Live Long and Well with Dr. Bobby
Let's explore how you can Live Long and Well with six evidence based pillars: exercise, good sleep, proper nutrition, mind-body activities, exposure to heat/cold, and social relationships. I am a physician scientist, Ironman Triathlete, and have a passion for helping others achieve their best self.
Live Long and Well with Dr. Bobby
#54 What are we to believe? (With Dr. Adam Cifu)
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
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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.
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A new study shows a supplement can help us live longer. Medical societies say avoid peanuts for kids, then reverses course years later. Hormone replacement therapy is helpful, then it's harmful, and now the pendulum has begun swinging back towards benefit. What are you supposed to believe? How can you separate fact from fancy? Let's find out. Hi, I'm Dr. Bobby Du Bois, and welcome to Live Long and Well, a podcast where we will talk about what you can do to live as long as possible and with as much energy and vigor that you wish. Together we will explore what practical and evidence-supported steps you can take. Come join me on this very important journey, and I hope that you feel empowered along the way. I'm a physician, Iron Man triathlete, and have published several hundred scientific studies. I'm honored to be your guide. More often than you might think, the medical profession seems to reverse course. Kids should avoid peanuts. No, they shouldn't avoid peanuts. Now Tylenol is unsafe during pregnancy. Hormone replacement therapy is good, then bad. Now is it okay again? And podcasters pout the latest supplements to improve energy or that probiotics will help you cure chronic complaints. And the headlines in the news media amplify these various twists and turns. I tend to be an open-minded skeptic. Show me the evidence, and I'm willing to change my mind. But in general, I'm a little skeptical before that happens. Well, today I'm joined by a special guest, Dr. Adam Sifu. He's really a kindred soul to me. We write about slightly different topics, but we approach it with that same kind of show me the evidence approach. And he has reviewed a lot about how medicine seems to frequently reverse course, and we're going to explore that here today. So welcome Adam Sifu. Dr. Sifu's professor of medicine and general internist at the University of Chicago. He received his MD degree from Cornell Medical College, completed his residency training at Beth Israel Hospital in Boston, then joined the faculty at the University of Chicago. He's the author of over 140 peer-reviewed publications. And he co-authored a book about medical decision making for the lay audience, Ending Medical Reversal. He has a great Substack column that he does with several others called Sensible Medicine. It's wonderfully written. He has a dry sense of humor, and he has key insights into the practice of medicine. Some of the recent articles are What New Medical Students Should Know, The Cult of a Healthy Lifestyle and Celebrity Doctors, and Flaws in recent studies that have grabbed headlines. Welcome, Adam.
SPEAKER_00:Thanks so much, Bobby. It's wonderful to be here. And I love you calling yourself an open-minded skeptic. That sounds like a t-shirt we should have made.
SPEAKER_01:Absolutely. I'll have merch on my uh on my podcast website. Although, as I'm fond of telling my listeners, there's no financial gain for me. I have no uh advertisers, no subscriptions, no uh companies I own. Hopefully, I'm uh I may not be right all the time, but I hopefully don't have a bias due to finances. And maybe tell the listeners a little bit about sensible medicine because it really is a wonderful place to learn about various aspects.
SPEAKER_00:Yeah, I think that grew out of a thinking um much like yours. Um we um, meaning me and a bunch of my co-editors, we were aggravated by what we were seeing sort of out there in the medical information sphere, let's call it. Um, and that actually wasn't just a lot of the kind of internet craziness, but actually a lot of the uh editorials and journals and a lot of the sort of perspectives in journals, and wanted a place where we could say, like, listen, you know, what is sensible medicine? What is medicine that is actually supported by evidence and not supported by people who are just trying to make a, you know, a buck-off pitching the latest supplement, or not people who are sort of so driven by their politics, whether it's to the left or the right, um, that that's sort of clouding their vision about how they look at the evidence coming through to them. So it's a little bit of a, hey, you know, let's return to evidence-based medicine and let's try to shed a lot of the political noise which is actually getting in the way of um uh medical decision-making these days.
