#54 What are we to believe? (With Dr. Adam Cifu)

Summary: I unpack why medicine sometimes reverses course—and how you can tell sound evidence from shiny anecdotes—with physician-author Dr. Adam Cifu of the University of Chicago and co-author of Ending Medical Reversal
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Key topics & takeaways

• Why medicine “flips”: Plausible theories + observational data → premature guidelines; true answers require randomized trials. Classic examples: menopausal hormone therapy, early peanut avoidance, and stents for stable angina (LEAP trial
  , COURAGE
  
  
• Open-minded skepticism: Ask, “What’s the human outcomes evidence?” Cool mechanisms and moving testimonials aren’t proof.
• Hype outside the clinic: Mitochondria “rechargers,” microbiome panaceas, and biological age tests are intriguing—but not ready for prime time.
• Nutrition sanity:  For supplement evidence summaries, I like Examine
  .
• When AI helps (and when it doesn’t): Tools can orient you to established topics; they’re weaker on breaking studies. Look for linked primary sources.
• N-of-1 experiments: When evidence is uncertain and the outcome is measurable (sleep, blood pressure, pain), test on yourself—track a baseline, try the change, measure again, and, if possible, stop-start to confirm. Use symptom diaries, validated scales, or wearables.
• Humility is a signal: Trust sources that sometimes conclude “we don’t know.” I often check Cochrane Reviews
  for balanced syntheses.

About my guest
Adam Cifu, MD is a professor of medicine at the University of Chicago, author of 140+ peer-reviewed papers, and co-author of Ending Medical Reversal. He writes at Sensible Medicine.

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