This becomes a legal issue. When a body becomes a gate-keeper, they have a legal obligation for “fairness”. If I teach courses for a living, I have a right to make a living. To stop me is legally difficult. A thread...
1/ https://twitter.com/runnerphysio/status/1319710021400186880

First way would be to demonstrate that I am causing harm to the public. That is a very high bar reserved to malpractice. So a lot slips through.
So we say instead that they must have “evidence”. But how do we define that? By citations. 2/

Well thanks to p-hacking, HARKing, and publication bias, we have “evidence” to support anything I want!
Even the best conducted science leaves “room for interpretation”. If I am a persuasive huckster I can talk circles around this. 3/

So I have the defense of “Why do you accept this thing here but not what I am teaching? We both have citations!” That answer is long, nuanced, and complicated. And if I take you to court for restraint of trade, the courts don’t want to hear all that. 4/

Courts look first at “harm” - too easy for me. Proving that what I do is harmful to the public is almost impossible. So then they look at practice. “A large percentage of your profession does this thing he teaches, so how can you say it can’t be taught?” 5/

Instead organizations make a Byzantine series of hoops for educators to jump through like fees, reviews, “standards”, etc in the name of “more evidence-based content.”But none of it actually can legally STOP me, as long as I have the time and money. 6/

So this just makes those with means and power keep doing what they want. Now you say it must be certified by a journal? Well my organization will start its OWN journal! Peer review hasn’t kept garbage out of publication has it? 7/

The key here is that the profession has to collectively become better consumers of these courses. To stop people from doing a shit course, the profession has to stop paying for them to do a shit course. That’s the answer. But what does that mean? 8/

1. Do a better job teaching critical thinking in the schools. Teach someone how to decide for themselves to spot bad content. Teach them how to spot bullshit when they see it. I’ve proposed a funnel process to help conceptualize but it was rejected by 3 journals. 9/

2. Stop expecting clinicians to independently read ALL the research. They can’t, they shouldn’t, they never will. The journals’ points of attack should be improving systematic reviews and consensus statements. 10/

Make systematic reviews open access, easily readable, and ACCURATE (thank you PRISMA). Keep consensus statements from being political and inclusive of popular interventions (good luck). 11/

Have consensus statements focus only on things everyone on the panel agrees MUST be done, not COULD be done. No more “no proof it doesn’t work” or “absence of evidence isn’t evidence of absence” excuses. Pseudoscience, by definition, never has “proof” against. 12/

I have spent the last 10 years trying to teach this profession practical critical thinking and it is an incessant slog. The power structure of associations and journals has provided the greatest resistance. Critical thinking is great until it challenges power. 13/

I like this article but no, I don’t think another “better” certifying body will solve this problem. Requiring course approvals has made the problem worse, not better.

Courses aren’t the problem. The profession is.

Thank you for coming to my TED talk.
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