Scott Alexander wonders why we don’t have “guideline” algorithms for more difficult-to-treat problems, in addition to depression. Meanwhile, elsewhere on the internet, the first steps toward establishing something like that for back pain.
I’m not satisfied with my previous post on back pain. Framing it as a review of three separate books was probably a mistake. When you review two books at once, you can frame things as a “compare and contrast”, but grouping things in threes is awkward.
I’m going to try to correct my error by comparing and contrasting the back pain theories and treatment recommended by Stuart McGill of BackFitPro.com and Paul Ingraham of PainScience.com. The two both claim to be proponents of “evidence-based medicine” for low back pain, and they share quite a few beliefs in common; namely, they believe that many common treatments and diagnoses for low back pain are scams, including: Continue reading
This is a review of three books about low back pain: Crooked, by Cathryn Ramin; Back Mechanic, by Stuart McGill, and the Complete Guide to Low Back Pain, an book-length article by Paul Ingraham from PainScience.com (paywalled.)
These are three very different books, written by three very different authors:
- Cathryn Ramin is an investigative journalist who suffers from severe low back pain.
- Stuart McGill is a Ph.D. kinesiologist at the University of Waterloo.
- Paul Ingraham is a science writer and massage therapist, but more importantly for our purposes, he’s a empiricist nerd obsessed with evidence-based medicine.
Disclaimer: Nothing I write here is a criticism, in the pejorative sense, of Guyenet’s advice; he reports scientific findings faithfully and we can ask no more than that. Instead, I want to explore why some people find his advice discouraging. Also, note that Guyenet’s advice involves more than just reducing food reward – he says you can also lose weight by eating a high-protein diet, exercising more, sleeping better, and reducing stress.
Scott Alexander suggested that the implications of The Hungry Brain are “neo-Puritan”, and I more or less repeated that claim in my review of the book. However, it could be argued that every diet plan is puritanical – after all, every diet plan, from the quackiest to the most scientifically sound, offers the same basic promise: Restrict in some way your consumption of delicious foods, and you will lose weight. Is Guyenet’s advice any different?
I think it is.