correlation is not causation

What gets in the way of Critical Thinking?

So here is the thing… In my previous posts I talked about Science literacy, Science vs Pseudoscience and critical thinking that you might want to read before this post, but the general overview is the massage profession is full of information that has been handed down by tradition and the lack of science creating a fair amount of pseudoscience in the profession. The crazy things massage therapists say about how and why massage and more specifically their technique works, is more about the need to be right, to be respected, to be the authority than something that is based on science. It is much easier to buy into these myths (fallacies) than to be a skeptic and believe more in what we see. It isn’t a bad thing—it is just the way humans are. (LOOK at the current Political Condition the US is in). The research we do have at best, shows massage looks promising.

Pseudoscience leverages the stories and expert advice (ethos) and strongly appeals to the emotions of people (pathos) while faking logic and sound evidence (logos). uncertainty can act as a powerful tool to manipulate beliefs and ideologies.

Logical fallacies are errors in reasoning that are based on poor or faulty logic.

Correlation is not Causation.

With massage therapy, we work with people and see right before our eyes (and hands), the results of what we do and use various methods and techniques. When we see things happen, we think that the massage we just gave must be the cause of the results — “it works for me” is often heard in the massage profession. Humans seek meaning and therefore tend to ‘see’ patterns where none exist. Things don’t work so straight forward. We cannot say without a doubt what caused what. Did they feel better because they took the day off or took some time off, went home and slept, took a bath and relaxed or was it all the massage? Was it that they ate better that day? So many other factors come in to play that we don’t know about or may know about. This is the heart of pseudoscience.

Correlation is a statistical measure (expressed as a number) that describes the size and direction of a relationship between two or more variables. A correlation between variables, however, does not automatically mean that the change in one variable is the cause of the change in the values of the other variable.

Causation indicates that one event is the result of the occurrence of the other event; i.e. there is a causal relationship between the two events. This is also referred to as cause and effect.

Australian Bureau of Statistics as mentioned in the course Science Literacy.

With Science we use experiments to test the roles of the variables and observe over and over again and try to limit the variables.

Although causation can be implied by a correlation, a correlation cannot be the only evidence used to conclude a causation. A correlation just implies an association. So we as massage professionals need to stop saying that everything that happens in a session is a direct result of the massage and also making the many false claims about how massage works and why it is working.
Illusions of causality can occur for anyone, just like visual illusions.
They occur because of the way the human mind has evolved: It extracts
causality from coincidences.

For more in-depth information on causality see: Illusions of causality: how they bias our everyday thinking and how they could be reduced


There are no facts or proof, only evidence, and the strength of a claim is based in the strength and reliability or replicability of the evidence.

One way to assess the replicability of a finding is by performing or reading up on meta-analyses. A meta-analysis is a type of research study the collects and examines data from a number of independent studies of the same subject, in order to determine overall trends. It tests the replicability of our observations and ignores the information that comes from anecdotes. It shows how strong the evidence is based on how often it is reproduced in similar studies.

For a more in-depth info on replica see: Reproducibility vs. Replicability: A Brief History of a Confused Terminology Hans E. Plesser

Extraordinary Claims

 We often hear claims that are backed by anecdotal evidence or ancient historical practices. This is a big issue in the massage profession. We often cite the fact that massage has been used for thousands of years by the Greeks, Romans etc. Does that make it credible?

Aroma therapy is often supported because millions of people swear by it. People have been using these practices for thousands of years. 
This is anecdotal or based on logical fallacies. Frankincense has been used widely historically as a medicine but has yet  to be systematically tested for the claim defects in humans.

  1. Evidence should be relevant to the claim
  2. Evidence should be systematically collected and skeptically evaluated
  3. Evidence should be highly replicated by others
  4. Evidence is not a product of logical fallacy


Many of the things we say in the massage profession are things based on belief, tradition and are not based on facts or evidence. Beliefs are not falsifiable meaning they cannot be proven as false. They are your beliefs. Being able to show something is false is the basis for scientific theory. When you cannot show that something is false it is not scientific.