SPEAKER_01: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 than you wish. Now, when I tend to think about reversals, and I alluded to them uh a few of them, you know, when I uh was younger, eggs were bad, shrimp was bad, lobster was bad, oops, the medical profession had it wrong. Yeah. You know, then the whole peanut allergy, where for a generation of kids we said, oh no, no, peanuts are bad, you'll get allergies. Well, then we realized peanuts are good, that'll prevent the allergies, and so medicine once again reversed course. And probably the most important one is the hormone receptor, hormone replacement therapy. Um, it was a good idea, then it was a bad idea, and now we're trying to sort of figure out is there elements of it that really are good. Right. What are some of the reversals that you focus on? And why do you think they occur more often than I think the average listener might think? Because I tend to think, well, their doctors generally using evidence, and the specialty society certainly must be uh using evidence. So which ones do you like and why do they happen?
SPEAKER_00:Yeah, so I think I would name two of the ones you already named. Um, one was hormone replacement therapy, which is if there was anything that kind of got me into the whole medical reversal sphere, it was that when I began practicing in the 90s. Um we sort of looked at hormone replacement as not an option that might make people feel better, but basically a public health intervention that every woman post-menopause should seriously consider starting hormone replacement therapy. Um, the peanut allergy one is a specific, is a terrific one where we saw the American Academy of Pediatrics, you know, recommending, you know, you cannot give your kids peanuts before, you know, age X. And, you know, in retrospect, once we had better data showed that that probably was responsible for, you know, a large percentage of the peanut allergies in a enormous in a whole generation of children. Um, and then maybe a more recent one is you know, a period in the um kind of aughts, you know, 2000s to early 2010s, of using coronary stents for people with stable coronary disease. These were not people who are having heart attacks, but these were people who were having angina heart pain when they exercised. Um, and the response that was like, oh, we got to put a stent in them because we can fix that. There's a blockage and we have to do something about that. And then as more and more data came out, we saw that like those make sense sometimes if they're necessary for symptoms, but they don't change a person's likelihood of having a heart attack. They don't have a change of the person's um uh likelihood of living sort of a long, uh long, healthy life. Um, and I think, you know, I am inside medicine. Um, so although I'm a skeptic and I end up blaming medicine for a lot of mistakes, I think mostly medical reversal sort of comes from a good place. Um, we want to do the right thing. The problem is sometimes we want to do the right thing or what we think is the right thing too quickly. Um, so we have a lot of biomedicine in our heads. We come up with these therapies that make sense. They kind of come with a good, um, you know, a good biomechanical story, right? It makes sense based on our textbooks and our knowledge that something should work. And then instead of waiting for really robust, experimental, randomized controlled trial data that shows it works, we settle for sort of, you know, reasonably good data, observational studies, which we know are not perfect, but we 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 out to, you know, hundreds of thousands or millions of people. And it's only then that, you know, years, sometimes decades later, do we get the real robust evidence that makes us say, oops, you know, we were tricked. Um, we've we know this should work, but things really only do work once we've shown that they do work in actual human beings. And we were tricked by observational studies, which were confounding, which show, you know, association and not causation. And then we have to backtrack and pull back on what we've done or recommended.
SPEAKER_01:So uh for the coronary stents, so for folks that may not know, this is going into your coronary arteries and basically improving the plumbing problems and putting something in that helps to open them up. And there were real studies that showed it helped people that had real symptoms. And they were in serious risk of dying or serious risk of another heart attack. And it really worked. And so people extrapolated and say, well, yeah, you know, plumbing is plumbing. And so if you don't have symptoms and you have a plumbing problem, we're going to work on that. I can almost accept how that unfolded. And of course, there was a randomized trial that showed that didn't help. The peanut allergy problem, I have almost no sympathy for the medical profession because as I understand it, it was based upon almost some case reports in England about peanuts and maybe while the woman was pregnant. There was, it wasn't like there was a huge set of studies that maybe they misinterpreted. It was like hearsay. And the hearsay somehow traveled across the pond, got here, and then the Academy of Pediatrics somehow ran with it with almost no evidence. That's one I guess hurts me more because it we just got on a snowball with almost no evidence unless I'm missing something.
