Few things in life deserve more respect and appreciation than science. Science has made our lives so much easier, warmer, drier and safer that it is hard to fathom.
Medical science has made a particularly large contribution to the quality of life we are blessed to lead now. Only 250 years ago, a child born in a Western country had less than a 20% chance of making it into their early teens. Taking out funeral insurance for your child as soon as they were born was common practice. Now only a handful of generations later, the loss of a child is more like a lightning strike than the everyday occurrence it was only a handful of ages ago. Thanks to innovations that all stem from medical science.
Closer to 500 years ago, King Henry VIII was infamously one of the worst husbands in all recorded history. But uxoricide wasn’t his only interest in life; he was also very interested in medical science.
Henry founded the Royal College of Physicians in 1518 and amalgamated ‘The Barbers Company of London and the ‘Fellowship of Surgeons’ to form the Company of Barber-Surgeons in 1540. His administration passed seven acts of parliament aimed at regulating medical practitioners that would endure for 300 years after his death. Henry presided over major improvements in public health, installing public water supplies and sewers and implementing segregation and disinfection processes during epidemics.
Henry’s interest in medicine may have arisen (as it often does) from his own substantial health struggles. In his early life, Henry was an unusually fit, healthy, strong, and robust young man, an athletic 6ft and 15 stone of muscle. Then, in his late 30s, he injured his foot badly playing tennis (most likely a bad sprain) and sometime later had an ulcer (probably caused by a mixture of stress and injury) in the same leg. Both of which resolved but foreshadowed the unimaginable physical suffering that would ultimately end his life.
In 1536 at 44 years of age, Henry suffered a catastrophic injury when he fell from his horse during a jousting match—sustaining what was almost certainly a severe brain injury and fracturing at least one leg bone. Following the injury, Henry exhibited signs of what we now know as CTE (chronic traumatic encephalopathy), which more than likely contributed very significantly to the fragmentation of his mental health. Then in the months following, he once again suffered from ulceration of the tissues in his leg, which this time was not destined to resolve.
Over time the ulcerations in Henry’s leg became giant deep pus-filled fistulae. For treatment, these frequently required red hot pokers to be inserted into them, such were the medical procedures of the day. Which, even in an age of anaesthesia, would have been a hellish cycle of pain most of us can’t imagine. The repeated cauterising of the wounds helped temporarily reduce individual ulcerations but was ultimately ineffective at halting the progression of the physical processes playing out in Henry’s leg tissues.
The day-to-day existence of a person whose legs are being eaten alive by bacteria is about as bad as it gets medically. It undoubtedly contributed to Henry’s ever-increasing proclivity for boiling people alive when they inconvenienced him later in life.
It is highly likely that Henry had DVT (deep vein thrombosis), where blood clots form in the blood vessels of the leg. Similarly, the presence of Type 2 diabetes is retrospectively a virtual certainty. The majority of DVT and diabetic ulcers are known to be bacterial ‘culture positive’, which means that even in modern times, the ulcers that form as a result of these vascular blockages often develop colonies of virulent bacteria.
By 1543 Henry was 51 years old and weighed around 30 stone. The vile stench of his leg ulcers could be detected from 3 rooms away. He was literally decomposing whilst refusing to rest whatsoever and continuing to fully function as Britain’s monarch. Then in 1547, after a decade of agonising decomposition and violent rage, Henry finally succumbed to the organisms that had been slowly consuming his tissues for all that time. The end would have shown up as a raging fever as the infection managed to take over his internal organs.
So, just a handful of generations ago, the wealthiest man on the planet died one of the most horrifying deaths imaginable. And if you suffer from the same health issues now, it is highly likely you would be fixed up within a month of antibiotics and anticoagulants, followed by some judicious longer-term dietary adjustments. None of which was available to Henry, who, despite having unlimited resources, had to watch helplessly as his body was slowly consumed by a large payload of (somewhat karmic) bacteria. He didn’t even have any pain relief to cover the countless days on which hot pokers were inserted into his leg ulcers.
Thanks to medical science, even the poorest among us now live a more privileged existence than the king of everything did only a very short time ago. The vast majority of yesterday’s fatal diseases, accidents and infections have been reduced to today’s mild inconveniences.
