The Only Experimental Subject Who Matters

We have come to expect that clinical trials require thousands of participants, tracked over years or decades.  Even for measures of clear long-term value like exercise and vitamin D, the trends have to be wrenched from the scatter with statistical vicegrips.  The message in this situation is that individual responses to any intervention vary widely, and the individual variation is far larger than the average effect.  Does this suggest an individual strategy for your personal health?  One man’s food is another man’s poison.  You are not an average.  There’s enormous potential benefit if you can figure out which side of the curve you fall on.  Of the many supplements and diets and practices that are beneficial to some people but not others, which is most helpful to you?

Headline: Soon, Medication Will be Custom Tailored to Your Specific Genetics

Everyone agrees that individualized medicine is the wave of the future.  You don’t have to wait for a gene map that tells you exactly the right treatment for your personal gene combinations.  With a little patience and discipline (ok—maybe a lot of discipline), you can find out for yourself.  What you need is a system for trying many different ideas—the more diverse the better—and a notebook or spreadsheet for recording what you notice.

There are many conditions at which Western medicine excels.  Vaccines have wiped out polio, which left my father with a right leg 4 inches shorter than his left.  If you have appendicitis, don’t hesitate to get an appendectomy, and if you contract malaria, thank science for quinine.   

But there remain many conditions for which Western medicine has no answer, and standard practice is to mask symptoms with temporary expedients.  It means only that medical science has not identified a cure that works for everyone; there may well be something available that can cure you.

All of “evidence-based” medicine is derived from studies of many people, usually thousands of people, sometimes millions of people.  The usual situation is that individual responses vary all over the map, and what is reported is the average.  

If there’s an absolute cure, no side-effects, no recurrence, but it only works in 20% of the subjects, you won’t even hear about it.  If there’s a cure that requires discipline—for example, a rigorous exercise program or a severely restricted diet–you’ll never hear about it even if it works for everyone, because the study will be undermined by “compliance issues”.

Of course, let’s learn all we can learn from large-scale studies.  But don’t let’s stop there.  The one experimental subject you care about is the one over whom you have the most control.  You are not an average, but you are knowable—your tolerances and your limits, your preferences, your individual and highly specific response to a medication or a diet or a new rhythm of sleeping and waking, of discipline and free play, of working and working out.

The procedure is perfectly straightforward and common sensical, though few people are doing it.  It is the essence of the scientific method:

• Choose one condition to focus on.  Prioritize what will have the greatest impact on your wellbeing, but also consider what has clear symptoms you can feel or measure.  Start with something about which you feel open-minded and optimistic—you can advance later to chronic conditions for which you may have abandoned hope.
• Choose a treatment or change in life habits that you think has a chance of addressing that condition.  (Guidance for this step below.)
• Decide how long is a fair test.  Naturally, an approach that offers results in with a few days is easier to test than something that you suspect will take a year.  (We’ll use “two weeks” as an example.)
• Choose a time when you expect a routine that is typical for you.  Better not to start at a time when you’re traveling or beginning a new job or a new relationship.
• Begin keeping records.  Every evening without fail, record a number that codes how well you’re doing with this condition.  Add a few words of description if you like.  Keep your record in a diary, a notebook, or (if you’re comfortable with them) in a spreadsheet.  Begin with a two week reference period, life as usual.
• Then begin your first treatment period.  Keep records for another two weeks.
• Only at the end of the first four weeks, look back at your daily records.  Can you see any difference between the reference period and the test period?  It may be clear at this point that this treatment isn’t working, and it’s time to try something else.  But unless you’re pretty sure, give it at least one more trial period: two weeks off and two weeks on.
• At this point, you have a decision to make.  You have recorded your subjective judgments, and now you step into the role of objective scientist to make the decision based on your data.  Was there a clear difference between the test periods and the control periods?  (Secondarily, ask, “is this something that it is easy to continue doing?”) You’re not desperate—there are lots of other things you can try.  Make a decision to
  • Drop this idea for now and try something else.
  • Keep doing this, and add a new treatment.
  • Keep doing what you’re doing—it looks as though it solves the issue completely.
• Repeat until you are where you want to be.