SPEAKER_00: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 our patients, you know, these are sick people who are trying to do something good for, right? Once we start getting out there into healthy people who really don't need doctors at all, right? And then start making recommendations that actually turn sort of people into patients, um, that's particularly appalling. And boy, then when you raise the stakes and do it with children, right, it is awful. Um, and the American Academy of Pediatrics is in a tough place because they want to make recommendations. There is a desire for people to have recommendations because every parent in the world is nervous and wants to do the right thing with their kids. Um, but the fact is, right, it is really hard to get good robust data in children. Um, not only because children are mostly healthy and you need to do a whole lot of things, you know, you need a whole lot of children to show that any intervention works. Um, but we're hesitant to do randomized controlled trials on kids, to put kids in experimental studies. And so the American Academy of Pediatrics has been, I think, tempted over and over to make recommendations based on really sketchy evidence, whether it's, you know, peanut consumption or screen time or, you know, how to discipline your children.
SPEAKER_01:So let's kind of shift from the medical profession reversing itself. And I think for me, the take-home message is listen to your doctor, be aware of these guidelines, but also still ask questions. You know, is there real evidence to support what you're asking me to do or not do? Understanding that sometimes what those specialty groups tell us turn out to be false. It doesn't mean all the time they turn out to be false, but it's more often than we'd like. So be an uh open-minded skeptic as you approach your doctor and the recommendations you hear. All right. So that's the kind of mainstream medicine. Now we're going to shift to part two, and what I will call the non-mainstream medicine, which is social media experts, and the hype that we hear so much over and over and over again. And you alluded to a couple of the, I think, the undergirding issues. So I put together this um formula that I talked about in a previous podcast where you end up in this mess of all this hype because you have a cool theory. Yeah. Heart disease is a plumbing problem. If you've got blockages, we must improve your the your plumbing. So you have a cool theory, it makes eminent sense. Then you have anecdotes. Oh, well, this person was exposed to peanuts. And look what happened to little Johnny over the course of years. And then you hear about little Sally and little Andrew, and all of a sudden you've got a whole bunch of these compelling anecdotes. And then you've got some credentialed expert in what we were talking about in part one. That was a specialty academy. But it could just be somebody on the internet with a doctor next to their name, likely not a medical physician, could be a nutrition person, it could be a chiropractor. So now we've got the third element: cool theory, compelling anecdote. And now we have a credential expert. And we're led to believe that's equal to evidence, credible evidence. And as my listeners know, and as you and I both feel deep in our hearts, that is an interesting set of theories. But until it's tested in humans, it um isn't evidence. So, Adam, where do you see hype in this sort of outside of mainstream medicine locations?
