"Just trust yourself, then you will know how to live."

-Johann Wolfgang von Goethe

One of the most common types of questions that I get from patients each and every day is "should I do procedure xyz, or take supplement xyz for condition abc?" or some other variation of this type of question.  Anymore these days it is becoming increasingly difficult to know whom to trust with our various healthcare questions.  We have commercials on TV and ads in magazines telling us to "ask our doctor about (insert latest wonderdrug here)!"  So who do we trust?  Do you trust your chiropractor?  Do you trust your medical doctor?  Do you just not trust anyone?  Dr. Marcia Angell, a former editor of the New England Journal of Medicine was recently quoted as saying

"It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine."  

I used this quote on an earlier blog post, as I believe it is one of the most telling statements with regards to our current state of health related information.  No one consciously intends to make bad decisions with regard to their health, and especially the health of their loved ones.  I see parents (myself included) constantly wondering if they are making the best decisions possible for their children.  Should we vaccinate our children?  Should we go through with this particular procedure or treatment for our son or daughter?  But it can seem extremely overwhelming at times to know what to do.  I feel like one of the greatest responsibilities and honors that I have been given as a chiropractic physician is to empower my patients.   I do this by providing them with the right tools and information so that they can make the best possible decisions for themselves and their loved ones.  I take this responsibility very seriously.  Rather than simply saying "yes, take this or that drug or supplement" or whatever the question may be, I instead try to give them a framework or a way of investigating things for themselves.  This is what I mean by empowering patients.  If I can give patients a way to critically analyze information to make better-informed decisions, then I feel I have done my job.  So, what I want to share with you is something that I tell all of my patients when they approach me with important health related questions.    

These are the 4 pillars of making informed healthcare decisions:

1.  Research

I talk about research first not necessarily because it is the most important (it actually isn't the most important in my opinion for several reasons) but more so because it is a good starting point.  The first question anyone should ask with relation to any particular health intervention is "does it have any research supporting it?"  With all of the various online tools available this is a pretty easy question to answer in a matter of seconds...Literally.  First, you can check online through the U.S. National Library of Medicine.  You don't need to have a PhD in research methodology to perform a simple search on this site.  If you've used Google before, you can use this site as well.  Wondering about side effects of a certain medication?  Wondering if Chiropractic might help with a particular problem?  Starting here might provide some good information.  Speaking of Google, there is also a cool tool that Google has provided for free called Google Scholar, which basically limits its search parameters to various research journals.  This will allow you to search through tons of great scientific literature rather than some random guys blog.  If there is some research to support the particular intervention in question, then that’s a good start.  However, just because the intervention doesn't have any research to support it, does not automatically mean that the intervention is of no use or dangerous.  Research is great, but it can be a tricky thing at times and can easily be manipulated through faulty statistics and bias from various parties with conflicts of interest.

2.  Clinical Evidence

The next thing I tell patients to look for is clinical evidence.  This means that there is other evidence supporting the particular intervention or treatment approach.  Some practitioners use different treatment interventions that have been used for years in a clinical setting with amazing results.  Does it mean that just because there is no research to support these things that they aren't real or they are simply just placebo?  I highly doubt it.  Clinical evidence is a strong indicator of validity to many different treatment interventions.  Does this mean that clinical evidence is perfect?  Certainly not, but what it does do is help in the decision making process.  If a particular doctor has been using a specific method with a large number of patients with a high percentage of success there is probably more to this than this doctor just being a great salesperson or just plain old placebo.

3.  Historical Precedent

Similar to clinical evidence, historical precedent is a way of examining whether or not a particular treatment intervention has some sort of historic validity or evidence to support it.  For example, some herbs have been used for hundreds, if not thousands of years to treat certain health problems.  This is strong evidence in favor of the particular intervention.  One of the problems with historical precedent is that it can sometimes get a bad rap because of various connotations that it is given by some of the traditional medicine world.  By using labels such as "alternative medicine" some people can come to conclude that these "alternatives" are somehow less affective or less desirable than the more widely accepted "conventional medicine".  Dr. Alex Vasquez, a brilliant physician once said this:  "Despite the long-standing historical precedent in which human disease was treated by natural means (i.e., diet modification, botanical medicines, physical modalities) for the majority of human existence, the current healthcare paradigm in America and other Western/industrialized nations is such that treatment with drugs and surgery is labeled “conventional” while natural treatment as with nutritional, botanical, and physical interventions is now described “alternative” and “unconventional.” This unfortunate inversion of terms causes confusion among doctors and patients alike while it connotes scientific superiority and cultural sanctification of pharmaceutical and surgical interventions, including those that are dangerous, ineffective, and unduly expensive."

4.  Personal Intuition

Last but certainly not least is the final pillar in healthcare decision-making.  I believe this to be one of the most important.  We are all entitled to personal intuition when it comes to making important decisions regarding our health, and especially for the welfare of our loved ones.  Call this what you will, call it guidance from your conscience, call it guardian angels, call it God.  Whatever you want to call it, it is real, and you can trust that inner voice that is there to guide you when making these critical decisions.  When your gut tells you "don't take this medication" or "you should go to the doctor," or "don't go through with that procedure," it is almost always right.  Learn to trust that inner voice.  Learn to trust your personal intuition.

Putting it all Together

Ultimately, the key to making the best decisions is that there is no one single "key" but rather a set of guides, or in this case, 4 pillars to help you make the best decisions possible.  You ideally want to see some level of overlap with all 4 pillars.  The perfect intervention would have plenty of research supporting it, a lot of clinical evidence, a strong historical precedent behind it, and it should intuitively make sense to you.  But unfortunately this can't always be the case.  So, the next best thing is to find as much of overlap as you can.  It may not always be so clear-cut.  In these types of instances, this is where you rely heavily on your personal intuition and common sense.  Hopefully, this has given you some good insight on any questions you may have and hopefully you have a good team of healthcare professionals that you can trust to answer your questions and concerns honestly.