’t they have just gone out for a run or cycle ride or something? 

What would actually drive someone to spend valuable time writing and airing their thoughts on any topic? What drives them to risk an avalanche of comment/critique if their particular diatribe hits the wrong button, or perhaps, a rising tide of gushing agreement from the ‘Bloggioso’ or the ‘Twitterati’ for their latest fashionable and populist masterpiece?

Some blogs are really helpful (or are they?) because they interpret and decipher some of those peer reviewed papers (which to be fair, may be a bit complex/wordy). So blogs may appear really helpful for those busy clinicians who only get limited time for reading/analysing the latest news on a topic.  

One clear attraction of blogging (for bloggers), unlike the restricted writing of peer review for instance, which requires writers to declare conflicts of interest ... is that you can say what you like … and it is clear that some bloggers ‘like what they say’.

But … is what they/we say, prone to BIAS or subject to ‘conflicts of interest’ as a result? 

To help my own decision making, I decided to gather a concoction of my own observations on some of the blog sites that may be influencing how we think and view evidence. Some bloggers may see parts themselves or their writing in one or all of the types (I did). That's not really the intention. Rather, it is for readers to see how a topic may, or may not, be spun.

I'll leave you to decide what you think ... Perhaps after a lighthearted game of 'biased BLOG bingo'.

I wrote about this in my last blog, so if you haven't already, take some time to consider the definition of confirmation bias ... 'the tendency for people to favour information that confirms their beliefs'. 

A quick look at this short YouTube clip may help.

Then consider the concept of conflict of interest which may be easy to identify in medicine for example, with concepts like 'Big Pharma' and 'Bad Pharma', which even have their own Wiki pages, but perhaps less overt in Health Sciences and related subjects. 

With those things in mind, here is my tongue in cheek personal take (from the experience of both reading and writing blogs) on a few of the types of blogger you may encounter out there … and some of the factors that may influence them ... Enjoy! 

Via https://www.flickr.com/photos/notionscapital/5379885034/

Meet some of the ‘blogger types’

1.     The altruistic/educational/hobby blogger – Blogs about a variety of topics of interest to potential readership. Evidence based, educational conduit, who likes to hear the sound of his/her voice … Keeps up to date and an open mind, avoids extremism and generally goes out of his/her way to avoid bias, May throw in some controversy for interest, but sticks to honest appraisals of the evidence. Likes a little devilish humour and for folks to read his/her blog. No commercial interests, no adverts, no shop. Altruistic, ego driven, no nonsense profile builder. Moderate use of social media (SoMe) to promote blogs. Checks blog metrics occasionally. Likes to be asked to ‘guest blog’. Secretly hopes for a trip to Hawaii to speak on his/her latest blog topic. Conflict of interest - Nil of note. Has had a book 'in the pipeline' for 15 years. 

2.     Student blogger – Students who (led by their University Professor) have entered the World of blogging, without actually knowing what they have let themselves in for. Main qualities are passion for the topic and enthusiasm. Downfall may be inexperience (blogging), naivety and failure to critique, or cover the topic from a wide and unbiased perspective. May find themselves, unwittingly at the sharp end of criticism from outraged readers. Not always prepared for this. Variable use of SoMe use, that is until they realise blog metrics contribute to their overall assessment mark. Comments are enabled … until they get thoroughly blasted by someone. Not entirely sure ‘exactly’ where Hawaii is, but would love to go. Conflict of interest? ... Actually, the main thing is ... to pass the assessment!

3.     The Snake oil seller – So enthusiastic about their particular brand of ‘snake oil’. They forgot, or chose not … to support any of their claims with even a shred of evidence. They tend to rely entirely on anecdote and personal recommendation from users of the product/idea/treatment technique. Tales of miracle cures are commonplace. Comments are moderated to include more anecdotal claims or gushing personal endorsements. Commercial interests are generally utmost on their minds and they will ALWAYS have an advert for their particular type of ‘snake oil’ on their blog. This blogger, will be targeted mercilessly by bloggers number 5 and 7, generally to no effect (because they live in their own World, or maybe Hawaii). Heavy use of SoMe. The course for this is product /idea/service is ‘brilliant’, said a delegate. Conflict of interest – Zero (there is no conflict, as their sole interest is profit). A modern day ‘medicine show’. Link directly to the 'shop' here. Entirely and unashamedly biased.

