health – Andrew Appleton MD

Two hard truths to set you free

We think we are more important than we actually are. I mean this in the individual sense. Afterall, our own thoughts are the only ones we can think. Try as you might to, “put yourself in someone else’s shoes,” the experience will undoubtedly be coloured by your prior thinking and cognitive biases. Why does this matter? Because we get caught up in our inner narratives that tell us our perspective, our work, our contribution is more impactful than someone else’s. This happens quietly and insidiously, creating a sense of self-righteousness that erodes our well-being.

If your self-esteem is related to being right, feeling validated, or having others recognize your accomplishments, be prepared to feel down. If your expectation is that your work will make a difference, something largely out of your control, prepare to feel frustrated. If you can’t understand why others don’t see things your way, perhaps your analytical skills have become blunted by self-importance. This may sound extreme, but as you traverse the regular highs and lows of your week, I think these sentiments will resonate.

Fortunately, you can free yourself from these perceptual binds by accepting two hard truths.

You are replaceable.

If I didn’t show up to work, a couple of people might think my unexplained absence was odd. After a day or two, some calls or e-mails would be placed to see what was up. Let’s say I then decided I was done; I wouldn’t go back. The immediate workplace concern would be to take stock of my former responsibilities and ensure that someone else was assigned to cover them. Intermediate to long-term plans would be made to find a lasting replacement. Three months from now, people may briefly recall the strange time when Andrew suddenly left. They would then go about their days.

Now a real-world example. A teacher has been on staff at a local high school for 30 years. They taught thousands of students over this time. They were part of the fabric and culture of the school. This year, they retired. The staff had a lunch on the last day of school. A couple of colleagues paid a public tribute, shared some stories and bid their farewell. There was pizza. The retiree then walked out of the building for the last time. The administration then hired a new teacher. The remaining staff will file into the school at the start of the next year, their routines entirely unchanged. The incoming students will only know the retiree by their picture on the wall.

These examples underscore that no matter how seriously you take your work, how much pride you have in the outcome, the world necessarily carries on in your absence. One could view this perspective as negative, deflating. The rational response is not to stop doing things because there is no point, but rather to cease worrying about day-to-day trivial matters and burdening oneself with overinflated self-importance. Accepting your replaceability causes you to evaluate the worth of your own progress, shifting toward a focus on the most meaningful pursuits.

There is a notable exception to the notion of being replaceable. You are not replaceable to your family and closest friends. It is to them, and only them, that your continued relationship matters, because the strength of that relationship is connected to their own well-being.

2. There is no legacy.

There are currently around 7 billion people on the planet. Billions have come before and billions more have yet to exist. The sheer magnitude of humanity makes the probability of your name or work being widely known, at present day, extremely low, let alone being recalled as some form of legacy generations from now. Of course, I recognize that most people don’t strive to become a global name. If notoriety is what you seek, it is likely to be sought or measured on a more local scale. But to what end?

Fame, that is strangers knowing who you are, is no reflection of the value you have created for yourself or anyone else. Fame is most often serendipitous. Value, on the other hand, is generally related to a dedicated pursuit of one thing that others deem to be desirable. Most links of the value chain, however, don’t indicate what happened upstream, or who was responsible for it. People are just happy to capture it. But time and desires change. What once was desired ceases to be so. The work done to generate value was not done in vain, it’s simply no longer as valuable as it once was.

If your goal is to build something that will result in your being remembered long after you are gone, a legacy, you will most likely fall short. For this, too, is mostly out of your control. As with your replaceability, this should be viewed in a positive light. Why burden yourself with trying to influence the lives of those not yet in existence, when there is so much to be addressed in the present? You risk tying your sense of well-being, achievement, meaning or success to something that you will never experience. Instead, focus on meaningful efforts where you can improve and bring value to the current situation.

This does not mean that we should not worry about the future state of humanity and the world we live in. The only way to effectively change it for the better, is to be firmly present in the happenings of this moment, where we can continuously do our best to be a force for good.

By accepting that you are replaceable and that your purpose is not to create a legacy, you will stop prioritizing your time and work to the neglect of what matters most; your family, your friends, and your unique human experience.

