To those of you who have read my blog over the past year, welcome back! To any new people, welcome. As a little update, I recently changed the name of this blog to Girls Love Evidence, as a bit of a tongue-in-cheek way of addressing that this is, yes, a girly blog, but it is a science-based girly blog damn it! As a segue into this new chapter, I wanted to talk about what evidence-based means to me and why I feel so strongly about evidence-based health and wellness.
Growing up, my family indulged my constant need to know. I always had my nose in a book about my favorite subject of the moment, whether it was anatomy, space, Egyptology, or haunted places.
As an adult, I have a bit of a reputation for pulling out my phone to verify a random question that comes up in conversation. When I started this blog (and its newsletter), I had a section for “the weirdest thing I looked up this week”. Evidence-based health and wellness research is based on my desire to know and understand.
It comes down to this: I’m not satisfied with not knowing if the answers are out there.
In my training as a scientist, one of the most important things I realized is that there aren’t many absolutes. In research, you set out with a hypothesis (i.e. what you think will happen), then you create a null hypothesis (i.e. your hypothesis was wrong). After testing, either you reject the null hypothesis, or you fail to reject the null hypothesis. If you reject the null hypothesis, it means your evidence was sufficient to show a significant difference. If you fail to reject the null hypothesis, maybe there was a difference, but it wasn’t statistically significant and didn’t give enough evidence to prove that something exists.
I’m definitely over-simplifying the research process, but the point is this— you don’t really ever get to prove anything. You can approach the truth, but you can’t really put your finger down on it and say “yes, this is exactly how this works”.
This makes the idea of evidence-based practice in health, medicine, etc., difficult! Even if a difference is statistically significant from the standpoint of research, there would still be a fraction of individuals for whom the experiment didn’t deliver. Statistically significant doesn’t mean all or nothing.
When I talk about evidence-based health and wellness, it means that I’m looking for things that are empirically validated. My experience (or your experience, or anyone’s experience) is completely valid within the scope of our own lives, but may not be in the context of statistical significance.
What Evidence-Based Health and Wellness Means- How I Define and Explore It
Let’s start with the dictionary definition of evidence-based, and then I’ll explain how I actually apply this.
Per the Oxford English Dictionary: evidence-based is an approach that emphasizes the practical application of the findings of the best available current research.
In the context of this blog this means two things:
- Practical application– I only choose topics to write about that have an impact on human health or are perceived to have an impact on human health.
- Best available current research– I read a lot of papers and I judge them pretty harshly.
Evidence-Based Practice Application
I care about the practical application for human health because I am not writing about complex medical interventions. I’m concerned about improving others’ scientific literacy and contributing to a knowledge base of more accessible information on everyday health.
This means I write about a lot of things that don’t require prescriptions, procedures, or a visit to the doctor’s office. I write about issues that impact real people and give them a good starting point for a conversation with their doctor should they need medical advice.
I might occasionally cite a mouse study or something like that, but mice are not people, and people do not exist in a laboratory. It is a million times easier to control for variables in these situations, and although they are compelling for primary research, it’s not sufficient for me to rely on to state any kind of practical benefit.
Best Available Current Research
This one is a bit of a doozy. What is “current”? What is “best”? These are subjective definitions for sure. I look at a few different things to evaluate the quality of the research.
First, I look at the study population and controls. Who was tested? Were they all the same gender, race, age, etc.? Does the population they studied represent a diverse group of people? Did they test enough people? If you care more about research quality, this guide is a pretty helpful introduction. Alternatively, consider reading articles with friends and trying to pick out potential errors or flaws. Compare notes. See what comes up. (I promise, it’s fun.)
Second, I look at who is funding the research and where it was published. If it’s published in a journal that forgoes most other scientific research to promote a certain claim, it’s a no from me. If the study was funded entirely by an organization that serves to benefit from a certain result, it’s going to get some side eye. This is not to say that industry-funded studies aren’t to be trusted outright— they still have high standards of ethical obligations. However, if a study is entirely industry-funded, I take a bit more of a critical look to see if their findings align with publicly-funded research.
If you want to get really into it, you can even investigate the financial interests of the researchers involved. This is a bit further than I’m willing to go for a blog post, but it has created a fair amount of controversy.
To analyze other aspects of the research, I look at the date conducted/published, the methods, and the conclusions versus the data. “Current” to me generally means during the 21st century, but this is, again, subjective.
If researchers describe a method based on another previously-described method, I read the article they’ve cited to make sure that the method checks out. Finally, I look at the data in the study rather than rely on the abstract (although it is sometimes so, so tempting).
This isn’t exhaustive, and once you get into the practice of reading a lot of research, this kind of thing seems almost like a second nature. But it can also be seriously frustrating and time consuming. Hence, this blog.
A recent example of something that looked promising but ultimately wasn’t evidence-based practice
This is just an anecdote, but I’m throwing this in here because it really bummed me out.
I have had GERD (gastroesophageal reflux disease) for a while, and it is a big ol’ bummer. For no reason, I feel like something is boring a hole under my sternum, and I consume a truckload of Tums to attempt to calm it. I was on PPIs and H2 blockers for a long time, and I have since been able to stop them due to better lifestyle management. However, because it tends to get worse when I get stressed out (nice), I am always looking into other potential strategies to mitigate it.
When I came across an article about dietary supplementation that showed that ALL subjects showed improvement compared to only 65% with the standard OTC treatment of PPIs, I was like WHOO.
Then I read the article, and I was like :/
There was no control group, which is a problem because a lot of GERD symptoms are linked to stress and mental state. A decent amount of GERD sufferers report improvement on placebo (14-26% based on the treatment).
Additionally, the subjects on the PPI treatment took it at night after dinner. From my own experience and the information given to me by my doctor, I had heard that PPIs are most effective when they are taken 20-30 minutes before the first meal of the day. This was backed up by research that showed the optimal dosing of PPIs is, in fact, in the morning prior to eating.
This doesn’t explain why 100% of subjects reported improvement on the supplements, but it doesn’t For my own use, I’d be happy to try it out to see if it works, but I would hesitate to say that this is “evidence-based” without those caveats. It’s a bummer. Unfortunately, this is par for the course for of a lot of the research I do on this blog.
What evidence-based means to me is that I take these kinds of things into account before making any claims, and I value being transparent with any potential gaps in research. It’s what I wish were par for the course on any/all science communication and blogging.
In looking for solid evidence on any given topic, I get frustrated when I can’t find good research. Especially when it comes to women and people of color, there is a lack of representation both in the demographics of those included in research as well as the health issues that disproportionately impact these groups. However, this is part of a greater critique of science as a field, and not a critique of the scientific method and evidence-based health overall.
I believe that transparency, thorough research, and better scientific literacy will improve the gaps in scientific research. I write about these things because I don’t think that there’s many spaces committed to doing so. Also because it makes me mad that people still promote detox tea as if Miralax in coffee wouldn’t be equally effective.