Navigating Pseudoscience: The Path to Evidence-Based Training
This article originally appeared on Trail Runner
The term “snake oil” is often used to describe contemporary pseudoscientific remedies that claim to offer a wide range of health benefits for various ailments. In history, one of the most notable instances of this was Stanley Clark’s Snake Oil, which was once promoted as a cure-all elixir. However, in 1916, the U.S. government, following the passage of the Pure Food and Drug Act, exposed it as a fraudulent concoction that contained no actual snake oil. The origin of snake oil can be traced further back to ancient Chinese medicine.
Nick Tiller, an exercise scientist and researcher at the Harbor-UCLA Medical Center in Los Angeles and author of "The Skeptic's Guide to Sports Science," says the issue with ancient Chinese medicine is that it is based upon outdated principles--primarily various forms of "energy healing" that rely on magic, mysticism, superstitious thinking and faith--and that doesn't align with modern science.
"We have to remember that when most of these practices were conceived and developed, we didn’t know any better," Tiller says. "We didn’t have the tools and systems and technologies available now. This was, in effect, our best attempt to understand how the body worked.”
The National Institutes of Health (NIH) categorizes ancient Chinese medicine, to include therapies such as acupuncture and cupping, as alternative medicine. Tiller defines alternative medicine as “anything that doesn’t align with mainstream scientific principles or science-based medicine."
"It's important to note that we shouldn't dismiss alternative medicine just because it's alternative, rather we should focus our time and resources on interventions that are supported by evidence," he says. "There has to be something which drives an informed decision."
“Scientists are not against anything that is alternative," he adds, "we’re just against anything that hasn’t been shown to work.”
As the Australian Comedian Tim Minchin jokes, "You know what they call alternative medicine that’s been proved to work? – Medicine."
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Navigating Pseudoscience
Throughout the 19th and 20th centuries, many Americans fell victim to the allure of snake oil products. During this era, transparent information about products was not as readily available (or legally required), and scientific knowledge was not as established as it is today. It's understandable that folks with no formal education, much less scientific literacy or a willingness to trust what they were told on a blind-faith basis fell prey to traveling charlatans hawking miracle cures, but even now, our willingness to buy into so-called "cure-alls" and supplements making unproven claims is worth examining.
In the modern, educated society of the 21st century, fraudulent claims and overhyped products continue to exist, especially in the realm of sports science. How does pseudoscience still thrive in the world of endurance sports? Shouldn’t we know better and be able to see through these frauds and baseless claims?
As science has progressed, so has sales and marketing. Marketers now leverage the science of human behavior, making use of our buying patterns, to optimize attention and sales. Grocery store aisles, online platforms, and social media algorithms are carefully engineered to influence our decisions based on how we think and feel. In today’s sophisticated sales process, some sellers resort to misapplication of scientific evidence or either suppressing or selectively highlighting data and information as necessary to support their products or services. This misleading practice is commonly referred to as “cherry-picking data,” and it can lead consumers astray, leaving them vulnerable to purchasing products without empirical evidence. We see this running rampant with the nutrition supplement industry today.
Influencers and Pro Athletes
The rise of influencer marketing on social media has further compounded the issue. "You have to realize that many people who have a platform, write, and create content are good at just that (creating content). They are not necessarily experts on what they are opining about," says Jason Koop, head coach of CTS and author of "Training Essentials for Ultrarunning." High-profile athletes and individuals with large audiences are often compensated to promote products, sometimes without even using them personally. Consumers are left questioning the authenticity of these endorsements, making it challenging to distinguish between what is genuine and what is not. Companies understand that brand association alone can lead to increased sales, even without any proof of product efficacy.
Simultaneously, high-profile athletes view these marketing opportunities as a means to generate income based on their name and success. This confluence of factors creates a complex problem where consumers may be swayed by unverified claims. You can typically raise a red flag when you see influencers without relevant credentials, especially if they are promoting multiple brands and products, based on their personal anecdotes.
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Several case studies shed light on the prevalence of pseudoscience in the world of sports. For example, Tom Brady, often regarded as the greatest quarterback in NFL history, attributes his longevity to “muscle pliability.”
“Brady attributes his incredible longevity to the concept of ‘muscle pliability’--a widely discredited term conjured by Brady's self-taught exercise guru who has twice been investigated by the FTC for making fraudulent health claims, once while impersonating a doctor," Tiller says. "Brady’s empire further includes a system of restrictive diets, alkaline foods, and immune-boosting supplements. Unfortunately, this is just the tip of the pseudoscience iceberg in the sports world."
Michael Phelps, one of the greatest athletes of all time, inadvertently popularized “cupping” during the 2016 Rio Olympics when he emerged from the pool with giant, hickie-like bruises across his back and shoulders. According to a 2012 meta-analysis by Cao, H., Li, X., and Liu, J., “cupping” is considered alternative medicine and has an attempted mechanistic explanation as to how it works. Tiller says this is a fallacy referred to as "blinding with science."