4.     Society or organisation ‘news’ blogs – Generally low-key interest/news articles for members. Designed to update folks on the latest development in the field of interest/profession. Tend to report and stick to facts, seldom court controversy and may tend to be a little bland. Media spokesperson quotes some 'evidence', but may not always be in context or entirely up to date (this will be spotted and hastily dealt with by blogger number 7). Low to moderate use of SoMe for promotion of blogs/articles. Comments commonly disabled. Bland content, seldom gives opportunity for bias. Metrics? Hawaii? Humour? Shop? ... Pardon me!?

5.     EBM proponent/Targeted attacker – Wily operator, who picks a specific (often universally disliked target) and exposes it/them and provides reams of evidence to back up his/her claims. The best of these will end up on a TV show deliver a TED talk or get a column in a broadsheet. Heavy use of SoMe to promote blogs. Commercial interests may include books, newspaper articles, TV show appearances, talks etc. Sycophants and wannabees will include them in a Tweet in the hope of a rebound (seldom works). Comments ARE enabled, and this blogger loves to argue the toss with anyone who cares to have a go and often does so with incisive humour or complex statistics. Perhaps a little obsessed and in possession of a large ego. Naturally biased towards own (often populist views) but generally and genuinely supported by the evidence. This blogger loves notoriety. Metrics are through the roof (seldom needs to check) Goes to Hawaii regularly via private jet. Conflict of interest? ‘Pah … call my booking agent, I'm busy working on my next book/TV show’.

       The rest … (Type 5b), may end up looking looking like aspiring wannabees with a particular axe to grind. These yet to be so ‘successful’ wannabee type 5's, are feverishly typing whilst waiting for ‘the phone call’ and busily fending off ad hominem attacks from ‘outraged of Tunbridge Wells’ or assorted trolls. 

6.     The evangelical blogger – Combines the friendly bonhomie of blogger type 1 with the spin of blogger 3 but has a clear underlying mission of promoting a particular product/method or school of thought. May have a track record in peer review publication, suggestive of authority, yet routinely cherry pick evidence, to support a particular view.  Entirely convinced by the sanctity of their chosen path/product. Extremist disciples, lambast non-believers or other 'churches' as unseeing heretics.

Blog comments are ALWAYS moderated and predominantly populated by devout and enthusiastic followers. Humour is not a common feature of their writing. Evidence based, but a stoic adherence to one doctrine/product/method, leads to blogs that are littered with confirmation bias and supported by cute anecdotal stories. Heavy use of SoMe for promotion. Strongly motivated by metrics and sales. Conflict of interest - You can join the latest crusade (in Hawaii) next week, which ironically coincides with their latest blog (submit HERE to apply). Merchandise shop? Click here.

7.     Frustrated, change agent blogger – This passionate and profuse blogger is entirely frustrated by the speed at which his/her profession effects change. Routinely supplies or demands ‘the evidence’, which calls for the immediate abolition of out-dated ideas, methods and products, which have been ‘shown to be ineffective’. Such vigour and attention to detail, means they may occasionally therefore, resemble the internet 'evidence police' or media watchdog. 

    Fierce belief that the only really valid evidence is the ‘gold-standard’ RCT. Particularly adept at highlighting what doesn't work ... but may omit to offer alternatives to the discarded idea/method/product ... therefore run the risk of leading his/her colleagues into an ‘evidence based’, but tool less cul-de-sac. Energetic, challenging and authoritative. Couldn’t make the conference in Hawaii, but hopes to be there next year (recently spoke in Milton Keynes/Basildon). Busy writing another blog in the mean time. Loves Twitter. Metrics matter. Big fan of type 5a.  Ubiquitous. No time for shops, but currently working on a few other conflicts of interest.