Take a Moment to Consider Your Moments that Matter

We spend most of our days busily going about things that need to get done. Each day is fairly similar to the one before. If we aren’t focused on the task at hand, we are usually thinking about a recent occurrence or something we have yet to do. It is rare to block out these fore- and afterthoughts, even for a moment.

When we experience a moment of full presence, often spontaneously, it should be savoured. In a short moment, you can feel completely at peace, satisfied.

I find these moments cannot truly be planned, despite my desire for their tranquility. Even meditation, a time of focused attention, does not bring about the feeling to which I am referring. However, there are some patterns or circumstances most apt to precipitate these moments.

For me, three scenes come to mind. The first involves a vista, ideally of a lake or ocean, but my backyard will do. The morning sun is shining, warm on my skin. The breeze is cool, though, and rustles leaves on nearby trees. I have a warm coffee mug cupped in both hands and I’m leaning on the railing, looking out. I close my eyes briefly, enhancing the feeling of opposing temperatures from sun and wind, as well as the white noise from the moving foliage. In this moment I am free. I am part of the scene. Then my coffee cools down, the screen door opens, and life comes rushing back.

The second is with my children. They are close in age, 19 months between them. Catherine, the older one, is a kind and gentle soul with a tremendous sense of curiosity. John is a passionate little boy who loves his sister dearly, but also loves to take things to the limit. The dynamic makes life interesting, busy, fun, infuriating, stressful, and full of joy in quick succession. When those two get along, speak kind words to each other, and demonstrate their deep bond, I feel a moment of pure love and pride.

These two scenarios are mine. Yours may be similar, but undoubtedly different in important and individual ways. The third, though, we all share.

No matter what happened during our day, be it success, failure, aggravation, happiness, the mundane, we all return to the same moment, alone with our thoughts. This is the moment right before we are overcome with sleep. Even if you have a bed partner, there is a quiet period before sleep when it’s just you. This moment is a daily gift. The day is done, there is still a buffer before the next. This is generally a time of rumination, your mind now free from tasks. We reflect on the day gone by, worry about loved ones, wonder if we said the right thing, swell with pride, or escape from it all. In this moment you experience a bellwether of your well-being. Are you happy? Are you anxious? Are you dreading what’s next? Are you looking forward to what lies ahead?

This recurring moment is an opportunity to take stock. When everything else is put away for the day, where does you mind go? Everything that happened is done, cannot be changed. Can you accept that?

I suggest that you should. What’s done is done. Then think, even if today was great, “How can tomorrow be better, how can I do better?” This moment is a chance to be progressive. Don’t worry about all the tasks you have to do. They will be waiting for you in the morning. Dwelling will not help. Right now, you get to sit with your unique human experience, no matter how briefly, before sleep.

For me, the thought of coming back to these moments brings me joy. I hope you think about yours and take steps toward moulding an environment that promotes them, allowing you to capture the essence of your own experience.

Have you ever considered your relationship with Time?

There are several theories on how people go about changing health behaviours. My favourite is Social Cognitive Theory. It discusses self-efficacy, outcome expectations, goals and sociostructural factors that either work for or against us on our quest to behave in a healthy manner. This is a useful theory to apply when designing public health campaigns, counseling or coaching interventions. But there is a necessary precondition that is not discussed, one that I think is the most crucial resource for improving health and well-being.

Time.

How often have you uttered something like “I just don’t have the time,” or “I wish there were more hours in the day,” or “I don’t know where the time went?”

All of these statements inaccurately reflect our relationship with time. They imply that we have control over it, that it can be stockpiled and moved around like some payload. We don’t and it can’t. Time acts independently from us. It goes by at the same rate for all of us, always. No one has time. We cannot alter its rate, at least not yet.

What we refer to when we gripe about time is how we measure ourselves in relation to it. Humans are obsessed with time. Birthdays, anniversaries, age, ASAP, deadlines, betimes, alarm clocks, watches, world records, workdays, weeks off, running pace, hourly wages, meetings, on and on it goes. Nearly everything we do is literally marked in relation to time.

This is somewhat startling when we reflect on the actual concept of time. After all, we only ever have the present. We think a lot about the past and future, but we never occupy these constructs.