SPEAKER_00:Let me even before I answer that, uh, you know, you wrote a very cool article kind of about this idea on sensible medicine, which I I loved and I would definitely point your your listeners to. Um this is such an interesting sort of subtle difference from how I usually think of reversal, because when I talked about reversal, it's mostly you know within medicine. Um it's really strong, you know, biomedical reasoning, you know, bioplausible, whether it's intervention, diagnostic, tests, whatever, which is then combined with data, which isn't um, you know, sort of hard and fast data. It's usually observational data, it's data with some some flaws, but it's data. Um, when we get into the world of, you know, not to mince words, but you know, internet charlatans, right? Um, every step in that process is worse. So instead of there being really um good bioplausibility based on real science, often there's like, oh, this is a catchy idea, right? This is something I can sell. And then instead of there being actual data, you know, and observational data with thousands of people, there is, as you say, an anecdote, okay? And anecdotes, you know, we as people, we love stories and we love to make relationships. So we sort of jump on that anecdote. And then, yes, you normally have very polished people, you know, with very good sound quality, very good video quality, people spending a lot of time on the editing. So it looks really good as well. Um, your your question was like where I see this the most, or maybe where I get irritated the most. You know, I think where I see this the most is certainly in the whole longevity sphere, right? Um, most of us, if we can do it in a healthy way, that we're enjoying ourselves, we want to live longer. Um, but you think about what it would take to show that something makes people live longer, right? You need a lot of people and you need to follow them for a long time to show that people actually live longer. That's super expensive. Nobody's investing in that these days. Um and then maybe as part of that, you know, the whole cancer screening thing, we're interested in living longer. Cancer scares everybody. Um, and a lot of people are very susceptible to a pitch that, oh, here's a new test you can get. And if you get through this test and you you're shown to not have cancer, you'll feel better, you'll be more relaxed, and we'll guarantee that you'll live longer. And if we find something, maybe we can treat that and and you know, cure your cancer um early.
SPEAKER_01:So I if you think back over the last number of years, I mean, vitamin C was touted by lots and lots of people from Linus Pauling on down. But we don't hear too much about vitamin C solves everything. I would say the ones that really bother me today, one is all things mitochondria. You know, you get older, your mitochondria wear out. That can't be good. They're the energy powerhouse. You want energy. Oh, by the way, I've got a supplement for you. Those really bother me a lot. Um, everything, almost everything related to the microbiome to me is still in the theory stage and maybe will turn out to be critical for some patients. We know some patients it is. So that's a second area. And the third that's getting so much attention now are these biologic clocks. We're gonna look at your, you know, your DNA and your your um uh all the things, and we're gonna tell you how old you are, and then we're gonna give you our mitochondrial supplement, and those blood tests are gonna get better without, again, any evidence that in people it really makes a difference. Those are some of the ones that really upset me today. I may turn out to be wrong and they may turn out to be right, but as an open-minded skeptic, I start with the assumption it that it's not ready for prime time.
unknown:Right.
SPEAKER_00:And they are interesting things, right? Uh I mean, I would like to know what causes aging, right? Um, we have a lot of markers that we can follow that show when people are getting older, when show people are becoming frailer. I would love to know what's behind that. And I'd love to see what actually helps it. Um, the problem is these are all, you know, such soft theories. Um, and the idea that we know what to do to, you know, halt aging, and that we can do something that actually works at the right place in the right time to make a difference, we have no idea right now. And it's frustrating, but it's unfortunately true.
SPEAKER_01:So I wasn't in medicine 60 years ago. I certainly wasn't around 100 years ago. There's always been snake oil salesmen, which apparently one of the stories of snake oil salesmen was it wasn't actually snake oil, it was something else they said. Oh, by the way, it came from this very special snake and it's therefore very expensive. I guess the question to for me is are there more snake oil salesmen now than before? Or is it just that because of social media, it's a part of our lives more than ever before? What do you think?
SPEAKER_00:Yeah, I I think it is probably both. Um, you know, it is so much easier to become a snake oil salesman these days, right? In the past, you had to, you know, buy a horse and a covered wagon and go from town to town.
SPEAKER_01:Exactly.
SPEAKER_00:Um, and now what does it take? You know, it takes an internet connection, a Twitter account, and and you're there. Um, I think it's also very attractive because it is really quite easy to make money these days, right? Um on social media, um, you know, if you're good at it, you can get a pretty good audience pretty quickly. It's not that hard now to turn clicks into a little bit of money. Um, and so this is something you know 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 can really sort of churn out content across multiple, multiple platforms, get people paying attention to them, and make a reasonable amount of money.