NOW it’s time brighten up the academic tedium with a game of ‘Biased BLOG Bingo’ with the blog YOU last read … errr NO, not this one, it is ENTIRELY biased to my point of view!

You can go to a presentation version of 'Biased BLOG Bingo' here 

DISCLAIMER: Bloggers take part in ‘Biased BLOG Bingo’ entirely at their own risk …
This presentation does not pertain to any bloggers called ‘Hamlin’ …or anyone else, it is merely a parody conglomeration of stereotypes. Anyway ... lighten up! 

Grid design MattLowPT

 

10 points = BINGO (start at zero) 

The higher the score the MORE biased the blog … GOOD LUCK!

1.     Is this blogger a 'snake oil seller'? (Score 6 immediately)

2.     Does the blog contain ANY credible evidence? (Deduct 1)

3.     Is the blog full of anecdote, personal experience and endorsements from users of said product/service/doctrine? (Score 3)   

4.     Is the blog balanced and offers more than one school of thought? (Deduct 2)

5.     Does the blog direct you to ALL of its sources? (Deduct 1)

6.     Does the blog direct you to just the sources it wants you to read? (Score 2)

7.     Does the blog promote ONE specific idea, method product/service? (Score 3)

8.     Does the blog recognise and report opposing views objectively? (Deduct 2)

9.     Does the blog denigrate/mock the ideas of others? (Score 2)

10.  Does the blog cherry pick evidence to support an idea, method product/service (Score 2)

11.  Are comments allowed? (Deduct 2)

12.  Are comments moderated? (Score 1)

13.  Are comments disallowed? (Score 2)

14.  Are the moderated comments predominantly congratulations from ardent ‘followers’? (Score 3)

15.  Is there a SHOP? (Score 3)

Note to BLOG readers: If your favourite blog scored 10 or more (arbitrary unscientific score) ... Just take a moment to reflect on that. There is no suggestion that blogs should not be biased, bloggers write (and sell) what they like ... BUT having a shop for instance, starts them nicely on the road to a pretty impressive BINGO score. However, it is entirely up to the reader to interpret what they see, or to recognise and identify sources of potential bias (if that is, they want to..?) just as they would, if perhaps they chanced upon a copy of the Daily Mail.

As one blogger recently said, "We are all biased" ... it is just a case of how much? So, whilst you may heartily agree with what your favourite blogger says, does or sells, it may be worth reflecting upon their potential for bias/conflict of interest AND how that affects your decision making ... and subsequent actions.

Yes, yes … I know! … I’ll be scoring my own blog later (BINGO!)

Big thanks to Will Self for his inspiration … I may include him in a Tweet (secretly hoping for a rebound ‘re-Tweet’) just before I delete my own Twitter account or become blogger number 4. 

Author: Alan J Taylor is a writer and critic who thinks about stuff and works as a Physiotherapist and University lecturer ... The views contained in this blog are his own and are not linked to any organisation or institution. Like Bukowski, he 'writes to stay sane'.

You'll find him mostly on Twitter https://twitter.com/TaylorAlanJ
... that is until, he finally deletes his account, or is 'evidence based blogged' to oblivion. 

Biased blog bingo grid design .... via @MattLowPT 

10 Good reasons why physiotherapists are perfectly placed to deliver exercise prescription.

A Physiotalk Tweet Chat recently posed the question ... 'Is exercise at the heart of Physiotherapy?' ... and that got me thinking!

So here is my take on that ... written in a mini-blog and offered up as a SlideShare version for those who prefer that sort of thing.

Here are 10 good reasons why physiotherapists are perfectly placed to deliver exercise prescription.