Time as a concept only exists because we are able to remember past events or project to future ones. We are able to conceptualize that these events are not occurring right now. This does not, however, accurately portray the passage of time.

We can recall a distant memory and say, “it feels like only yesterday.” This merely means that we have an accessible memory, one that has no relation to when the event actually happened or the fact that we are recalling it in the present.

If you think about time in this way you might start to question why we are so beholden to something over which we have no control. Why does time have you under her thumb?

Like any generation before us we are a product of the society into which we were born. It so happens that the present society is time-obsessed. But let’s consider for a moment why humans would have wanted to measure time at all.

Ancient humans would have had a simple relationship with time. Sun comes up. Sun goes down. This cycle erected boundaries around the opportunity they had to get things done, especially before the age of artificial light sources. If out and about during the day, the position of the sun in the sky would indicate roughly how much time they had to get back to camp. Similarly, the pattern of constellations, once mapped, would indicate seasonality and impending vicissitudes of local climate.

All this is to say that early conceptions of time would have been used as a tool, a measuring stick. I put forth that this is how we should still think of it. Time helps us organize ourselves and our groups. Its ubiquity makes it understood by all, a common language.

When at the mercy of time, however, we never feel we can accomplish enough. This is largely the result of historical and arbitrary scheduling. For example, the Monday to Friday, 9-5 work week is tyrannical operationalizing of time. Many of us are on this ride, suffering its long and restrictive route. Someone else, your employer, has decided to book 40 hours of your week regardless of how much they realistically expect to be produced during that time.

This results in your planning everything else “after-hours.” In turn, this leads to more detrimental applications of time like counting down to your next vacation, or retirement.

At this point you might be thinking that you can’t just get a new job or start dictating your own hours, and you would be right. It likely would not be easy, or done right away, because our economy is structured against it. The way our economy is set up is another societal construct, which can, and do, change over…time. If enough people agree that we should evolve from being held captive by time and rigid schedules to using time as the tool it should be, we can change.

Practically now, what can an individual do in their relationship with time to promote health and well-being? First, I suggest, think about time in the terms we’ve just covered. Think about your current relationship with time. Are you using it as a tool? Or is it using you as one of its interconnecting cogs in the giant timepiece of our era?

Next, reflect on all of the things you’ve ever heard or read about “time management.” You can find multiple time management strategies out there with between seven and twenty so-called rules. The existence of these self-help diatribes is a symptom of our broken relationship with time. No matter the list, these strategies always have two simple themes in common:

Theme 1: There are a certain number of things you must do regularly to live as a human:

Eat
Sleep
Perform hygiene
Generate income
Get supplies to do all of the above

This is modern survival. It takes a certain amount of time. How much depends on your context.

Theme 2: Time remaining after the must-dos is ideal if used in meaningful ways.

This means prioritizing, determining the essential things for you. What do you want to experience and how do you plan to bring these experiences to your present, so that they may become the things you recall in your past, “like it was only yesterday?”

Theme 1 is where the core of health is captured. Theme 2 is where health and well-being thrive.

Notice what isn’t in Theme 1; exercise, family time, socializing, reading, romance, higher education, to name a few. These are the first things to go when you don’t get to control your allocation of time. The same list makes up the main constituents of our well-being.

If you are successful with this dichotomy, the income generating component of Theme 1 will be something that you care about, effectively moving it to Theme 2, providing meaning and purpose. Otherwise, your vocation may have an adverse ripple effect, eating into Theme 2-time, paperwork and e-mails after-hours, early meetings, traveling, and so on.

To summarize, each week (or whatever chunk of time you choose) we have to do a bunch of little things, and we get to do one or two big things, the ones we deeply care about. Yet what we often do is schedule 3-4x as many little things as we need, forcing out the more important big things.

I suggest using time as a tool to book and measure the little things, to ensure they don’t use too much time. This way we have the opportunity to explore the essential big things. For these we should not assign arbitrary deadlines. The future remembering self will not care how long it took or if it was “late.” The most important things, the ones that bolster our well-being, don’t have time limits. If you are doing the right things, fully present while doing them, time really doesn’t matter.

