The Truth? Whose Truth?

Our impetus for writing this blog is our disappointment with modern United States news media outlets, how they report information, and how it impacts the public. Their extremist style of reporting has led to a division of thought within this country and an intolerance of middle-of-the-road beliefs. And sadly, we think this has influenced how we acquire and interpret information in physical therapy practice. In this blog we will show how extreme statements by dissemination sources have eroded the truth in physical therapy practice.

Although the news media examples we give are US-centric, they mirror what we’ve observed internationally. Please don’t misinterpret our purpose. This blog is not a call for censorship in thought nor does it single out a group of people or information sources. It requests a reflective, balanced, and tolerant evaluation of all views and available evidence. We feel that all ideas and beliefs deserve honest, candid, and transparent due process.

News Media? Which type?

Each year, groups such as AD FONTES MEDIA https://adfontesmedia.com/ and AllSides https://www.allsides.com/unbiased-balanced-news release a report on bias in the United States news media. News media outlets are rated as left (extreme left-wing bias), left-leaning, center (minimal bias), right-leaning, and right (extreme right-wing bias).¹ Left and left-leaning media outlets include CNN, MSNBC, The New York Times, Yahoo, NPR, CBS, ABC, the Atlantic, and many more. Right and right-leaning news media outlets include Fox, the New York Post, the Washington Times, and a few others. Fewer news media outlets fall in the “center” but include well-known examples such as USA Today, BBC, Reuters, and AP. Interestingly, most left, and right-leaning news media will source their information from AP and Reuters and then add their spin on the findings to reflect the areas they are interested in disseminating.

Why is it important to know the bias of your news media outlet?  By watching only news media outlets that serve a particular bias, one will experience the highlighting of news stories that coincide with the agenda of either the Left or the Right, ignoring stories that coincide with the opposing view (also known as cherry picking, confirmation bias, or the fallacy of incomplete information). In other words, you will not get the complete information regarding the story at hand; instead, you will get what the news media outlet wants you to hear.

Although it should not, Physical Therapy has left and right-leaning (extremist) influences

Peer-reviewed publishing is designed to provide a balanced overview of research submitted for publication. Authors are expected to present their research in what they feel are equitable ways, providing a balanced discussion about the results of a study. Reviewers are expected to weigh the pros and cons of a finding and make recommendations that support the truth behind a result. Editors are expected to accept/reject papers based on the merits of the science that was performed.

What cannot be ignored is that researchers are looking to be published, reviewers are often interested in embedding their point of view or bias in the papers they review, and journal editors are interested in improving their journals’ impact factor and prestige. Extreme, statistically significant findings, are more likely to be published and cited.² This has led to a number of situations in which findings are distorted in way that enhance the paper’s standing in the literature. Data are manipulated after results are attained so that it does not accurately represent the initial purpose of the study leading to HARKing (generating a hypothesis after results are known), cherry-picking (selectively reporting and discussing data that supports an idea), p-hacking (running statistical analyses until statistical significance is found), or data dredging or data mining (looking for relationships between variables just because the data is available).³

“If you torture the data long enough, it will confess to anything” -Ronald H. Coase.

These embellishments occur because most interventions have similar outcomes when managing musculoskeletal disorders (MSK) and most comparative trials provide similar results.^4-8 Whereas this is useful to know that there are no interventions with a superiority of treatment effect across all potential patients with musculoskeletal conditions, this “middle of the road” (centrist) result is often unsellable for continuing education providers and unremarkable for social media influencers as well as biased clinicians with extreme assumptions about their favorite area of physical therapy. Just as centrist media often does not satisfy a news seeker, centrist evidence does not appease a significant number of physical therapists.

Extremism sells; in media and physical therapy

Is there evidence that people gravitate toward extremism when seeking news? Indeed, there is. In the first quarter of 2022, only one centrist news outlet was in the top 20 most popular news websites (Reuters – centrist – was 18^th out of 20).⁹ Although we don’t have similar quantitative sources to explain physical therapists’ beliefs, we know that physical therapists seek care that is extraordinary, often with unproven, untested, or unrealistic results. For years, continuing education courses have offered products that are likely marginal at best. Often, the evidence for their utility is very selective contributions from PubMed, involving only pre-clinical work or information taken out of context. Some of the most frequented blogs and podcasts are unwaveringly attacking or advocating for something while framing their view in an extremist fashion. Extremism sells. Extremism is interesting! Nonetheless, extremism is potentially destructive.

