Sunday, November 29, 2015

Information contraindication

Information is a great thing, but sometimes it can be a terrible thing. Sometimes, there’s too much information, and when it conflicts, people will often choose bad information, particularly on matters of health and nutrition. Personally, I often see that with information about gout.

The thing about gout is that it’s very confusing—not the disease itself, but the advice about it. What’s okay to eat? What should one avoid? How does one treat an attack? It turns out, there are all sorts of varieties and flavours of answers.

When I was looking for the video at the top of this post, I also saw some videos talking about how to deal with gout. Some were from what one might kindly call crackpots, people with clearly strong opinions and few facts to back them up. I also saw some videos with actual doctors in them, but these often contradicted each other, as medical sources often do, too.

It was at this point that I had an epiphany: I’ve often wondered why otherwise sensible people will listen to crackpots and cranks for health and nutrition advice, and not to doctors. I realised that the crackpots present their information with definite assurance and certainty. Doctors, on the other hand, base their advice entirely on what science has proven to be true. So, doctors will offer suggestions for things that studies have proven to be useful, but will not offer suggestions for things that aren't proven—even if those things may actually be helpful. Moreover, they’ll often offer the advice with equivocation.

For example, I saw a video made about three years ago in which a doctor said at the end of the video words to the effect of, ”Some people say cherry juice is helpful. While there’s no scientific evidence yet, if you find it helpful, use it.” Since that video was posted, there have been studies that have proven that cherry juice (from cherry varieties known as “tart cherry” or “sour cherry”, though they’re neither) is effective in helping to prevent gout attacks and lessen their severity, particularly when used with conventional anti-gout prescription drugs. At the time the video was made, there was already evidence to suggest that this might be the case, however, because there were not yet any clinical studies, the doctor in the video wouldn’t suggest cherry juice as part of a preventative dietary routine.

Crackpots, however, have no such restraints: They don’t need proof that a remedy is safe and effective, they only need anecdotes. So, an ordinary person coming across the video of a crackpot offering health advice will notice the certainty and unequivocal assurance that everything they say is true. But someone going to a real doctor’s video will notice the equivocation and qualification of the advice offered. When an ordinary person is looking for certainty and for reassurance, information that is not equivocal will usually be more appealing.

It doesn’t help when doctors give conflicting information, either. For example, a booklet from Arthritis New Zealand tells people with gout to minimise the amount of meat, chicken, and seafood they eat because the foods contain protein. They suggest, “Try beans, peas, lentils, and tofu instead of meat. Beans, peas, lentils, and tofu contain less protein than meat and seafood.” However, other medical sources say to avoid beans, legumes and pulses, and that doctor in the video I mentioned earlier specifically said to avoid tofu.

Is it any wonder that people with gout can be so confused about what to do?

Without any real help from the medical establishment, people will often go looking for “alternative” answers, which can cause problems or make their condition worse. It also doesn’t help when actual medical advice is given with a declaratory nature, as in, “avoid this thing”, when gout is highly individual and some things just won’t bother some people.

There was a theory, since mostly disproven, that Vitamin C was helpful. Despite new studies suggesting it has no affect whatsoever, some sites are still suggesting it. Some evidence suggests that low-fat dairy may be beneficial, that it may have a protective affect, while some medical sites still say to avoid or highly restrict dairy.

And those beans and so on that people with gout should avoid? There’s evidence that vegetable sources of protein may be treated differently by the body than protein from animal sources—apart from lentils and black-eyed peas, which are extremely high in purines, the protein component we’re actually trying to avoid.

This could provide the solution to the vegetarian paradox: Gout is so rare as to be virtually unknown among vegetarians. Logically, a vegetarian diet—ideally the lacto-ovo variety—should be the healthiest option for people with gout, though more research is needed. Even so, the fact that some medical sources say avoid all beans confuses the hell out of people.

The video at the top of this post is a TV ad that began running earlier this year, and the thing that started this little journey. It has its own misleading information. It portrays gout as something that springs out of nowhere to strike suddenly, like a steel trap, to catch someone when they’re just out and about. It just doesn’t work that way. Sure, gout can and does strike suddenly, but that’s often at night, when one is in bed. But there are usually warning signs an attack is coming: Unusual soreness in a joint, maybe even general feeling of illness (for example, I usually feel like I’m coming down with the flu before a big attack).

The ad is misleading about the way gout attacks typically happen— in my opinion, unnecessarily. The rest of the ad is spot on—gout is a manageable disease, often through diet, exercise, and healthy weight maintenance alone.

But if even the people who are THE body dealing with gout couldn’t make an ad that was clear and completely accurate, then what hope do we ordinary people have of finding good and useful information?

Real doctors should be less equivocal with their advice, saying what is currently believed, even when adding that more research is needed. We NEED reliable medical information that helps us know what to do. If the professionals in medicine and science won’t provide it, crackpots will, and that benefits no one.

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