1.    Specific knowledge of exercise physiology and sports science
2.    Specific knowledge of neurology
3.    Specific knowledge of MSK pathology, co-morbidity and disability
4.    Specific knowledge of the respiratory system
5.    Specific knowledge of biomechanics
6.    Specific knowledge of pain science, and the ability to communicate strategies for behavioural change
7.    Specific knowledge of the psychological, mental health and societal  implications of injury/illness/dysfunction
8.    The ability to progress and modify exercise prescription to meet mutually agreed goals/targets
9.    The ability to develop exercise prescription to meet agreed functional needs
10.  The ability to modify exercise prescription to meet the need of all age groups and levels of aspiration.
 

Question is … Are we using a ‘system based approach' and leading the pack? … or simply too busy sniping from silos?

I have some thoughts about that ... but I think we should concentrate on directions for the future ... for physiotherapy and exercise prescription. 

 
1.    Step outside your silo ... and lay down your guns! Firing at others is a waste of time and energy ... save it ... or your performance will suffer!

2.    Concentrate on integrating and sharing the knowledge

3.    Spend more time and energy on what DOES work

4.    Consider exercise prescription as a powerful TREATMENT MODALITY

5.    Develop and promote a ‘Systems based approach’ to exercise prescription, which incorporates all of the above

6.    Exercise your minds … Become leaders NOT followers

See a full 'SlideShare' version of this mini blog here

For resources/evidence for exercise and health, together with just a few reasons WHY exercise matters go here.

Author: 

Alan J Taylor is a writer and critic who thinks about stuff and works as a Physiotherapist and University lecturer ... The views contained in this blog are his own and are not linked to any organisation or institution. Like Bukowski, he writes to stay sane.

You'll find him mostly on Twitter https://twitter.com/TaylorAlanJ

Neuroplasticity, neuroplasticity, neuroplasticity … The new overuse syndrome: Neuro-babble Tourettes

Never have I seen a word bandied about with such reckless abandon. 'Neuroplasticity' is simply ubiquitous, try a search on Twitter or Google, it’s a veritable delight of the good the bad and the ugly.
 
BUT what if I told you that ‘neuroplasticity is considered by some to be a dirty word … Not my opinion, but rather that of Vaughan Bell a London based neuroscientist and clinical psychologist.

So why does an eminent neuroscientist have such an aversion to the term?

Well my advice is to read the post, he describes far better than I ever could, how phrases like ‘your brain is plastic’, ‘rewire your brain’ and ‘neuroplasticity’ are virtually meaningless.

‘Neuroplasticity sounds very technical, but there is no accepted scientific definition for the term and, in its broad sense, it means nothing more than ‘something in the brain has changed’. As your brain is always changing ... the term is empty on its own.’ 

The article has a helpful educational element and puts neuroplasticity into perspective, going on to describe some of the most common processes associated with the term. With the rider that  ...

‘the next time you hear anyone, scientist or journalist, refer to neuroplasticity, ask yourself what specifically they are talking about. If they don’t specify or can’t tell you, they are blowing hot air.’

But Bell is not the only one critical of the current trend towards neuro-babble. Tom Stafford a Cognitive Scientist at the University of Sheffield in the UK wrote an equally cutting piece on the emerging trend of neuroessentialism, a classic neurologism if ever I heard one!

‘The belief in, or tactic of, invoking evidence, or merely terms, from neuroscience to justify claims at the psychological level...’ 

It goes on … in a delightfully written piece entitled ‘Your brain on pseudoscience: the rise of popular neurobollocks’ which appeared in the New Statesman. Stephen Poole the British author and journalist dissects ‘the plague of neuroscientism – aka neurobabble, neurobollocks, or neurotrash …’ Poole has written previously on the misuse and abuse of language in the brilliantly acerbic ‘Unspeak: Words are weapons’ and his rhetoric comes as a warning to all with regard to the rise in neuro-vernacular. His incisive observation of how ... 'the “neural” explanation has become a gold standard of non-fiction exegesis, adding its own brand of computer-assisted lab-coat bling to a whole new industry of intellectual quackery that affects to elucidate even complex sociocultural phenomena.' takes a couple of reads (whilst I neuroplasticise and conceptualise ...), but is particularly enlightening.
 
