1 Question That Can Save Your Life
What if you could save your life by asking one simple question? Imagine that you are diagnosed with a serious condition and your doctor recommends a treatment that sounds scary or risky. Or maybe you are offered a screening test or a preventive measure that seems harmless or beneficial. Before you agree to anything, there is one question that you should always ask: What is the evidence for this treatment?
This question can help you avoid unnecessary, harmful, or ineffective interventions that may harm your health or even kill you. It can also help you make informed decisions based on the best available scientific data. In this article, you will learn how to ask this question, how to evaluate the evidence, and how to find reliable sources of information.
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How to ask the question
Asking "What is the evidence for this treatment?" may seem simple, but it can be challenging in some situations. You may feel intimidated by your doctor's authority or expertise. You may worry about offending your doctor or appearing distrustful. You may also feel pressured by time constraints or emotional stress.
However, asking this question is not rude or disrespectful. It is your right and responsibility as a patient. You have the right to know what you are putting into your body and what effects it may have. You also have the responsibility to make sure that you are getting the best possible care for your condition.
Here are some tips on how to phrase the question politely but firmly:
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Start with a positive statement: Express your appreciation for your doctor's diagnosis or recommendation. For example: "Thank you for explaining my condition and suggesting this treatment."
Follow with a question: Ask for the evidence for the treatment in a clear and concise way. For example: "Can you please show me the evidence for this treatment?"
Clarify your expectations: Specify what kind of evidence you are looking for and why. For example: "I would like to see some scientific studies that show the benefits and risks of this treatment compared to other options."
Be respectful and assertive: Acknowledge your doctor's expertise and experience, but also express your own preferences and values. For example: "I respect your opinion and I appreciate your advice, but I also want to make sure that I am making the best decision for myself."
Here are some examples of how to ask the question in different situations:
Situation
Question
Your doctor prescribes you a new medication for your high blood pressure.
"Thank you for prescribing me this medication. Can you please show me the evidence that it works better than the one I was taking before? I would like to see some clinical trials that compare the effectiveness and safety of the two drugs."
Your doctor suggests that you have a colonoscopy to screen for colon cancer.
"Thank you for suggesting this screening test. Can you please show me the evidence that it is necessary and beneficial for me? I would like to see some systematic reviews that show the impact of colonoscopy on reducing the risk of colon cancer and death."
Your doctor recommends that you have a surgery to remove your gallbladder.
"Thank you for recommending this surgery. Can you please show me the evidence that it is the best option for me? I would like to see some randomized controlled trials that show the outcomes and complications of surgery versus other treatments."
By asking this question, you can empower yourself, protect your rights, and make informed decisions about your health. You can also improve your relationship with your doctor by showing that you are interested and involved in your care.
How to evaluate the evidence
Asking "What is the evidence for this treatment?" is only the first step. The next step is to evaluate the evidence and see if it supports or contradicts the treatment. Not all evidence is created equal. Some types of evidence are more reliable and relevant than others.
Evidence-based medicine is an approach that uses the best available scientific data to guide clinical decisions. It involves three steps:
Asking a clear and specific question about a health problem or intervention.
Finding and appraising the relevant evidence from various sources.
Applying the evidence to the individual patient's situation and preferences.
The quality, validity, and relevance of the evidence depend on several factors, such as:
The type of study: Different types of studies provide different levels of evidence. For example, randomized controlled trials (RCTs) are considered the gold standard for testing the effectiveness of interventions, because they randomly assign participants to receive either the intervention or a placebo or a comparison group, and measure the outcomes objectively. Systematic reviews (SRs) are comprehensive summaries of all the available evidence on a specific question, using rigorous methods to select, appraise, and synthesize the studies. Meta-analyses (MAs) are statistical analyses that combine the results of multiple studies on the same question, to produce a pooled estimate of the effect size. Observational studies (OSs) are studies that observe and measure the associations between variables, without manipulating them. They can be cohort studies, case-control studies, cross-sectional studies, or ecological studies. Case reports (CRs) are descriptive reports of individual cases or events, without any comparison group or statistical analysis.