Falsifiable does not mean false. For a proposition to be falsifiable, it must – at least in principle – be possible to make an observation that would show the proposition to be false, even if that observation has not actually been made. For example, the proposition “All crows are black” would be falsified by observing one white crow. A falsifiable proposition or theory must define in some way what is, or will be, forbidden by that proposition or theory (e.g., in this case a white crow is forbidden). The possibility, in principle, of observing a white crow to disprove this proposition thus makes it falsifiable.

Claims that are unfalsifiable when it is a theory that can never be shown to be false. Whilst some “pure” sciences do adhere to this strict criterion, many fall somewhere between the two extremes, with pseudo-sciences falling at the extreme end of being unfalsifiable.

In science, there is no such thing as proof, only evidence, which can provide disproofs. Proof implies that it is 100% beyond a doubt that something is correct. Since there are so many variations that could be studied, we can’t say that in science/research. We can say we have confidence or it looks promising but it is impossible to say something works beyond a doubt.

Falsifiable hypotheses, if disproven, will advance knowledge and often leads scientists to re-evaluate a theory in light of new evidence. Unfalsifiable hypotheses, are common in pseudoscience. 

Ocam’s Razor

Occam’s razor (  named after English Franciscan friar William of Ockham (c. 1287–1347)) is the principle of parsimony which is the basic scientific principle that tells us to choose the simplest scientific explanation that fits the evidence – “the simplest explanation is most likely the right one”. When you have two or more different hypotheses about something, you should choose the solution with the fewest assumptions.

The preference for simplicity in the scientific method is based on the falsifiability criterion. For each accepted explanation of a phenomenon, there may be an extremely large, perhaps even incomprehensible, number of possible and more complex alternatives. Since failing explanations can always be burdened with ad hoc hypotheses to prevent them from being falsified, simpler theories are preferable to more complex ones because they are more testable.


Think of it as shaving off the unnecessary assumptions to find the simplest one with the evidence available. When we simplify things like this we reduce assumptions

 When a falsifiable hypotheses is simplified, it can be more easily tested making it so the conclusion has a higher chance of being correct.  When a hypothesis gets too complicated, it can create many assumptions which will require much more complicated testing which will lead to less evidence, less knowledge which is really the goal of pseudoscience.

It doesn’t replace the scientific method, logic or insight. It is just a reminder to keep your hypotheses simple so they can be tested more easily. Keeping the evidence based explanations simpler helps us to learn what questions still need to be tested so we can develop falsifiable hypotheses to set guidelines for collecting and evaluating the systematic observations.

 Logical Fallacies also get in the way of thinking.

What to say instead.

 I touched on a few things in my first article on this topic Science Literacy . I am sure there are many more.

  • Massage should not be done in the first trimester of pregnancy
  • Pressure points should be avoided during pregnancy
  • Massage releases toxins
  • Does massage decrease cortisol?
  • Does massage increase circulation?
  • Reflexology and the zones on the hands and feet
  • Craniosacral therapy theory
  • Cupping therapy theory
  • Acupressure, Shiatsu and any other meridian based traditional healing
  • Does massage work and how does it work?
  • Conditions treated with massage – what works and what doesn’t?
  • The theories used to explain taping. Does taping work?
  • The theories used to explain foam rolling. Does foam rolling work?

So how do you explain the things you see happen in your sessions that helps people understand science and keeps you from spreading pseudoscience? What things are not scientifically based on the massage profession? Most of what we know is not based on science. Can we just start saying “We don’t really know how this works” and let ourselves be free of the need to know everything and be right all the time (or whatever it is that makes you feel you need to continue to explain everything.) It is also very difficult to let go of these old beliefs, theories and ways of explaining things. It required being open-minded but not just blindly accepting the information that’s provided, it’s about being open to changing your mind in light of new evidence; detaching from your beliefs and focusing on unbiased thinking void of self-interest; as well as being open to constructive criticism and new ideas.

  1. Science Literacy
  2. Metaphysics, Magical Thinking
  3. Traditional Medicine
  4. Science vs Pseudoscience
  5. Critical Thinking
  6. What gets in the way of critical thinking?
  7. Logical Fallacies
  8. Scientific Method
  9. The Art of Massage
  10. Being Skeptical in the Massage Profession