Today we get to complain about the negative impact antibiotics have on our guts and waiting times at emergency departments. Yesterday those were luxuries that even kings and queens could only dream of. Modern medical science is a technological marvel.
Yet, despite its success in treating diseases, medical science has many failures. And one of those is its failure to make any meaningful impression on the pandemic of chronic pain we live amidst. In that instance, it has proven to be as ineffectual as Henry VIII’s physicians were in their attempts to prevent his legs from being consumed.
When it comes to healthcare, the word ‘science‘ is commonly misappropriated and misrepresented. Increasingly the term science is used to mean ‘ isolated, tested and statistically proven by large volumes of recorded experimental data’. The type of science we use to discern the effectiveness of drugs. Which is a part of some sciences but categorically not what science is.
There are whole branches of science that are purely theoretical and not based on experimentation, like theoretical physics. The mechanisms proposed in scientific concepts that we accept wholeheartedly, like natural selection (evolution) and the big bang, are theories.
Science is not ‘experimental data’; it is something much broader and deeper than that. Amongst other things, science includes sound methodologies, theories and working hypotheses. All of which are valid.
The scientific process is something far broader and more nuanced than ‘data’.
Modern medicine has heavily inferred that it’s best to limit one’s pain treatment options to those that are ‘scientifically proven’ by data. Yet, in the real world, this approach rarely leads to the best possible long-term outcomes for chronic pain sufferers.
The best results in pain management come from a willingness to take the current evidence and build on it with a sound working hypothesis, like many other sciences do, and put these hypotheses into action. Both with proven tools and other tools that have yet to be properly ‘researched’; but nonetheless have a strong anecdotal track record. Then apply all of the above aggressively in an attempt to get the patient out of pain now. Not in some distant and improbable future where we have enough data to act effectually.
Sadly, pain management is a speciality plagued by a severe lack of high-quality ‘scientific data’ regarding the effectiveness of treatments. Relative to the scale of the problem, at least. This is in no small part due to the extreme difficulty of generating high-quality data for pain treatments. For study design and economic reasons, it is infinitely harder to generate high-quality data on a new osteopathic treatment than it is a new non-steroidal anti-inflammatory. And sadly, drug therapies don’t resolve pain; they simply mask it.
You would be mistaken if you assume that this lack of quality research only applies to allied health treatments like chiropractic, acupuncture and osteopathy.
Consider the following statement published in the British Medical Journal. Based on a 2021 meta-analysis of a large number of randomised control trials on the effectiveness of elective orthopaedic surgeries.
‘No strong, high-quality evidence base shows that many commonly performed elective orthopaedic procedures are more effective than non-operative alternatives.’.
The data analysed revealed that 8 out of 10 orthopaedic surgical procedures either had no evidence to support their effectiveness or had evidence that specifically pointed to a lack of effectiveness. Relative to the far safer alternatives, like acupuncture, shockwave therapy, LLLT, osteopathy and exercise prescription.
For complete clarity, the pre-eminent British Medical Journal is telling us that there is a severe lack of high-quality scientific evidence to support the use of 8/10 of the most common orthopaedic surgeries.
The funding pool behind surgical research outstrips every other pain management profession by an exponential margin. Yet, despite this vast research budget, orthopaedic surgery for pain still seriously lacks quality supporting data.
Sadly this data on surgery, or lack thereof, accurately reflects the broader state of pain management research in the 21st century.
Yet, a lack of data does not necessarily imply a lack of effectiveness.
A ‘lack of evidence’ often just means that no one has got around to generating any quality data. With pain treatments, one tends to find a few scraps of data but no rigorous study on a large enough group of patients to have gained any certainty.
More often than not, this leaves the scientifically minded patient and practitioner alike being forced to choose between no treatment and ‘unproven’ treatment. But luckily, a strong case can be made for trying out many ‘unproven’ pain treatments.
Reflecting on non-healthcare disciplines sometimes helps pain patients develop some comfort with the idea of ‘valid but unproven science‘. Which, in truth, applies to the vast majority of life’s competencies.
Over the past 20 years, Brazilian Jiu-Jitsu (BJJ) has moved from complete obscurity to becoming one of the world’s most popular martial arts. BJJ is a reiteration of Japanese Jiu-jitsu, modified into a shockingly effective system of grappling, chokes and submissions.
