The things we read: fact or ...?

In the movies of my youth you knew who the bad guys were because they wore black hats and the music that played when they appeared sent your psyche into red alert. When the villain was about to lead someone astray, there was no mistaking his intent. In the artificial reality of the movies images can be painted in bold strokes, but the real world often lacks these clear lines of demarcation, and often there are no villains. Those who would lead us from virtue often know not where they take us. Many times mistakes are made when beliefs take precedence over evidence--and even "experts" make mistakes.

Shortly after completing what he thought was an elegant model of the DNA molecule, James Watson[1] shared his news with a colleague, who, in no uncertain terms, told him the idea would not work. Watson shot back at Jerry Donohue that the model was based on the best available texts. Donohue, however, "happily let out that for years organic chemists had been arbitrarily favoring particular tautomeric forms over their alternatives on only the flimsiest of grounds."[1](p120) Apparently, as Donohue noted to Watson, the text writers had been unencumbered by the need for evidence. Had Watson and his colleague Francis Crick continued on their course, depending on unproven text as their basis, they would have wasted precious time and resources pursuing the impossible.

Even in the "pure science" of chemistry, in the rarified world of crystallography, ideas can be repeated time and again without challenge; in the DNA case, with each repetition these ideas had taken on greater stature until they had become "truth." There was no need to test in reality what everyone supposedly knew. Or, as Eugene Jerome, Neil Simon's alter ego in the movie version of Biloxi Blues, came to understand: "People believe whatever they read. Something magical happens once it is put down on paper. They think that no one would have gone to the trouble of writing it down if it wasn't true."

So it is for crystallographers, and so it is for physical therapists. Our profession, like so many other professions, is based primarily on the words of "experts." An expert is often simply someone acclaimed as such; therefore, the word "expert" can become an appellation based on a popularity contest. Sometimes the judges are a restricted few, as occurs when we seek "expert" reviewers for this journal. Sometimes the judges are the masses, as occurs when the designation is given to those who crisscross the country giving continuing education courses. Of course no one holds the exclusive and absolute right to call or not to call someone an expert. This is a subject about which people will disagree. We must be wary of those who would stifle new ideas by preventing others from expressing their "expertise," but, more than that, we must be wary of accepting the words of people simply because we view them as experts.

In the real world, good people say things that may not be correct, and if the words are repeated often enough, they unfortunately can begin to sound like truth. In disputing a recent article on low back classifications, a group of students recently wrote questioning how the authors could be ignorant of the work of James Cyriax. They based their argument on the contention that Cyriax knew how to localize the tissue causing back pain. It was they who made me think of Watson and Donohue and of Eugene Jerome's discovery in Biloxi Blues. Because it is written does not mean it is so. Ideas of thoughtful men like James Cyriax should be tested, not blindly accepted. There is no evidence for the scheme presented by Cyriax. Too often within our profession we accept written words even when there is no credible scientific evidence to support them. Too often we see all words as equally meaningful and fail to critically evaluate them.

When we accept unsubstantiated words because we have heard them repeated, we may find ourselves living in a simplified, but unrealistic, world. Pleasant fictions almost stood in the way of the discovery of the structure of DNA. In physical therapy, pleasant fictions often keep us from questioning. How much of our education and practice are based on what was written rather than what was proven? In a world where too much "knowledge" comes not from scientific inquiry, but from the pronouncements of "experts," certainty is often the enemy of discovery. Perhaps we should embrace uncertainty as a friend that beckons us onward even though it can make us uncomfortable. As we listen to what people say and read what they have written within the pages of books, let us resolve to ask how they came to know what they share with us and what evidence they can offer us. Having learned that people often do believe everything they read, Eugene Jerome, as a budding writer, observed, "Responsibility was my new watchword." This is admirable advice for readers, too!

Reference

1 Watson JD. The Double Helix: A Personal Account of the Discovery of the Structure of DNA. New York, NY: New American Library; 1969.