As you know, there is a range of opinions about good health practices, including from highly credentialed clinicians and researchers. In that range, at one end are those who are skeptical of changes to established practices and at the other end are those who are exploring innovations. We’ve seen this range throughout history and we’ve seen it in our lifetimes.
For example, there is a joke in medicine about how progress occurs:
Stage 1: That’s crazy, it should be outlawed, anyone who does that should lose their license.
Stage 2: It shows promise but needs more studies.
Stage 3: We knew it all along.
In my view it is important to find a middle way between dogmatic resistance to innovation on the one hand and wild-eyed adoption of dangerous unproven methods on the other. For me, there are three markers of this middle path:
- The proposed innovation (e.g., reducing carbohydrates to treat Type 2 diabetes) has proposed mechanisms of action that are grounded in an underlying frame of biological science (rather than, say, some kind of mysterious cosmic energy from Mt. Shasta).
- The innovation is not recommended to be done instead of a well-established medical technique (e.g., if your leg is broken, don’t think that rubbing essential oils into your leg will make the bones reknit properly).
- The risks of the innovation are relatively low (e.g., if you’re not pregnant, supplementing vitamin D up to 5000 I.U./day has next to no risks, and it might help reduce the consequences of getting Covid-19).
Regarding #3, if the risks of a medical intervention are high, then the evidence for it should be equally high. On the other hand, if the risks are low, then the threshold of evidence for trying something can be low as well. This is a key point.
For example, the third leading cause of death in America is medical error, causing about 200,000 deaths per year, mainly involving medications. (Which is a more serious problem, the Goop Lab or deaths due to medical error?) The tools used by physicians are powerful, so they need to be very very well justified. Interestingly, in the Lancet a few years ago, it was acknowledged that about half of the methods that medical professionals use every day, in hospitals and outside them, do not have a single study that supports them. This does not mean they are malpractice. But I think it suggests that there should not be a double standard in which high risk medical interventions – often backed by the potent lobbying efforts of pharmaceutical companies – are used routinely with minimal research evidence while low risk health recommendations such as “reduce carbohydrates and eat more whole foods” are challenged for not having enough studies behind them.
As to what is “unscientific,” if this term means that something requires multiple excellent studies to be credible…then that view is itself truly unscientific. First, many things are true that no scientific study can prove.
For example, if you love someone, no study in the world can prove it. Second, just because there wasn’t yet a study that vitamin D may reduce the consequences of Covid-19 did not mean that this was not true all along. As the genuinely scientific saying puts it: “The absence of evidence is not evidence of absence.” For me, “unscientific” means something contrary to what science has clearly shown to be true, such as biological evolution.