The primary feather in the cap of BJJ is that it was once tested in open competition against many other martial art forms and came out on top of the heap. Thus ending countless testosterone-laced debates about which is the most effective martial art. BJJ also has a proven track record for enabling smaller men to beat much larger men in martial arts contests—a major feat and one that has been performed repeatedly with the BJJ system.
For those of us who have no experience in the grappling arts, being on the ground with the wrong amateur BJJ practitioner has great potential to be a life-altering unpleasant experience.
On being instructed to avoid getting choked or having any of our joints snapped, we make a few instinctive attempts at self-preservation. Then, depending marginally on our level of physical strength, within a handful of moments (or possibly just one), we would find ourselves in serious trouble.
An instinctive movement of our neck, arm or leg that felt like the right thing to do. Leading on to a sudden realisation that something important, like an elbow, was about to snap out of its socket. Other exciting possibilities include blacking out due to a lack of blood in our brain faster than we dreamed was a physical possibility or having our ankle joint snapped. Luckily for us, though, most BJJ practitioners are very wholesome types who wouldn’t dream of fully executing the move. So the whole thing could be put down to a near-death experience for the elbow.
Over the past 20 years, Brazilian Jiu-Jitsu (BJJ) has moved from complete obscurity to becoming one of the world’s most popular martial arts. BJJ is a reiteration of Japanese Jiu-jitsu, modified into a shockingly effective system of grappling, chokes and submissions.
The primary feather in the cap of BJJ is that it was once tested in open competition against many other martial art forms and came out on top of the heap. Thus ending countless testosterone-laced debates about which is the most effective martial art. BJJ also has a proven track record for enabling smaller men to beat much larger men in martial arts contests—a major feat and one that has been performed repeatedly with the BJJ system.
For those of us who have no experience in the grappling arts, being on the ground with the wrong amateur BJJ practitioner has great potential to be a life-altering unpleasant experience.
On being instructed to avoid getting choked or having any of our joints snapped, we make a few instinctive attempts at self-preservation. Then, depending marginally on our level of physical strength, within a handful of moments (or possibly just one), we would find ourselves in serious trouble.
An instinctive movement of our neck, arm or leg that felt like the right thing to do. Leading on to a sudden realisation that something important, like an elbow, was about to snap out of its socket. Other exciting possibilities include blacking out due to a lack of blood in our brain faster than we dreamed was a physical possibility or having our ankle joint snapped. Luckily for us, though, most BJJ practitioners are very wholesome types who wouldn’t dream of fully executing the move. So the whole thing could be put down to a near-death experience for the elbow.
Now, if we take that same novice BJJ practitioner who went easy on us and put her against a fully-fledged black belt, her experience could easily be over faster than ours was. She would almost certainly lose 100/100 matches against her teacher. Then having conducted that experiment, if we take that black belt and put them against a BJJ world champion, once again, we would see someone being submitted very fast every single time.
You could go to any number of clubs all over the world; and find a gravely consistent disparity in ability between yourself and the novice, between the novice and the black belt, and between the black belt and the champion. Which incidentally is a lot like repeatable scientific data.
BJJ is an effective, practical and repeatable system based on sound scientific principles. If you doubt this, all you need to do is go to your local club and tell them; they will help you to understand better.
Now that you understand BJJ a bit, there is something else important to understand. ‘There is zero scientific data to support BJJ’s effectiveness. It is ‘scientifically’ completely unproven.
There are no research articles published on BJJ’s effectiveness at breaking elbows. There are no literature reviews on how consistently black belts choke out blue belts. There are no in-depth peer-reviewed technical papers on the best way to secure an arm bar. And there are no randomised blind controlled studies on the probability of getting choked unconscious by a club black belt after you tell them in front of the class that BJJ is an unscientific system.
BJJ’s effectiveness is ‘purely anecdotal’ in scientific terms. And yet, this utter lack of data has no bearing whatsoever on the stark, visceral and predictable reality of grappling with its practitioners. BJJ is a verifiable and repeatable science.
But if BJJ practitioners limited themselves to the parts of their art form that were scientifically proven by medical standards, they would all just have to sit on mats looking at each other – Paralysed by the need for statistical proof. But they don’t worry about that; they just get on with it – extremely well.
