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Research on worldwide distribution of back pain

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Following up on the quote from Latimer, "If you look up the worldwide distribution of back pain—just Google it, there are several studies by the U.N., all sorts of different NGOs—what you will find out is that back pain is one of the most common if not the most common disabilities that humans suffer from"

I've requested help at FTN once again to properly incorporate the mainstream medical/anthropological viewpoint that back pain is common, in similar proportions, across all cultures. I made a couple of edits to indicate where I think changes need to be made to start. --Ronz (talk) 16:33, 7 September 2017 (UTC)[reply]

I appreciate your work. Then again, integrating content that does not mention the Gokhale method at all could easily become synthesis or OR. Maybe we just need to wait for (mainstream) scholars to respond to this new trend.
What is certain is we cannot add any unsourced content, even it reflects mainstream scholarship.--Farang Rak Tham (talk) 22:46, 8 September 2017 (UTC)[reply]
I'm not clear that you've read or understand the discussions here or at FTN about how FRINGE applies, or if you have even looked at WP:FRINGE yet. WP:ARBPS applies here, and a detailed understanding of policies and guidelines is pretty much required. --Ronz (talk) 23:14, 8 September 2017 (UTC)[reply]
Hi, first time I'm contributing on wikipedia, so I hope this works. Anyway, I don't think this section is currently very satisfactory. The link to the WHO statistics, supposedly demonstrating that back pain is just as prevalent in low-income countries, is dead.
The other source that is mentioned is not a scientific article, just a journalist who tried the method and got a quote from a scientist saying that a certain primitive culture had high arthritis levels. However, arthritis is not the same as back pain, and the link between the two is much, much weaker than is commonly assumed. All in all, I wouldn't say this qualifies as serious evidence.
The only link I could find that contains relevant data is this: https://pubmed.ncbi.nlm.nih.gov/9259786/, and it supports Gokhale's conclusions. There's another scientific article that supports it, but based on anecdotal evidence: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1119282/.
All in all, I would say there is a strong case here to support Gokhale's conclusions that westerners tend to be more prone to low back pain. Even if, statistically, there were just as many cases in low countries, one should take into account how much heavier the physical labour in those countries is. In this case, westerners getting equal amounts of low back pain with less intensive labour still means they had worse backs to start out with.
What I would suggest is to remove the existing section and replace it with the links I have found. If not, maybe just a comment that the evidence is inconclusive and difficult to compare.
Would that work for you? MeerJoost (talk) 16:12, 29 March 2024 (UTC)[reply]
The first proposed source is very old, the second is old and more of an OpEd. We need sources that specifically comment on the Gohhake Method. Bon courage (talk) 16:22, 29 March 2024 (UTC)[reply]
That doesn't match with the section the way it is now. It specifically discusses the evidence for Gokhale's claim that westerners are more prone to back problems. If that's not relevant, then that part of the article should be removed. MeerJoost (talk) 16:25, 29 March 2024 (UTC)[reply]
That's because we relay Gokhale's WP:FRINGE claims, and they need to be contextualized as WP:FRINGESUBJECTS to comply with Wikipedia's rules on neutrality. I've just had a quick look on Pubmed and it seems[1] there is zero secondary literature on this, so it appearsjust the NYT piece may be right that it's not been studied. And it seems now has fallen into obscurity. Maybe the article should be deleted? Bon courage (talk) 16:30, 29 March 2024 (UTC)[reply]
I'm not sure it has fallen into obscurity. This recent scientific article was inspired by the Gokhale method: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9801964/#:~:text=Implications%20for%20Inferring%20Lordosis%20in,more%20similar%20to%20modern%20humans.
I don't know the guidelines well enough to say whether the article should be removed. What I do know is that the current text in the section is unsupported, and contradicts the only evidence that I can actually find. So I think at least this section should be removed. MeerJoost (talk) 16:35, 29 March 2024 (UTC)[reply]
There was some relevant discussion about this a while ago here. Bon courage (talk) 16:44, 29 March 2024 (UTC)[reply]
I think for me it makes most sense just to edit the section and replace the current text with a statement that there have been no scientific studies that can either contradict or corroborate the method's health claims. Can I just do that? MeerJoost (talk) 17:18, 29 March 2024 (UTC)[reply]
A source would be needed. It seems from the sources Gokhale's stated premise(s) were in error. Bon courage (talk) 17:23, 29 March 2024 (UTC)[reply]
Which sources are you referring to? MeerJoost (talk) 17:37, 29 March 2024 (UTC)[reply]
There was a WHO source in the discussion I linked above? Bon courage (talk) 17:40, 29 March 2024 (UTC)[reply]
Yeah that's the same link I discussed earlier, it's dead. Also, even if it were correct about low back pain in low-income countries, it's not really on point. Gokhale compares bodies in the western world to traditional societies, which is not at all the same as low-income countries. Low-income's just about income, not lifestyle. And, as I pointed out earlier: similar low back pain rates in countries where physical labour is more intense, could just as well be said to corroborate Gokhale's theory that western backs are worse. MeerJoost (talk) 17:47, 29 March 2024 (UTC)[reply]
Additionally, it is important to note that Gokhale does not compare between countries, but communities. A good example is this article: https://timesofindia.indiatimes.com/blogs/siliconvalley/the-myth-of-good-posture-really/
I quote: In the industrialized world an estimated 80% of the adult population will suffer a serious episode of back pain in their lives. By contrast, the prevalence of back pain in rural south China is only 12–14% and in a mountainous farming community in the Philippines, 7% .
She specifically does not compare western backs to those of urban populations in low-income countries, where many people have by now adopted many lifestyle and child-raising practices.
This brings me to a second point: you argue that the 1997 article I linked is too old, and modern data is more relevant. However, Gokhale's book was published in 2008, and her research was done in the two decades before that. So Gokhale compares our backs to the people she studied in those cultures around 1997. As you may know, globalisation, urbanisation, capitalism and economic growth have drastically altered life in many low-income countries over the last few decades. The 1997 data is therefore more relevant for Gokhale's claims than later data.
I'm not saying we should alter the section to say that the available data confirms Gokhale's theories. I'm just saying the current section does the exact opposite, relying on weak and irrelevant sources, and should therefore be removed. MeerJoost (talk) 08:21, 30 March 2024 (UTC)[reply]
I have raised a query at WP:FTN. Bon courage (talk) 15:47, 31 March 2024 (UTC)[reply]
Thank you. MeerJoost (talk) 18:04, 31 March 2024 (UTC)[reply]

