November 6, 2025 • 40 mins
Summary: I unpack why medicine sometimes reverses course—and how you can tell sound evidence from shiny anecdotes—with physician-author Dr. Adam Cifu of the University of Chicago and co-author of Ending Medical Reversal
.
Key topics & takeaways
- Why medicine “flips”: Plausible theories + observational data → premature guidelines; true answers require randomized trials. Classic examples: menopausal hormone therapy, early peanut avoidance, and stents for stable angina (LEAP trial
, COURAGE - Open-minded skepticism: Ask, “What’s the human outcomes evidence?” Cool mechanisms and moving testimonials aren’t proof.
- Hype outside the clinic: Mitochondria “rechargers,” microbiome panaceas, and biological age tests are intriguing—but not ready for prime time.
- Nutrition sanity: For supplement evidence summaries, I like Examine
. - When AI helps (and when it doesn’t): Tools can orient you to established topics; they’re weaker on breaking studies. Look for linked primary sources.
- N-of-1 experiments: When evidence is uncertain and the outcome is measurable (sleep, blood pressure, pain), test on yourself—track a baseline, try the change, measure again, and, if possible, stop-start to confirm. Use symptom diaries, validated scales, or wearables.
- Humility is a signal: Trust sources that sometimes conclude “we don’t know.” I often check Cochrane Reviews
for balanced syntheses.
About my guest
Adam Cifu, MD is a professor of medicine at the University of Chicago, author of 140+ peer-reviewed papers, and co-author of Ending Medical Reversal. He writes at Sensible Medicine.
Call to action
If this episode helped you think more clearly about health claims, share it with a friend and leave a quick review on Apple or Spotify. For my newsletter on practical, evidence-supported longevity, visit DrBobbyLiveLongAndWell.com
.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_01 (00:00):
A new study shows a supplement can help us live
(00:04):
longer.
Medical societies say avoidpeanuts for kids, then reverses
course years later.
Hormone replacement therapy ishelpful, then it's harmful, and
now the pendulum has begunswinging back towards benefit.
What are you supposed tobelieve?
How can you separate fact fromfancy?
(00:25):
Let's find out.
Hi, I'm Dr.
Bobby Du Bois, and welcome toLive Long and Well, a podcast
where we will talk about whatyou can do to live as long as
(00:45):
possible and with as much energyand vigor that you wish.
Together we will explore whatpractical and evidence-supported
steps you can take.
Come join me on this veryimportant journey, and I hope
that you feel empowered alongthe way.
I'm a physician, Iron Mantriathlete, and have published
(01:09):
several hundred scientificstudies.
I'm honored to be your guide.
More often than you might think,the medical profession seems to
(01:30):
reverse course.
Kids should avoid peanuts.
No, they shouldn't avoidpeanuts.
Now Tylenol is unsafe duringpregnancy.
Hormone replacement therapy isgood, then bad.
Now is it okay again?
And podcasters pout the latestsupplements to improve energy or
that probiotics will help youcure chronic complaints.
(01:53):
And the headlines in the newsmedia amplify these various
twists and turns.
I tend to be an open-mindedskeptic.
Show me the evidence, and I'mwilling to change my mind.
But in general, I'm a littleskeptical before that happens.
Well, today I'm joined by aspecial guest, Dr.
(02:14):
Adam Sifu.
He's really a kindred soul tome.
We write about slightlydifferent topics, but we
approach it with that same kindof show me the evidence
approach.
And he has reviewed a lot abouthow medicine seems to frequently
reverse course, and we're goingto explore that here today.
(02:38):
So welcome Adam Sifu.
Dr.
Sifu's professor of medicine andgeneral internist at the
University of Chicago.
He received his MD degree fromCornell Medical College,
completed his residency trainingat Beth Israel Hospital in
Boston, then joined the facultyat the University of Chicago.
He's the author of over 140peer-reviewed publications.
(03:01):
And he co-authored a book aboutmedical decision making for the
lay audience, Ending MedicalReversal.
He has a great Substack columnthat he does with several others
called Sensible Medicine.
It's wonderfully written.
He has a dry sense of humor, andhe has key insights into the
(03:21):
practice of medicine.
Some of the recent articles areWhat New Medical Students Should
Know, The Cult of a HealthyLifestyle and Celebrity Doctors,
and Flaws in recent studies thathave grabbed headlines.
Welcome, Adam.
SPEAKER_00 (03:38):
Thanks so much, Bobby.
It's wonderful to be here.
And I love you calling yourselfan open-minded skeptic.
That sounds like a t-shirt weshould have made.
SPEAKER_01 (03:46):
Absolutely.
I'll have merch on my uh on mypodcast website.
Although, as I'm fond of tellingmy listeners, there's no
financial gain for me.
I have no uh advertisers, nosubscriptions, no uh companies I
own.
Hopefully, I'm uh I may not beright all the time, but I
hopefully don't have a bias dueto finances.
(04:09):
And maybe tell the listeners alittle bit about sensible
medicine because it really is awonderful place to learn about
various aspects.
SPEAKER_00 (04:18):
Yeah, I think that grew out of a thinking um much
like yours.
Um we um, meaning me and a bunchof my co-editors, we were
aggravated by what we wereseeing sort of out there in the
medical information sphere,let's call it.
Um, and that actually wasn'tjust a lot of the kind of
(04:41):
internet craziness, but actuallya lot of the uh editorials and
journals and a lot of the sortof perspectives in journals, and
wanted a place where we couldsay, like, listen, you know,
what is sensible medicine?
What is medicine that isactually supported by evidence
and not supported by people whoare just trying to make a, you
(05:04):
know, a buck-off pitching thelatest supplement, or not people
who are sort of so driven bytheir politics, whether it's to
the left or the right, um, thatthat's sort of clouding their
vision about how they look atthe evidence coming through to
them.
So it's a little bit of a, hey,you know, let's return to
evidence-based medicine andlet's try to shed a lot of the
(05:28):
political noise which isactually getting in the way of
um uh medical decision-makingthese days.
SPEAKER_01 (05:33):
So with that, let's sort of dive into part one.
You wrote a whole book on this,why the medical profession
reverses course more often thanyou wish.
Now, when I tend to think aboutreversals, and I alluded to them
uh a few of them, you know, whenI uh was younger, eggs were bad,
(05:54):
shrimp was bad, lobster was bad,oops, the medical profession had
it wrong.
Yeah.
You know, then the whole peanutallergy, where for a generation
of kids we said, oh no, no,peanuts are bad, you'll get
allergies.
Well, then we realized peanutsare good, that'll prevent the
allergies, and so medicine onceagain reversed course.
And probably the most importantone is the hormone receptor,
(06:17):
hormone replacement therapy.
Um, it was a good idea, then itwas a bad idea, and now we're
trying to sort of figure out isthere elements of it that really
are good.
Right.
What are some of the reversalsthat you focus on?
And why do you think they occurmore often than I think the
average listener might think?
(06:37):
Because I tend to think, well,their doctors generally using
evidence, and the specialtysociety certainly must be uh
using evidence.
So which ones do you like andwhy do they happen?
SPEAKER_00 (06:50):
Yeah, so I think I would name two of the ones you
already named.
Um, one was hormone replacementtherapy, which is if there was
anything that kind of got meinto the whole medical reversal
sphere, it was that when I beganpracticing in the 90s.
Um we sort of looked at hormonereplacement as not an option
(07:10):
that might make people feelbetter, but basically a public
health intervention that everywoman post-menopause should
seriously consider startinghormone replacement therapy.
Um, the peanut allergy one is aspecific, is a terrific one
where we saw the AmericanAcademy of Pediatrics, you know,
recommending, you know, youcannot give your kids peanuts
(07:32):
before, you know, age X.
And, you know, in retrospect,once we had better data showed
that that probably wasresponsible for, you know, a
large percentage of the peanutallergies in a enormous in a
whole generation of children.
Um, and then maybe a more recentone is you know, a period in the
um kind of aughts, you know,2000s to early 2010s, of using
(07:58):
coronary stents for people withstable coronary disease.
These were not people who arehaving heart attacks, but these
were people who were havingangina heart pain when they
exercised.
Um, and the response that waslike, oh, we got to put a stent
in them because we can fix that.
There's a blockage and we haveto do something about that.