The quality of study: The quality of study refers to how well it was designed, conducted, reported, and analyzed. A high-quality study minimizes bias, confounding, error, and uncertainty in its results. Bias is a systematic deviation from the truth due to flaws in the study design or execution. Confounding is a distortion of the association between variables due to the presence of another variable that affects both of them. Error is a random deviation from the truth due to chance or measurement error. Uncertainty is a lack of precision or confidence in the results due to small sample size, wide confidence intervals, or heterogeneity among studies.
The relevance of study: The relevance of study refers to how applicable it is to the specific patient or population, intervention or exposure, outcome or effect, and setting or context. A relevant study answers a question that matters to the patient or population, tests an intervention or exposure that is feasible and acceptable to them, measures an outcome or effect that is meaningful and important to them, and reflects the setting or context where they live or receive care. A relevant study also considers the potential benefits, harms, costs, and preferences of the patient or population, and compares them with alternative options.
Here are some examples of different types of evidence and how to assess their quality and relevance:
Type of evidence
Example
Quality
Relevance
Randomized controlled trial (RCT)
A study that compares the effects of aspirin versus placebo on preventing heart attacks in healthy men over 50 years old.
High: The study randomly assigns participants to receive either aspirin or placebo, and measures the outcomes objectively and blindly.
High: The study answers a question that matters to the population, tests an intervention that is feasible and acceptable to them, measures an outcome that is meaningful and important to them, and reflects the setting where they live or receive care.
Systematic review (SR)
A study that summarizes all the available evidence on the effects of acupuncture on chronic low back pain.
High: The study uses rigorous methods to select, appraise, and synthesize the studies, and reports the results transparently and comprehensively.
High: The study answers a question that matters to the population, tests an intervention that is feasible and acceptable to them, measures an outcome that is meaningful and important to them, and reflects the setting where they live or receive care.
Meta-analysis (MA)
A study that combines the results of several RCTs on the effects of statins on lowering cholesterol levels.
High: The study uses statistical methods to pool the data from multiple studies, and accounts for heterogeneity and bias among studies.
High: The study answers a question that matters to the population, tests an intervention that is feasible and acceptable to them, measures an outcome that is meaningful and important to them, and reflects the setting where they live or receive care.
Observational study (OS)
A study that observes and measures the association between smoking and lung cancer in a large cohort of people.
Low: The study does not randomly assign participants to smoke or not smoke, and may be subject to confounding, bias, or error in measuring the exposure and outcome.
Low: The study does not answer a question that matters to the population, test an intervention that is feasible and acceptable to them, measure an outcome that is meaningful and important to them, or reflect the setting where they live or receive care.
Case report (CR)
A report that describes a rare case of a patient who developed liver failure after taking a herbal supplement.
Low: The report does not have any comparison group or statistical analysis, and may be subject to bias or error in reporting the case or outcome.
Low: The report does not answer a question that matters to the population, test an intervention that is feasible and acceptable to them, measure an outcome that is meaningful and important to them, or reflect the setting where they live or receive care.
By evaluating the evidence, you can determine whether it supports or contradicts the treatment, and how confident you can be in its results. You can also identify the limitations and uncertainties of the evidence, such as bias, confounding, error, or generalizability.
How to find reliable sources of information
Finding reliable sources of information is another crucial step in asking "What is the evidence for this treatment?". Not all sources of information are trustworthy. Some sources may provide inaccurate, incomplete, outdated, or biased information. Some sources may also have conflicts of interest, hidden agendas, or ulterior motives. Some sources may even deliberately spread misinformation, disinformation, or pseudoscience.
To find reliable sources of information, you need to consider several factors, such as:
The source's credibility: The source's credibility refers to its authority, expertise, reputation, and transparency. A credible source is one that has relevant qualifications, experience, and recognition in the field. A credible source is also one that provides clear and accurate information, cites its sources, discloses its conflicts of interest, and updates its content regularly.