Redefining Health and Well-Being – How the WHO has it wrong

What is health? Nutritious food and exercise quickly come to mind. Being healthy makes us think of doing something. We have a healthy diet, lead a healthy lifestyle, have healthy relationships. “Healthy”, the adjective, is easily understood as a good way of doing something. It’s more difficult to define “health”, the noun. Presumably doing healthy things brings us health. Why else would we do healthy things? The reasons, and hence the “health” being sought, differ from person to person. Enter “well-being” and the subjectivity amplifies. The two are intimately linked. Perhaps not in the way we’ve been sold.

Let’s start with a definition. I know, I am breaking 10^th grade English dogma – don’t start your introduction with a definition! My purpose is to show you how a widely accepted definition is not only wrong but is not actionable. The World Health Organization definition of “health”:

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

I appreciate the inclusion of “physical, mental and social” as necessary components of health. The utility of this definition ends there for me. Starting with the second clause the WHO suggests that the presence of “disease or infirmity” (read: disability) negates the achievement of a state of health. Can one not have health while living with chronic disease or disability? Rhetoric aside, I don’t think I need to expand further.

Back to the first clause, “Health is a state of complete […] well-being”. I’ve removed the part I like to reveal the absolute nature of this statement. If you broadly apply the WHO’s definition of health, you would be hard pressed to find any human being who meets the criteria of clause one alone. Let’s give the WHO the benefit of the doubt – their definition is aspirational. It’s meant to inspire nations and their policy-makers to reach the highest possible heights of health, equity, and productivity. I’m skewering their definition to make the point that health, to the individual, must be cast in a different light. What of well-being?

In the philosophical sense, well-being is how well your life is going for you. There is debate about how to quantify this. One has to know the constituents of well-being and how to determine what makes them good for the individual. There are three leading theories, Hedonism (balance of pleasure over pain), Desire-satisfaction (fulfillment of desires), and Objective list (constituents of well-being outside of pleasure and desires). I will not dive into these here, suffice it to say that each has its limitations. Given the theoretical equipoise, I feel I have license to propose my own definition, albeit leaning in the direction of Objective list theory. Let’s first address the relationship between health and well-being.

According to the WHO, health cannot be achieved until you have well-being. For those policy-makers trying to bring health to their people, the problem of defining well-being becomes eminently vexing. If defining health is the Mona Lisa, defining well-being is the ceiling of the Sistine Chapel. My main contention, however, is against the assertion that health is secondary to well-being. I argue that the opposite is true.

Argument from First Principles

You are a biological being. You have physiologic systems that require inputs and produce outputs. An ideal state of health, then, could be considered providing the precise quantity and rate of inputs your systems need to perform effectively and efficiently. Nothing more, nothing less. Inputs may include nutrition, sleep, physical activity, mental stimulation, and so on.

Now imagine a scenario where someone has completely engineered your life for you. They have designed a way to provide all inputs, tailored to your biological and genetic profile – proper food, eight hours of sleep per night, physical training, exemplary education, even socialization. Everything is controlled. Even though you could be in perfect physical and mental health, you would not be surprised to find yourself completely miserable.

How can this be so? Because whatever we do to be healthy is ultimately being done to prepare us for something else. That something else is conscious experience. I do not wish to invoke any arguments about dualism here. Regardless of how you think about the nature of consciousness, its existence is undeniable.

Consciousness presents the world to us. It is within consciousness that we do or do not achieve well-being. An ideal state of health gives us our best chance to achieve well-being but does not guarantee it. Well-being is achieved when our consciousness perceives that our internal and external states are aligned and complimentary. If I am in pain and I do not think I should be in pain, I am suffering, and my well-being is under attack. If I have a set of beliefs but others are forcing theirs upon me, there is conflict, and my well-being is under attack. If I love the natural world and have time to go for long hikes (and the physical health to do so), I feel fulfilled, and my well-being is sustained.

Argument from Evolution

From an evolutionary standpoint the healthiest, strongest, fittest people had an advantage. This includes mental health and intelligence, requirements to succeed in a group. In a hunter-gatherer tribe, most waking hours would be spent on activities to promote survival. Good health would allow individuals to contribute more and pass on their genes. Well-being doesn’t emerge as something with which one has to be concerned until you can do something more than simply survive.