Further, he quotes Paul Fletcher, professor of Health Neuroscience at the University of Cambridge, who suggests …
 
‘Too often, a popular writer will “opt for some sort of neuro-flapdoodle in which a highly simplistic and questionable point is accompanied by a suitably grand-sounding neural term and thus acquires a weightiness that it really doesn’t deserve. In my view, this is no different to some mountebank selling quacksalve by talking about the physics of water molecules’ memories, or a beautician talking about action liposomes.’

As physiotherapists we should both know and care what other professions and key writers are making of the real achievements and developments in neuroscience. Not least, because we need to be able to communicate effectively but also because we need to maintain and develop credibility. To spout forth repetitious neuro-babble, risks making us sound like new age neuroflaneurs and I am pretty sure that’s not a route we should be taking, as the profession steadily weeds out the nonsense.


While I’m on the case, just keep a look out for the emergence of neuro linguistic programming (NLP) amongst the maelstrom of information that comes your way. Indeed, I saw a tweeted PPT slide from a recent Physiotherapy conference detailing the key elements of NLP. If you’ve read around the subject, you may have encountered this eloquent deconstruction of that particular branch of ‘neurononsense’ … which you can find here.  If you are of a scientific persuasion, it would be wise to root out the ‘neuro-flapdoodle’ of NLP before it has chance to take root.


Thankfully, there does appear to be some awareness that we need to consider what we say and how we say it … I was alerted to an excellent piece on pain by Lorimer Moseley, entitled ‘It is not just the brain that changes itself – time to embrace bioplasticity?’, where, somewhat ironically, but honestly, he discusses the concept of ‘bioplasticity’. Moseley, clearly alerted to the linguistic pressures of the topic, makes light of the neurobabble by constructing a few (tongue in cheek) terms of his own. Then adds the following slice of antipodean back pedalling humour:


‘Bioplasticity is, from herein, the new black. I repent my neurocentric ways and hold aloft the banner of biocentricity. It seems to me to be a fairer reflection of what we know about ourselves and it is a sensible umbrella term for the changes that occur across multiple systems when, for example, pain persists, or when, for example, we try to change pain. In fact, these tasks that we call neuroplasticity training, do not only induce changes in the nervous system, so perhaps they should be called bioplasticity training. Just a thought. And immune activation. And endocrine response. And motor output. And heart rate fluctuation….’

So there we have it … and it truly is a thought that we should keep. Perhaps we really should consider a ‘system based approach’ (I think I have argued this case before…) to our consideration of pain and dysfunction. We should work together to combine the brilliant emerging elements of pain science and brain function with a sound consideration of the amazing system that is the human body, which of course includes the periphery. A brain requires a body, and vice versa … ask any suffer of quadriplegia or Wallenberg syndrome. BUT let us not become the new neuroflaneurs of pseudo pop-psychology, by endless repetition of meaningless neurobabble, because there are folk out there who clearly, can see through it.

Our role requires us to work in multidisciplinary teams and it may be prudent for us to be cognisant of the opinions of other professions with regard to the way the emerging knowledge is considered, disseminated and taught. It may be wise to consider our own linguistics and mantras in this field too ... lest we begin to sound like 'beauticians talking about action liposomes'. Therein lies our challenge ...
 
Here's a helpful linguistics tip … via the eloquently entitled neurobollocks website …

‘when you see (or hear – sic) the word ‘neuroplasticity’ think ‘bollocks’ instead ... 99% of the time you’ll be absolutely dead-on.’ 

For those who find that perhaps a little harsh ... My own personal strategy hereon in, is to simply substitute 'neuroplasticity' with 'neuro-flapdoodle' every time I encounter it in common parlance ... It just brightens my days up no end. Such is the power of language. 



Author:  
Alan J Taylor is a writer and critic who thinks about stuff and works as a Physiotherapist and University lecturer ... The views contained in this blog are his own and are not linked to any organisation or institution. Like Bukowski, he writes to stay sane.

You'll find him mostly on Twitter https://twitter.com/TaylorAlanJ
 
 

Confirmation bias, physiotherapy and the highlighter pen ...