And then as more and more datacame out, we saw that like those
(08:19):
make sense sometimes if they'renecessary for symptoms, but they
don't change a person'slikelihood of having a heart
attack.
They don't have a change of theperson's um uh likelihood of
living sort of a long, uh long,healthy life.
Um, and I think, you know, I aminside medicine.
Um, so although I'm a skepticand I end up blaming medicine
(08:43):
for a lot of mistakes, I thinkmostly medical reversal sort of
comes from a good place.
Um, we want to do the rightthing.
The problem is sometimes we wantto do the right thing or what we
think is the right thing tooquickly.
Um, so we have a lot ofbiomedicine in our heads.
We come up with these therapiesthat make sense.
They kind of come with a good,um, you know, a good
(09:06):
biomechanical story, right?
It makes sense based on ourtextbooks and our knowledge that
something should work.
And then instead of waiting forreally robust, experimental,
randomized controlled trial datathat shows it works, we settle
for sort of, you know,reasonably good data,
observational studies, which weknow are not perfect, but we
(09:27):
feel like, oh, that's enough.
And then instead of doing, okay,we need more data, we say, let's
deploy this, let's get this outto, you know, hundreds of
thousands or millions of people.
And it's only then that, youknow, years, sometimes decades
later, do we get the real robustevidence that makes us say,
oops, you know, we were tricked.
(09:48):
Um, we've we know this shouldwork, but things really only do
work once we've shown that theydo work in actual human beings.
And we were tricked byobservational studies, which
were confounding, which show,you know, association and not
causation.
And then we have to backtrackand pull back on what we've done
or recommended.
SPEAKER_01 (10:07):
So uh for the coronary stents, so for folks
that may not know, this is goinginto your coronary arteries and
basically improving the plumbingproblems and putting something
in that helps to open them up.
And there were real studies thatshowed it helped people that had
real symptoms.
And they were in serious risk ofdying or serious risk of another
(10:29):
heart attack.
And it really worked.
And so people extrapolated andsay, well, yeah, you know,
plumbing is plumbing.
And so if you don't havesymptoms and you have a plumbing
problem, we're going to work onthat.
I can almost accept how thatunfolded.
And of course, there was arandomized trial that showed
that didn't help.
The peanut allergy problem, Ihave almost no sympathy for the
(10:53):
medical profession because as Iunderstand it, it was based upon
almost some case reports inEngland about peanuts and maybe
while the woman was pregnant.
There was, it wasn't like therewas a huge set of studies that
maybe they misinterpreted.
It was like hearsay.
And the hearsay somehow traveledacross the pond, got here, and
(11:17):
then the Academy of Pediatricssomehow ran with it with almost
no evidence.
That's one I guess hurts me morebecause it we just got on a
snowball with almost no evidenceunless I'm missing something.
SPEAKER_00 (11:33):
Right.
And I think the other reason,not to try to get you like more
irritated about it, but right,when we make mistakes, you know,
with the recommendations for ourpatients, you know, these are
sick people who are trying to dosomething good for, right?
Once we start getting out thereinto healthy people who really
(11:54):
don't need doctors at all,right?
And then start makingrecommendations that actually
turn sort of people intopatients, um, that's
particularly appalling.
And boy, then when you raise thestakes and do it with children,
right, it is awful.
Um, and the American Academy ofPediatrics is in a tough place
(12:16):
because they want to makerecommendations.
There is a desire for people tohave recommendations because
every parent in the world isnervous and wants to do the
right thing with their kids.
Um, but the fact is, right, itis really hard to get good
robust data in children.
Um, not only because childrenare mostly healthy and you need
(12:37):
to do a whole lot of things, youknow, you need a whole lot of
children to show that anyintervention works.
Um, but we're hesitant to dorandomized controlled trials on
kids, to put kids inexperimental studies.
And so the American Academy ofPediatrics has been, I think,
tempted over and over to makerecommendations based on really
sketchy evidence, whether it's,you know, peanut consumption or
(13:01):
screen time or, you know, how todiscipline your children.
SPEAKER_01 (13:06):
So let's kind of shift from the medical
profession reversing itself.
And I think for me, thetake-home message is listen to
your doctor, be aware of theseguidelines, but also still ask
questions.
You know, is there real evidenceto support what you're asking me
(13:27):
to do or not do?
Understanding that sometimeswhat those specialty groups tell
us turn out to be false.
It doesn't mean all the timethey turn out to be false, but
it's more often than we'd like.
So be an uh open-minded skepticas you approach your doctor and
the recommendations you hear.
All right.
So that's the kind of mainstreammedicine.
(13:50):
Now we're going to shift to parttwo, and what I will call the
non-mainstream medicine, whichis social media experts, and the
hype that we hear so much overand over and over again.
And you alluded to a couple ofthe, I think, the undergirding
issues.
So I put together this umformula that I talked about in a
(14:14):
previous podcast where you endup in this mess of all this hype
because you have a cool theory.
Yeah.
Heart disease is a plumbingproblem.
If you've got blockages, we mustimprove your the your plumbing.
So you have a cool theory, itmakes eminent sense.
Then you have anecdotes.
(14:34):
Oh, well, this person wasexposed to peanuts.
And look what happened to littleJohnny over the course of years.
And then you hear about littleSally and little Andrew, and all
of a sudden you've got a wholebunch of these compelling
anecdotes.
And then you've got somecredentialed expert in what we
were talking about in part one.
That was a specialty academy.
(14:55):
But it could just be somebody onthe internet with a doctor next
to their name, likely not amedical physician, could be a
nutrition person, it could be achiropractor.
So now we've got the thirdelement: cool theory, compelling
anecdote.
And now we have a credentialexpert.
And we're led to believe that'sequal to evidence, credible
(15:15):
evidence.
And as my listeners know, and asyou and I both feel deep in our
hearts, that is an interestingset of theories.
But until it's tested in humans,it um isn't evidence.
So, Adam, where do you see hypein this sort of outside of
mainstream medicine locations?
SPEAKER_00 (15:37):
Let me even before I answer that, uh, you know, you
wrote a very cool article kindof about this idea on sensible
medicine, which I I loved and Iwould definitely point your your
listeners to.
Um this is such an interestingsort of subtle difference from
how I usually think of reversal,because when I talked about
(15:58):
reversal, it's mostly you knowwithin medicine.
Um it's really strong, you know,biomedical reasoning, you know,
bioplausible, whether it'sintervention, diagnostic, tests,
whatever, which is then combinedwith data, which isn't um, you
(16:18):
know, sort of hard and fastdata.
It's usually observational data,it's data with some some flaws,
but it's data.
Um, when we get into the worldof, you know, not to mince
words, but you know, internetcharlatans, right?
Um, every step in that processis worse.
So instead of there being reallyum good bioplausibility based on
(16:42):
real science, often there'slike, oh, this is a catchy idea,
right?
This is something I can sell.
And then instead of there beingactual data, you know, and
observational data withthousands of people, there is,
as you say, an anecdote, okay?
And anecdotes, you know, we aspeople, we love stories and we
love to make relationships.
So we sort of jump on thatanecdote.
(17:04):
And then, yes, you normally havevery polished people, you know,
with very good sound quality,very good video quality, people
spending a lot of time on theediting.
So it looks really good as well.
Um, your your question was likewhere I see this the most, or
maybe where I get irritated themost.
You know, I think where I seethis the most is certainly in
(17:25):
the whole longevity sphere,right?
Um, most of us, if we can do itin a healthy way, that we're
enjoying ourselves, we want tolive longer.
Um, but you think about what itwould take to show that
something makes people livelonger, right?
You need a lot of people and youneed to follow them for a long
time to show that peopleactually live longer.
That's super expensive.
(17:46):
Nobody's investing in that thesedays.
Um and then maybe as part ofthat, you know, the whole cancer
screening thing, we'reinterested in living longer.
Cancer scares everybody.
Um, and a lot of people are verysusceptible to a pitch that, oh,
here's a new test you can get.
And if you get through this testand you you're shown to not have
(18:09):
cancer, you'll feel better,you'll be more relaxed, and
we'll guarantee that you'll livelonger.
And if we find something, maybewe can treat that and and you
know, cure your cancer um early.
SPEAKER_01 (18:22):
So I if you think back over the last number of
years, I mean, vitamin C wastouted by lots and lots of
people from Linus Pauling ondown.
But we don't hear too much aboutvitamin C solves everything.
