As if turning 30 wasn’t enough of an incentive to start feeling anxious about getting older, I recently started having back trouble. The other day, getting out of bed, I threw my back out, and so ended up on the floor with my iPad, as usual contemplating how I could turn this unfortunate turn of events into a blog post.
Lower back pain is particularly frustrating, because as far as the medical establishment is concerned it is an ailment without a clear treatment. Even the most standard type of treatment prescribed by the NHS (rest, painkillers and physio) only shows very moderate success.
This frustration pales in comparison to that of having everyone tell you what they think you should be doing. Physiotherapy, Yoga, massage, chiropractor, better posture, swimming, acupuncture, eating rare herbs and lying down (this suggestion came from a Tanzanian friend), or the standard GP response of just deal with it.
Many people, often those who have suffered from pain themselves, will swear by their given treatment. I’ve always found this perplexing: surely if there was a obvious method for curing lower back pain, that method would quickly have spread and someone would have become very rich. There are of course reasons why this might not be the case. Let’s consider a few:
1. None of the treatments work, and people just randomly recover from back pain.
This is particularly disconcerting, but given that most of these treatments haven’t been proven with rigorous methods, it’s perfectly possible that people are just recovering at random. If you are trying out treatment X when you happen to get better, it’s likely that you’re going to start seeing a casual relationship where there isn’t one.
2. People have back pain for random reasons and some treatments only work for some types of lower back pain.
This is possibly even more disconcerting. There are a myriad number of potential causes for back pain, and not every treatment will work. So even if you run an RCT examining the impact of a given treatment on pain, if the proportion of people suffering from the exact ailment that the treatment will fix is small enough you might end up failing to reject the null hypothesis anyway. So no particular treatment wins because we don’t have a good sense of what causes back pain, nor which treatment is most appropriate for a given circumstance.
I feel that most of development is (unfortunately) a lot like back pain. There are a lot of people out there who think they know the answer, but if they are living in worlds 1) or 2) where development is random or counties exhibit heterogeneity in the underlying structural prerequisites, then we’re in for a tough time. This isn’t a call to start lamenting – we just need to be aware of the various biases which lead us to over-prescribe certain policies (situation (1)) and under-prescribe others (situation (2)).