Consider the Source- how to know whom and what to trust with your health

You’re faced with a health concern you can’t quite figure out on your own. Maybe you have a bacterial  infection, or perhaps a tendon is aching from all the running you’ve been doing. Where do you turn for help? What reasoning do you use to discern what to believe and trust among all the voices vying for your attention? 

In the day and age of concepts such as “fake news”, many people are left with the (fortunately erroneous!) impression that there is no consensus in the health sciences either. This article is intended to help you approach taking care of your body, in sickness and health, and finding the help you need to do so, in the most logical and effective way, and in the process help you avoid the many potential pitfalls along the way.


When it comes to the serious infection, most people tend to turn to a medical doctor. They know that by doing this they have chosen a professional that is a graduate of a rigorous program and who will base their recommendation —probably a course of antibiotics — on scientific evidence, not on best guesses or hearsay, or on what some other person told them. 


This practice, basing your actions on scientific evidence in addition to the traditionally honored      
      practices of clinical knowledge and the patient’s desires, is called Evidence Based Practice.


Evidence Based Practice therefore strongly incorporates and emphasizes the scientific method; systematically testing a hypothesis and drawing conclusions based on the findings. Once such as study has been performed, scientists seek to publish their findings in the form of a scientific paper in a peer-reviewed journal. Many different studies then accrue over time, and other scientist authors summarize these many studies into one, and draw conclusions based on these. If 20 studies point to A, and only one, poorly designed, study points to B, we have good reason to conclude that A is correct. We don’t, however, rest on out laurels, and scientific evidence is continuously accumulating, ever refining and enhancing our understanding.


Experts back their claims with scientific references

The above system also leads to a hierarchy of evidence where the opinion of an expert ranks the lowest and systematic reviews the highest. The latter is also what is later used to base practice guidelines on for various types of practitioners, and any “expert” worth listening to also continually refers to the highest levels of evidence to back their claims.

Even lay persons can access many of these scientific papers eg on Pub Med https://www.nlm.nih.gov/bsd/pubmed.html .PubMed is a free resource provided by the NIH for peer-reviewed biomedical and life sciences literature “with the aim of improving health – both globally and personally.” 

Unfortunately, the lay press often contributes to the confusion by focusing on individual case control studies and expert opinions, creating among their readers the impression that our scientific consensus is weak and ever changing.


Because.... science

All this means that when you are turning to your medical doctor for help with that serious infection, you can rest assured that her or his recommendation is based on sound scientific evidence, not tradition, guesswork or dogma. You certainly wouldn't have someone with self-proclaimed surgical expertise remove your gallbladder. You'd insist on a professional with a degree proving his or her expertise. This is the rigor with which you arguably should approach all aspects of your healthcare. Scientist have gradually worked to understand physiology, biochemistry etc, other scientists have critiqued and refined their work, and a large body of evidence has accumulated. Your physician has not only received a specific degree based on this, but is also receiving periodic updates to their practice guidelines. All this to make sure that your care is up to date, based on the best of our knowledge today, not on assumptions an not on beliefs that were held 20 years ago.


How about that aching tendon then? When it comes to musculoskeletal issues, there are many, mostly well-intentioned individuals who, thanks to the world-wide web, have found an unprecedented outlet for their creativity. While, in the times before personal computers, only credentialed individuals with formal expertise in any given area were given a platform, usually in the form of publishing a book on any given topic, today anyone with a computer can post videos on Youtube or create entire websites dedicated to their ideas.  Any self-proclaimed guru with enough marketing savvy can easily reach an audience large enough to create a course, claiming to certify (usually after a brief course of study), that the certified individual possesses some type of expertise (has become a certified practitioner or expert of this or that). 


Convincing as this may sound, a brief course on any given topic doesn’t come anywhere near the knowledge base of a practitioner with a multi-year formal academic degree, based on a rigorous science-based program. Unfortunately this is not always obvious to the unsuspecting audience, which instead may be influenced by a convincing tone or a captivating video. Appearances matter a lot these days, and coming up with a catchy name or slogan goes a long way - just not towards creating good health. 



Don’t fall for easy tricks and simple claims - your body is not simple


The greatest enemy of truth, however, tends to be our increasing appetite for simplistic explanations, concepts that can be grasped immediately, without the pre-existing context of a scientific understanding. But the human body is incredibly complex, and any intervention, any concept, any approach that is based on actual scientific evidence is therefore, by definition, going to be complex, not something that is easy to generalize and sell. And at the end of the day, Mother Nature follows her own rules, and only by following those rules can we safely obtain the results we are looking for.

So, with the infection cured by antibiotics, to once again be able to run without pain or injury in that tendon, you need to find out how to proceed. Should you look to various movement practices? Will yoga have the secret sauce? Should you, as your friend recommends, simply rest, because running, she says she's heard, is bad for you anyway? Is there one simple trick you need to find somewhere?