SPEAKER_01:Yeah, it's everywhere. So I want to now turn to part three, which is in essence the antidote to the problems we've talked about. So, you know, what can you believe? So, what should our listeners take from this and where can they get some answers? So, for me, since a lot of the topics that people get excited about are nutrition related, um, I really like the website examine.com. Uh, I think they do a credible job of summarizing evidence and bringing, you know, to me articles that I might not have looked at. Yes, if they have a study of eight people, uh, I don't make much out of it. But I think that's a kind of a first place that I go to. What about you? Are there any uh sites that you trust?
SPEAKER_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, I would say that especially in the realm of nutrition, um, it's maybe one place that I would say, boy, you know, you should be somewhere between a minimalist and a nihilist, right? Um we are a successful species who have evolved over, you know, tens of thousands of years. Um, and what we need to eat is is really not complicated, right? Um uh you know, I would say we we need to eat well, we need to eat a diverse diet, um, right? We need to make sure that we're not eating things that are going to lead to obesity, stay away from a lot of the concentrated um sweets that are sort of built into so many of our diets today. Um when we've actually studied nutritional interventions, it has been very, very, very difficult to show that one thing versus another thing makes a whole lot of difference. Um I think that most patients I see, if I sit them down and I say, hey, let's go through your diet, um, they will tell me things that they're very proud of, the things that they're mostly making at home, um, the things that they're buying, you know, grains and fruit and vegetables and meat and fish at the market and making for themselves, and they're sort of proud of that. Um, and then they will be kind of 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 they sometimes eat in the morning. You know, most people know what they should and should not be doing. So I think um we might actually be looking for too much information about nutrition, and we should just rely on some of our common sense.
SPEAKER_01:So if we move beyond nutrition and where to find a good answer, there's a myriad of other things. You know, I have tennis elbow and and it's not getting better. Should I get an injection because one of my doctors says we should inject it? You know, or I have back pain and I've tried this, that, and the other, and I'm not getting better. Um, you know, there's obviously the newsletters or news sources within major academic institutions. There's a Harvard newsletter and a Mayo and a Medscape is out there. Do any of those sources is is that a reasonable place for folks to begin? And can you trust what you read there?
SPEAKER_00:I think those are reasonable places to begin. Um the two the things that I would say my patients tell me the most about those sites, which I really do understand, is um they're very good for telling you options. Um, they tend to be uh pretty generic, right? Um any care that you're getting, you know, on the internet, let's say, is sort of meant to be for the average patient. Um, and anybody who's writing those sites is going to be very careful about giving actual advice to an individual reader. So many times they will say, you know, your doctor might recommend this or might recommend this, or might recommend this. You know, here are the pluses and minuses of those. You do have to be a little bit um cautious about things like the Harvard site and the Mayo site and the Cleveland Clinic site. Um, because yes, they are trying to sort of polish their brand, but they are also recruiting patients, right? So they are trying to say, oh, you know, we are terrific at this, and this may then be pitched over some of the other things. Um, but I do think using those sites to get a sense of, okay, you know, what is tennis elbow? How did I get tennis elbow? What are the possibilities to treat this? So when you go actually and do see your doctor, you'll be armed with a lot of knowledge. And that whole conversation, which may be limited to 20 minutes, you know, can start a little further on.
SPEAKER_01:So, okay, those are a couple of places to begin. But now we all have Chat GPT or Claude or Grok or whichever one you happen to like. And they really have gotten better and better over the last couple of years. And when I'm looking at a subject, I do go to the deep part of Chat GPT because I find, you know, you have to be very careful because it does invent references and it does invent studies that don't exist. So you have to be very careful. But it does bring up aspects of whatever I'm looking at that I wouldn't necessarily have thought of. Oh, you mean there's another reason to be scared of ultra-processed foods? I was thinking of these three, but it added one or two or three more. What do you think about the various chat uh capabilities? Is that something that potential patients should trust?
