Patients are faced with a big dilemma. Healthcare is highly technical. It literally has it's own language. As a result, patients can't evaluate claims for themselves. They are left with two options: trust an expert to evaluate the claims, or rely on the success stories of friends and acquaintances.
This strategy, however, has a major issue: EVERY claim in healthcare has that kind of evidence. Think about supplements; there are 90,000 supplements currently on the US market. Each one is backed by an esteemed expert and dozens of testimonials.
The problem is that experts and patient's alike carry a lot bias. They fool and get fooled. It's why we used bloodletting and leeches for two millennium, and it's why, we invented more reliable kinds of evidence, like the randomized double-blind placebo controlled trial.
Because experts and anecdotes are unreliable kinds of evidence, it's imperative that the modern patient learn how to evaluate healthcare claims for themselves.
I am going to show you how we know these claims are mostly false, and what tools are the best to evaluate claims.
Lesson from meta-research
To answer this question we can apply an excited new field in healthcare called meta-research. Meta-research is what it sounds like: a bird's eye view of science. There are 35 million published papers in biomedicine going back 60 years. With this we can establish some patterns.
The replication crisis - In an analysis of 2,000,000 medical studies, 96% had positive results. There is no incentive to replicate most of these results because no one wins a Nobel prize for showing a treatment does NOT work. When we actually try to replicate these studies, less than 25% can be replicated. This is known as “the replication crisis” in science.
The hierarchy of evidence - Some evidence is unreliable, like: anecdotes, laboratory evidence, animal studies, and observational studies. They are a good starting point and may lead to something, but they are prone to errors and needs to be confirmed with better evidence. The best kind evidence is the randomized placebo controlled trial. It is designed to correct for the problem encountered with the weaker evidence. Unfortunately, randomized trials are limited by their expense, their feasibility, and like any kind of evidence, not immune to fraud.
The discovery rate in medicine - How do we know this? It's actually quite simple. We can follow the pharmaceutical industry. They take the best ideas from weak evidence, and as a regulated industry, must put them through very large randomized trials prove they are safe and effective. Question... for every 100 drugs how many will actually pass these trials? The answer... less than 1%. Take note, that rate is in the best hands. The pharmacetucal industry has the best scientists, with the most resources, and the most money on the line. With respect to Alzheimers disease, they found 140 drug candidates over the last 30 years. None of them worked. They spent $600 billion. What is the likelihood the supplement on TV has found the cure to Alzheimer's? Cures in medicine are few and far between. Every Penicillin lies on a mountain of failures you don't see.
Evidence-based medicine and Shared-decision making
The purpose of evaluating claims is not to make decisions for you and close doors. On the contrary, it's a way of empowering you by assigning an objective probability to the claim. What you decide to do with that information is your choice. Every patient is different, every situation is different, and every patient's tolernace for risk is different.
Helping you decide which claims you should try and which you shouldn't is another skill of critical thinking in medicine. It's called shared decision making. You can read about it here.
Using AI to make things even easier
To make things even easier you can use AI to evalute a healthcare claim. The only caveat is that you must teach it how to think about approaching a claim. In AI lingo this is called "prompt engineering". In this case, you must prompt engineer the lessons from meta-research
Suppose you want to find out if the popular supplement NAD will make you live longer. Asking AI, "Will NAD make me live longer?" will result in the wrong answer. (Try it).
Instead ask AI, "Utilizing the principles of evidence base medicine, the replication crisis, the hierarchy of evidence and the pharmaceutical industry discover rate of less than 1%, will NAD make me live longer?"
The academics are incentivized because a cure leads to fame, fortune, and academic advancement.
(For a more detailed explanation check out my lecture on YouTube)
Concierge medicine and evaluating claims
The Concierge Medicine model is the optimal platform to employ critical thinking in medicine. Because my practice is small I have ample time to evaluate all of my patient's queries, and even time to teach them how to evaluate claims for themselves.
Over the last 25 years I've evaluated thousands of healthcare claims. Since most evidence is weak and preliminary, it should not be of no surprising that I found most of these claims unlikely to be true. This may leave patients with few options to solve their medical problems with.
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