This is a reflection on epistemology in medicine. It deals with my personal case of a bad stiff neck that lasted for more than a year, until I found the trick to make it go away. Please understand that I am no doctor and I don't claim to be able to cure anyone. I am just pointing out that you should always remember that you are a holobiont. So, if you treat your biome well, your biome will treat you well.
About two years ago, I developed a bad case
of stiff neck. Sometimes it meant so much pain that I had to stop
whatever I was doing and clench my teeth to avoid screaming. And sometimes I really screamed aloud. Then, I had to trust God every time I crossed a street because I
couldn't turn my head to see if a car was running in my direction.
There
are various medicines you can take to ease the pain of a stiff neck and
I tried several of them. Aspirin, NSAIDs, creams, exercises, acupuncture, massages. But, apparently, my case was bad enough to be
resistant to pills, creams, and manipulations. What the hell was happening to me?
I
tried to reason it over and I thought I had found an explanation. More
or less in coincidence with the start of my neck pain,
I had relocated to a new home.
It was partly underground, and the humidity inside was
much higher than in my old home. On the right, you see one of the windows of my new home. No, not the big one. Look at where my wife, Grazia, is pointing.
Yes, that one! The hygrometer in the new home consistently marked over
70% humidity, whereas in the old home the needle would normally stay
between 40% and 50%.
I know that correlation
doesn't mean causation, but the logical inference was that humidity was
the reason for my stiff neck. I found that it is commonly written on
the Web that indoor humidity should be between 40% and 60% for optimal
comfort, and that seemed to confirm my suspicion: my home was too humid. Even my hygrometer said that there was something wrong when the needle went over 70%. It was made in Germany, and their boffins are said to know what they say. Humidity could have been the reason of my stiff neck.
So, I bought a professional dehumidifier, It made a lot of
noise and it considerably raised my electricity bill, but it did lower the humidity level at home. Not so much, but it could bring it below 70%. But the effect on my neck was nil. During that period, I also happened to visit Iran for a couple of weeks.
Tehran is a very dry city, I had brought my hygrometer with me: humidity was
around 20%. I thought that it would have some good effect on my stiff neck, but
I noted no improvement at all.
In the meantime, I searched the
literature to try to understand why the "perfect" humidity is situated
exactly in the middle of the scale. I found very little. Plenty of people say that if humidity goes above 80%, it is bad for your health. And they say that, above that level, you should see
green mold appearing on the walls of your home. I saw that happening at
home, but did it have anything to do with my stiff neck? I couldn't find
a serious study on the effect of high humidity on human health and, in
particular, on neck pain.
About
one year and a half of pain had gone by when I had one of those
serendipitous moments that change your life.
Wait one moment.....
something HAD changed about two years before:
I had bought a new pair of glasses
with bifocal lenses. As soon as I started thinking about
that, I also noted that in moving to the new apartment I had set up my desk
on a table that was a little higher than the one I was using before.
And I noted that in order to focus my eyes on the screen, I had to
strain my neck backward.
This noted, this done. I got rid of my
glasses, discovering that I didn't really need them to read text on
screen. And the improvement was rapid: I felt better after just a
few days. Completely getting rid of the stiffness took at least 4-5
months, but I can report to you that now it is gone. Zero pain, it is wonderful! I can
turn my neck as much as I like and I can cross the street in safety.
So,
what did I learn from this experience? That medicine is a complicated
matter. I am trained as a scientist and I am a firm believer in the
experimental method. But that's very difficult to apply to
medicine. In my case, I found a trick that cured my neck, but does it
have a general validity? Does it prove that humidity doesn't cause
health damage? Does it prove that my stiff neck was caused by my new glasses? Would that apply to other people? How could I tell?
It is the general problem of "evidence based medicine."
The golden standard in medicine is the "randomized controlled trial."
That means a complex series of procedures to evaluate a significant
number of patients while trying to control all the multiple parameters
that might affect their health.
Seen in this light, my experience
with neck pain doesn't count anything. How can I prove that my neck
improved because I stopped wearing my glasses? How can I exclude other
factors, maybe a special astral conjunction? Or something else?
The
interesting point of this story is that it would be practically
impossible to carry out a randomized controlled trial on whether
excessive humidity causes a stiff neck. Think about that: how do you find a standardized set of
patients? How do you standardize the humidity conditions? How do you
define the intensity of one's stiff neck? In addition, who would pay for
such a study? Since it doesn't involve pills, no pharmaceutical company
would sponsor it.
The result is that everybody says that
medicine is a science, but it is a peculiar kind of science where the
"scientific method" is often applied in a creative way (to say the
least). That was seen very well with the recent Covid epidemics, where most of the actions that governments took were not based on hard data, but on haphazard evaluations taken on the spur of the moment. Just as an example, we saw everyone suddenly disinfecting everything, everywhere, all the time. Do we have proof that all that has any effect on the spread of the Covid epidemic? No, as you can read on "Nature" -- not normally so unreliable as a source.
Does that mean that randomized control studies are a bad idea? Not at all, and I invite you to follow the blog by Dr. Sebastian Rushworth, a true gold mine of ideas, suggestions, and data, all useful for your health. He is specialized in evaluating randomized control studies and he is very good at translating the dry and incomprehensible language of scientific papers into something that normal people can understand.
It is, just, that medicine is a world that deals specifically with the most complex system we know: the human body. And complex systems, it is known, can't normally be described in terms of "causes" and "effects." No, complex systems only know forcings and feedbacks. And a small forcing applied on a complex system can generate a chain of feedbacks that sends the system to a completely different state. Just like when a pair of new glasses pushed me from a state of "healthy neck" to a state of "stiff neck."
In the end, I think that always asking for proof in medicine is a double-edged weapon. It may help in many cases, but in others it may lead you completely astray. If you ask me (and let me repeat, I am not a doctor) I would say, "try what looks reasonable and keep what works." And always remember that you are a holobiont. Treat your biome gently (don't try to kill it using disinfectants) and your biome will treat you gently. And onward we go, fellow holobionts!
(on a line completely opposite to that of trusting randomized control studies, you may be interested in the work of Dr. Natasha Campbell-McBride, who wrote the book “Gut and Psychology Syndrome." She never mentions the concept of holobiont in her book or in her talks, but her whole approach is very, very holobiontic!)
