Evidence-based Boulevard

Just like the book of love, the road to evidence-based medicine is long and boring. The following is an excerpt from an article on the use of black cohosh as a botanical treatment for menopause and dysmenorrhea. It illustrates the tedious process of coming to a reliable conclusion on not only whether a drug works, but exactly how much is necessary.

In clinical studies before 1996, the dose was […] equivalent to 48–140 mg of black cohosh extract per day. A recent clinical trial comparing two different dosages of Remifemin® (40 mg vs. 127 mg daily), for six months, in 116 women with menopausal complaints, found similar safety and efficacy profiles for both doses (Liske et al., 2002). Based upon the results of this trial, a recommended dose equivalent to 40 mg of black cohosh (dried root) daily is currently recommended (Liske, 1998).

2014 Health Recap

Prompted by Katy Bowman at katysays.com

1. What was your biggest health triumph in 2014? Training for and completing my first (and second) ultra-marathon.

2. What was the smartest health decision you made in 2014? Decreasing my mileage to focus on correcting my lower extremity function.

3. What one word best sums up and describes your 2014 health experience? Exploratory. From high-carb quasi-vegetarian, to low-carb/high-fat with plenty of bacon, I've played with a variety of approaches.

4. What was the greatest lesson about health you learned in 2014? It's not so much about the macro-nutrients as the form they come in.

5. What was the most loving service that you performed in 2014? Chiropractic humanitarian trip to Haiti and the Dominican Republic.

6. What is your biggest piece of “unfinished (health) business” in 2014? Improving strength and increasing lean body mass.

7. What (about your health) are you most happy about completing in 2014? Finishing an ultra-marathon.

8. Who were the three people with the greatest impact on your health life in 2014? My roommate, Marina. Her simple meals of veggies and protein flavored by herbs & spices have changed the way I look at cooking. Dean Karnazes and Scott Jurek. While both are ultra-runners, their diets and life-styles are different. One follows a paleo/cave-man diet with plenty of fish while the other is a strict vegan. Katy Bowman. I heard about her a couple of years ago, but have only recently paid attention. Surprisingly, she's written a lot of the same thoughts on natural movement and general health that I've slowly had over the years, though she does a much better job developing them into coherent and well supported articles (and makes a career out of it).

9. What is the biggest health risk you took in 2014? Running an ultra-marathon. Due to my flat feet, classic lower-crossed syndrome, and switch to minimalist footwear, I've experienced a number of issues with my ankles, knees, and hips that could have worsened. There's also a slight chance I have some inherited heart condition that could have manifested in a grueling race, but didn't.

10. What was your biggest health surprise in 2014? Learning about FODMAPs as a more likely culprit than gluten (and being thankful I don't have to avoid them - I need avocados).

11. What important health relationship improved most in 2014? Awareness of my use of electronics - particularly iPhone, iPad. I still use them - a lot - but I am more conscious of when and how.

12. What compliment would you have liked to received but didn’t? Damn, you sexy! (Actually, I got that one, just in a different language.)

13. What compliment would you have liked to have given but didn’t? You look fit and healthy all at the same time.

14. What else do you need to do or say to be complete with 2014? Break my dependence on sweets and refined sugars.

Run Commuting

I originally drafted this blog post during the late spring of 2014. Never to late to publish a good thought, right?

I'm training for my first ultramarathon. That's a race longer than a marathon. I've opted for a 50 mile race on Mt. Hood, although I'll likely precede that with a 25k or 50k in early June. Training for an ultramarathon isn't much different than training for a marathon. You just have to run. A lot.

The big question is…

How do you fit in all that running? I'm ramping up my mileage very slowly this year to avoid the medial tibial stress syndrome (shin splints) that nagged me before my first marathon. Currently I'm hitting about 45 miles per week. Eventually I'll get up to 70+ miles in a week, including a single run of 30 or more miles.

As a graduate student, it's a huge challenge to find time to run all that much. So recently I've been playing with different ways to log miles. Dean Karnazes, also known as The Ultramarathon Man, doesn't own a car. He lives in Marin County outside of the Bay Area and gets around primarily on foot. I decided to give his technique a try.

Work it off

I went out for a normal run last Monday after school. I did a common loop around a golf course and came back to my apartment, for a total of 5 miles. As I was stretching outside my door, my phone rang. I'm on call as an A/V Technician at my school, and a professor was having trouble with the projector. Usually I'm reluctant to go back to campus in the evening, even though it's only 1/2 mile from my place. But you look at things differently when your brain is infused with endorphins and BDNF. "I'll run right over," I told him. I snuck in another mile, saved the day for a small group of massage students just yearning for more PowerPoint slides, and I got paid for it. Win-Win-Win!

Shopping

I've needed to get some audio cables to upgrade my little podcast set-up. These aren't the type of thing you buy at BestBuy or Staples. No, I wanted the real deal from Pro Audio & Lighting, an independent shop for audiophiles and indie-bands 6 miles away from home. I took a cue from Dean Karnazes, threw on my Anton Krupicka Ultimate Direction race vest, fired up The Tim Ferriss Show on my favorite podcasting app, and trotted over. Generally, I hate running on roads. This time wasn't much different, but it was a fun change to navigate the busy streets on foot rather than in a hunk of metal. The look I got from the store clerks was amusing.

So how do you fit in all your training?

Science vs. Scientism: A Rebuttal

Dr. Christopher Kent, chiropractor and subluxation activist, recently wrote an interesting post about Science vs. Scientism. His basic thesis was that Scientism is the habit of accepting scientific evidence as the only way to understand the world, excluding philosophy, aesthetics, etc. I don't disagree with this premise, but his conclusion - that anyone who fails to accept subluxation or innate intelligence as a valid construct must be adhering to Scientism, not science - seems to be a misconstrual of the scientific process.

[W]e cannot measure innate intelligence. Does this mean that it is not “real” and that we should abandon the concept merely because we have no technology to detect or quantitate it? I think not.

Straw man. Or red herring, I can't remember which.

Scientists do not suggest that we should abandon concepts merely because we don't yet have the technology for it, but rather that we should not blindly accept these hypotheses until we have evidence to support them. Kent mentions previously unproven concepts such as DNA and viruses, suggesting that we never would have benefited from understanding these ideas if it weren't for an open mind accepting ideas outside of what science can quantify. That isn't how science works, as I understand it. We would not have DNA technology if it weren't for the scientific process which has since substantiated it, not because of an acceptance of unproven hypotheses. DNA was accepted as the container of the code of life since Miescher first identified it in the 1860s long before it's structure was discovered circa 1953. But, read Watson's account of him and Crick stumbling upon The Double Helix and you clearly see that the process was one full of struggle, push-back, and incredulity among colleagues. Slowly the scientific community came to agree upon the structure we now accept – but only once the evidence was sufficient.

The concepts of subluxation and innate intelligence have been around for well over 100 years. There has yet to be convincing evidence of its validity as a construct other than anecdotal evidence which may or may not be explained by other well understood mechanisms.

Kent's argument that "doctors must not lose sight of the fact that science may not be the only valid method of inquiry" is accurate but not complete, because science is still the best method of inquiry.

As Carl Sagan shared in Demon Haunted World:

The difference between physics and metaphysics […] is not that the practitioners of one are smarter than the practitioners of the other. The difference is that the metaphysicist has no laboratory.

And so it is with chiropractic. The study of subluxation cannot be conducted in a laboratory, so cannot be considered a science and therefore is not a valid comparison by which to call others out for scientism.