The problem with evidence based health is not what you think
I’ve based a huge chunk of my career on the assumption that evidence-based information helps people make better informed health decisions, have better health conversations with their doctors and ultimately leads to better health outcomes.
Evidence is my stock in trade. I have spent many years translating evidence into a form that people can understand. I’ve written thousands of evidence-based articles across many channels. I’ve written position statements, belonged to guideline writing groups and spend many hours in the grand pursuit of evidence.
I really do think evidence-based health information helps consumers and the health system as a whole, or I wouldn’t have chosen to dedicate my medical career to information and communication.
Yet lately the inadequacies with evidence have become more and more glaring to me. Lately it seems to me that we need to start paying better attention to what evidence can’t do — as much as to what it can do. And I wonder if it isn’t time for a better approach in developing and transmitting health information via any channel.
Evidence, for one thing, doesn’t last. It is a fluid beast — forever slithering under our grasp. Recommendations change over time and there seems to be a growing fuzziness around the edges.
So to take a simple example: Evidence shows fish oil capsules can reduce triglyceride levels but it doesn’t look like they reduce heart attacks. So should fish oils be recommended for heart health? And in what dose? And how do we communicate those uncertainties?
It seems that for every fact we think we know, there are tens and hundreds, perhaps thousands more we don’t. Much of what I write is peppered with words and phrases like: “may,” “might,” “suggests,” “possibly,” “is likely to,” “there is some evidence for …”
There is a large industry interpreting all this and developing systematic reviews, guidelines and recommendations for practice. This helps a lot.
But it is a reductionist and a little like joining up the dots we think we’ve got and proclaiming we have a giraffe — when all along we have a combine harvester.
Relying on evidence to describe reality for us is like relying on person with vision loss to describe an intricate carving. At best it’s fuzzy and incomplete. At worst it’s misleading.
But we are working on sharpening that picture — bit by bit. New evidence is published every day. So dropping evidence based medicine is clearly not the answer. It’s important and useful.
But I wonder if an over-reliance on evidence has watered down the intuitiveness and people skills that we have used for millennia to provide unconditional empathy, encouragement, hope and other ingredients for healing. Perhaps these skills need to be brought back to the fore in communicating about health whether in writing, video or in person. Perhaps this will better help help bridge the gulf between evidence and reality.
Instead of making evidence-based recommendations from a position of expertise could it be better to consider what we know about people’s values and viewpoints to see how the evidence best fits them?
Can we become more comfortable in embracing the space where there is no evidence yet? Saying “We don’t know” shouldn’t mean there is no hope. Can we find a way to provide hope in the face of uncertainty — and stand by people whatever they choose?
With or without evidence, it seems so important in communicating about health to foster the capacity within ourselves and within the community to approach medicine and healing with wonder, awe and faith.
So really there is no problem with evidence. The biggest problem is the gap between evidence and reality that only the human side of us can fill.
My hope is when we can transmit the evidence with empathy, love and humility we’ll get better at connecting the right information to the right people at the right time. And then we’ll get better at inspiring people to make healthy decisions — and that should benefit all of us.
First published on KevinMD