I would say the ones that reallybother me today, one is all
(18:42):
things mitochondria.
You know, you get older, yourmitochondria wear out.
That can't be good.
They're the energy powerhouse.
You want energy.
Oh, by the way, I've got asupplement for you.
Those really bother me a lot.
Um, everything, almosteverything related to the
microbiome to me is still in thetheory stage and maybe will turn
(19:06):
out to be critical for somepatients.
We know some patients it is.
So that's a second area.
And the third that's getting somuch attention now are these
biologic clocks.
We're gonna look at your, youknow, your DNA and your your um
uh all the things, and we'regonna tell you how old you are,
and then we're gonna give youour mitochondrial supplement,
(19:28):
and those blood tests are gonnaget better without, again, any
evidence that in people itreally makes a difference.
Those are some of the ones thatreally upset me today.
I may turn out to be wrong andthey may turn out to be right,
but as an open-minded skeptic, Istart with the assumption it
that it's not ready for primetime.
unknown (19:48):
Right.
SPEAKER_00 (19:49):
And they are interesting things, right?
Uh I mean, I would like to knowwhat causes aging, right?
Um, we have a lot of markersthat we can follow that show
when people are getting older,when show people are becoming
frailer.
I would love to know what'sbehind that.
And I'd love to see whatactually helps it.
Um, the problem is these areall, you know, such soft
(20:13):
theories.
Um, and the idea that we knowwhat to do to, you know, halt
aging, and that we can dosomething that actually works at
the right place in the righttime to make a difference, we
have no idea right now.
And it's frustrating, but it'sunfortunately true.
SPEAKER_01 (20:33):
So I wasn't in medicine 60 years ago.
I certainly wasn't around 100years ago.
There's always been snake oilsalesmen, which apparently one
of the stories of snake oilsalesmen was it wasn't actually
snake oil, it was something elsethey said.
Oh, by the way, it came fromthis very special snake and it's
(20:54):
therefore very expensive.
I guess the question to for meis are there more snake oil
salesmen now than before?
Or is it just that because ofsocial media, it's a part of our
lives more than ever before?
What do you think?
SPEAKER_00 (21:10):
Yeah, I I think it is probably both.
Um, you know, it is so mucheasier to become a snake oil
salesman these days, right?
In the past, you had to, youknow, buy a horse and a covered
wagon and go from town to town.
SPEAKER_01 (21:23):
Exactly.
SPEAKER_00 (21:24):
Um, and now what does it take?
You know, it takes an internetconnection, a Twitter account,
and and you're there.
Um, I think it's also veryattractive because it is really
quite easy to make money thesedays, right?
Um on social media, um, youknow, if you're good at it, you
can get a pretty good audiencepretty quickly.
(21:46):
It's not that hard now to turnclicks into a little bit of
money.
Um, and so this is something youknow people can do in a couple
of hours after work.
And then if they're successful,they can turn this into a
full-time job where they canreally sort of churn out content
across multiple, multipleplatforms, get people paying
attention to them, and make areasonable amount of money.
SPEAKER_01 (22:08):
Yeah, it's everywhere.
So I want to now turn to partthree, which is in essence the
antidote to the problems we'vetalked about.
So, you know, what can youbelieve?
So, what should our listenerstake from this and where can
they get some answers?
So, for me, since a lot of thetopics that people get excited
(22:29):
about are nutrition related, um,I really like the website
examine.com.
Uh, I think they do a crediblejob of summarizing evidence and
bringing, you know, to mearticles that I might not have
looked at.
Yes, if they have a study ofeight people, uh, I don't make
much out of it.
(22:50):
But I think that's a kind of afirst place that I go to.
What about you?
Are there any uh sites that youtrust?
SPEAKER_00 (23:00):
Right.
So so that is a terrific site,which I do absolutely send
people to.
So I would underline that.
Before I even give sites, Iwould say that especially in the
realm of nutrition, um, it'smaybe one place that I would
say, boy, you know, you shouldbe somewhere between a
minimalist and a nihilist,right?
(23:22):
Um we are a successful specieswho have evolved over, you know,
tens of thousands of years.
Um, and what we need to eat isis really not complicated,
right?
Um uh you know, I would say wewe need to eat well, we need to
(23:44):
eat a diverse diet, um, right?
We need to make sure that we'renot eating things that are going
to lead to obesity, stay awayfrom a lot of the concentrated
um sweets that are sort of builtinto so many of our diets today.
Um when we've actually studiednutritional interventions, it
has been very, very, verydifficult to show that one thing
(24:06):
versus another thing makes awhole lot of difference.
Um I think that most patients Isee, if I sit them down and I
say, hey, let's go through yourdiet, um, they will tell me
things that they're very proudof, the things that they're
mostly making at home, um, thethings that they're buying, you
know, grains and fruit andvegetables and meat and fish at
(24:29):
the market and making forthemselves, and they're sort of
proud of that.
Um, and then they will be kindof quiet when they talk about
the fast food they're eating,you know, the three Big Macs
they've had in the last week,um, maybe the hyper-processed
sugary cereal that theysometimes eat in the morning.
You know, most people know whatthey should and should not be
(24:52):
doing.
So I think um we might actuallybe looking for too much
information about nutrition, andwe should just rely on some of
our common sense.
SPEAKER_01 (25:03):
So if we move beyond nutrition and where to find a
good answer, there's a myriad ofother things.
You know, I have tennis elbowand and it's not getting better.
Should I get an injectionbecause one of my doctors says
we should inject it?
You know, or I have back painand I've tried this, that, and
the other, and I'm not gettingbetter.
Um, you know, there's obviouslythe newsletters or news sources
(25:27):
within major academicinstitutions.
There's a Harvard newsletter anda Mayo and a Medscape is out
there.
Do any of those sources is isthat a reasonable place for
folks to begin?
And can you trust what you readthere?
SPEAKER_00 (25:44):
I think those are reasonable places to begin.
Um the two the things that Iwould say my patients tell me
the most about those sites,which I really do understand, is
um they're very good for tellingyou options.
Um, they tend to be uh prettygeneric, right?
Um any care that you're getting,you know, on the internet, let's
(26:08):
say, is sort of meant to be forthe average patient.
Um, and anybody who's writingthose sites is going to be very
careful about giving actualadvice to an individual reader.
So many times they will say, youknow, your doctor might
recommend this or mightrecommend this, or might
recommend this.
You know, here are the plusesand minuses of those.
(26:31):
You do have to be a little bitum cautious about things like
the Harvard site and the Mayosite and the Cleveland Clinic
site.
Um, because yes, they are tryingto sort of polish their brand,
but they are also recruitingpatients, right?
So they are trying to say, oh,you know, we are terrific at
(26:52):
this, and this may then bepitched over some of the other
things.
Um, but I do think using thosesites to get a sense of, okay,
you know, what is tennis elbow?
How did I get tennis elbow?
What are the possibilities totreat this?
So when you go actually and dosee your doctor, you'll be armed
with a lot of knowledge.
And that whole conversation,which may be limited to 20
(27:14):
minutes, you know, can start alittle further on.
SPEAKER_01 (27:18):
So, okay, those are a couple of places to begin.
But now we all have Chat GPT orClaude or Grok or whichever one
you happen to like.
And they really have gottenbetter and better over the last
couple of years.
And when I'm looking at asubject, I do go to the deep
part of Chat GPT because I find,you know, you have to be very
(27:40):
careful because it does inventreferences and it does invent
studies that don't exist.
So you have to be very careful.
But it does bring up aspects ofwhatever I'm looking at that I
wouldn't necessarily havethought of.
Oh, you mean there's anotherreason to be scared of
ultra-processed foods?
I was thinking of these three,but it added one or two or three
(28:01):
more.
What do you think about thevarious chat uh capabilities?
Is that something that potentialpatients should trust?
SPEAKER_00 (28:11):
I do.
Um, again, I think that mostpeople are not going to take
something off there and say,okay, this is the treatment I'm
going with.
They're using those to educatethem, which is I think is
appropriate.
My experience with most of thosetools has been actually quite
positive.
The places where I've struggledwith them are in sort of the
(28:36):
break-in news.
Um, you know, new studies comeout which are just being
interpreted.
And, you know, those aregathering information from
across the internet.
And very often the first peopleto weigh in on studies are not
right, right?
