Common sense is too common

The snow has finally stopped falling and you're pleased to be inside, driveway all shovelled neatly (first one on the block!), the aroma of a fresh pot of coffee permeating your home. Too bad for you that the squeezing sensation in the centre of your chest that kind of niggled while you were outside has just returned, but this time with a vengeance. Your wife calls 911 because the worried look on your face is actually worse than hers. What's the first thing paramedics will do when they arrive and learn that you're having chest pain? What's the first thing you probably want them to do?

Before even giving you an aspirin to chew, they'll probably strap on nasal prongs and give you some oxygen. After all, if you're having a heart attack, the problem is that the supply of blood, and therefore of good ol' oxygen, to your heart muscle is being choked off by a blood clot in a heart artery.

What could go wrong by giving a supplement of a natural substance that all our cells need to survive and of which those cells are being deprived?

Lots, apparently. Just click here to see the results of a clinical trial that randomly assigned 638 patients with chest pain to receive supplemental oxygen or not. Four hundred and forty one of them turned out to be having heart attacks and during followup, compared to those who just breathed ambient air, those who got the oxygen had larger heart attacks, more recurrent heart attacks, and more cardiac arrhythmias.

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Now just think, if oxygen turns out to be bad for you in the midst of a heart attack - a natural and "common sense" treatment given a basic understanding of the situation - what other supplements that are natural and appeal to common sense might be bad for you, too?

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The available data make a strong enough case to stop routinely providing supplemental oxygen to patients having chest pain and heart attacks. A time honoured treatment should no longer be employed. There is a long list of medical therapies established by common sense that are no longer offered because they've been shown in clinical trials to be ineffective or harmful (and it's an amazing list that you really should click on and see so here's another chance if you missed it before).

Tell me this: when was the last time that a supplement, herbal, or homeopathic treatment was tested by those practitioners in a clinical trial and pulled from the shelves?

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Another timely example of the failure of common sense is screening for cancer. If you have a test that can detect cancer, applying it to populations should reduce premature deaths. Simple, right? But the situation for screening is much more complicated than it seems and, in fact, screening the general population for cancer, including breast, lung, colon and prostate cancer, is probably a huge waste of time, effort, worry, and money (with the possible exception of pap smears for cervical cancer). Not only that, it probably causes more harm than good, and it's a practice that should stop. The same is true for the annual physical examination, which is going the way of the Dodo. Why? Because skeptical people put these common sense notions to the real test of randomized trials and the results weren't what common sense had predicted.

Common sense tells us that because something seems like it should work, it does work, but it's time to get humble, to became skeptical of common sense. It's time to admit that many things are far more complicated than they seem. I know that may make some people feel small and insignificant, but that's really not necessary. Evidence makes us powerful. Experts aren't necessarily smarter than you. Real experts just know the evidence better than others. By learning how to find and assess the evidence, you can become powerful, too. An easy way to get to the best understanding of the available health-related evidence is to use Cochrane, a global non-profit, non-governmental organization that you can read all about at Wikipedia here. Search your health query and Cochrane is your friend.

Voltaire said that common sense is not common. On the other hand, it seems far too common to me. In everything from philanthropy to economics, from politics to education, and beyond, what we need is less common sense, and more high quality evidence.