The recent Body in Mind blog post ‘Exercise for chronic whiplash: does it matter how we do it?’ by Zoe Michaleff, was an unexpected delight and breath of fresh air. Here you can see a top researcher reporting on a study that found the virtual OPPOSITE of what her team found, in an open objective account, without bias and without trying to tear that study apart from a methodological (or any other) perspective. She even went on to offer a plausible scientific explanation for the differences between the studies.

Why, you may ask is this so refreshing? Well, because we so seldom see it!

Whilst some commentators have gamely suggested we think carefully before alighting the latest 'bandwagon' (whatever that may be this week) and others have exhorted us to simply think. More commonly, we see a plethora of blogs/articles/tweets which support various theories or schools of thought, which are driven consistently by confirmation bias. In fact, it could be argued, some have even gone so far as to patrol the internet, helpfully fulfilling the role of rapid response 'Cyber Evidence Police'... and that's OK ('it's for your own security'), providing they are always right, BUT sadly, no-one is right 100% of the time.

Let's first consider the definition of confirmation bias or 'my side' bias ... 'the tendency for people to favour information that confirms their beliefs'. 

This YouTube clip is an excellent short resource.

Have you ever picked up a newspaper or magazine article and been drawn to a particular article and read it voraciously, lapping up the prose and rhetoric as you go? Conversely, have you picked up an article and discarded it after the first paragraph or less? Most people have, and the one of the factors that dictates whether you persist or stop is confirmation bias. In other words we like and enjoy reading stuff that floats our boat, or that confirms our long held/new found ideas and beliefs, and tend to avoid or ignore the converse.

The result is that we may become biased towards articles, research literature, books blogs, tweets, people etc. that confirm our thinking … It is human nature. I often see students working on critique of research papers for example, using a single marker pen. I can’t resist asking what they are highlighting … “the interesting stuff”, “the relevant stuff”, “the bits that support the theory I’m working on” etc. 

Only occasionally does anyone have two different coloured marker pens … one for the supporting evidence and one for the opposite point of view. Try it yourself, concentrate on what doesn’t support your theory for a moment, concentrate in the holes in the theory, the method, look at an argument from the opposite side. It is both illuminating and revealing and naturally, you’ll probably find the second marker pen is used a lot less than less than the first. Of course, that may be because of what you chose to critique in the first place.

Believe it or not … Human nature and confirmation bias may lead you to overlook the methodological, scientific, statistical or philosophical holes in one paper, whilst using all of your might to apply those things to another. In other words, there may be a tendency to ignore or under weigh evidence that could dis-confirm an opposing hypothesis. We see examples of this time and time again in the interpretation of physiotherapy evidence.

It is always worth asking yourself ... “When is the advocated theory ever wrong?” Nothing works all the time. An astute person is aware of the limitations of any idea or practice. Challenge any 'authority' to explain the alternative of their position, and when they might use another option ... You can see more on that approach here.
 

What is even more revealing is when we see ‘conversions’ from one school of thought to another. Take a moment to look at this blog article on the 'conversion' of a staunchly religious person to an atheist and what happened thereafter. Not untypically, the post conversion individual went on the attack and " … dismissed all others’ beliefs and assumed his was correct". That frankly, is not a brilliant scientific or philosophical stance to take regardless of the 'evidence', there is always a contrary view and another side to any coin ... and the evidence base, as we know is an ever changing landscape. 

So that is why Michaleff's article was a breath of fresh air … I think, as a profession we can all take something from that ... and perhaps 'work together and learn together'.

If you want to read a little more on the various types of bias that may permeate our World ... this article is not a bad place to start. 

Personally, I’m just off to the 24h multicoloured highlighter pen shop.

Author: Alan J Taylor is a writer and critic who thinks about stuff and works as a Physiotherapist and University lecturer ... The views contained in this blog are his own and are not linked to any organisation or institution.

You'll find him mostly on Twitter https://twitter.com/TaylorAlanJ