Well-being requires time, with which one can turn their attention to or think about whatever they choose. It requires time to experience a sense that what you’re doing is worthwhile.

Well-being became possible once we had larger societies with economies and adequate resources. Once you can purchase or trade for what you otherwise would have spent your time acquiring, you have time to learn, travel, care, volunteer, socialize, play, and more. These are things with which we associate meaning or purpose. Plato and Aristotle were able to think extensively about well-being, virtue, and the like, because they lived in a society that valued knowledge and was able to support a number of citizens who did not contribute to the production of physical resources.

One could point out that we would not be able to conceptualize or experience well-being were we not adapted for it. While true, this does not negate my argument. Before modernity the major selective pressures would have primarily favoured characteristics that promoted survival. In keeping with the story of evolution, it is generally only known what characteristics conferred an advantage in hindsight. The emergence of consciousness and ability to reason are clear evolutionary advantages, allowing ancient peoples to develop language and band together in complex societies. These events needed to occur prior to the ability to articulate and reflect on what is now being considered as well-being. Hence, I contend that the notion of well-being is an interesting development that came along for the ride while humans evolved to become the primary dominant species that we now are.

Conclusion and New Definitions

To bring this full circle, two questions help underscore the fact that health precedes well-being and not the converse:

Can you have good health without well-being? Yes, without a doubt.

Can you have well-being without good health? Unlikely.

Notice I haven’t answered ‘No’ to question two. Health is an important (likely the most important), but not sole component leading to well-being. If you are a Buddhist Dzogchen master and have become enlightened, unencumbered by a sense of self, you could have well-being without good health, because there is no self that requires it. You would still require some degree of health, though, to hold the body upright and have clarity of mind enough to meditate.

Also note that within my questions ‘good health’ does not ascribe to the WHO’s “absence of disease or infirmity”. Health is a product of the individual within whom is resides. With that said, here are my suggested new definitions for health and well-being:

Health: A state of optimal physical, mental and social functioning that gives one the best opportunity to live well.

Well-being: A state of consciousness in which one’s internal and external experiences are aligned to create feelings of happiness, fulfillment, meaning and/or satisfaction, over the course of one’s lifetime.

Within the definition of health, I have used the word “optimal”. This allows anyone to optimize their physical, mental and social functions to fit their current state, be it free of disease and disability, or not. The definition also tells us that health is a foundational state. If we have health, we are on solid ground. Health is the jumping-off point for us to live our best lives.

Well-being is less tangible. While not the only route, health is the major conduit to well-being. As the definition states, your internal and external states must align. This means that your physical, mental and social functioning, as well as your environment, occupation, goal structure, expectations, and more, must converge to create the feeling of fulfillment. By its nature, well-being is transient, but can be kept closer at hand with deliberate attention.

As a final thought, I have designed the definitions to be actionable. Getting to an optimized state, modifying, and optimizing some more, is achievable. Getting to “complete […] well-being” is not. Reflecting on your internal and external experiences to assess their alignment can also be done. Keep these definitions close at hand as we continue to explore ways to empower your pursuit of health & well-being.

How to set SMART goals

Goals are necessary to help us achieve our desired ends. People need to see progress to derive meaning and success. In matters of health & well-being goals are effective and motivating tools. We consistently compare ourselves to benchmarks, internally and externally. If we don’t deliberately set appropriate goals for ourselves, we are destined to feel frustration and failure. When we meet our goals, we feel successful and capable of taking on more.

We have all achieved something of which we are proud. Perhaps it was challenging physically or intellectually. We feel at the summit of success. But from this new vantage point, we see higher peaks in the distance, yet to be climbed. Our sights become transfixed on the future. So it is with goals. Once achieved, you set about planning the next steps.

NFL football offers an example. During the season, there is nothing more important than winning the Super Bowl. During the playoffs, though, you begin hearing analysts and fans from eliminated teams discussing the draft, trades, scouting. They no longer care about their former quest. Even for the championship team, within a week of the game, the conversation turns to maintaining their dominance, there’s more work to be done.

This underscores the importance, but not supremacy, of goals. Goals give you direction and motivation. Equally, they can be unreachable and demoralizing. They need to be designed the right way to help your progress towards capturing health and well-being.

