How to decide when you don’t know how to decide

I don't know why they picked 29, since that the atomic number for copper, but this design is from

I don’t know why they picked 29, since that the atomic number for copper, but this design is from

Two things happened this week that inspried me to write this post:

1) I was mentioned in a blog post by my friend, Bryan Krahn, on lay interpretation of research.

2) I happened to catch my friend, Yoni Freedhoff, being interviewed by one of my favourite media hosts, Jian Ghomeshi on Q about corporate sponsorship and health expertise:

Out of these two things, the main question that came forward was, “None of us are experts like you are experts. How do we know who to trust and what to believe? What happens when experts disagree?”

Up until a few months ago, I didn’t really have a good answer to this question. But it’s a topic I’ve been trying to resolve because it’s difficult to have no answer for such an obvious question. I happen to believe that critical appraisal (i.e. the skill of evaluating a scientific manuscript) is something you can’t just “pick up” by reading more scientific manuscripts. There’s a reason there are whole-year graduate level courses devoted to developing this skill—and even then, you still have to take the accompanying statistics courses to go along with it. Just as with all skill acquisition, practice doesn’t make perfect, perfect practice makes perfect and if you’re trying to developing the skill of critical appraisal in a vacuum, you’re just practicing.

So here’s what I’ve come up with as a response to a tricky question, which basically boils down to, “How can I protect myself if I have no expertise?”

1) Is this even relevant to you?

RSS feeds, Flipboard, Facebook, Twitter…all are such double-edged swords. They are big blessings in increasing our connectivity, accessibility as well as putting some of the power of publishing into the hands of anyone who has a computer. They’re also the ultimate bane in providing unfiltered garbage in front of your eyes.

The war on the internet is for your attention. Attention=money, attention=power. Your attention, which is finite and renewable is the currency of the internet. However, it doesn’t come for free and it’s not cheap.

So before you pay attention to a new study or an article about a new study, you should ask yourself, “Does this actually apply to me?” Is the population studied one of which I am a part? If you’re in your mid-30’s then a study on 18-22 year olds doesn’t apply to you. Move on. If you’re a woman, and the study only had men in it, move on (yes, it’s sad that as a woman, there a smaller literature base for a lot of fitness topics.) If you’re not a runner and don’t plan on running, why read an article about how running may or may not be bad for you? If you’re not an elite athlete (and as a definition, I would term elite as national-level and higher, which means most of the world isn’t, no matter how ego damaging that is to read), then a LOT of fitness research doesn’t apply to you. Move. On. It’s just not that into you.

The internet is not going to filter for you. You have to do it.

The price you pay for giving your attention without restraint is 1) it takes away from attention that you can pay to other things, including attention-based actions that allow you to stay on track to your goals, and 2) it muddles your brain with respect to being consistent with the actions that you need to stay on track to your goals. Either way, it distracts you from your goals. And it’s not even relevant to you.

2) If the issue DOES apply to you, there are two patterns that you should recognized before you delve further:

A) A lot of times, you already know the answer. Do you REALLY need a Heart and Stroke Foundation seal of approval on a pack of gummy candy made from fruit juice to tell you whether it’s good or bad for you? Does the seal REALLY change what you know deep down inside? Candy is not good for you. It’s candy. Didn’t we all learn this in kindergarden? Why does anyone allow this symbol on the packaging to even enter their brain as a valid counterpoint to, “Candy is not good for you.” Stop giving up your volition and THINK. Labels are there to give you an excuse to buy something you already know is not good for you. Remember, the food industry doesn’t care if you eat it or not; only that you buy it.

B) Obvious answers quickly reach consensus.

There are only a handful of issues that I can think of where the answer was hidden amongst conflicting evidence that required advanced statistical techniques to uncover. The poster-child for this is the example I use far too much, which was the systematic review on corticosteroid use in premature infants. The second one that I think is emerging is the use of statins and the use of aspirin; and I think this is the case because the incidence of harms is so low that we’re only starting to reach enough power to see it.

If harms from long-distance running were so dramatic, marathons and fun-runs would have been outlawed years ago. The answer would have been crystal clear. The fact that you’re more likely to be electrocuted or thrown from a wall (and possibly willingly) should be of a higher concern to you than a thickened right ventricle.

If something is dramatically important, you will not hear about it on a blog, or a fringe movement. And as ignornant as some people claim their physicians are about all things fitness/nutrition, if the issue is THAT big, I guarantee you, your doctor WILL know about it, because it will be everywhere. While it’s sensational to claim that a lot of these studies are ‘canaries in the coalmine’,  you are not a miner. And sometimes, canaries just die for no good reason while sitting in the coalmine. When all the miners come running out of the coalmine and telling you to back off, then you should probably pay attention. Until then, let the miners figure out the canaries. If the mine is going to explode, you’re not going to hear it from just one or two miners.

3) It’s too late. And now you need to know.

So you failed to guard your attention and unsubscribe from the newsletters and feeds and now you’re stuck. Butter in my coffee? Beaver fever in my fun run? A stiffened aorta from weightlifting? WHAT DO I DO???

Here’s my step-by-step method for getting out of this mess.

A) If it’s research that is against what you already do, ask yourself whether you would be willing to give it up if that research was true. If you’re a dyed-in-the-wool runner, chances are, you’d rather die early than run less (which, I’m told is distinctly unsatisfying—disclaimer: I am not a runner,) which makes the research moot. The research isn’t going to change your actions; therefore, for you, it’s irrelevant. I’m not saying that running long distances is necessarily bad for you, but there are smokers who just accept that they just like smoking way more than living longer lives. There are people who jump out of planes for fun (the risk of dying from jumping out of a plane is 0 if you never jump out of a plane.) It’s their lives, and their choices. Your life, your choice.

B) If you WOULD change your behaviour based on the research, then you’re just going to have to go digging. And by digging, I mean looking for point and counterpoints just like you would if you were going to buy a car, or a house. I personally know so little about cars that when my friends say something like, “Check out that X583,” I look in the general direction of their gaze and respond, “The black one or the silver one? Oh wait. They’re all black or silver.”  And I don’t care enough about the question of whachamacallit drive-trains to go reading up on first principles of combustion engines (and yes, I know they might not have anything to do with each other, which just shows how little I know about cars.) I DO know that I shouldn’t buy a Geo Tracker. And that I wouldn’t be caught dead in a Civic no matter how good the experts might say it is (sorry, Civic fans.) Going car shopping with me is like going into a jewelery store with a raven (which is why my brother won’t go car shopping with me.) Is it shiny? Does it go? How well will it protect me if I roll into a ditch? And does it have Bluetooth? And does it come in any other colours other than black and silver? I accept that when I buy a car, I am most likely not going to get the car that is the ‘best optimized car for me” (whatever the heck that might mean.)

If you want an easy answer in a topic that has no clear consensus, so that you can just FEEL better about your choices, then it’s going to require a lot of up-front investment to develop the skills and knowledge so that evaluating the science becomes relatively easy. Worried about gut health? If you can’t define ‘biome’ then you have a lot of work ahead of you. Not sure if your diet should be more acidic or alkaline? Better get to work on reading about things like the TTKG. Don’t know what TTKG stands for? Ah, that’s a pickle.

There is no information without work: If you’re unwilling to do some digging then the decision can’t be that important to you. If it’s not important, then go back to point 1. I’ll take the blue car, thanks.

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