(28:56):
Um, they're reading them for aspecific reason, they have a
specific bias.
And if you go to ChatGPT orClaude or Perplexus, whatever,
that's going to just echo thatbias.
And so I think the tools we haveright now are probably much
better for the um, you know,older, bigger, bigger, you know,
(29:20):
sort of 10,000 foot views um uhtype questions.
I, you know, with my trainees,um use open evidence a ton,
which is unfortunately notsomething which is kind of you
know widely available to the tothe lay public.
What open evidence does is itworks as just your your usual AI
(29:42):
tool, but it just draws fromPubMed, right?
It just draws from um umarticles published at a certain
level of the medical literature,and that gives actually very
good guidance.
Um, we often run things by thoseas sort of a checked.
ourselves, you know, are wemissing something?
(30:02):
Or boy, this is a topic I knowabsolutely nothing about.
You know, let me start and I'llget an answer and I'll get
actual real references fromwhere the these answers have
been drawn from that then I canuse to sort of begin to educate
myself.
SPEAKER_01 (30:17):
I think you raised um a way of thinking about this
that's really quite excellent.
Uh it's is the knowledge I'mtrying to understand something
that's been around for a while,or is it kind of late breaking?
And so when I think about it, Ithink about well, this issue of
vitamin D or vitamin C reducingmy risk of cancer.
(30:38):
This is not a new question.
And there have been studies.
And so there are places on theweb that you can find a summary
of the evidence.
It might be a meta-analysis.
I like Cochrane reviews if theyhappen to be available.
And for listeners of CochraneReview are these centers around
the world that specialize incertain topics and they're
(30:59):
always abreast of all the latestinformation on it.
There may be even a tennis elbowsite for all I know.
And you know they'llperiodically summarize the
evidence.
But these are kind oflongstanding questions.
Where I think as you point out,it's a different ball game is
new information.
So the the latest one is Tylenoland whether it causes autism.
(31:24):
You know, you can read agovernment report, you can read
a couple people's views of it,but this is what I would say is
not yet a knowable you knowthere's some information out
there.
I personally don't believe it'sa big issue.
It has gotten a lot ofattention.
But I think there's a realdifficulty when it's something
new and we're not sure then youcould get yourself into trouble.
(31:48):
And that's where as always talkto your doctor your doctor
hopefully is a little more intouch with kind of what's the
proper answer.
SPEAKER_00 (31:57):
I I'm going to just bounce two things off of you.
I I I I love you referencingCochrane.
One of the things that I I thinkfind most useful about the
Cochrane, you know, theirmeta-analysis, their reviews of
topics is that very often theycome out with we don't know.
(32:18):
And that is super interestingthat is super helpful in today's
medical information environmentbecause you'll hear people
saying like this is the thing todo, this is the thing to do.
You'll go to Cochrane, Cochranewill have looked at you know 30
trials on the topic and they'llsay there's no answer, right?
And what you learn from that isthat wow, you know, these people
(32:41):
who are pushing it for onereason or another are doing it
not based on data, but on eithertheir own beliefs or their own
self-interest in making moneyoff of their recommendations.
SPEAKER_01 (32:52):
Boy does that make sense.
Okay so that is a perfect segueinto our part four topic.
All right so you're faced with asituation where the evidence
isn't so clear.
And I am really fond of the endof one approach of testing it in
yourself.
Obviously you're not going totest a new chemotherapy drug in
(33:14):
yourself if you have metastaticcancer.
There are times and places andsituations where testing in
yourself is the only way to knowbecause the evidence is either
uncertain or maybe some patientsdo well, some patients don't.
So I'll throw out a couple ofareas that I tend to love for
people when the evidence isn'tobvious.
(33:37):
Well I have high blood pressureshould I cut out salt in my
diet?
Every doctor says that but thereality is probably 25% or more
if people aren't salt sensitive.
And I happen to be one of thoseand I enjoy salt.
The only way to do it is to testit in yourself.
Well what about melatonin tohelp my sleep well in the big
(33:58):
studies it improves your fallingasleep by five or 10 minutes.
But that doesn't mean somepeople don't get a half hour
benefit and some people get zerobenefit.
Again, the only way you're goingto figure it out is by testing
in yourself.
And then the other popular oneis oh cut out saturated fats
because that raises cholesterolmaybe on population levels or
(34:22):
something to that, but notnecessarily on an individual
level.
And so what I suggest to peopleis if the evidence isn't clear
and you think there may be someheterogeneity some people and
some people don't then find away of measuring it.
So it's got to be objective.
You can't just say well I triedthe melatonin and I think it
(34:43):
worked.
So you have to have a way tomeasure your baseline and you
have to have a way of then doingyour new intervention and then
you test it again and if you'rereally ambitious then you stop
it and you test it again thenyou restart it and you test it
again.
But as I alluded to you can't doit for every illness so it has
(35:04):
to be something that's ameasurable and b short term.
So sleep is a good one.
You can do a sweetquestionnaire, you can have an
aura ring or something likethat.
If it's a blood pressurequestion you can measure your
blood pressure and all thosethings are going to be obvious
within a week or two or three.
Now you can't do that inyourself for hormone receptor
(35:26):
hormone replacement therapy andyour bone health because that's
a 10, 20, 30 year propositionand you can't test it.
Are you using N of oneapproaches with your patients?
And then for folks on thispodcast, would it be useful for
them?
SPEAKER_00 (35:43):
Right.
So I am using N of one um trialsand I would say I may look at
them a little bit different fromyou.
Okay, great.
Because what I do with mypatients is is I sort of figure
out at the beginning you know,are we looking for something
that we can objectively measureor are we looking at something
(36:04):
which is truly subjectivebecause I would say you know I
don't know a third of thetreatments I offer you know in
my clinic are truly just to makesomeone feel better.
SPEAKER_01 (36:17):
But subjective doesn't mean unmeasurable you
can have an anxietyquestionnaire.
You can have a daytimesleepiness questionnaire.
They're widely available I justthink we need to quantify it.
SPEAKER_00 (36:30):
Right.
But the reason to point this outis that um when people can say I
stopped drinking and my you knowI have graphs of my sleep from
my Apple Watch right that tendsto be very powerful and really
impacts people.
Okay.
If it's two weeks on gabapentinand two weeks off gabapentin for
(36:53):
their peripheral neuropathy,right?
Sometimes just the sense of oh Iwas feeling a little bit better
or I was not feeling a littlebit better seems less important
to the person.
And they may not remember thatas well may not use that as as
much going forward.
And so I do try to make it asyou say as objective as
(37:15):
possible.
Keep a symptom diary, right?
Have something that you'rewriting down which you can hold
on to then so then you can goback to it when a year later
you're considering I'm on a tonof medications do I really need
this anymore and you can remindyourself that I'm taking this
medication because I made thedecision that it was useful to
me.
Doesn't mean you can't stop itbut you have a good sense of of
(37:39):
why I'm using each medicationyou're using.
SPEAKER_01 (37:42):
I completely agree.
Well I think it's time to wrapup here it's very clear we live
in a sea of health and wellnessinformation.
Some is accurate a lotexaggerated and some is frankly
wrong and will be reversed.
I will continue to be anopen-minded skeptic and perhaps
(38:02):
you will too.
Adam I think you raised a reallyimportant point when an article
says you know we just don't knowthat says a lot about the type
of person who did the work.
And I think if you're on theinternet and you're getting a
very one-sided this is obviouslythe answer to weight loss or
(38:24):
fatigue or whatever it might be,if there's not that kind of
humility of we just don't know,but you might try this, then I
would shop elsewhere.
I just think that's a red flagif there's no humility around
the recommendation.
That's kind of my take on it.
SPEAKER_00 (38:44):
Adam any kind of final words for the audience
right some someone who seemslike they're trying to tune you
into the location of thefountain of youth that like
nobody else knows about this,you know, and if you do this
little hack everything will bebetter.
SPEAKER_01 (38:59):
You gotta understand that that's probably not worth
listening to that's the best wayto end this.
So please my audience send mequestions or ideas or emails
about kind of podcast issues.
I am trying to put together aquestionnaire on whether the
(39:20):
work that you're hearing from meand my guests is changing your
life in any way?
Is it improving your health inany way?
As I said, I don't have anyfinancial part of this where my
joy is when people let me knowthat their lives have improved
in some way.