In his 2020 book “Hate Inc.“,¹⁰ Matt Taibbi indicates how extremist modern news media creates division and hatred, perpetuates bias, and fosters a chronic sense of crisis. We’re concerned a similar pattern has occurred through similar tactics of continuing education courses, social media influencers, and those with selective biases that are primarily interested in reference material that supports their point of view and censoring information that does not. If someone has a dissenting view, even a centrist one supported by evidence, they are attacked. If a paper is published that shows a contrary finding, it is denigrated as a bogus study. Instead of an open debate, and the recognition that nearly all interventions have the same treatment effect, one promotes hostility and discourse. This leads to escalation and a division of thought. Nietzsche once wrote: “Extreme positions are not succeeded by moderate ones but by extreme positions of the opposite kind.” Sadly, he was right.

If this so-called extreme bias truly exists, what should we do?

First, do your homework and fact-check extreme claims that are made. Look for opposing findings and realize that the truth is likely somewhere between extremes. Second, recognize that most information, especially on a blog or social media, is economized and cherry-picked. Third, look for the “gain” of the person or organization making a claim. If the claims are from the authorship group, look to see if the results are consistent with what the authors said they were going to do, and is it consistent throughout the analysis, discussion, and conclusion? Do the authors consistently report findings inconsistent with what other researchers are finding? Do the authors have any financial interest in the research that they are conducting? Do they disclose that interest and identify it as a limitation of their study? If they are truly balanced, they will report both sides of an issue during the discussion and let the consumers make their own decision. Last, if extremes are being reported by someone other than the authors, go to the original source. PubMed is generally the AP or Reuters of evidence. By pulling the article and evaluating the findings at hand, you are less likely to be driven toward the “spin” of the results.

Chad E Cook PT, PhD, FAPTA
Twitter @chadcookpt
Professor, Department of Orthopaedics, Duke University, Durham, NC. 27516
Competing interests: A portion of Dr Cook’s salary is funded by the NIH/VA/DoD and the Center of Excellence in Manual and Manipulative Therapy at Duke University.

Sean P. Riley, PT, DPT, ScD
Twitter @seanrileypt
Assistant Professor, Doctor of Physical Therapy Program, University of Hartford, West Hartford, CT. 06117

References

1. Should you trust media bias charts? https://www.poynter.org/fact-checking/media-literacy/2021/should-you-trust-media-bias-charts/
2. Koletsi D, Karagianni A, Pandis N, Makou M, Polychronopoulou A, Eliades T. Are studies reporting significant results more likely to be published? Am J Orthod Dentofacial Orthop. 2009 Nov;136(5):632.e1-5; discussion 632-3. doi: 10.1016/j.ajodo.2009.02.024. PMID: 19892276.
3. Andrade C. HARKing, Cherry-Picking, P-Hacking, Fishing Expeditions, and Data Dredging and Mining as Questionable Research Practices. J Clin Psychiatry. 2021 Feb 18;82(1).
4. Veehof MM, Oskam MJ, Schreurs KMG, Bohlmeijer ET. Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis. Pain. 2011; 152:533–542.
5. Burns JW. Mechanisms, mechanisms, mechanisms: it really does all boil down to mechanisms. Pain. 2016;157(11):2393-2394.
6. Chmielewski TL, George SZ, Tillman SM, et al. Low- versus high-intensity plyometric exercise during rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med. 2016;44:609–617.
7. Cook CE, George SZ, Keefe F. Different interventions, same outcomes? Here are four good reasons. Br J Sports Med. 2018;52(15):951-952.
8. Day MA, Ehde DM, Burns J, et al. A randomized trial to examine the mechanisms of cognitive, behavioral and mindfulness-based psychosocial treatments for chronic pain: Study protocol. Contemp Clin Trials. 2020;93:106000.
9. YouGov America. The Most Popular News Websites (Q1 2022). https://today.yougov.com/ratings/media/popularity/news-websites/all
10. Taibbi M. Hate Inc. OR Books/Counterpoint Press. 2021.