Propose removal tag

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Originally the neutrality tag was added because "article appears fundamentally unencyclopedic - written like a public relations piece". I think this no longer holds. Propose removing tag.--Farang Rak Tham (talk) 00:46, 18 October 2017 (UTC)[reply]

I don't see how the article can be neutral given the poor sourcing that's strongly dependent upon Gokhale's public relations campaigns, and unavailability of anything better. --Ronz (talk) 14:35, 18 October 2017 (UTC)[reply]
Lack of WP:MEDRS is different from lack of neutral tone. Shouldn't we distinguish the two and tag correctly?--Farang Rak Tham (talk) 15:23, 18 October 2017 (UTC)[reply]
Those are two valid concerns, but mine is different: We're working from, and giving too much weight to, poor sources that have very little encyclopedic value but rather are part of an organized public relations campaign. --Ronz (talk) 15:57, 18 October 2017 (UTC)[reply]
Having read through this again, I agree there is a problem. We are giving a lot of exposure to this "method" from rather weak sources without any corrective context (and the lede is criticism-free). In lieu of better context I'm thinking we need to trim weak sources which imply things in the realm of health/science. Alexbrn (talk) 16:19, 18 October 2017 (UTC)[reply]
That sounds like the best approach at this point. --Ronz (talk) 16:54, 18 October 2017 (UTC)[reply]

Are crowdbased medical ratings valid here?

