Say it ain't so.

As Alice observed, sometimes things get "curiouser and curiouser." Actually sometimes things get downright weird. Looking back on the '60 and the Woodstock generation shows, however, that appreciation of the weird often takes some perspective. My appreciation for this phenomenon occurs when I confront two daughters who convulse at the sight of people in oversized bell-bottoms. They just don't understand why Afros had to be beachball size, and I won't even get into their lack of appreciation for arguments in favor of doffing bras as a political statement.

Not being privy to the culture of the times, my daughters bring an offensive objectivity to their criticisms that I find downright annoying. My defenses of my generation's excesses are crushed by their smug appreciation of the potency of their arguments. In the end I am left with that last respite of those who have no logical argument. I simply look them in the eye and tell them, "You just don't understand."

My daughters' failure to "understand" is seen by them as a triumph, not only of filial supremacy, but also of logic and common sense. The contest is not dissimilar to what often occurs when we publish research about practice. Often critics supported by their culture and the environments in which they live fail to see that their arguments have no more scientific basis than does my paean to the bell-bottom. We sometimes have trouble differentiating matters of taste and personal choice from those that can be based on evidence, logic, and science. You can like what you like, but too often we are unwary and forget we are basing choices on personal preferences that fly in the face of data and external realities.

As an investigator I have participated in several studies that cast doubt on the relationship of force generated during voluntary contractions and posture. Often when I discuss these papers I conclude that we need to reassess our therapeutic strategies based on "strengthening muscles" to change posture, particularly when it comes to modifying lordosis or a forward head position. These are my opinions, and they are based on my understanding of the literature and basic sciences, but more importantly they are supported by data we and others have collected. Others may, and certainly do, disagree, but what I continue to find peculiar is a contention often heard. The same contention has recently been applied to many articles that appear in this journal. Some contend that faith and personal beliefs are all that are needed to support the use of techniques, whereas credible evidence is required of those who challenge their assumptions.

As evidence is put forward to cast doubts on ideas and methods, people will quickly and often correctly note limitations in studies. For example, our own work on the posture topic has dealt with limited numbers of subjects and has not used all available measurement techniques. Questions about posture and muscle force, like so many central to practice, cannot be satisfactorily addressed by only a few studies. But I also wonder what advocates of techniques are looking for, and what it will take to make them question and rethink what they are doing.

Although the studies that cast doubt on the relationship of maximal force production and posture have their limitations, they all do suggest there is no relationship - and there is no research to suggest otherwise. In the absence of any confirming evidence for the idea, and even in the presence of data suggesting negation, many people argue vigorously that the ideas must be upheld. Why are limitations in some studies more important than the total absence of evidence to the contrary? Why must the burden be on those who question? What happened to the need for evidence to support widespread behaviors?

Whether by intent or failure to critically consider the logical consequence of our arguments, we have turned the world topsy-turvy. We now challenge researchers to prove what does not exist rather than what does exist. Treatments are thought to be good and effective until proven otherwise. Measurements are useful until proven otherwise. We grab hold of new treatment procedures and measurement devices with enthusiasm; we do not wait for the evidence. We become enthralled, and believers then challenge the disbelievers to disprove what we think we know. Consider for example the article by Wirth-Pattullo and Hayes and the accompanying commentaries within this issue that deal with the measurement of what proponents call "craniosacral rhythm."

Some argue that practice should be dominated by what we do now and that we should change behaviors only when evidence is incontrovertibly negative. This can never happen! In other words, if we like something we can keep doing it regardless of the evidence or lack of evidence.

Recently in Physical Therapy, we published a paper that cast doubts on the use of Cyriax's capsular patterns to guide clinical practice for patients with osteoarthritis of the knee. A colleague argued that in my Editor's Note I had overstated the case for stopping the use of this schema, and another colleague voiced concern over the study's focus on osteoarthritis of the knee because capsular patterns are used for many other situations. in both cases, my colleagues suggest that there is not enough evidence to change practice yet. The arguments seemed so reasonable that my initial reaction was to concur that of course we must proceed cautiously. My temerity, however, is borne more out of tradition than common sense. What evidence is there for the continued use of the patterns? What research is there?

I can hear the voices of colleagues shouting, "But it works clinically" or "In my practice I see these things working." Until someone less tolerant than I says you cannot do something, then you can go on doing what you are doing, and if you choose to wear bell-bottoms while doing it, so be it. For both actions you will be manifesting your tastes, your personal choices, and your personal desires, and for neither action can there be justification beyond those simple imperatives. Practitioners who base behaviors on such personal perspectives may draw support because they are not alone and because their behaviors do not differ from those of their peers, but that will hardly be defensible in the long run. If they want true defense, then they should collect some data and publish them. We should present cases, not just conclusions, present data, not just objections.

I have no doubt that my daughters will fare as badly as I if they attempt to explain their generation's tastes to their offspring. I hope that we as a profession will do better if we choose to defend our actions of today amid the questioning of the next generation of practitioners, and the best way to do that is to practice using the best possible available evidence, not merely using our similarities to peers. We need to return to a more logical view of how we know things and what we accept, and we need to place the burden for evidence where it belongs.

I am reminded of the hapless country boy who went to his grave contending he really did not conspire to fix the 1919 World Series. When a little boy looked at his fallen hero and beseeched him to "Say it ain't so, Joe," Shoeless Joe Jackson missed the opportunity of a lifetime. He should have looked the boy in the eye and said, Make them prove it is so." Now, just as then, we too often depend on saying it ain't so. We should be saying what things are, rather than what they are not, and the need for evidence should rest primarily on proponents, not on critics.