Q. Really enjoyed your video on HVMN. You’re like a checks and balances for the Health Optimization Community. The thing I found interesting was how remission instead of cure is the more appropriate word regarding diabetes & keto. One thing I’ve found, since these concepts are so novel, experimentation and anecdotal evidence should at least be heard….it’ll take years before they can be proven, or get funding etc. What’s your take on that?

A. I would say that anecdotal evidence should be a guide for research, not for practice. Before scientific medicine, we had a medical practice in the West that was based on anecdote. Much of it was useless, and some of it, like bleeding during acute illness, was shown to be harmful. I think medicine should therefore be based on experimentally controlled results whenever possible.

Theoretical foundations. Interventions that can fight diseases are very serious. The body is always trying to restore homeostasis. In all likelihood, powerful interventions will disrupt that process. In some rare instances, however, some powerful interventions actually help. But the interventions we have now are a tiny, tiny fraction of the total pool of interventions that have been tried. Most have not helped or have been harmful. Therefore, while we don’t know if any given intervention is dangerous, it might be; and it is most likely useless or harmful. Therefore I think the conservative approach–unless death is certain–is to allow the body to heal itself, unless it can be shown that an intervention will help. The latter can only be shown experimentally.

This is in contrast to everyday practice, where one or another decision must be made. Everyday life is different from the body. In everyday life, decisions must be made. But in the body, decisions are already being made–by the body. The body is wise and it knows how to achieve homeostasis and survive. But medicine is quite blunt and stupid. And thus we should always favor the body, unless we have rigorous evidence otherwise.

This distinguishes scientific medicine from the folk medicine that preceded it, and is why scientific medicine is generally superior. It isn’t always—sometimes anecdote runs ahead of science. But it is usually—usually anecdote is false or needs to be qualified before it can be generalized to clinical practice. We often hear about anecdotes that lead to treatment success and breakthroughs. But what we don’t hear about are many, many more anecdotes that fail. History books are filled only with treatment successes. But this is a major bias that blinds us to the litter, much more sizable, of treatment failures. Vinay Prasad and Adam Cifu’s book serves as an important corrective on this point.

This is what I think.

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