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  • "The platform Healthoutcome.org ('Crowdsourced Treatment Ratings for Common Medical Conditions') rates 'Postural Modifications' as the best general treatment for lower back pain (3.8/5 as of October 2017), and specifically the Gokhale Method as the best single treatment for lower back pain (4.6/5 as of October 2017).[22] The validity of crowdbased medical ratings have been studied and confirmed in a recent study by the Stanford Center for Biomedical Informatics Research.[23]" was removed with reason Not WP:MEDRS. How can this information be rephrased so that it fits, as I consider it valuable information in order to judge the validity of the method.78.34.232.219 (talk) 08:22, 18 October 2017 (UTC)[reply]
78.34.232.219 (talk · contribs · WHOIS), I have taken the liberty to move this matter to a new section. As to your question, articles on health have different rules than other articles on Wikipedia, per the policy cited (WP:MEDRS). Medical claims as to the validity of certain types of healthcare, even alternative, need to be backed up by reviews of scholarly medical studies. If you think a case can be made for healthoutcome.org as a reliable source for medical claim validity, I am sure there is a noticeboard where these things can be discussed. The general noticeboard for reliable source related discussions is WP:RSN, but I am not certain whether this can also be used for medical articles. If it can, you could start a new thread there about the healthoutcome.org website, and see what people think about it.--Farang Rak Tham (talk) 13:59, 18 October 2017 (UTC)[reply]
        • When the original addition of the crowdsourced ref and text was added, Alexbrn beat me to the revert by a few seconds. My edsum was not as collegiate as Alex' but essentially said the same thing. Not acceptable per MEDRS I'm afraid. You could take it to that noticeboard, but the answer will be the same. -Roxy the dog. bark 15:03, 18 October 2017 (UTC)[reply]
Still, could save some time in the future, when it's settled over there. For future reference.--Farang Rak Tham (talk) 15:25, 18 October 2017 (UTC)[reply]

My edsum was not as collegiate as Alex' I don't see the point of such statements, especially towards what is most likely a new user.--Farang Rak Tham (talk) 15:27, 18 October 2017 (UTC)[reply]

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Objectivity of Penultimate Sentence

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"However, one of the main assumptions of the Gokhale Method, that people in less industrialized societies have less back pain,[4] is incorrect: mainstream science states back pain occurs to a similar extent in all cultures.[20][21]"

This statement is not supported by the two references cited.

citation [20] Figure 6.24.1 shows large differences in days lost to back pain in different parts of Europe and Table 6.24.2 shows large variations in the incidence of back pain in a selection of countries from around the world (but notes that the numbers are unadjusted). There is no statement in this paper that the incidence of back pain is uniform across the world, just that it is common. There is no effort in this paper to compare the incidence of back pain between industrialized and pre- or less industrialized countries.

citation [21] There is a statement from one expert, Bruce Latimer, that they can find plenty of incidences of arthritic backs in pre-contact Native American skeletons. This expert cites no research by himself or anyone else to compare the rate of back arthritis in pre-contact Native American skeletons with current populations.

Either the statement needs to be modified or better citations need to be found

William Wilcock (talk) 14:15, 26 December 2018 (UTC)[reply]