The source's content: The source's content refers to its quality, validity, relevance, and completeness. A reliable source is one that provides high-quality, valid, relevant, and complete information on the topic. A reliable source is also one that uses evidence-based methods, follows ethical standards, and avoids logical fallacies or emotional appeals.
The source's purpose: The source's purpose refers to its goal, intention, or motive. A trustworthy source is one that has a clear and honest purpose, such as informing, educating, or entertaining the audience. A trustworthy source is also one that respects the audience's intelligence, autonomy, and diversity. A suspicious source is one that has a hidden or ulterior purpose, such as persuading, manipulating, or deceiving the audience. A suspicious source is also one that exploits the audience's emotions, biases, or fears.
Here are some examples of reliable sources of information and how to recognize them:
Source
Example
Credibility
Content
Purpose
Peer-reviewed journal
The Lancet
High: The journal is a reputable and authoritative publication in the field of medicine. It has a rigorous peer-review process that ensures the quality and validity of the articles. It also discloses the conflicts of interest and funding sources of the authors.
High: The journal provides high-quality, valid, relevant, and complete information on various topics related to health and medicine. It uses evidence-based methods, follows ethical standards, and cites its sources.
High: The journal has a clear and honest purpose of informing and educating the scientific community and the public about the latest research and developments in medicine. It respects the intelligence, autonomy, and diversity of its audience.
Reputable website
Mayo Clinic
High: The website is a credible and respected organization in the field of health care. It has qualified and experienced staff who provide clear and accurate information. It also updates its content regularly and provides contact information.
High: The website provides high-quality, valid, relevant, and complete information on various topics related to health and wellness. It uses evidence-based methods, follows ethical standards, and cites its sources.
High: The website has a clear and honest purpose of informing and educating the public about health issues and solutions. It respects the intelligence, autonomy, and diversity of its audience.
Independent organization
Cochrane Library
High: The organization is a reputable and independent network of researchers, professionals, patients, and carers who produce systematic reviews on various health topics. It has a transparent and rigorous methodology that ensures the quality and validity of the reviews. It also discloses the conflicts of interest and funding sources of the reviewers.
High: The organization provides high-quality, valid, relevant, and complete information on various topics related to health interventions. It uses evidence-based methods, follows ethical standards, and cites its sources.
High: The organization has a clear and honest purpose of informing and educating the public about the best available evidence on health interventions. It respects the intelligence, autonomy, and diversity of its audience.
Here are some examples of unreliable sources of information and how to avoid them:
Source
Example
Credibility
Content
Purpose
Anecdotal evidence
A blog post by someone who claims that they cured their cancer by drinking lemon juice.
Low: The source is not an authority or expert in the field of medicine. It does not provide any credentials or references to support its claims. It also does not disclose any conflicts of interest or funding sources.
Low: The source provides low-quality, invalid, irrelevant, and incomplete information on the topic. It does not use evidence-based methods or follow ethical standards. It does not cite any sources or provide any data to support its claims.
Low: The source has a hidden or ulterior purpose of persuading or manipulating the audience to believe or buy something that is not supported by evidence. It exploits the emotions, biases, or fears of its audience.
Testimonial
A video testimonial by a celebrity who endorses a weight loss product.
Low: The source is not an authority or expert in the field of nutrition or health. It does not provide any credentials or references to support its claims. It also has a conflict of interest or a financial incentive to endorse the product.
Low: The source provides low-quality, invalid, irrelevant, and incomplete information on the topic. It does not use evidence-based methods or follow ethical standards. It does not cite any sources or provide any data to support its claims.
Low: The source has a hidden or ulterior purpose of persuading or manipulating the audience to believe or buy something that is not supported by evidence. It exploits the emotions, biases, or fears of its audience.
Advertisement
A banner ad that claims that a supplement can boost your immune system and prevent COVID-19.
Low: The source is not an authority or expert in the field of immunology or infectious diseases. It does not provide any credentials or references to support its claims. It also has a conflict of interest or a financial incentive to sell the product.
Low: The source provides low-quality, invalid, irrelevant, and incomplete information on the topic. It does not use evidence-based methods or follow ethical standards. It does not cite any sources or provide any data to support its claims.