It is possible, of course, that BJJ isn’t the best all-around martial art. In fact, rolling around on the floor isn’t always the safest form of combat when it comes to self-defence in the real world. The point is that it is a verifiably effective science that has been developed without the need for ‘scientific proof’.
What if successful management of chronic pain is the same? An area where competence is possible despite the lack of quality research data. Do you choose to steer clear of it due to this lack of high-quality evidence? Or do you dive in?
Regardless of what your answer is, pain management is not a martial art. There is an unseen subtlety and complexity to effective pain management. One that is admittedly lacking relative to the art of choking one’s neighbour unconscious in white pyjamas.
Pain resolution is a nuanced well-being issue. The underlying goal of which is achieving a good state of health, given that a healthy body and mind naturally tends to be a pain-free body and mind. So in the data drought, the pain sufferer finds themselves in, it’s worth wondering whether we have any collective track record for gathering valid health and well-being knowledge; outside the medical science realm. And happily, we most certainly do.
The old Norse word for cod liver oil is ‘lysis’, which means light. Which we can safely assume was a name born out of reverence. Light has special significance to cultures that spend a large part of their yearly cycle in relative darkness.
Over 1000 years ago, the Vikings had come fully to terms with the unmatched benefits of Omega 3 fatty acids. Ten centuries before we even knew Omega 3’s existed, Norse cultures prized fish liver oil to such an extent that they referred to it as ‘the gold of the ocean’. They were not the only culture to uncover this class of ‘medicines’.
The oil of marine species’ livers has a long history of medicinal use. In ancient Greece, Hippocrates himself (the so-called “Father of Medicine”) prescribed dolphin liver oil to treat skin problems.
The Vikings most commonly extracted cod liver oil by laying birch tree branches over a kettle of water and placing fresh fish livers on them. The water was brought to a boil, and as the steam rose, the oil from the liver dripped into the water and was skimmed off. They also had methods for producing fresh raw cod liver oil.
The Vikings primarily consumed cod liver oil during winter when the days were shorter and lacked sunlight. This was both convenient and poetic, given that they referred to it as ‘less’ light. Vitamin D is a key constituent in cod liver oil and a key benefit of sunlight. They may well have been aware that the benefits of light and oil were comparable. Living in the open air in an intensely seasonal environment offers many subtle insights that would be lost on us.
The old Norse word for cod liver oil is ‘lysis’, which means light. Which we can safely assume was a name born out of reverence. Light has special significance to cultures that spend a large part of their yearly cycle in relative darkness.
Over 1000 years ago, the Vikings had come fully to terms with the unmatched benefits of Omega 3 fatty acids. Ten centuries before we even knew Omega 3’s existed, Norse cultures prized fish liver oil to such an extent that they referred to it as ‘the gold of the ocean’. They were not the only culture to uncover this class of ‘medicines’.
The oil of marine species’ livers has a long history of medicinal use. In ancient Greece, Hippocrates himself (the so-called “Father of Medicine”) prescribed dolphin liver oil to treat skin problems.
The Vikings most commonly extracted cod liver oil by laying birch tree branches over a kettle of water and placing fresh fish livers on them. The water was brought to a boil, and as the steam rose, the oil from the liver dripped into the water and was skimmed off. They also had methods for producing fresh raw cod liver oil.
The Vikings primarily consumed cod liver oil during winter when the days were shorter and lacked sunlight. This was both convenient and poetic, given that they referred to it as ‘less’ light. Vitamin D is a key constituent in cod liver oil and a key benefit of sunlight. They may well have been aware that the benefits of light and oil were comparable. Living in the open air in an intensely seasonal environment offers many subtle insights that would be lost on us.
Ultimately, cod liver oil was prized by the Vikings because they knew its ability to prevent sickness and disease. So they rubbed it on their bodies and routinely consumed whole fresh livers dipped in liver oil.
Cod liver oil has remained a widespread folk remedy in Northern European fishing communities over the centuries. And we can safely assume they were not consuming it because of its flavour profile.
As early as 1782, English physicians began studying cod liver oil and prescribing it for rheumatism. In 1822, cod liver oil was officially recognised by the medical profession for its curative powers. Yet no one understood why or how it worked. By the mid-18th century, it was widely observed that cod liver oil was highly effective in the treatment of rickets, rheumatism, skin wounds, chronic pain, gout and some forms of tuberculosis.
