Wednesday, October 6, 2010

A Terminal Case of Ambiguity Fatigue

[This was published in the San Diego Union-Tribune]

My sister and I were having our weekly lunch at Rock Bottom (she eating Atkins, and I the Syndrome X diet), and discussing all the flip-flops in medical wisdom that have occurred in our 50-something years. We concluded at the end that our biggest health problem may not be high cholesterol but “ambiguity fatigue”. It seems that everything we thought we “knew” is now wrong.

When our sons were infants, babies had to sleep on their stomachs to avoid crib death; now they have to be on their backs. Our friends with ulcers who spent 30 years avoiding spicy foods are now being treated for a bacterial infection. Brushing your hair 100 strokes a night was said to make it shiny and healthy (but now gives it split ends). People with diverticulosis were once relegated to soft diets; now they’re filling up on roughage. My sister and I have dutifully switched back and forth from butter to margarine several times in the last 30 years (but frankly preferred the butter years); now we can’t figure out whether the saturated fat or the trans fats are more likely to get us. Cholesterol may not matter; artery inflammation measured by C-Reactive Protein may be the better measure. At my health club the other day, a fellow treadmiller was overheard to say that her doctor says to stop drinking 8 glasses of water a day - too hard on the kidneys.

Is nothing sacred?

Of course, my sister and I agree that the two that have truly broken our spirits are the HRT (hormone replacement therapy) and carbs versus fat debates. I spent twenty years limiting myself to two eggs a week and now suddenly eggs are OK again? I demand a cholesterol refund! Our genuinely beloved Primary Care Physician, nobly adhering to prevailing medical wisdom, is trying to get her patients off the hormones and onto the statins that she hopes will add a few years to our otherwise decrepit middle-aged bodies. But we’ve become a hard sell. Ambiguity fatigue has taken its toll. In our heart of hearts, we’re beginning to think of medical researchers, albeit unfairly, as the Enron executives of health care. What happened to all those studies showing HRT was good? If those studies were all flawed, how do we know the new ones aren’t too? Before I completely change my life again, they’re going to have to convince me.

Then there’s the issue of all these statistics. By my calculations, I do at least 20 things that are purported to reduce my risk of heart disease by 50%. – like eating fish twice a week. At what point does my heart owe me? When do I get a hot fudge sundae risk free? (I am hoping that someone who paid more attention to college statistics will write in and tell me.)

As my sister looked longingly at the whole wheat bun on my turkey burger, and I salivated over her high-fat plain hamburger, we concluded there is only one real health care question:

Does anybody really know?

All you can really do, we decided, is weigh up the evidence and go with what feels right, knowing that whatever you’re doing is bound to come back into favor again at some point. It’s kind of like riding out a down market. In fact, I like to think of it in terms of medical research ``futures”: I personally plan to go short on Lipitor (my pick as the next pariah of health care) and go long – very long – on chocolate. A person, after all, has to live.

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