"It's where you throw technical jargon at the consumer, and for someone who is not trained as a scientist, they might say, "Oh, that sounds plausible," he says. "But for someone who knows how the body works, it's usually just a meaningless word salad."
Theoretically, the suction cups create a pool of blood to the surface of the skin and improve circulation, relieve pain, promote mobility, and decrease toxins, among other things. However, there have been erroneous and dangerous claims by cupping advocates, including its effectiveness in treating asthma--a dangerous claim that could lead people to forgo otherwise life-saving treatment from professionals. Multiple studies, including the 2012 meta-analysis, have debunked many of these claims.
In the trail and ultrarunning community, the concept of “Aerobic Deficiency Syndrome” propagated by Phil Maffetone, is another example of pseudoscience creeping into training methodologies. Maffetone is a researcher, educator, clinician and author with a bachelor’s degree in human biology and a doctorate in chiropractic, as well as certifications in physiotherapy, Chinese medicine, and kinesiology. Although the concept of Aerobic Deficiency Syndrome can be simplified as simply not having optimal aerobic fitness or more commonly just the state of being out of shape, Maffetone describes it as a condition that "can be devastating for athletes." He goes on to claim those suffering from such a syndrome experience a "loss of aerobic speed" and "chronic conditions," such as "fatigue and increased body fat."
Tiller warns that this is direct response marketing, a strategy that creates fear and anxiety through "manufacturing or embellishing problems, before providing a solution, usually in the form of diets, supplements, and training interventions." Maffetone has created this fear of a made-up syndrome and then sells books, training, and heart rate monitors as the solution to the problem. Fear based marketing is always a red flag when evaluating claims.
But there are many more issues with this pseudoscientific training methodology. It's not plausible based on what we know about exercise physiology.
“The fact of the matter is, after you pass just a minute or two of an all-out effort, nearly 100 percent of the energy contributions will come from an aerobic pathway," Koop says. "Thus, for any endurance athlete, even if you are doing high-intensity interval work, you are still deriving almost all of that energy aerobically.”
Tiller confirmed this statement. Koop adds, “that anyone foregoing high intensity work to maximize mitochondrial function missed freshman level physiology. To maximize mitochondrial function (where all the aerobic energy is produced) you need both low-intensity volume and high-intensity work. Low-intensity volume (primarily) builds more mitochondria, while high-intensity work makes the mitochondria you have more effective. So by only doing one, you would technically have a deficiency (in mass or function)."
Hence, there is no need to fear high-intensity work, as it does not lead to chronic conditions, illnesses, or any other detrimental effects as suggested by Maffetone. On the contrary, incorporating high-intensity work is beneficial in developing our aerobic energy system, complementing low-intensity training.
In addition to the lack of plausible evidence and fear-based marketing, it is essential to note that Maffetone’s claims are not supported by scientific literature. Consequently, his assertions fall under the category of pseudoscience, defined by unsupported and unverified hypotheses.
The Need for Instant Gratification
The very human desire for instant gratification makes this worse. As technology has advanced, we have grown accustomed to quick results, whether through next-day shipping, instant food, microwave cooking, high-speed internet and delivering content through instant messaging. This mentality extends to our approach to health and fitness, where we seek shortcuts and quick fixes instead of embracing the long-term process of building fitness through consistent effort.
In other words, because there is a percentage of athletes interested pseudoscience alternatives continue to pop up because instead of following science-proven methods of developing physical adaptations required for improved fitness and performance.
Many athletes and coaches swear by interventions associated with pseudoscience, often due to the powerful placebo effect. According to a survey conducted by Szabo, A, and Muller, A. (2016), placebos can significantly impact athlete performance, with 60 percent of coaches admitting to intentionally using placebos with elite athletes. Recall Michael Phelps’ experience with cupping therapy and the visible bruises it caused. Despite having access to top medical experts, this unproven training intervention was utilized based solely on Phelps’ belief in its effectiveness. However, implementing interventions without proven physical benefits raise ethical concerns for coaches. It is crucial for coaches to maintain a foundation in evidence-based training to appreciate the time and effort required for genuine improvement.
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Building a Foundation with Evidence-Based Training
To avoid wasting time, energy, and resources, athletes must develop a toolkit to navigate the minefield of pseudoscience and embrace evidence-based training. This way, athletes can make informed decisions based on scientific research rather than personal anecdotes or misapplied data.
However, Tiller suggests, the best thing we can do is start with a proper mental framework. We don't have to worry about being right or wrong, we just need to question our own minds and be aware of our perceptions and biases. Bias refers to a tendency or inclination, either conscious or unconscious, to favor or hold a particular perspective, belief, or opinion over others. It can influence how individuals perceive and interpret information, make judgments, and form decisions. Therefore, an open mind and self-awareness are the genesis for protecting yourself against pseudoscience.