Here’s an example of a bad goal: “I want to be more fit.” This provides no useful direction. In what way would you like to be more fit? Within what timeframe? How will you measure success? “I want to be more fit” is a vision. It’s a sense for betterment that you have. This is important. But you can’t strategically move toward realizing your vision, unless you set goals along the way.

I suggest using a concept from the business world called SMART goals:

Specific
Measurable
Attainable
Relevant
Time-based

Specific:

Goals should be narrow in scope. This allows you to focus and plan. Improving fitness is too general. You could go about this in 1000 ways. Becoming a better runner is more specific.

Measurable:

I don’t know who to attribute it to, but there is a mantra in the quality improvement space, “You can’t improve what you can’t measure”. Tracking metrics allows you to see change. Objectivity is ideal, but subjective measures are useful as well. For example, tracking calories will help you meet your targets. But if you feel hungrier, this is important information too.

Attainable:

This seems intuitive but deserves attention. Thinking you want to be the next Usain Bolt, even if you’re already a sprinter, is probably not attainable. This is another example closer to a vision, than a goal. It’s far better to set easily attainable goals, especially at the outset of any endeavour. There is no cap on the number of goal iterations you will navigate. Achieving goals is a positive reinforcement. It bolsters your confidence in your ability to succeed. Near-term, incremental improvements are the best goals to set.

Relevant:

Goals need to support the long-term vision you are striving toward. Adhering to this strategy can be liberating. All manner of quick fixes and alternatives to your current goals are constantly foisted upon you via social media and the like (check out my post on assessing health information). Before clicking down the internet hole, ask yourself “would making this a new goal help me toward my ultimate vision?” If the answer is no, don’t waste your time. SMART goals should keep you laser-focused.

Time-based:

Everyone knows deadlines are motivating. They keep us accountable. They add structure where whimsy naturally lives. Adding time incentives is a good tactic, so long as they aren’t unreasonable or arbitrary. Too far in the future, things can be put off to tomorrow. That said, we are generally terrible at estimating how long a project will take to complete. Things usually take 1.5 times longer than we think. Keeping this in mind, proximal goals fuel the fire, while overlay distant goals extinguish it.

Let’s bring this home. Consider a person who runs as part of her fitness routine. She typically logs 5-8km at a 5:30km pace. Her vision is to become a better runner in her quest for healthy living. Her SMART goal is as follows – By the end of the summer, I will run 10km in under 55 minutes. With this simple statement, she has met all the SMART criteria. Even better, to make herself accountable, she signs up for a 10km road race at the end of the summer.

It doesn’t have to be complicated, but it does take thoughtful planning. Now start applying SMART goals to your strategy for health & well-being.

How to Practically Assess Health Information

You may have heard the term ‘evidence-based medicine’. This refers to practicing medicine with a solid grounding in scientific research. In medical school, we were taught how to critically appraise the evidence. Like any skill, this needs to be practiced. Hence, groups of doctors often assemble at a nice restaurant to discuss scientific journal articles. These ‘journal clubs’ promote evidence-based practice while bolstering our vibrant social lives.

Most of us, however, are not getting health information from the primary literature. The following scenario might sound familiar:

As you scroll through social media, a click-baity headline catches your attention. You take the bait and link out to an article from a media site you’ve never heard of with flashy ads all down the righthand side. You quickly skim the article or jump to the last paragraph to read its conclusion. In doing so, you’re unknowingly answering two questions:

Can I relate to this?
Does this support my already held beliefs about the topic?

After your brief skimming and intuition, you promptly decide if it supports or rejects your current worldview on the subject. In the former, you think ‘what an insightful piece’ (confirmation bias) and share it with your followers. In the latter, you think ‘this person has no idea what they are writing about…they are probably ignorant, stupid, or both’.

This approach, while common, is not useful. It is a product of our distracted world and results in hardening of already held beliefs. Instead, I suggest the following practical approach to assessing any health information you might be consuming, outside of the primary literature. It involves reflecting on five important questions.

Who is the source?