Cod liver oil is approximately 20% omega-3 fatty acids. Though similar in fatty acid composition to other fish oils, cod liver oil has higher concentrations of vitamins A and D. According to the United States Department of Agriculture, a tablespoon of cod liver oil contains 4,080 μg of retinol (vitamin A) and 34 μg (1360 IU) of vitamin D.
In the modern era, the use of Omega 3’s, a dietary supplement, is supported by a mountain of scientific data. They are one of the very few nutritional supplements whose value there is no disagreement upon. The benefits are extremely broad and well-documented across brain and mental health, cardiovascular health, eye health, liver health, respiratory health and bone health. It would be easy to make a case for Omega 3 fatty acids being the king of ‘nutraceuticals’.
So The Vikings and many others before and since managed to identify that there was medicinal magic held within fish livers. And not only that, they accurately discerned that it was the oils in the cod liver that had special significance and possibly even that it contained a key benefit that matched the benefits of sunlight. When all is said and done, they discovered what may be the world’s most important nutritional supplement 1000 years before medical science was even conceptualised.
We clearly have the ability to perform sophisticated problem-solving in the wellness arena. Without modern medical science. By means of empirical and experiential real-world problem solving, and ultimately, science.
The only conceivable argument against this type of learning being a valid part of how we select healthcare interventions is our inherent fallibility. Yet there are few more well-documented examples of a fallible system than the very one that claims, above all others, to be supported by medical science—the pharmaceutical industry.
In the past decade alone, big pharma has paid out in excess of 20 billion USD in damages and criminal fines due to the wholesale carnage caused by drugs that were deemed ‘proven’ therapies by the data-based standards of Western medical science. The real story behind these numbers is not a financial one but one of heartbreaking human suffering on a grand scale. Caused by complete failures on the part of medical science itself.
All forms of science carry some level of fallibility. From those we develop purely through real-world experience to those that are validated by substantial investment in the generation of ‘medical proof’.
It is possible, and perhaps perfectly reasonable, to hire your pain management team on the same basis you hire a lawyer, martial arts coach, singing coach, piano teacher, carpenter, or even a barrister. On the basis of education, experience and a sound working hypothesis about the cause of your pain. Rather than on the basis of rigorously designed, large-scale, double-blinded, randomised control trials published in peer-reviewed journals, which seldom exist in any case.
There are times when it is safer to keep the entire scientific process locked away from the public through the entire arch of its development. Successful development of bioweapons would be an excellent example of this. And many drug therapies need to be treated with similar caution.
There are, however, also times when it is far safer to unleash the scientific process on the general public at the ‘working hypothesis’ stage. An exploding global pandemic that shortens millions of lives and ruins the quality of countless others could be an example of this – certainly when the safety profile of the relevant procedures is beyond a reasonable doubt – as it is with the likes of acupuncture, fascial release, meditation, core exercises and spinal mobilisation.
And when all is said and done, the entire topic of science is only one part of healthcare.
Healing disciplines are not science; they are based on science. In the real world, all healing disciplines are, to varying degrees, art forms based on scientific principles. Pain management is a safe and effective art form based on scientific principles.
Those of us who are suffering with chronic pain have a golden opportunity. To dive into effective pain management on the basis that it is an ‘unproven’ but valid art form underpinned by scientific principles. Like Brazilian Jiu Jitsu, or the extraction of oil from fish livers using wisdom, birch and steam.
Pain is a symptom. Symptoms are the feedback that the body generates when it faces problems with its delicate internal balance (homeostasis). Without symptoms like pain, thirst, nausea and fevers, it would be very difficult for us to maintain a healthy body in the same way that it would be hard to drive a car safely with no dashboard display.
John is one of those rare gentlemen who has continued to play competitive soccer well into his late 50s. He is in really good shape, which you need to be to play football at that age—good shape except for his left leg. His left leg is not in good condition at all. In fact, once you get to know his left leg a bit better, it becomes apparent that it’s miraculous that he’s able to run at all, Let alone the type of running required to play competitive soccer against younger men.
Why Is Sleep Necessary?
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