So if you'll send me some ideasabout that then I'm ultimately
going to put together aquestionnaire, send it out to
(39:42):
you, my audience, see what youthink and then I'll share the
results with you.
And if you like the podcast, byall means share it with others.
I'm now on YouTube.
You can uh watch it there I'm onsubs I have a sub stack as well
you can find articles I'vewritten there or on my website.
So until next time I hope youall live long and well and
(40:05):
perhaps um uh become a littlebit of optimistic but skeptical
uh folks until next time thanksso much for listening to Live
Long and Well with Dr.
Bobby if you like this episodeplease provide a review on Apple
(40:26):
or Spotify or wherever youlisten.
If you want to continue thisjourney or want to receive my
newsletter on practical andscientific ways to improve your
health and longevity pleasevisit me at DrBobby
Livelongandwell dot com.
That's doctor as in Dr BobbyLivelongandwell dot com
A new study shows a supplement can help us live
(00:04):
longer.
Medical societies say avoidpeanuts for kids, then reverses
course years later.
Hormone replacement therapy ishelpful, then it's harmful, and
now the pendulum has begunswinging back towards benefit.
What are you supposed tobelieve?
How can you separate fact fromfancy?
(00:25):
Let's find out.
Hi, I'm Dr.
Bobby Du Bois, and welcome toLive Long and Well, a podcast
where we will talk about whatyou can do to live as long as
(00:45):
possible and with as much energyand vigor that you wish.
Together we will explore whatpractical and evidence-supported
steps you can take.
Come join me on this veryimportant journey, and I hope
that you feel empowered alongthe way.
I'm a physician, Iron Mantriathlete, and have published
(01:09):
several hundred scientificstudies.
I'm honored to be your guide.
More often than you might think,the medical profession seems to
(01:30):
reverse course.
Kids should avoid peanuts.
No, they shouldn't avoidpeanuts.
Now Tylenol is unsafe duringpregnancy.
Hormone replacement therapy isgood, then bad.
Now is it okay again?
And podcasters pout the latestsupplements to improve energy or
that probiotics will help youcure chronic complaints.
(01:53):
And the headlines in the newsmedia amplify these various
twists and turns.
I tend to be an open-mindedskeptic.
Show me the evidence, and I'mwilling to change my mind.
But in general, I'm a littleskeptical before that happens.
Well, today I'm joined by aspecial guest, Dr.
(02:14):
Adam Sifu.
He's really a kindred soul tome.
We write about slightlydifferent topics, but we
approach it with that same kindof show me the evidence
approach.
And he has reviewed a lot abouthow medicine seems to frequently
reverse course, and we're goingto explore that here today.
(02:38):
So welcome Adam Sifu.
Dr.
Sifu's professor of medicine andgeneral internist at the
University of Chicago.
He received his MD degree fromCornell Medical College,
completed his residency trainingat Beth Israel Hospital in
Boston, then joined the facultyat the University of Chicago.
He's the author of over 140peer-reviewed publications.
(03:01):
And he co-authored a book aboutmedical decision making for the
lay audience, Ending MedicalReversal.
He has a great Substack columnthat he does with several others
called Sensible Medicine.
It's wonderfully written.
He has a dry sense of humor, andhe has key insights into the
(03:21):
practice of medicine.
Some of the recent articles areWhat New Medical Students Should
Know, The Cult of a HealthyLifestyle and Celebrity Doctors,
and Flaws in recent studies thathave grabbed headlines.
Welcome, Adam.
SPEAKER_00 (03:38):
Thanks so much, Bobby.
It's wonderful to be here.
And I love you calling yourselfan open-minded skeptic.
That sounds like a t-shirt weshould have made.
SPEAKER_01 (03:46):
Absolutely.
I'll have merch on my uh on mypodcast website.
Although, as I'm fond of tellingmy listeners, there's no
financial gain for me.
I have no uh advertisers, nosubscriptions, no uh companies I
own.
Hopefully, I'm uh I may not beright all the time, but I
hopefully don't have a bias dueto finances.
(04:09):
And maybe tell the listeners alittle bit about sensible
medicine because it really is awonderful place to learn about
various aspects.
SPEAKER_00 (04:18):
Yeah, I think that grew out of a thinking um much
like yours.
Um we um, meaning me and a bunchof my co-editors, we were
aggravated by what we wereseeing sort of out there in the
medical information sphere,let's call it.
Um, and that actually wasn'tjust a lot of the kind of
(04:41):
internet craziness, but actuallya lot of the uh editorials and
journals and a lot of the sortof perspectives in journals, and
wanted a place where we couldsay, like, listen, you know,
what is sensible medicine?
What is medicine that isactually supported by evidence
and not supported by people whoare just trying to make a, you
(05:04):
know, a buck-off pitching thelatest supplement, or not people
who are sort of so driven bytheir politics, whether it's to
the left or the right, um, thatthat's sort of clouding their
vision about how they look atthe evidence coming through to
them.
So it's a little bit of a, hey,you know, let's return to
evidence-based medicine andlet's try to shed a lot of the
(05:28):
political noise which isactually getting in the way of
um uh medical decision-makingthese days.
SPEAKER_01 (05:33):
So with that, let's sort of dive into part one.
You wrote a whole book on this,why the medical profession
reverses course more often thanyou wish.
Now, when I tend to think aboutreversals, and I alluded to them
uh a few of them, you know, whenI uh was younger, eggs were bad,
(05:54):
shrimp was bad, lobster was bad,oops, the medical profession had
it wrong.
Yeah.
You know, then the whole peanutallergy, where for a generation
of kids we said, oh no, no,peanuts are bad, you'll get
allergies.
Well, then we realized peanutsare good, that'll prevent the
allergies, and so medicine onceagain reversed course.
And probably the most importantone is the hormone receptor,
(06:17):
hormone replacement therapy.
Um, it was a good idea, then itwas a bad idea, and now we're
trying to sort of figure out isthere elements of it that really
are good.
Right.
What are some of the reversalsthat you focus on?
And why do you think they occurmore often than I think the
average listener might think?
(06:37):
Because I tend to think, well,their doctors generally using
evidence, and the specialtysociety certainly must be uh
using evidence.
So which ones do you like andwhy do they happen?
SPEAKER_00 (06:50):
Yeah, so I think I would name two of the ones you
already named.
Um, one was hormone replacementtherapy, which is if there was
anything that kind of got meinto the whole medical reversal
sphere, it was that when I beganpracticing in the 90s.
Um we sort of looked at hormonereplacement as not an option
(07:10):
that might make people feelbetter, but basically a public
health intervention that everywoman post-menopause should
seriously consider startinghormone replacement therapy.
Um, the peanut allergy one is aspecific, is a terrific one
where we saw the AmericanAcademy of Pediatrics, you know,
recommending, you know, youcannot give your kids peanuts
(07:32):
before, you know, age X.
And, you know, in retrospect,once we had better data showed
that that probably wasresponsible for, you know, a
large percentage of the peanutallergies in a enormous in a
whole generation of children.
Um, and then maybe a more recentone is you know, a period in the
um kind of aughts, you know,2000s to early 2010s, of using
(07:58):
coronary stents for people withstable coronary disease.
These were not people who arehaving heart attacks, but these
were people who were havingangina heart pain when they
exercised.
Um, and the response that waslike, oh, we got to put a stent
in them because we can fix that.
There's a blockage and we haveto do something about that.
And then as more and more datacame out, we saw that like those
(08:19):
make sense sometimes if they'renecessary for symptoms, but they
don't change a person'slikelihood of having a heart
attack.
They don't have a change of theperson's um uh likelihood of
living sort of a long, uh long,healthy life.
Um, and I think, you know, I aminside medicine.
Um, so although I'm a skepticand I end up blaming medicine
(08:43):
for a lot of mistakes, I thinkmostly medical reversal sort of
comes from a good place.
Um, we want to do the rightthing.
The problem is sometimes we wantto do the right thing or what we
think is the right thing tooquickly.
Um, so we have a lot ofbiomedicine in our heads.
We come up with these therapiesthat make sense.
They kind of come with a good,um, you know, a good
(09:06):
biomechanical story, right?
It makes sense based on ourtextbooks and our knowledge that
something should work.
