Guiding Principles

When thinking about matters of health and well-being it’s helpful to have a set of guiding principles. Ultimately, we are always trying to inform our actions by deciding what is good or bad for us. The impossibility of this effort stems from the constant barrage of information and opinion about how we ought to conduct ourselves. I use the following principles to help find the signal in the noise:

1. Autonomy.

Decisions about one’s health and well-being must be made by the individual, so long as they have the capacity to do so. As a doctor, I carry the responsibility to help my patients make the best decisions for themselves, guided by my expert knowledge and experience. They may ultimately make a decision with which I do not agree. I must respect their decision, because it is theirs to make.

Similarly, as a society, we have a responsibility to make available the best knowledge of the day, so that each of us may use it to decide how to conduct our lives. What is best for one individual can be at odds with what is best for society. Nevertheless, good societies uphold the individual’s right to autonomy, especially regarding personal health and well-being. Limits should only be considered when there is clear evidence that an individual’s choices could result in appreciable harm to others.

2. Equal opportunity.

Society should be tasked with creating equal opportunities for each of its citizens. None of us chose when, or where, or to whom we were born. The random event of our birth, and the situation into which we were born, should not adversely affect our opportunity to achieve our full potential. A good society recognizes this and works toward removing unnecessary barriers to opportunity. This is especially so for the opportunity to realize good health and well-being. Once presented with opportunity, however, it should remain up to the individual to decide if and when to act.

3. Evidence-informed reasoning.

The scientific method is to be respected and celebrated. We should always look first to ‘the evidence’ to inform our actions. Not everyone is armed with skills to appraise science, however. For this, we will always have to rely on experts. Unfortunately, in matters of health and well-being, there are plenty of charlatans. So, in areas we are not expert ourselves, we must retain skepticism, asking what any self-proclaimed expert may have to gain from their machinations.

If one’s skepticism is piqued, a simple strategy is to ask for references or data upon which conclusions have been made. If produced, one then has an opportunity to appraise it for themselves or seek a second opinion. This effort is not in vain, for once we leave the land of evidence, we find ourselves afloat in the sea of opinion.

4. Embracing uncertainty.

I often remark to my trainees, “The only thing we know for certain is that we can know almost nothing for certain.” After speaking so highly of evidence-informed reasoning, we must address the reality of context. Scientific studies are necessarily narrow in scope and conducted in a rigorously controlled setting. This is the only way to validly test a hypothesis. But it creates a problem when we then apply findings to the real world. The context of our present scenario is almost always different than experimental conditions. Enter uncertainty.

Uncertainty makes people uncomfortable. Our minds are put at ease when we know exactly how things will transpire. In medicine, this is seldom the case. Hence the frustration that ensues when patients ask if a given treatment will work. More often than not, we just don’t know. However, we can certainly offer a well-reasoned guess based on evidence.

In matters of health and well-being, be skeptical of anyone who claims they know anything for certain. Instead, find someone who embraces uncertainty, for they will likely retain the curiosity to seek further understanding.

5. Open and respectful dialogue.

Far too much time is wasted on unnecessary debate between opposing ideologies. Outrage abounds these days, even for matters that are trivial. The only remedy is open and respectful dialogue. This occurs when each party is seeking to learn and expand their understanding. If we approach dialogue in this manner, we all benefit. If you disagree, great! Explain why and how your perspective is different, or possibly better. We would not learn anything if we all agreed about everything. Exploring differences of perspectives or discordant scientific findings is how we progress knowledge. No offence necessary.

6. Accepting that what we currently think might be wrong.

This is directly related to principles 4 and 5. Believing oneself right all the time and having to defend it can be quite stressful! It also creates unnecessary conflict in defence of ideology, rather than rational thought. History is full of examples of how prevailing practices of the day turned out to be wrong. And that’s okay, because we learn and change our ways by applying new evidence. If we approach matters of health and well-being with an acceptance that we might be wrong about current practice, we stand to progress far more than by embracing dogma. 

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