SPEAKER_00:I do. Um, again, I think that most people are not going to take something off there and say, okay, this is the treatment I'm going with. They're using those to educate them, which is I think is appropriate. My experience with most of those tools has been actually quite positive. The places where I've struggled with them are in sort of the break-in news. Um, you know, new studies come out which are just being interpreted. And, you know, those are gathering information from across the internet. And very often the first people to weigh in on studies are not right, right? Um, they're reading them for a specific reason, they have a specific bias. And if you go to ChatGPT or Claude or Perplexus, whatever, that's going to just echo that bias. And so I think the tools we have right now are probably much better for the um, you know, older, bigger, bigger, you know, sort of 10,000 foot views um uh type questions. I, you know, with my trainees, um use open evidence a ton, which is unfortunately not something which is kind of you know widely available to the to the lay public. What open evidence does is it works as just your your usual AI tool, but it just draws from PubMed, right? It just draws from um um articles published at a certain level of the medical literature, and that gives actually very good guidance. Um, we often run things by those as sort of a checked. ourselves, you know, are we missing something? Or boy, this is a topic I know absolutely nothing about. You know, let me start and I'll get an answer and I'll get actual real references from where the these answers have been drawn from that then I can use to sort of begin to educate myself.
SPEAKER_01:I think you raised um a way of thinking about this that's really quite excellent. Uh it's is the knowledge I'm trying to understand something that's been around for a while, or is it kind of late breaking? And so when I think about it, I think about well, this issue of vitamin D or vitamin C reducing my risk of cancer. This is not a new question. And there have been studies. And so there are places on the web that you can find a summary of the evidence. It might be a meta-analysis. I like Cochrane reviews if they happen to be available. And for listeners of Cochrane Review are these centers around the world that specialize in certain topics and they're always abreast of all the latest information on it. There may be even a tennis elbow site for all I know. And you know they'll periodically summarize the evidence. But these are kind of longstanding questions. Where I think as you point out, it's a different ball game is new information. So the the latest one is Tylenol and whether it causes autism. You know, you can read a government report, you can read a couple people's views of it, but this is what I would say is not yet a knowable you know there's some information out there. I personally don't believe it's a big issue. It has gotten a lot of attention. But I think there's a real difficulty when it's something new and we're not sure then you could get yourself into trouble. And that's where as always talk to your doctor your doctor hopefully is a little more in touch with kind of what's the proper answer.
SPEAKER_00:I I'm going to just bounce two things off of you. I I I I love you referencing Cochrane. One of the things that I I think find most useful about the Cochrane, you know, their meta-analysis, their reviews of topics is that very often they come out with we don't know. And that is super interesting that is super helpful in today's medical information environment because you'll hear people saying like this is the thing to do, this is the thing to do. You'll go to Cochrane, Cochrane will have looked at you know 30 trials on the topic and they'll say there's no answer, right? And what you learn from that is that wow, you know, these people who are pushing it for one reason or another are doing it not based on data, but on either their own beliefs or their own self-interest in making money off of their recommendations.
SPEAKER_01:Boy does that make sense. Okay so that is a perfect segue into our part four topic. All right so you're faced with a situation where the evidence isn't so clear. And I am really fond of the end of one approach of testing it in yourself. Obviously you're not going to test a new chemotherapy drug in yourself if you have metastatic cancer. There are times and places and situations where testing in yourself is the only way to know because the evidence is either uncertain or maybe some patients do well, some patients don't. So I'll throw out a couple of areas that I tend to love for people when the evidence isn't obvious. Well I have high blood pressure should I cut out salt in my diet? Every doctor says that but the reality is probably 25% or more if people aren't salt sensitive. And I happen to be one of those and I enjoy salt. The only way to do it is to test it in yourself. Well what about melatonin to help my sleep well in the big studies it improves your falling asleep by five or 10 minutes. But that doesn't mean some people don't get a half hour benefit and some people get zero benefit. Again, the only way you're going to figure it out is by testing in yourself. And then the other popular one is oh cut out saturated fats because that raises cholesterol maybe on population levels or something to that, but not necessarily on an individual level. And so what I suggest to people is if the evidence isn't clear and you think there may be some heterogeneity some people and some people don't then find a way of measuring it. So it's got to be objective. You can't just say well I tried the melatonin and I think it worked. So you have to have a way to measure your baseline and you have to have a way of then doing your new intervention and then you test it again and if you're really ambitious then you stop it and you test it again then you restart it and you test it again. But as I alluded to you can't do it for every illness so it has to be something that's a measurable and b short term. So sleep is a good one. You can do a sweet questionnaire, you can have an aura ring or something like that. If it's a blood pressure question you can measure your blood pressure and all those things are going to be obvious within a week or two or three. Now you can't do that in yourself for hormone receptor hormone replacement therapy and your bone health because that's a 10, 20, 30 year proposition and you can't test it. Are you using N of one approaches with your patients? And then for folks on this podcast, would it be useful for them?