And then instead of waiting forreally robust, experimental,
randomized controlled trial datathat shows it works, we settle
for sort of, you know,reasonably good data,
observational studies, which weknow are not perfect, but we
(09:27):
feel like, oh, that's enough.
And then instead of doing, okay,we need more data, we say, let's
deploy this, let's get this outto, you know, hundreds of
thousands or millions of people.
And it's only then that, youknow, years, sometimes decades
later, do we get the real robustevidence that makes us say,
oops, you know, we were tricked.
(09:48):
Um, we've we know this shouldwork, but things really only do
work once we've shown that theydo work in actual human beings.
And we were tricked byobservational studies, which
were confounding, which show,you know, association and not
causation.
And then we have to backtrackand pull back on what we've done
or recommended.
SPEAKER_01 (10:07):
So uh for the coronary stents, so for folks
that may not know, this is goinginto your coronary arteries and
basically improving the plumbingproblems and putting something
in that helps to open them up.
And there were real studies thatshowed it helped people that had
real symptoms.
And they were in serious risk ofdying or serious risk of another
(10:29):
heart attack.
And it really worked.
And so people extrapolated andsay, well, yeah, you know,
plumbing is plumbing.
And so if you don't havesymptoms and you have a plumbing
problem, we're going to work onthat.
I can almost accept how thatunfolded.
And of course, there was arandomized trial that showed
that didn't help.
The peanut allergy problem, Ihave almost no sympathy for the
(10:53):
medical profession because as Iunderstand it, it was based upon
almost some case reports inEngland about peanuts and maybe
while the woman was pregnant.
There was, it wasn't like therewas a huge set of studies that
maybe they misinterpreted.
It was like hearsay.
And the hearsay somehow traveledacross the pond, got here, and
(11:17):
then the Academy of Pediatricssomehow ran with it with almost
no evidence.
That's one I guess hurts me morebecause it we just got on a
snowball with almost no evidenceunless I'm missing something.
SPEAKER_00 (11:33):
Right.
And I think the other reason,not to try to get you like more
irritated about it, but right,when we make mistakes, you know,
with the recommendations for ourpatients, you know, these are
sick people who are trying to dosomething good for, right?
Once we start getting out thereinto healthy people who really
(11:54):
don't need doctors at all,right?
And then start makingrecommendations that actually
turn sort of people intopatients, um, that's
particularly appalling.
And boy, then when you raise thestakes and do it with children,
right, it is awful.
Um, and the American Academy ofPediatrics is in a tough place
(12:16):
because they want to makerecommendations.
There is a desire for people tohave recommendations because
every parent in the world isnervous and wants to do the
right thing with their kids.
Um, but the fact is, right, itis really hard to get good
robust data in children.
Um, not only because childrenare mostly healthy and you need
(12:37):
to do a whole lot of things, youknow, you need a whole lot of
children to show that anyintervention works.
Um, but we're hesitant to dorandomized controlled trials on
kids, to put kids inexperimental studies.
And so the American Academy ofPediatrics has been, I think,
tempted over and over to makerecommendations based on really
sketchy evidence, whether it's,you know, peanut consumption or
(13:01):
screen time or, you know, how todiscipline your children.
SPEAKER_01 (13:06):
So let's kind of shift from the medical
profession reversing itself.
And I think for me, thetake-home message is listen to
your doctor, be aware of theseguidelines, but also still ask
questions.
You know, is there real evidenceto support what you're asking me
(13:27):
to do or not do?
Understanding that sometimeswhat those specialty groups tell
us turn out to be false.
It doesn't mean all the timethey turn out to be false, but
it's more often than we'd like.
So be an uh open-minded skepticas you approach your doctor and
the recommendations you hear.
All right.
So that's the kind of mainstreammedicine.
(13:50):
Now we're going to shift to parttwo, and what I will call the
non-mainstream medicine, whichis social media experts, and the
hype that we hear so much overand over and over again.
And you alluded to a couple ofthe, I think, the undergirding
issues.
So I put together this umformula that I talked about in a
(14:14):
previous podcast where you endup in this mess of all this hype
because you have a cool theory.
Yeah.
Heart disease is a plumbingproblem.
If you've got blockages, we mustimprove your the your plumbing.
So you have a cool theory, itmakes eminent sense.
Then you have anecdotes.
(14:34):
Oh, well, this person wasexposed to peanuts.
And look what happened to littleJohnny over the course of years.
And then you hear about littleSally and little Andrew, and all
of a sudden you've got a wholebunch of these compelling
anecdotes.
And then you've got somecredentialed expert in what we
were talking about in part one.
That was a specialty academy.
(14:55):
But it could just be somebody onthe internet with a doctor next
to their name, likely not amedical physician, could be a
nutrition person, it could be achiropractor.
So now we've got the thirdelement: cool theory, compelling
anecdote.
And now we have a credentialexpert.
And we're led to believe that'sequal to evidence, credible
(15:15):
evidence.
And as my listeners know, and asyou and I both feel deep in our
hearts, that is an interestingset of theories.
But until it's tested in humans,it um isn't evidence.
So, Adam, where do you see hypein this sort of outside of
mainstream medicine locations?
SPEAKER_00 (15:37):
Let me even before I answer that, uh, you know, you
wrote a very cool article kindof about this idea on sensible
medicine, which I I loved and Iwould definitely point your your
listeners to.
Um this is such an interestingsort of subtle difference from
how I usually think of reversal,because when I talked about
(15:58):
reversal, it's mostly you knowwithin medicine.
Um it's really strong, you know,biomedical reasoning, you know,
bioplausible, whether it'sintervention, diagnostic, tests,
whatever, which is then combinedwith data, which isn't um, you
(16:18):
know, sort of hard and fastdata.
It's usually observational data,it's data with some some flaws,
but it's data.
Um, when we get into the worldof, you know, not to mince
words, but you know, internetcharlatans, right?
Um, every step in that processis worse.
So instead of there being reallyum good bioplausibility based on
(16:42):
real science, often there'slike, oh, this is a catchy idea,
right?
This is something I can sell.
And then instead of there beingactual data, you know, and
observational data withthousands of people, there is,
as you say, an anecdote, okay?
And anecdotes, you know, we aspeople, we love stories and we
love to make relationships.
So we sort of jump on thatanecdote.
(17:04):
And then, yes, you normally havevery polished people, you know,
with very good sound quality,very good video quality, people
spending a lot of time on theediting.
So it looks really good as well.
Um, your your question was likewhere I see this the most, or
maybe where I get irritated themost.
You know, I think where I seethis the most is certainly in
(17:25):
the whole longevity sphere,right?
Um, most of us, if we can do itin a healthy way, that we're
enjoying ourselves, we want tolive longer.
Um, but you think about what itwould take to show that
something makes people livelonger, right?
You need a lot of people and youneed to follow them for a long
time to show that peopleactually live longer.
That's super expensive.
(17:46):
Nobody's investing in that thesedays.
Um and then maybe as part ofthat, you know, the whole cancer
screening thing, we'reinterested in living longer.
Cancer scares everybody.
Um, and a lot of people are verysusceptible to a pitch that, oh,
here's a new test you can get.
And if you get through this testand you you're shown to not have
(18:09):
cancer, you'll feel better,you'll be more relaxed, and
we'll guarantee that you'll livelonger.
And if we find something, maybewe can treat that and and you
know, cure your cancer um early.
SPEAKER_01 (18:22):
So I if you think back over the last number of
years, I mean, vitamin C wastouted by lots and lots of
people from Linus Pauling ondown.
But we don't hear too much aboutvitamin C solves everything.
I would say the ones that reallybother me today, one is all
(18:42):
things mitochondria.
You know, you get older, yourmitochondria wear out.
That can't be good.
They're the energy powerhouse.
You want energy.
Oh, by the way, I've got asupplement for you.
Those really bother me a lot.
Um, everything, almosteverything related to the
microbiome to me is still in thetheory stage and maybe will turn
(19:06):
out to be critical for somepatients.
We know some patients it is.
So that's a second area.
And the third that's getting somuch attention now are these
biologic clocks.
We're gonna look at your, youknow, your DNA and your your um
uh all the things, and we'regonna tell you how old you are,
and then we're gonna give youour mitochondrial supplement,
(19:28):
and those blood tests are gonnaget better without, again, any
evidence that in people itreally makes a difference.
Those are some of the ones thatreally upset me today.
