As
body piercers, we share the common experience of having been
interrupted midway through our (hopefully) well-considered aftercare
instruction by our client’s friend, sibling, or family member who
declares: “Just use ‘Product X’, it worked for me.” There’s a problem,
though: We know Product X. We have checked it out. Not only has the
bulk of the industry agreed that Product X is inappropriate for piercing
aftercare, but the Product X website says you shouldn’t use it on body
piercings. None of this matters to the person who has successfully
healed a piercing with Product X: “Well, it worked for me.”
This
is a problematic perspective, because an individual’s personal
experience is powerful “evidence” to that individual. Explaining to them
that they healed in spite of, not because of, a particular product is
an uphill, and often losing battle. The problem is, personal experience
is flawed. Our brains are wired to make the most of positive results and
the least of negative results. When piercers try to evaluate a product,
we can't help but "like" or "dislike" it ahead of time, usually based
on marketing or who introduced us to the product to begin with. This
skews our perception of the results we see to the side we want. There
are a ton of cognitive biases at work when we attempt to evaluate a new
product, but when we try something out, we are bound to have our
assumptions prove correct. This is a cognitive bias called the
confirmation bias “the tendency to search for or interpret information
in a way that confirms one's preconceptions” (1). This is exactly why so
many studies are “blind” or “double blind”. Scientists try to eliminate
biases like experimenter's bias and confirmation bias.
Most
body piercings will heal because people’s bodies are built to heal
wounds. Before the advent of modern medicine, we healed regularly
through prayer and quackery. Before the advent of prayer and quackery,
we simply healed like any other animal heals. A body piercing isn't a
difficult wound to heal considering homo sapiens sapiens had to hunt
dangerous animals, get injured in the process, and heal to survive.
Recently,
a new aftercare product was discussed on the popular Body Modification
Learning Forum. I was pleased to see the lion’s share of my colleagues
approach the new product skeptically. “Is it FDA approved?” “May I see a
Material Safety Data Sheet?” “What evidence do you have that this
product is better than what is currently available on the market?” were
all questions discussed with representatives for the product. My peers
wanted evidence that the product worked. The representative for the
product suggested that we try it, and see if it worked first hand.
This got me thinking about the idea of first hand experience and how flawed it is.
How does one evaluate something like an aftercare product? A skin prep? A hard surface disinfectant?
The short answer is this: you don't.
The long answer is this: you can't.
Evaluating
a product like an aftercare product requires money. The kind of money,
regrettably, piercers tend not to have. It takes scientists. Control
groups. Blind studies. Clinical evaluations. Large amounts of data.
Peers to review that data. A piercer cannot do this.
An
example: a piercer suggests to her clients that they clean their
piercings with a new soap on the market, for our purposes we will call
this fictional soap Placeboderm. The makers of Placeboderm have marketed
heavily to the piercing community, boasting the health benefits and
germ killing abilities of their product. Our fictional piercer buys into
the hype, and suggests this new soap to her clients.
After
one month, and 100 piercings later, our piercer is loving Placeboderm!
Piercings seem to be healing better! Fewer problems! Her clients like
the packaging and the smell of the soap. All is well, exactly as she had hoped.
Here
is the problem: our piercer doesn't have all the data. Our piercer
never asked for clinical studies on how effective Placeboderm is on
injuries similar to body piercings (a draining puncture wound, for
instance). Had she asked, she would have gotten more marketing but no
studies. Again, paying scientists to accurately evaluate a new product
is expensive, and if we as piercers do not demand it, it won’t be done.
Our
piercer was never in position to really evaluate her new aftercare. She
never saw the piercings that didn't heal well when using the soap. The
clients with the worst reactions didn't follow up, got frustrated and
removed their piercings, or went to other shops and got different
aftercare. Even then, our piercer only did 100 piercings. For this
intellectual exercise, let's assume Placeboderm actually is bad for healing piercings. It prevents 2% more
of the population from healing well than the aftercare laid out in the
APP “Suggested Care for Body Piercings” pamphlet. Let's also assume,
90% of piercings would heal with the APP aftercare. Our fictional
piercer would have to keep amazing records, get honest follow up, and be
able to accurately assess what problems were caused by soap versus
everything else, and still only 2 of the 100 clients she pierced would
heal worse than the APP aftercare. I don't think our piercer has the
capacity to discover this minute difference in aftercare issues. I don't
think I do either. Even if the opposite is true, and Placeboderm is a
fantastic improvement on the standard APP aftercare pamphlet, our
piercer doesn't have the resources to really establish if a new soap is
the basis for this improvement or not.
Not
to mention, that these piercings weren't pairs. Our fictional piercer
didn't do 100 sets of ear lobes, with identical jewelry, using soap on
one side and then using APP aftercare on the other.
Add to that how small the sample size is... well you can see where this is going.
Chemicals
for hard surface disinfection, skin prep, and aftercare simply cannot
be evaluated by body piercers. We need the help of scientists and
doctors, as well as government oversight. Does this mean that piercers
will have a tough time innovating industry specific products?
Absolutely. Is this a problem? No.
We
need to see this as it is: a blessing. There are some hoops that are
really tough to jump through, and those hoops are tough to jump through
for a reason. When I use a hard surface disinfectant on my instrument
stand, my client is (unknowingly) happy that this disinfectant was
government approved, tested for several months or years by the company
who made it, and slowly adopted by a skeptical medical industry,
followed by the piercing industry. We consistently strive for
legitimacy: jumping through the right hoops, taking our time, and
waiting for evidence only lends to our legitimacy.
Piercers
understand that there are aspects of their job that they cannot
evaluate. The best example of this is autoclave sterilization. We use
sterilization indicators, sterilization integrators and regular spore
tests to double and triple check the efficacy of our sterilizers. We
accept that we cannot “like” the way our sterilizer works, we need
scientists and engineers to provide us tools that can allow us to trust the way our sterilizer works.
As
of late, I read a lot of piercers talking about how they “like” certain
chemicals. I've been guilty of saying things like that myself. What we
actually mean is we trust
certain chemicals. This is an important distinction. Trust needs to be
earned. When a new product is introduced, it is always best to be
skeptical: make every product earn your trust.
Step
one, get approved for the use intended for your chemical by the
government agency your particular product is regulated by. There are,
indeed, products that do not require government approval. When a
product tries to “side step” FDA approval, for example getting a product
approved as a soap when the people making it intend it to be used as a
skin prep... this should draw our strongest skepticism, not our best
apologetics.
Step
two, publish studies about your product. Ideally, have published
studies comparing your product to other products that compete with it.
An example of this would be a peer reviewed study of the healing of a
specific kind of wound with several different aftercare treatments.
Step three, market your product.
It really is that easy, yet all too often, we settle for step three alone.
It's
after these criteria have been met that we piercers can discuss what we
“like” or “don't like”. We need to be able to discuss and debate the
merits of certain products, and without the evidence to back up an
argument, we truly are just making noise. When piercers are skeptical
of products, it is body piercing at its best. We should demand data.
We should demand rigorous science. Over time, this will actually ease
the introduction of industry specific products, as we will have proven
to the companies that want to sell us something that we need more than
marketing, more than appeals to our biases, and more than popular spokes
people for our industry to embrace their product.
