There's something fishy going on in the podcast universe.
Admit it. Getting your cardio in on the bike or treadmill during the cold winter months is boring. If you're like me, you revert to podcasts to stimulate the brain as you work out. Some of my go-to shows right now are the Tim Ferriss show, the Drive with Peter Atilla and the Huberman Lab. I don't listen to them for professional advice. It's mostly out of interest for my own health and wellness, but I do find it interesting to listen to them as if I were an uninformed consumer, especially when the topics touch upon the realm of physical health and therapy. I like to know what my patients might be listening to, to keep my ear to the ground on the current chatter.
I've written in the past about Tim Ferriss's interview with Shirley Sahrmann, the legendary American physical therapist. That podcast is worth a listen, and is full of interest for a physiotherapist. Recently, on the Huberman Lab podcast, an entire show is dedicated to the treatment of pain, which falls well within all of our professional domains. In spite of a few gems, I was terribly disappointed with the way the interview veered at a few particular points.
I will share the specific things I disagreed with shortly. But what disappointed me most was my loss of faith in this podcast format altogether; the format of having a pseudo-expert host bring on a series of actual experts to talk about their expertise, while at the same time veering off into topics that they are not an expert in.
It's a slippery slope, as an expert speaker on a podcast; speaking on topics within your domain, and then letting yourself weigh in on other topics based on your opinion. Speakers rarely do this at a professional conference - with a roomful of experts, we tend to admit ignorance when a question is brought forth to which we don't know a solid science-based answer. There is a hesitancy to state your opinion as fact, and then get a follow-up embarrassing question from an actual expert in the audience. But in the podcast format, that inhibition is missing.
In this specific Huberman Lab podcast, some very key bits of information provided by the "expert" were tragically insufficient, out of context, purely anecdotal or flat-out wrong. Here's where a loss of faith occurs: If this is how they treat a subject with which we are deeply familiar, how much of the rest of the podcast is suspect? One can only wonder.
When we consume health and wellness podcasts in this current era, we need to be very careful about trusting the advice provided.
There is a curious lack of humility amongst the "experts" in the health and wellness podcast universe. They seem to be given a pulpit to speak to their particular expertise, and are then free to speak on areas well outside of their expertise. I see no hesitation to answer questions by opinion, rather than by evidence.
Here are a few questionable moments from the Huberman Lab's podcast entitled "Tools to reduce and manage pain." (all quotes by Dr. Sean Mackey)
“With chiropractic work, you're talking about, often, the attempt to relieve compression of nerves, or certainly nerves are being manipulated”.
This is undoubtedly a very poor explanation for the underlying approach of chiropractic. Perhaps what he is referring to is the traditional approach of chiropractic that may have been standard at one point in time. At the present time, most chiropractors are far more eclectic in their treatment options. Is this really his best attempt at explaining the entire profession?
“In some patients, in some circumstances, I've found acupuncture to be useful, and it's worth a try…”
This moment comes later in the episode, after a long discussion on the research behind the current understanding of pain management. Notice how he has switched from an evidence-informed discussion to a completely anecdotal defense. Rather than discuss the research on the use of acupuncture for pain management, he reports his (limited) experience with patients who have used acupuncture. Does a so-called expert in pain management really say "it's worth a try..."? That's akin to saying "there is no research on this to guide our decision." (But in fact, acupuncture is on the list of therapies that have been proven to be beneficial for chronic low back pain, as you can read here.) This would be the moment in the interview when it would be more appropriate to say "I can't speak to the research on acupuncture as a whole because I'm not familiar with it, but I can share some of my experiences."
“"Chiropractic: mixed data. In well controlled studies, some have shown that it can be helpful for low back pain.”
See what he's doing here? Rather than referring to a specific treatment, he's referring to a profession as a whole. A true scientist would define exactly which modality is being discussed, not which profession. It may have been appropriate to say "when you consider manipulation of the spine with a high velocity thrust manoeuvre, the research says..." Again, his expertise here is deeply suspect. If he isn't able to define the variable in question (ie: what exact type of treatment is being investigated), how can we trust him to explain the rest of the literature to us? (And by the way, if you're talking about high velocity thrust manipulation for low back pain, we have strong (not mixed) evidence to support it's use.)
“The type of chiropractic that involves high velocity manipulation... as a physician I have some concerns about that.... I've taken care of patients that have had vertebral artery dissection…”
This one's remarkably ignorant. His opinion is that, when it comes to manipulation of the neck, the first thing that one should be aware of is the risk of a vascular event. There's actually a lot of very convincing, recent research on risk factors for adverse events with neck manipulation. According to true experts in this topic, the risk of a vascular event is statistically so low as to be considered a non-issue, from an epidemiology point of view. It's certainly not the first thing folks should think about when they consent to neck manipulation. All the known benefits far outweigh the risks (except for a small proportion of the population with well-defined risk factors). Again, Dr. Mackey's defence of his opinion is his anecdotal experience, not the literature itself. How can a so-called expert fail to refer to the literature? What else has he spoken on, in this podcast, without a good research basis?
It's a very curious thing, what's going on here. In another section of the podcast, Dr. Mackey provides an incredibly powerful explanation of a key principle in the management of chronic pain. He's discussing the use of medication, procedures, or injection therapy. He points out, quite rightly, that the main purpose for any analgesic intervention is simply to allow the patient to better engage in physical rehabilitation to improve their function in life. This is great wisdom. How can such great wisdom coexist in the same interview with such questionable advice?
When we speak with authority on things of which we have less-than-expert knowledge, we move from "Master" to "Pretender". Willingness to admit ignorance is a strength, not a weakness. But not in the podcast universe, it appears.