I may turn out to be wrong andthey may turn out to be right,
but as an open-minded skeptic, Istart with the assumption it
that it's not ready for primetime.
unknown (19:48):
Right.
SPEAKER_00 (19:49):
And they are interesting things, right?
Uh I mean, I would like to knowwhat causes aging, right?
Um, we have a lot of markersthat we can follow that show
when people are getting older,when show people are becoming
frailer.
I would love to know what'sbehind that.
And I'd love to see whatactually helps it.
Um, the problem is these areall, you know, such soft
(20:13):
theories.
Um, and the idea that we knowwhat to do to, you know, halt
aging, and that we can dosomething that actually works at
the right place in the righttime to make a difference, we
have no idea right now.
And it's frustrating, but it'sunfortunately true.
SPEAKER_01 (20:33):
So I wasn't in medicine 60 years ago.
I certainly wasn't around 100years ago.
There's always been snake oilsalesmen, which apparently one
of the stories of snake oilsalesmen was it wasn't actually
snake oil, it was something elsethey said.
Oh, by the way, it came fromthis very special snake and it's
(20:54):
therefore very expensive.
I guess the question to for meis are there more snake oil
salesmen now than before?
Or is it just that because ofsocial media, it's a part of our
lives more than ever before?
What do you think?
SPEAKER_00 (21:10):
Yeah, I I think it is probably both.
Um, you know, it is so mucheasier to become a snake oil
salesman these days, right?
In the past, you had to, youknow, buy a horse and a covered
wagon and go from town to town.
SPEAKER_01 (21:23):
Exactly.
SPEAKER_00 (21:24):
Um, and now what does it take?
You know, it takes an internetconnection, a Twitter account,
and and you're there.
Um, I think it's also veryattractive because it is really
quite easy to make money thesedays, right?
Um on social media, um, youknow, if you're good at it, you
can get a pretty good audiencepretty quickly.
(21:46):
It's not that hard now to turnclicks into a little bit of
money.
Um, and so this is something youknow people can do in a couple
of hours after work.
And then if they're successful,they can turn this into a
full-time job where they canreally sort of churn out content
across multiple, multipleplatforms, get people paying
attention to them, and make areasonable amount of money.
SPEAKER_01 (22:08):
Yeah, it's everywhere.
So I want to now turn to partthree, which is in essence the
antidote to the problems we'vetalked about.
So, you know, what can youbelieve?
So, what should our listenerstake from this and where can
they get some answers?
So, for me, since a lot of thetopics that people get excited
(22:29):
about are nutrition related, um,I really like the website
examine.com.
Uh, I think they do a crediblejob of summarizing evidence and
bringing, you know, to mearticles that I might not have
looked at.
Yes, if they have a study ofeight people, uh, I don't make
much out of it.
(22:50):
But I think that's a kind of afirst place that I go to.
What about you?
Are there any uh sites that youtrust?
SPEAKER_00 (23:00):
Right.
So so that is a terrific site,which I do absolutely send
people to.
So I would underline that.
Before I even give sites, Iwould say that especially in the
realm of nutrition, um, it'smaybe one place that I would
say, boy, you know, you shouldbe somewhere between a
minimalist and a nihilist,right?
(23:22):
Um we are a successful specieswho have evolved over, you know,
tens of thousands of years.
Um, and what we need to eat isis really not complicated,
right?
Um uh you know, I would say wewe need to eat well, we need to
(23:44):
eat a diverse diet, um, right?
We need to make sure that we'renot eating things that are going
to lead to obesity, stay awayfrom a lot of the concentrated
um sweets that are sort of builtinto so many of our diets today.
Um when we've actually studiednutritional interventions, it
has been very, very, verydifficult to show that one thing
(24:06):
versus another thing makes awhole lot of difference.
Um I think that most patients Isee, if I sit them down and I
say, hey, let's go through yourdiet, um, they will tell me
things that they're very proudof, the things that they're
mostly making at home, um, thethings that they're buying, you
know, grains and fruit andvegetables and meat and fish at
(24:29):
the market and making forthemselves, and they're sort of
proud of that.
Um, and then they will be kindof quiet when they talk about
the fast food they're eating,you know, the three Big Macs
they've had in the last week,um, maybe the hyper-processed
sugary cereal that theysometimes eat in the morning.
You know, most people know whatthey should and should not be
(24:52):
doing.
So I think um we might actuallybe looking for too much
information about nutrition, andwe should just rely on some of
our common sense.
SPEAKER_01 (25:03):
So if we move beyond nutrition and where to find a
good answer, there's a myriad ofother things.
You know, I have tennis elbowand and it's not getting better.
Should I get an injectionbecause one of my doctors says
we should inject it?
You know, or I have back painand I've tried this, that, and
the other, and I'm not gettingbetter.
Um, you know, there's obviouslythe newsletters or news sources
(25:27):
within major academicinstitutions.
There's a Harvard newsletter anda Mayo and a Medscape is out
there.
Do any of those sources is isthat a reasonable place for
folks to begin?
And can you trust what you readthere?
SPEAKER_00 (25:44):
I think those are reasonable places to begin.
Um the two the things that Iwould say my patients tell me
the most about those sites,which I really do understand, is
um they're very good for tellingyou options.
Um, they tend to be uh prettygeneric, right?
Um any care that you're getting,you know, on the internet, let's
(26:08):
say, is sort of meant to be forthe average patient.
Um, and anybody who's writingthose sites is going to be very
careful about giving actualadvice to an individual reader.
So many times they will say, youknow, your doctor might
recommend this or mightrecommend this, or might
recommend this.
You know, here are the plusesand minuses of those.
(26:31):
You do have to be a little bitum cautious about things like
the Harvard site and the Mayosite and the Cleveland Clinic
site.
Um, because yes, they are tryingto sort of polish their brand,
but they are also recruitingpatients, right?
So they are trying to say, oh,you know, we are terrific at
(26:52):
this, and this may then bepitched over some of the other
things.
Um, but I do think using thosesites to get a sense of, okay,
you know, what is tennis elbow?
How did I get tennis elbow?
What are the possibilities totreat this?
So when you go actually and dosee your doctor, you'll be armed
with a lot of knowledge.
And that whole conversation,which may be limited to 20
(27:14):
minutes, you know, can start alittle further on.
SPEAKER_01 (27:18):
So, okay, those are a couple of places to begin.
But now we all have Chat GPT orClaude or Grok or whichever one
you happen to like.
And they really have gottenbetter and better over the last
couple of years.
And when I'm looking at asubject, I do go to the deep
part of Chat GPT because I find,you know, you have to be very
(27:40):
careful because it does inventreferences and it does invent
studies that don't exist.
So you have to be very careful.
But it does bring up aspects ofwhatever I'm looking at that I
wouldn't necessarily havethought of.
Oh, you mean there's anotherreason to be scared of
ultra-processed foods?
I was thinking of these three,but it added one or two or three
(28:01):
more.
What do you think about thevarious chat uh capabilities?
Is that something that potentialpatients should trust?
SPEAKER_00 (28:11):
I do.
Um, again, I think that mostpeople are not going to take
something off there and say,okay, this is the treatment I'm
going with.
They're using those to educatethem, which is I think is
appropriate.
My experience with most of thosetools has been actually quite
positive.
The places where I've struggledwith them are in sort of the
(28:36):
break-in news.
Um, you know, new studies comeout which are just being
interpreted.
And, you know, those aregathering information from
across the internet.
And very often the first peopleto weigh in on studies are not
right, right?
(28:56):
Um, they're reading them for aspecific reason, they have a
specific bias.
And if you go to ChatGPT orClaude or Perplexus, whatever,
that's going to just echo thatbias.
And so I think the tools we haveright now are probably much
better for the um, you know,older, bigger, bigger, you know,
(29:20):
sort of 10,000 foot views um uhtype questions.
I, you know, with my trainees,um use open evidence a ton,
which is unfortunately notsomething which is kind of you
know widely available to the tothe lay public.
What open evidence does is itworks as just your your usual AI
(29:42):
tool, but it just draws fromPubMed, right?
It just draws from um umarticles published at a certain
level of the medical literature,and that gives actually very
good guidance.
Um, we often run things by thoseas sort of a checked.
ourselves, you know, are wemissing something?
(30:02):
Or boy, this is a topic I knowabsolutely nothing about.