The source could be an individual or an organization. It’s important to find out where the information is coming from. What are the author’s credentials? Is this a researcher, journalist, news outlet, blogger (irony acknowledged), industry sponsor, etc? If you can’t figure out who the source is, consider this a red flag.

How is the source biased?

Everyone is biased. You need to figure out how, and if it could impact the presentation of their work. Be particularly cautious if the source has something to sell, benefits from a paid sponsorship, or has a track record of promoting a specific ideology.

Is the content credible?

In evidence-based medicine, we term this ‘internal validity’. This is harder to assess than the first two questions. One clue for credibility is the inclusion of references to primary literature. Even so, the author is generally betting that you won’t fact check them. If the subject is important enough, you should. Other indicators of credibility are discussion of limitations of findings or exploration of alternative views. These are necessary components of peer-reviewed scientific papers.

Beware content that makes extreme claims, using key words like ‘never’, ‘always’, ‘x causes y’, or ‘y cures z’. Good science is narrow in scope. In order to control for things, research studies have to be very specific. The result is that most evidence pushes our knowledge only incrementally. Findings usually don’t allow us to generalize to all contexts and populations, let alone make causal statements.

Does this apply to me within my context?

If you’ve made it this far, you now have to decide if the health information is actually relevant to your own situation. To do so, you need to know if the evidence upon which the source is based was generated from a population that shares your personal characteristics. These include age, sex, health status, socioeconomic status, ethnicity, geography, and more. Put simply, does the study population look like me? If not, you don’t really know if the findings apply to your situation.

How can I apply this to my current health goals?

If all of the above questions hold (they won’t 95% of the time) you finally need to determine if the new information adds value. You probably have some goals for your health and well-being. These goals, both proximal and distant, inform your strategy and behaviour. If the health information you just assessed doesn’t fit with your goals, it’s not helpful. At least not now. But there is a chance that it applies to something you are working on right now. Great, this adds value! Now you’ve got some bona fide evidence-informed data to apply. Wasn’t that easy?

Your problem is you don’t know what your problem is.

Life is full of problems. In fact, we spend most of our time solving problems; everything from deciding what to eat to figuring how much to save each month for an early retirement. In our pursuit to solve, two common glitches occur:

We apply solutions in search of problems; OR
We solve the wrong problems.

Both of these approaches get us nowhere.

Most people think that cleaning up their diet, signing up for the gym, or getting 30 minutes extra sleep will improve their health. While these seem like good ideas, they are examples of solutions in search of problems.

How can this be? After all, clever marketing would have us believe that we must do these things to be well. But marketing doesn’t know anything about you, other than your being as prone to irrational decision-making as anyone else.

You go ahead and sign up for a new gym membership. Then you attempt to insert this ‘solution’ into your already jammed schedule. Immediately, your quick fix has created conflicts with how you’ve designed your use of time. We know how this goes. You change things to accommodate, it works for a while, then things regress back to normal. You feel bad for letting yourself down, guilty for buying the membership, and so on. This could have been avoided by thinking more about what problem you really need to solve.

Here’s another example: if I just sleep better, everything would change. This is false reasoning. What is the ‘change’ I’m looking for? How would I measure it? What is the threshold for success? Unless I define these things, any sleep intervention would risk solving the wrong problem. But before I even define my outcomes and measurements, I need to dig deeper into the root problem.

I suggest a tool we often use in quality improvement research, called the ‘5 Whys’. Here’s how it works:

Why do I think my health is not optimal?

My sleep is poor.

Why is my sleep poor?

After I put the kids to bed, I have trouble winding down. So, I go to bed later than I should.

Why do I have trouble winding down?

I feel like I still have a million things to do before tomorrow.

Why do I feel I need to accomplish all of these things now?

If I don’t, then I will get behind at work.

Why am I feeling behind at work?

Well…let me count the ways…

In this example, it turns out that extra pressure at work (or self-imposed deadlines) are the actual problem. Fixing this problem will be far more likely to free up the evenings to then have the desired sleeping routine. The solution is certainly not, ‘I just need to sleep better’.

This line of questioning could have gone several ways, depending on the responses to the questions. This depends on the individual. What’s important is to ask the questions before we set ourselves up to fail by fixing the wrong problems or applying the wrong solutions.

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.