SPEAKER_00:Right. So I am using N of one um trials and I would say I may look at them a little bit different from you. Okay, great. Because what I do with my patients is is I sort of figure out at the beginning you know, are we looking for something that we can objectively measure or are we looking at something which is truly subjective because I would say you know I don't know a third of the treatments I offer you know in my clinic are truly just to make someone feel better.
SPEAKER_01:But subjective doesn't mean unmeasurable you can have an anxiety questionnaire. You can have a daytime sleepiness questionnaire. They're widely available I just think we need to quantify it.
SPEAKER_00:Right. But the reason to point this out is that um when people can say I stopped drinking and my you know I have graphs of my sleep from my Apple Watch right that tends to be very powerful and really impacts people. Okay. If it's two weeks on gabapentin and two weeks off gabapentin for their peripheral neuropathy, right? Sometimes just the sense of oh I was feeling a little bit better or I was not feeling a little bit better seems less important to the person. And they may not remember that as well may not use that as as much going forward. And so I do try to make it as you say as objective as possible. Keep a symptom diary, right? Have something that you're writing down which you can hold on to then so then you can go back to it when a year later you're considering I'm on a ton of medications do I really need this anymore and you can remind yourself that I'm taking this medication because I made the decision that it was useful to me. Doesn't mean you can't stop it but you have a good sense of of why I'm using each medication you're using.
SPEAKER_01:I completely agree. Well I think it's time to wrap up here it's very clear we live in a sea of health and wellness information. Some is accurate a lot exaggerated and some is frankly wrong and will be reversed. I will continue to be an open-minded skeptic and perhaps you will too. Adam I think you raised a really important point when an article says you know we just don't know that says a lot about the type of person who did the work. And I think if you're on the internet and you're getting a very one-sided this is obviously the answer to weight loss or 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 flag if there's no humility around the recommendation. That's kind of my take on it.
SPEAKER_00:Adam any kind of final words for the audience right some someone who seems like they're trying to tune you into the location of the fountain of youth that like nobody else knows about this, you know, and if you do this little hack everything will be better.
SPEAKER_01:You gotta understand that that's probably not worth listening to that's the best way to end this. So please my audience send me questions or ideas or emails about kind of podcast issues. I am trying to put together a questionnaire on whether the work that you're hearing from me and my guests is changing your life in any way? Is it improving your health in any way? As I said, I don't have any financial part of this where my joy is when people let me know that their lives have improved in some way. So if you'll send me some ideas about that then I'm ultimately going to put together a questionnaire, send it out to you, my audience, see what you think and then I'll share the results with you. And if you like the podcast, by all means share it with others. I'm now on YouTube. You can uh watch it there I'm on subs I have a sub stack as well you can find articles I've written there or on my website. So until next time I hope you all live long and well and perhaps um uh become a little bit of optimistic but skeptical uh folks until next time thanks so much for listening to Live Long and Well with Dr. Bobby if you like this episode please provide a review on Apple or Spotify or wherever you listen. If you want to continue this journey or want to receive my newsletter on practical and scientific ways to improve your health and longevity please visit me at DrBobby Livelongandwell dot com. That's doctor as in Dr Bobby Livelongandwell dot com