Beyond self-awareness and an open mind, scientific research serves as the gold standard for acquiring knowledge. The scientific process, while imperfect, remains the best heuristic for making decisions about training. Disregarding scientific methods, because it changes when new information is available, overlooks the fact that other approaches, such as surface-level googling, word of mouth, and personal bias, are less rigorous and inferior in determining verifiable facts. Embracing science as our best available system allows us to make informed decisions and uphold the pursuit of truth. Let’s trust in the reliability of scientific research rather than what worked for your Uncle Mike in his last Ultra!
To critically evaluate claims, developing strong critical thinking skills and a skeptical mindset is essential. There is a big difference between being skeptical and cynical. Being skeptical means having a questioning and doubting mindset towards claims, beliefs, or information until sufficient evidence is provided to support or refute them. Skeptics approach things with a critical and rational eye, seeking evidence and reasoning to form their conclusions. They are open to changing their views based on new evidence and are not easily swayed by unsubstantiated claims. Cynicism, on the other hand, involves a more negative and distrustful outlook towards others’ motivations or actions. While your family and friends may find this skeptical mindset annoying at times, this approach when applied appropriately protects you from being misled and helps you differentiate between factual information and pseudoscientific claims.
Here are some steps to evaluate claims through a critical lens:
Consider Source Reliability: Assess the credentials, expertise, and reputation of the source. Look for academic qualifications, affiliations with reputable institutions, and a track record of publishing peer-reviewed research. For example, trusting a Registered Dietitian for nutritional advice rather than anecdotal experiences from someone who found something that worked for them. Additionally, there can often be a low barrier to entry in endurance coaching. In today’s digital age, obtaining an online certification and updating one’s Instagram bio allows almost anyone to position themselves as an advisor to athletes. However, when seeking professional guidance, it’s essential to inquire about their education and certifications to ensure complete confidence in their qualifications.
Look for Consensus Among Experts: In the scientific community, differing opinions can arise due to beliefs or financial interests. When reading research, check for potential conflicting interests from authors, like someone with a major stake in a Keto company promoting the performance superpowers of a low-carb, high-fat approach to nutrition. More credibility lies in the collective scientific community agreeing upon training methods or practices rather than individual opinions.
Examine Research and Evidence: Differentiate between study types and designs. Look for studies with larger sample sizes, control groups, and statistical analysis, particularly those in human populations. Systematic Reviews and Meta-analyses carry more weight than Observational Studies. Prioritize more rigorous methods to think critically about differing results in the same field.
Watch for Logical Fallacies: Be cautious of false causality, appeals to authority, and cherry-picked data. False causality frequently arises in the nutrition supplement space when athletes begin a new supplement regimen and observe performance improvements. While they may solely credit the positive outcome to the new supplement, it’s essential to consider other contributing factors. Improved environmental conditions, enhanced fitness from training, reduced life stress, or better overall eating and sleeping habits might also be influencing the observed results. Evaluating these various elements is crucial for accurate conclusions about the supplement’s actual impact. Generally, we must beware of marketing claims offering a single solution for various problems, often disguised as a “cure-all” solution.
Fortunately, there is a sea of information available today to access information and critically evaluate claims. To prioritize evidence-based training, utilize the following resources to complete your tool kit:
Peer-Reviewed Journals: Access scientific journals in sports science, exercise physiology, and related fields. These studies undergo rigorous evaluation by experts in the field, providing reliable information.
Accredited Institutions and Organizations: Rely on resources from national governing bodies and reputable institutions that prioritize evidence-based approaches.
Trusted Experts and Coaches: The best coaches and experts stay up to date on the latest science and continually evolve their craft. Look for coaches who are doing this at the highest level, who they surround themselves with, what their education and qualifications are, and who has mentored them. Effective coaches rely on scientific principles rather than solely implementing methods that have worked for them in their personal training and racing experiences.
While evidence-based training serves as a solid foundation, individuality must also be acknowledged. No two athletes are alike, and training needs to be tailored to specific goals, needs, and circumstances. Incorporate personal feedback, conduct self-experiments, and adapt training based on individual observations.
As athletes, we now possess a powerful toolkit to navigate the intricate world of pseudoscience and embrace evidence-based training. By becoming self-aware of our personal bias and developing strong critical thinking skills and skepticism, we can protect ourselves from misleading claims and make informed decisions rooted in scientific research. Remember, scientific inquiry is the gold standard for acquiring knowledge, offering a reliable system to distinguish fact from fiction.
In today’s world of instant gratification, let us resist the allure of pseudoscience and embrace the long-term process of building fitness through consistent effort. By incorporating evidence-based practices and critical thinking into our training, we pave the way for success, enhance our athletic performance, and protect ourselves from falling prey to the snake oil of the modern era.
Cliff is the Director of Coaching for CTS. In addition to serving on the CTS Leadership Team, Cliff continues to coach both beginner and elite ultra athletes across a variety of distances.
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