Many of the health-related complex
issues arising recently contain the same central confusion, which is
the need to make decisions without full knowledge. That is what health
care providers do all day every day.
On the one hand, this can be extremely frustrating. After all, who really
likes guessing, no matter how educated that guess may be? We all want
consistent, reliable results. On the other, life and living organisms
are innately only semi-predictable. We seldom know enough to know the
full consequences of our actions.
As I have to deal with this uncertainty continually, it has taught me
a good approach to making tough decisions. This applies to everything
from using vitamins and drinking lots of water, to even some health-related
political choices. When semi-informed decisions are required, I find
that following this process leads to pretty good choices. The process
seems to be innately moderating, as giving undue importance to small
sprigs of data or wild speculation, can lead you far out onto a thin
limb leaving you in a tenuous position.
First, I gather information about what is known. One example is that
we know that increased levels of many vitamins are associated with lowered
rates of certain diseases, but supplementation with those very same vitamins
is sometimes associated with increased risk of the disease.
Another example is that we know that genetically modified foods by definition
contain amino acids/proteins from other living organisms, and that modification
fundamentally alters the biological activity of the organism in the environment
(allergenicity, toxicity, ability to spread, etc., etc.) Although we
do know about the horrendous problem with eosinophilic myalgia that resulted
from genetically modified L-trypotophan, we have not had significant
reports of ill health effects from GMO foods.
To support your own information gathering, one of the best sources of
information on the interface between foods, industry and politics is
Marion Nestle, Ph.D. I highly recommend her books SAFE FOOD: Bacteria,
Biotechnology and Bioterrorism and FOOD POLITICS: How the Food Industry
Influences Nutrition and Health. Although she is a high-powered academic,
her books are interesting and clearly written.
Next comes critically analyzing that information to sort out the deeper
meanings, the clues about what that information is really telling us.
In the case of vitamins, synthetic vitamins are different than natural
forms taken along with other nutrients. In many instances we know that
wild foods contain much, much higher levels of vitamins and minerals
than domesticated ones (a notable exception is Vitamin E.) So, we need
to consider the forms of the vitamin, attend to a balanced overall diet
and continue to learn about varying individual needs.
In the case of GMO foods, the same issue of incomplete study of the problem
looms large. In other words, an inadequate research base prevents full
understanding of the problem. If you have yet to look carefully for a
snake in the grass, you won’t know it is there until it bites you.
Other factors do come into play when industrial technology is involved.
In my years in medicine I have seen many, many strongly advocated, safe
treatments turn out to be ineffective or dangerous. That makes me skeptical
of the latest advances, particularly when those corporations or physicians
with something to gain tout them. In the case of genetically modified
organisms, the economic stakes are quite high.
Finally, we move on to consider the repercussions, the consequences of
action and inaction. In medicine we call this the risk/benefit ratio.
If the intervention is not likely to cause harm, the need for convincing
proof of efficacy is entirely different than it would be for a high risk
procedure. For vitamins, it becomes an individual matter. A patient with
heart disease who has never taken vitamin E is at much greater risk than
another person taking high doses of B vitamins.
GMOs are potentially extremely risky. They could be beneficial as well,
but in my opinion, considering the uncertain scientific data and the
potential for extreme and entirely unforeseen consequences, the risk
is too great at this time.
The GMO issue is a good example of another aspect of this decision-making
process. There are situations in which the penalty for inaction is so
much less than the risks of a rash decision. The wisest decision is to
place things on hold until more is known. Many patients follow this approach
with certain immunizations. The official medical recommendation is to
vaccinate children for some diseases that would only cause harm in adulthood
because we have the kids in our offices already. Medical authorities
feel we can’t trust those patients to come back later. Because
we learn more with time, wise families will instead chose to hold off,
recognizing their right to delay as well as their responsibility to keep
informed in coming years. |