Low: The source has a hidden or ulterior purpose of persuading or manipulating the audience to believe or buy something that is not supported by evidence. It exploits the emotions, biases, or fears of its audience.
Pseudoscience
A website that promotes homeopathy as a cure for all diseases.
Low: The source is not an authority or expert in the field of medicine or science. It does not provide any credentials or references to support its claims. It also ignores or contradicts the established scientific consensus and evidence.
Low: The source provides low-quality, invalid, irrelevant, and incomplete information on the topic. It does not use evidence-based methods or follow ethical standards. It does not cite any sources or provide any data to support its claims.
Low: The source has a hidden or ulterior purpose of persuading or manipulating the audience to believe or buy something that is not supported by evidence. It exploits the emotions, biases, or fears of its audience.
By finding reliable sources of information, you can access high-quality, valid, relevant, and complete information on the topic. You can also avoid unreliable sources of information that may provide inaccurate, incomplete, outdated, or biased information.
Conclusion
Asking "What is the evidence for this treatment?" can save your life by helping you avoid unnecessary, harmful, or ineffective interventions that may harm your health or even kill you. It can also help you make informed decisions based on the best available scientific data.
In this article, you learned how to ask this question, how to evaluate the evidence, and how to find reliable sources of information. You learned how to phrase the question politely but firmly, how to assess the quality, validity, and relevance of the evidence, and how to recognize and avoid unreliable sources of information.
By asking this question, you can improve your health outcomes, reduce your medical costs, and contribute to a more rational and ethical health care system. You can also empower yourself, protect your rights, and respect your preferences and values.
If you want to learn more about how to apply this question in various scenarios and situations, you can download the pdf book "1 Question That Can Save Your Life" by Dr. Biswaroop Roy Chowdhury for free from his website. This book will provide you with more information and examples on how to use this question effectively and efficiently.
Remember: Asking "What is the evidence for this treatment?" is not only a question. It is also an answer. An answer that can save your life.
Frequently Asked Questions
What is the difference between evidence-based medicine and conventional medicine?
Evidence-based medicine is an approach that uses the best available scientific data to guide clinical decisions. Conventional medicine is a term that refers to the mainstream medical practice that is based on scientific principles and methods. Evidence-based medicine and conventional medicine are not mutually exclusive. In fact, most conventional medicine practitioners use evidence-based medicine in their practice. However, some conventional medicine practitioners may not use evidence-based medicine consistently or adequately, and may rely on outdated, ineffective, or harmful interventions that are not supported by evidence.
What are some examples of unnecessary, harmful, or ineffective interventions that can be avoided by asking "What is the evidence for this treatment?"?
Some examples of unnecessary, harmful, or ineffective interventions that can be avoided by asking "What is the evidence for this treatment?" are: - Antibiotics for viral infections: Antibiotics are drugs that kill or inhibit bacteria, but they have no effect on viruses. Taking antibiotics for viral infections, such as colds, flu, or COVID-19, is unnecessary and harmful. It can cause side effects, such as allergic reactions, diarrhea, or yeast infections. It can also contribute to antibiotic resistance, which is a serious global health threat that makes bacteria harder to treat. - Vitamin supplements for healthy people: Vitamin supplements are pills or liquids that contain vitamins, minerals, or other nutrients. They are intended to prevent or treat deficiencies or diseases caused by inadequate intake of these nutrients. However, for most healthy people who eat a balanced diet, taking vitamin supplements is unnecessary and ineffective. It can also be harmful, as some vitamins can be toxic in high doses or interact with other medications. For example, taking too much vitamin A can cause liver damage, headaches, nausea, and birth defects. Taking too much vitamin E can increase the risk of bleeding and stroke. - Homeopathy for any condition: Homeopathy is a pseudoscientific system of alternative medicine that claims to treat diseases by using highly diluted substances that supposedly cause the same symptoms as the disease. For example, homeopaths may use onion juice to treat allergies, because onion juice can cause watery eyes and runny nose. However, there is no scientific evidence that homeopathy works for any condition. In fact, most homeopathic remedies are so diluted that they contain no active ingredient at all. Taking homeopathic remedies is ineffective and potentially harmful, as they may contain contaminants or interfere with other treatments.