I agree that it should be removed, William Wilcock--Farang Rak Tham (Talk) 15:14, 26 December 2018 (UTC)[reply]
Removal is probably out of the question per WP:FRINGE.
uniform across the world We aren't saying that.
Well you kind of are because if it was less common in less industrialized countries then that would be consistent with the premise of the Gokhale method. In Table 6.24.2 of reference [20], the rate of back pain is low in India which is one of the countries cited in Ester Gokhale's book as having good posture (but it is also low in Australia). Other region cited by Gokhale - sub-saharan Africa, south America - are not in the table so this reference is just not very definitive either way. William Wilcock (talk) 07:02, 28 December 2018 (UTC)[reply]
from one expert, Bruce Latimer If you can find similar experts claiming otherwise, please provide the sources. --Ronz (talk) 16:08, 26 December 2018 (UTC)[reply]
Regardless of Bruce Latimer, citation 20 does not support the content, and thus amounts to WP:SYNTH. This citation must go, to follow policy.--Farang Rak Tham (Talk) 09:14, 27 December 2018 (UTC)[reply]
Fair enough regarding finding citations for experts with opposite view but this would be more convincing if it cited some of the studies Bruce Latimer alludes to in the article. William Wilcock (talk) 07:02, 28 December 2018 (UTC)[reply]
Complete removal would violate NOT and POV. --Ronz (talk) 16:20, 27 December 2018 (UTC)[reply]

To be consistent with the references cited and thus more objective, I suggest that the penultimate sentence be modified to "However, one of the main assumptions of the Gokhale Method, that people in less industrialized societies have less back pain,[4] has not been demonstrated by mainstream science. Although the reported incidences of back pain can differ significantly between countries [20], back pain is a major health problem throughout the world [20][21] and arthritis of the spine was common in pre-contact Native American populations [21]." William Wilcock (talk) 07:02, 28 December 2018 (UTC)[reply]

