The Black Swan Effect

Medical science is constantly reinventing itself. Every day, we are assaulted with headlines that tell us the opposite of what we may have been convinced of for decades. Our favorite foods and most touted supplements – coffee, butter, coconut, chocolate, fish, just to name a few – are praised or cautioned against, sometimes outright reviled, for their benefits or dangers.

How are you supposed to figure out what to do? You can’t give up everything that could possibly be bad for you and you can’t figure out what to do on your own.

That’s why I am here!

Fortunately, there’s a point at which the data is conclusive and you can shut the book on an issue. Studies are still being done on therapies that have had established therapeutic value for decades, centuries, even millennia. We can close the book on the question of whether so many therapies have value from what we already know – arguably, most of the therapies we hear about, with the exception of new drugs, have been studied to the point that their benefits and downsides are known. There are many things for which you can avoid the new headlines of hype, whether it’s fear-mongering or claims of benefits. Unfortunately, pharmaceutical companies and medical device companies will always have a big incentive to make other older, cheaper therapies look bad, which is what drives most of the negative headlines about remedies, foods, or supplements that we have come to trust and rely on. You have to know when to shut the book on a clinical question.

When can you do that? When the evidence has reached a certain point and not when the positive studies outnumber the negative studies. Unfortunately, the pharmaceutical and device industries will always make money by casting doubt on older, cheaper remedies. Where people lose the truth is when they weigh the studies by sheer number, rather than by quality. When I think about shutting the book on a clinical question, I think about black swans.

No matter how many clinical trials come out stating that all swans are white, it only takes one to upend the idea. Just one. One well-designed clinical trial is all you need! That means the right duration, the right patients, quality supplements or medications, high enough doses – it means a lot. Find a negative study for a well-established therapy, and you can usually find that they’ve created such a mistake.

The other factor to consider before closing the book on a therapy is the cost of being wrong. Doctors are gun-shy of prescribing supplements and vitamins because they equate them with drugs. One famous blunder in the history of medicine was rate control versus rhythm control for certain irregular heart rhythms. Doctors thought it would benefit the patient if they could make their heart rhythm look normal, using drugs. Other doctors just tried to slow the rhythms down, but didn’t worry about what the rhythm looked like. What happened? The patients who were shoe-horned into normal, healthy looking rhythms died at catastrophic rates. A casual estimate is that more Americans died than from “rhythm control” than died in the Korean War. Did you ever think going to the doctor could be more dangerous than going to war?

Drugs and devices carry immense potential for negative side effects. The FDA consistently fails to identify these issues before the drugs or devices reach the market and thousands may die before the problems are recognized. Being wrong may mean death. Even with a huge amount of supporting evidence, should you risk a drug that was recently approved? Given the reality that even professors at a reputable medical school has essentially been bribed in the past, should you trust even the authoritative clinical trials that support drugs? They may be nothing but smoke and mirrors.

What does this have to do with nutrition? Unlike drugs and devices, nutrients – vitamins, minerals, antioxidants, flavonoids, fiber, fish oil, fatty acids – have little to no serious or life-threatening side effects, since we’ve developed in an environment where we could easily eat huge quantities in short periods of time. Time and again, diet and exercise out-perform drugs and devices – hands down, no contest.

Once the evidence for a vitamin, mineral, or other nutrient reaches more than a few major trials, it’s time to shut the book and consider it a valid treatment, no matter what the headlines tell you tomorrow, or even centuries from now. You can ignore those fear-mongering headlines that want to make you turn your back on your diet and supplements, and embrace new drugs or costly surgeries that are making someone else enough money to cloud the judgement of even the most well-meaning.