 

How do you know if it’s working?

Some kinds of feedback are easier than others.  The most difficult concern your long-term risk of getting cancer or heart disease, but even here you may be able to find surrogate measures that provide a good indication of what is helping.

• The easiest case is objectively measurable.  If you are interested in losing weight or lowering blood sugar or increasing sprint speed or the number of pushups you can do, it’s obvious what to measure.  (There’s emerging technology for checking blood sugar frequently, without finger pricks, available from several sources [Dexcom, iHealth, Abbotts, review].)  
• More subtle are subjective feelings, including chronic pain, congestion, stiffness, anxiety, wellbeing, engagement, enthusiasm, mental focus and physical energy.  Only you can judge; but it’s easy to fool yourself, and perceive patterns that don’t stand up to scrutiny.  Your best strategy is to keep meticulous daily records.  Rate your pain or your energy on a scale from 1 to 10.  How many hours were you able to work undistracted?  Record, too, brief, qualitative descriptions of your mood and energy level and your creative output.  Don’t review these until the experiment is complete, and then look back and evaluate your record as objectively as you can, comparing “on treatment” and “off treatment” times in the aggregate.  (For this stage, you may find it helpful to engage a friend to evaluate your written account more objectively.)
• Yet more subtle are indications from our bodies that offer a clue to what is good or bad for us.  Many of us have been raised in a culture which tells us to pop an aspirin and show up at work no matter how miserable we feel.  Yoga and meditation practice can lead you back to an intuitive sensitivity to your body.  Mindfulness practice can re-sensitize you to subtle body signals that you have learned to ignore.

Blood tests are useful for longer-term experiments.  A1C is an indication of average blood sugar.  C-reactive Protein tracks with the body’s inflammation level and correlates with cardiovascular risk.

Many of us are interested in long-term benefits that are unlikely to show up in a two-week test.  These experiments are not more difficult, just slower.  Test at intervals of 6 months to a year.  There are commercial telomere tests available that can plot one indication of your biological age.  Horvath’s DNA methylation clock can be used to track a set of markers that is, collectively, a more robust, objective indicator.  For these long-term tests, we don’t have the luxury of trying one test at a time, (one year on – one year off?) but we can try a combination of lifestyle changes based on a hunch, then check our progress annually to see if we are on the right track.

 

What to try?

• Do I sleep better if I do Qi Gong before bed?
• Do I get more done at work if I bicycle than if I drive?
• Does my blood sugar go down if I don’t eat wheat?
• Is daily aspirin making my back less stiff?
• Does bacopa improve my creative output?

A friend of mine, a PhD biochemist, jumped into action when his sister-in-law was diagnosed with glioblastoma.  This is a devastating form of brain cancer that is almost always fatal within a few months.  But, scouring PubMed, Greg located three unrelated, obscure studies from the past in which safe and available supplements led to complete cures in a minority of subjects. He found the three ingredients—one from an off-shore source—but he couldn’t get permission to administer them until his sister-in-law was in a hospice unit, deemed to be in her final hours.  But within weeks she was back on her feet, and now, two years later, she is still alive.

This is one model: look on the web for listserves with personal stories, or traditional medicines, or “failed” trials in the medical literature.  

I’ve mostly used Examine.com and LEF as fertile sources of ideas.  Suggestions from friends are perfectly legitimate.  Follow your intuition; hunches are the seed of many scientific discoveries.  (Don’t censor up front; the time for objectivity is in the evaluation phase.)

Develop your sensitivity
The controlled experiment is a powerful tool for learning about yourself.  But even more basic, paying attention to your inner life can be an important first step toward elevating your wellbeing.  We are all conditioned to keep mum about our inner state, men even more than women.  Simply paying attention to what is going on inside helps to avoid injuries and (in my unscientific opinion) helps to speed healing locally.  Notice your mood, your energy level, subliminal pains, productivity, ability to pay attention and connect to others.  It’s a habit that leads to more conscious choices and better alignment of your outer habits with your inner directions.