I gave it a shot [2], and wonder if a short statement belongs in the lede. --Ronz (talk) 18:28, 28 December 2018 (UTC)[reply]
I still quibble with "is contradicted by mainstream science" because it not clear that there are any scientific studies that have looked at the incidence of back pain pre-industrialized populations (a subset of the population in most undeveloped countries) and compared it to industrialized populations using comparable metrics. It would be more objective if you substituted "has not been demonstrated by mainstream science".
I think the most important statement from this section to put in the lead is a statement that the method has not be scientifically evaluated. This is acknowledged on the Gokhale web site - https://gokhalemethod.com/data - so there is no need to preface that with 'As of June 2015". In terms of evaluating the technique, the key question is whether it reduces back pain and not whether some populations have lower incidences of back pain so focusing on global patterns of back pain distribution in the lead seems a bit of tangent.
Finally, there is plenty of scientific evidence that posture modification is an effective treatment for back pain (e.g., https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145000/). This is essentially what the Gokhale method teaches so one could modify the final sentence to statement with "but other posture modification techniques have been proved effective". — Preceding unsigned comment added by William Wilcock (talk • contribs) 21:35, 28 December 2018 (UTC)[reply]
I agree with William Wilcock that contradicted by mainstream science is something we can't write, because the Newsworks article does not directly state this. The paragraph will still give the same facts without it, but just not draw any conclusions yet. A second issue is that only one expert was consulted, that is Bruce Latimer. We do not know for sure whether this is mainstream opinion. Using the WHO article is problematic and possibly in violation of WP:SYNTH, since it does not mention the subject of the article at all. I still believe it should be removed from the article, per WP:OR guidelines. We cannot just pick sources that do not directly discuss the subject of the article.--Farang Rak Tham (Talk) 17:16, 29 December 2018 (UTC)[reply]
With regard to the "as of" statement, that is in there because Gokhale has a plan to have her method scientifically studied. It is mentioned in the source cited.--Farang Rak Tham (Talk) 17:16, 29 December 2018 (UTC)[reply]
The feeling I'm getting from all that is that we're trying to run around FRINGE. Latimer is an expert. Rather than waste time trying to nitpick the experts, and stray from writing an encyclopedia article, we should trim away anything where the authors took Gokhale's self-promotion whole cloth. --Ronz (talk) 00:51, 30 December 2018 (UTC)[reply]
It seems to me that the correct approach to FRINGE is to make the whole article objective. There are no scientific studies that have specifically set out to test the hypothesis that back pain is less common in indigenous cultures. The 2010 Global Burden of Disease Study shows about a factor of 2 variation in the age-adjusted incidence of lower back pain regionally (https://www.researchgate.net/publication/261070129_The_global_burden_of_low_back_pain_Estimates_from_the_Global_Burden_of_Disease_2010_study) which appears to be unexplained. Stating that Ester Gokhale's hypothesis is "contradicted by mainstream science" is not an objective statement. The article could justifiably state that it has not been demonstrated by mainstream science, that there are no scientific studies that support it, and/or and that scientists have expressed skepticism but if states that it is "contradicted by science" the article should to be able to cite a study that reaches this conclusion (not an expert expressing an opinion). So with all due respect I think Ronz is hiding behind FRINGE rules to preserve wording that cannot be justified William Wilcock (talk) 19:40, 30 December 2018 (UTC)[reply]
with all due respect Please WP:FOC instead.
the article should to be able to cite a study The whole purpose of FRINGE is to address claims where we don't expect any studies to exist because the claim is fringe... --Ronz (talk) 01:30, 31 December 2018 (UTC)[reply]
I don't see why it is required to refer to WP:FOC, when the issues at hand are still being discussed, and supported by good arguments.
  1. Furthermore, I agree with William Wilcock that "contradicted by mainstream science" is not supported by the sources, as William Wilcock and I already explained above. There is no source cited that compares the method to mainstream science.
  2. Secondly, the WHO source does not even contain the word Gokhale and including it is a form of OR. It does not say anything about the Gokhale method, let alone that it is contradicted by science.
  3. When looking back in history,[3] we can notice that content about mainstream science was included to prevent violating fringe policies, but this content was initially unsourced. Afterwards, sources were found and included. This manner of working is of course not ideal, even if your intentions are to indicate fringe as such. Other core policies also must be uphold, including WP:V and WP:OR. Therefore, the phrase "contradicted by mainstream science", which was never sourced in the first place, must go.--Farang Rak Tham (Talk) 12:24, 31 December 2018 (UTC)[reply]
Ronz states that "The whole purpose of FRINGE is to address claims where we don't expect any studies to exist because the claim is fringe". I think this is incorrect. The Wikepedia page WP:FRINGE states right off the bat that " fringe theory is used in a very broad sense to describe an idea that departs significantly from the prevailing views or mainstream views". To me "very broad sense" means that it covers more than crackpot ideas that no scientist would even consider. It is a matter of opinion, but I would argue that Gokhale's hypothesis is a perfectly rational idea that deserves testing and would provide a basis for explaining why postural modification in general (if not the Gokhale method) are a mainstream treatment for back pain. Now because Wikipedia was wise enough to define FRINGE broadly, I accept that my argument is not a basis for arguing that the idea is not FRINGE. William Wilcock (talk) 03:14, 2 January 2019 (UTC)[reply]
I've added a footnote, quoting from the reference, the same quote discussed earlier.
If editors wish to rephrase the medical consensus, please make an edit request. --Ronz (talk) 17:25, 31 December 2018 (UTC)[reply]
I suggest simply changing "is contradicted by mainstream science" to "is not supported by mainstream science". This subtle change in wording does not give the incorrect impression that there are scientific studies that refute the hypothesis, but instead conveys that (1) there are no scientific studies supporting it and (2)there is scientific skepticism. These two points are supported, respectively, by references 20 and 21 and amplified in the following sentence. William Wilcock (talk) 03:14, 2 January 2019 (UTC)[reply]

I've incorporated your suggestion. Thanks. I also pulled the quotation out of the footnote and added it as a direct quote. We could rephrase it if we like. It would be fine to use in Wikipedia's voice, and doing so might be slightly better. --Ronz (talk) 03:32, 2 January 2019 (UTC)[reply]

Thank you William Wilcock (talk) 06:06, 2 January 2019 (UTC)[reply]
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