Fortunately, while you may not be sure how to proceed, as your area of expertise may lie elsewhere, science does. While there is a lot left to learn, we do know quite a lot about tendons, and we do not need to waste time, as the saying goes, “throwing some stuff at a wall to see what sticks,” trying various dogmatic approaches that claim that their movement philosophy is the cure-all.

We know that tendons have a certain ability to accept and transmit load (eg the pulling force through it as you’re running). We know that tendons, over time, change according to the load you place on them (inactive people have thinner tendons and ligaments than  people who place a great load on their tendons, eg by running or lifting weights). We know that tendons ail (we call this tendinopathy) when the forces we place on them exceed their strength, and their ability to repair overnight. We know that to heal tendinopathy we need to temporarily decrease the load while gently stimulating the tendon to grow stronger.



    These basic facts are no less true, but actually more so, in specific cases such as chronic pain, joint hypermobility syndromes, aging etc. Individuals that fit into these categories need to take even greater care to be guided by properly trained healthcare  
                                                            professionals.



Consider the source

Can those two funny guys you found on youtube guide you through this? Maybe, although unlikely, but how can you tell whether what they are saying is correct or not? You consider the source, and the sources your source uses. If that sounds complicated, here’s what it means. You consider what, if any, credentials the individual has. Have they gone through a long academic program in order to obtain a, preferably terminal, degree specific to the claims they are making? Are you listening to a DPT (Doctor of Physical Therapy), MD (Medical Doctor, preferentially with a specialization in orthopedics of physiatry), DO (Doctor of Osteopathy), DC (Doctor of Chiropractic) or ND (Naturopathic Doctor), or are you listening to someone who never mentions their credentials because they don’t have any? 


If the latter is the case, you are most likely placing your health in hands that lack the requisite competence. I have the utmost respect for autodidacts, and to a certain extent we all have to be responsible for broadening our scope of knowledge  and understanding in order not to endanger patients through the almost absurd degree of specialization that exists in health care today. Certainly not all knowledge that is worth sharing has to obtained through formal education. But in order to gain your trust, your source should always at least be able to tell you why they are making the claims that they are. “Everyone knows”, “I’ve noticed” or “I learned this from someone I really trust” are not scientifically valid arguments.


So here are some things to think about and look for when you are about to place what is  arguably one of your greatest assets, your health, in the hands of someone, trust their claims and follow their advice:

• Does this person have actual formal, academic credentials (see above). You simply cannot learn enough from a brief, cursory class or certification program.

 

• Does this person stay up to date? Many degreed professionals unfortunately do not have the time , money or inclination to continuously update their practice with recent knowledge, and continue practicing the way they were taught to, decades ago. 

 

• Does this person refer to either accepted practice guidelines, and, preferably, to specific high-quality studies to back their claims?

 

• Is what this person is saying specific to you? Remember, the human body is complex, and no intervention, action or idea is ideal for everyone at all times.

 

• Does the suggested  intervention help you understand how you should proceed and progress?                                                                                                                                                                                           
• Are you sure that your problem actually is what you think it is? A non-healthcare provider does not necessarily possess the necessary skills to diagnose you. 

 

• Nice does not equal knowledgeable. We all want to interact with people we like, that have good intentions. But we need to take care not to conflate these admirable qualities with the possession and dissemination of actual scientifically valid information.

 

• When reading an article, again, look for references. If the author doesn’t offer any scientific references for scientific claims, do not trust the content. At best, it now serves as an inspiration for further learning and research on your part. Unfortunately, even many authors of both articles and books pad their work with false references (references to studies that do not actually substantiate their claims) in order to lend it a false sense of credibility, so proceeding with caution is always prudent. An excellent source for judging the validity of claims in health-related books is Red Pen Reviews.

Once again, the body is complex, and those of us who have devoted years of study and practice to understanding the body are in awe of its complexity and ingenuity. We do not believe that there are easy and quick fixes, nor do we advocate one size fits all approaches. We stay attentive to new research as it emerges and make changes to our clinical practice accordingly. And when our patients ask us for advice, and ask us where our information originated, and why we make the claims we do, we can usually refer to science.  We make a clear distinction between our clinical observations and practice guidelines, whether we agree with them or not. 


Most of all, we value the knowledgeable patient, and always strive to both educate our patients and help them become a discerning and educated audience for health-related claims, whoever is making them. To this end, our patients have to understand how we arrive at our conclusions, claims and practices. They have to understand the basic structure of the scientific process and it’s clinical application. My hope is that this article has been helpful with that.


To your health, and your knowledge and understanding  thereof!

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