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Every Time Someone Says “Evidence Based” a Kitten Dies

Last year I took part in an online roundtable of running experts. I was the only coach in the group; the others were physiotherapists, kinesiologists, and strength and conditioning specialists. Toward the end of the overlong session, when everyone was a little punch drunk, the conversation degenerated into a sour-toned airing of grievances concerning the inexcusable failings of running coaches. The words “evidence based” were uttered so many times in the course of this verbal savaging of my profession that if the roundtable had been a drinking game with “evidence based” as the trigger phrase, I would have ended up in the hospital with acute alcohol poisoning.

The problem these folks had with running coaches, near as I could tell, was that we aren’t very good scientists. I was strongly tempted to point out that running coaches aren’t scientists at all, in fact, and we should not be judged by the standards used to judge scientists, but I knew that I’d only invite a pile-on if I did so. As it was, the experience left me feeling out of sorts for days. It bothered me that these experts thought they were right about my colleagues when in fact they were so terribly wrong. A phrase came to me—tyranny of evidence based—and it thereafter echoed continuously in my head throughout this period of brooding. I started to feel better only when I googled the phrase and came up with a bunch of links to articles and papers about—are you ready for this?—the tyranny of evidence-based medicine and other clinical practices. I wasn’t alone!

In one such paper, Australian physiotherapist Dave Nicholls wrote, “In recent years, a number of authors have offered significantly more critical commentary on [evidence-based practice]. Spence recently claimed that ‘Today EBM is a loaded gun at clinicians’ heads. “You better do as the evidence says,” it hisses, leaving no room for discretion or judgment. EBM is now the problem, fueling overdiagnosis and overtreatment’ (Spence, 2016), whilst Trisha Greenhalgh et al argued that ‘The evidence based “quality mark” has been misappropriated by vested interests’ (Greenhalgh et al, 2014).”

In a recent blog post of mine, I discussed the difference between knowledge and thinking. Some people are better at absorbing and applying knowledge, I proposed, while others are better at solving problems and figuring things out, and a special few are good at both and an unlucky handful aren’t good at either. Certain professions, including physiotherapy, kinesiology, and strength and conditioning, tend to attract knowers–rote learners who are good at following if/then instructions and who function essentially as body mechanics–whereas other fields, including elite-level endurance coaching, tend to attract thinkers. A large fraction of the body mechanics I’ve dealt with are paint-by-numbers types. They lean hard on evidenced-based practice, in part because they genuinely believe in it but also because they are largely incapable of solving problems creatively and figuring things out for themselves.

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Nearly all of the elite-level endurance coaches I’ve ever known are completely the opposite. They don’t know a ton of science, but they can almost always find a way to guide their athletes from point A to point B regardless of how many, or what kinds, of obstacles stand in between. A lot of body mechanics observe these coaches with a mixture of bafflement, disdain, and insecurity. In their minds, endurance training ought to be scientific, and these science-dependent individuals are deeply bothered, sometimes outright threatened, by the fact that the most effective endurance coaches operate more like artists. A certain number of these folks are sufficiently threatened that a one-sided turf war has erupted in and around endurance sports, wherein body mechanics like those participating in the roundtable I just described publicly chastise endurance coaches for being bad scientists in an effort to . . . I don’t know, actually. Take over?

The irony is that these body mechanics would themselves make terrible endurance coaches if they were to steal our jobs. They would be paralyzed by every tricky problem lacking any obvious evidence-based solution that arose in an athlete’s training–and as every coach knows, such problems arise often. They would never innovate or experiment or even treat each athlete as unique because by definition none of these practices can ever be evidence based. Their athletes would come to despise these coaches, who in always deferring to the secular higher power of evidence would lack the charisma—the guru factor—that makes great coaches great, each in a sui generis sort of way. Much of the fun would be drained out of the training process, which would lack any spontaneity or specialness or differentiation from the cookie-cutter training prescribed by every other coach manacled to the immovable steel post of science.

Athletes excel when they believe their coach has a “secret sauce.” If every endurance coach were a body mechanic, there would be no secret sauce. And there would come a time when each athlete confronted their coach, saying, “I swear to God, if you say ‘evidence-based’ one more time . . .”

Here’s an interesting idea for a study: Two dozen coaches and their athletes would be monitored for a period of several months. During this period, researchers would track how often each coach used the phrase “evidence based” in communicating with athletes, who in turn would undergo regular testing to track changes in their level of fitness. I’d bet the farm that the coaches who used that kitten-killing phrase least often would produce the greatest fitness gains in their athletes. And from then on it would be considered an evidence-based practice to avoid saying “evidence-based” in endurance coaching!