How can I learn more about evidence-based medicine and how to apply it in my own health care?
There are many resources available online and offline that can help you learn more about evidence-based medicine and how to apply it in your own health care. Some of them are: - The Centre for Evidence-Based Medicine (CEBM): This is an organization based at the University of Oxford that provides training, education, research, and support on evidence-based medicine. It also offers online tools and resources, such as tutorials, podcasts, blogs, databases, and calculators. - The Cochrane Library: This is a collection of databases that contain high-quality systematic reviews and other evidence on various health topics. It also provides summaries and plain language explanations of the reviews for the general public. - The NICE Evidence Search: This is a search engine that allows you to find reliable and relevant evidence from various sources, such as guidelines, journals, databases, websites, and organizations. It also provides filters and tools to help you refine your search and appraise the evidence. - The Patient Education Materials Assessment Tool (PEMAT): This is a tool developed by the Agency for Healthcare Research and Quality (AHRQ) that helps you evaluate the quality and usability of patient education materials. It consists of a set of criteria and a scoring system that assesses how well the materials are written and designed.
What are some common myths or misconceptions about evidence-based medicine?
Some common myths or misconceptions about evidence-based medicine are: - Evidence-based medicine is the same as cookbook medicine: This myth suggests that evidence-based medicine is a rigid and inflexible approach that ignores the individuality and preferences of patients and practitioners. However, this is not true. Evidence-based medicine is not a set of rules or recipes that must be followed blindly. It is a process of integrating the best available evidence with clinical expertise and patient values. It allows for flexibility and adaptation to different situations and contexts. - Evidence-based medicine is only based on randomized controlled trials: This myth suggests that evidence-based medicine only considers randomized controlled trials as valid sources of evidence, and disregards other types of studies or information. However, this is not true. Evidence-based medicine recognizes that different types of questions require different types of evidence. It uses a hierarchy of evidence that ranks the reliability and relevance of different types of studies according to their design and quality. It also considers other sources of information, such as clinical guidelines, expert opinions, patient experiences, and local data. - Evidence-based medicine is only for doctors or researchers: This myth suggests that evidence-based medicine is a complex and technical skill that only doctors or researchers can master or use. However, this is not true. Evidence-based medicine is a skill that anyone can learn or use, regardless of their background or profession. It is a way of thinking and acting that helps you make better decisions about your health and well-being. It is also a way of communicating and collaborating with others who share the same goal of improving health outcomes and quality of life. What are some challenges or barriers to using evidence-based medicine in practice?
Some challenges or barriers to using evidence-based medicine in practice are: - Lack of time or resources: Practitioners or patients may not have enough time or resources to access, appraise, or apply the evidence. They may face constraints such as busy schedules, limited access to databases or journals, high costs of subscriptions or fees, or low internet speed or connectivity. - Lack of skills or knowledge: Practitioners or patients may not have enough skills or knowledge to use evidence-based medicine effectively. They may lack the ability to formulate clear and specific questions, search for relevant and reliable sources, assess the quality and validity of the evidence, or apply the evidence to their own situation and preferences. - Lack of motivation or interest: Practitioners or patients may not have enough motivation or interest to use evidence-based medicine. They may have low awareness or appreciation of the benefits of evidence-based medicine, or high resistance or skepticism towards changing their current practice or behavior. They may also have strong beliefs or preferences that conflict with the evidence, or face social or cultural pressures that discourage them from using evidence-based medicine. - Lack of support or collaboration: Practitioners or patients may not have enough support or collaboration to use evidence-based medicine. They may face barriers such as lack of leadership, guidance, feedback, incentives, or recognition from their peers, managers, organizations, or systems. They may also face challenges such as lack of trust, communication, cooperation, or coordination among different stakeholders, such as practitioners, patients, policymakers, researchers, educators, etc.
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