There are many levels of evaluation of scientific ‘facts’, from hearsay and subjective experiences, through to the ‘gold standard’ – the double-blind randomised control trial (RCT).
In this exercise two groups of subjects are exposed to either the intervention being studied, or to a fake intervention called a placebo. The intervention must be statistically better than the placebo effect. Many sceptics of lifestyle medicine claim that health recommendations do not meet scientific muster because they are not subjected to RCTs.
I came across an article written recently by that walking encyclopaedia – Dr Michael Greger – in which he reports a satirical editorial written in The Journal of Alzheimer’s Disease. RCTs are essential in doing pharmacological research because one is studying potentially life-threatening drugs – and over 100 000 people die each year in the US from taking approved medicines ‘appropriately’. But can one apply the same scrutiny to lifestyle interventions?
They suggested we choose 10 000 young adult participants and over the next 40 years we subject them to varying RCTs. Alzheimer’s disease, it is claimed, can be associated with blunt brain trauma. So, we take 2000 subjects. Half we beat with a baseball bat over the head, and the other half we use a Styrofoam bat as a control. Another study – chain 1000 people to a treadmill for 40 years, and the other 1000 to a couch – to prove the benefits of exercise.
We can force feed one group with meat and dairy every day for 40 years, and the other group vegetables and fruits. Or create a machine that forces the individual to smoke 40 cigarettes per day, versus a control group that is exposed to humidified air every day.
Obviously, the RCT is inappropriate in these situations. He says: “It is time to realise that the ultimate study regarding lifestyle…cannot be done. Yet the absence of definitive evidence should not restrict physicians from making reasonable recommendations based on the evidence that is available.”
It is time to be rational in our approach to the benefits of lifestyle interventions. There is more than enough convincing evidence. Only those who are either conflicted by their personal cravings, or by vested interests, can deny the evidence.
Dr Dave Glass
MBChB, FCOG(SA), DipIBLM
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