You know, let me start and I'llget an answer and I'll get
actual real references fromwhere the these answers have
been drawn from that then I canuse to sort of begin to educate
myself.
SPEAKER_01 (30:17):
I think you raised um a way of thinking about this
that's really quite excellent.
Uh it's is the knowledge I'mtrying to understand something
that's been around for a while,or is it kind of late breaking?
And so when I think about it, Ithink about well, this issue of
vitamin D or vitamin C reducingmy risk of cancer.
(30:38):
This is not a new question.
And there have been studies.
And so there are places on theweb that you can find a summary
of the evidence.
It might be a meta-analysis.
I like Cochrane reviews if theyhappen to be available.
And for listeners of CochraneReview are these centers around
the world that specialize incertain topics and they're
(30:59):
always abreast of all the latestinformation on it.
There may be even a tennis elbowsite for all I know.
And you know they'llperiodically summarize the
evidence.
But these are kind oflongstanding questions.
Where I think as you point out,it's a different ball game is
new information.
So the the latest one is Tylenoland whether it causes autism.
(31:24):
You know, you can read agovernment report, you can read
a couple people's views of it,but this is what I would say is
not yet a knowable you knowthere's some information out
there.
I personally don't believe it'sa big issue.
It has gotten a lot ofattention.
But I think there's a realdifficulty when it's something
new and we're not sure then youcould get yourself into trouble.
(31:48):
And that's where as always talkto your doctor your doctor
hopefully is a little more intouch with kind of what's the
proper answer.
SPEAKER_00 (31:57):
I I'm going to just bounce two things off of you.
I I I I love you referencingCochrane.
One of the things that I I thinkfind most useful about the
Cochrane, you know, theirmeta-analysis, their reviews of
topics is that very often theycome out with we don't know.
(32:18):
And that is super interestingthat is super helpful in today's
medical information environmentbecause you'll hear people
saying like this is the thing todo, this is the thing to do.
You'll go to Cochrane, Cochranewill have looked at you know 30
trials on the topic and they'llsay there's no answer, right?
And what you learn from that isthat wow, you know, these people
(32:41):
who are pushing it for onereason or another are doing it
not based on data, but on eithertheir own beliefs or their own
self-interest in making moneyoff of their recommendations.
SPEAKER_01 (32:52):
Boy does that make sense.
Okay so that is a perfect segueinto our part four topic.
All right so you're faced with asituation where the evidence
isn't so clear.
And I am really fond of the endof one approach of testing it in
yourself.
Obviously you're not going totest a new chemotherapy drug in
(33:14):
yourself if you have metastaticcancer.
There are times and places andsituations where testing in
yourself is the only way to knowbecause the evidence is either
uncertain or maybe some patientsdo well, some patients don't.
So I'll throw out a couple ofareas that I tend to love for
people when the evidence isn'tobvious.
(33:37):
Well I have high blood pressureshould I cut out salt in my
diet?
Every doctor says that but thereality is probably 25% or more
if people aren't salt sensitive.
And I happen to be one of thoseand I enjoy salt.
The only way to do it is to testit in yourself.
Well what about melatonin tohelp my sleep well in the big
(33:58):
studies it improves your fallingasleep by five or 10 minutes.
But that doesn't mean somepeople don't get a half hour
benefit and some people get zerobenefit.
Again, the only way you're goingto figure it out is by testing
in yourself.
And then the other popular oneis oh cut out saturated fats
because that raises cholesterolmaybe on population levels or
(34:22):
something to that, but notnecessarily on an individual
level.
And so what I suggest to peopleis if the evidence isn't clear
and you think there may be someheterogeneity some people and
some people don't then find away of measuring it.
So it's got to be objective.
You can't just say well I triedthe melatonin and I think it
(34:43):
worked.
So you have to have a way tomeasure your baseline and you
have to have a way of then doingyour new intervention and then
you test it again and if you'rereally ambitious then you stop
it and you test it again thenyou restart it and you test it
again.
But as I alluded to you can't doit for every illness so it has
(35:04):
to be something that's ameasurable and b short term.
So sleep is a good one.
You can do a sweetquestionnaire, you can have an
aura ring or something likethat.
If it's a blood pressurequestion you can measure your
blood pressure and all thosethings are going to be obvious
within a week or two or three.
Now you can't do that inyourself for hormone receptor
(35:26):
hormone replacement therapy andyour bone health because that's
a 10, 20, 30 year propositionand you can't test it.
Are you using N of oneapproaches with your patients?
And then for folks on thispodcast, would it be useful for
them?
SPEAKER_00 (35:43):
Right.
So I am using N of one um trialsand I would say I may look at
them a little bit different fromyou.
Okay, great.
Because what I do with mypatients is is I sort of figure
out at the beginning you know,are we looking for something
that we can objectively measureor are we looking at something
(36:04):
which is truly subjectivebecause I would say you know I
don't know a third of thetreatments I offer you know in
my clinic are truly just to makesomeone feel better.
SPEAKER_01 (36:17):
But subjective doesn't mean unmeasurable you
can have an anxietyquestionnaire.
You can have a daytimesleepiness questionnaire.
They're widely available I justthink we need to quantify it.
SPEAKER_00 (36:30):
Right.
But the reason to point this outis that um when people can say I
stopped drinking and my you knowI have graphs of my sleep from
my Apple Watch right that tendsto be very powerful and really
impacts people.
Okay.
If it's two weeks on gabapentinand two weeks off gabapentin for
(36:53):
their peripheral neuropathy,right?
Sometimes just the sense of oh Iwas feeling a little bit better
or I was not feeling a littlebit better seems less important
to the person.
And they may not remember thatas well may not use that as as
much going forward.
And so I do try to make it asyou say as objective as
(37:15):
possible.
Keep a symptom diary, right?
Have something that you'rewriting down which you can hold
on to then so then you can goback to it when a year later
you're considering I'm on a tonof medications do I really need
this anymore and you can remindyourself that I'm taking this
medication because I made thedecision that it was useful to
me.
Doesn't mean you can't stop itbut you have a good sense of of
(37:39):
why I'm using each medicationyou're using.
SPEAKER_01 (37:42):
I completely agree.
Well I think it's time to wrapup here it's very clear we live
in a sea of health and wellnessinformation.
Some is accurate a lotexaggerated and some is frankly
wrong and will be reversed.
I will continue to be anopen-minded skeptic and perhaps
(38:02):
you will too.
Adam I think you raised a reallyimportant point when an article
says you know we just don't knowthat says a lot about the type
of person who did the work.
And I think if you're on theinternet and you're getting a
very one-sided this is obviouslythe answer to weight loss or
(38:24):
fatigue or whatever it might be,if there's not that kind of
humility of we just don't know,but you might try this, then I
would shop elsewhere.
I just think that's a red flagif there's no humility around
the recommendation.
That's kind of my take on it.
SPEAKER_00 (38:44):
Adam any kind of final words for the audience
right some someone who seemslike they're trying to tune you
into the location of thefountain of youth that like
nobody else knows about this,you know, and if you do this
little hack everything will bebetter.
SPEAKER_01 (38:59):
You gotta understand that that's probably not worth
listening to that's the best wayto end this.
So please my audience send mequestions or ideas or emails
about kind of podcast issues.
I am trying to put together aquestionnaire on whether the
(39:20):
work that you're hearing from meand my guests is changing your
life in any way?
Is it improving your health inany way?
As I said, I don't have anyfinancial part of this where my
joy is when people let me knowthat their lives have improved
in some way.
So if you'll send me some ideasabout that then I'm ultimately
going to put together aquestionnaire, send it out to
(39:42):
you, my audience, see what youthink and then I'll share the
results with you.
And if you like the podcast, byall means share it with others.
I'm now on YouTube.
You can uh watch it there I'm onsubs I have a sub stack as well
you can find articles I'vewritten there or on my website.
So until next time I hope youall live long and well and
(40:05):
perhaps um uh become a littlebit of optimistic but skeptical
uh folks until next time thanksso much for listening to Live
Long and Well with Dr.
Bobby if you like this episodeplease provide a review on Apple
(40:26):
or Spotify or wherever youlisten.
If you want to continue thisjourney or want to receive my
newsletter on practical andscientific ways to improve your
health and longevity pleasevisit me at DrBobby
Livelongandwell dot com.
That's doctor as in Dr BobbyLivelongandwell dot com
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