Remember when we could ask a question and have a reasonable expectation of a truthful, clear, direct and to-the-point answer? I’m not sure I do. We Americans seem to have boxed ourselves into a prison of vaguery, avoidance, and circumvention. There is no one else to blame—we did this to ourselves, intentionally or not, and now we are paying the price.
We have made it horrendously difficult to distill the precisely pertinent information we seek about nearly anything. This certainly applies to our health, but first I’d like to illustrate why we find ourselves in this predicament by means of a simple analogy: soup.
Is there meat in that soup?
My wife likes soup, but doesn’t generally like any kind of meat in it. At home this is no problem, but the restaurant scenario is different. We see a delicious-sounding soup on the menu, and Lucy will ask our server—let’s call him Skip—a seemingly simple question:
Is there meat in that soup?
This is the simplest of questions. It’s unambiguous, and there are only two possible answers—or so it would seem. But Skip finds a third reply, “I don’t think so.” Now, what are we to do with this information? Trust Skip’s instinct? We asked because it’s important to Lucy, so we continue with, “Are you sure?” to which Skip predictably replies, “Pretty sure.”
Why does he respond this way? We might presume Skip to be merely lazy. His answer might be a disguised version of “I don’t know, I don’t care, and I’m not going to offer to find out for you.” But let’s give Skip the benefit of a doubt. Maybe he’s actually making an educated guess. He might know that their chef rarely uses meat in soup, translates this into “probably not,” and innocently fails to realize we don’t want to play the odds—we want a definitive answer.
Or maybe he does know there’s no meat, but is afraid to tell us. After all, what if for the first time there is meat? It’s certainly conceivable. What if he tells us there is none, and then it turns out he’s wrong? What if Lucy is allergic to meat? What if she becomes deathly ill? There could be dire consequences for Skip—risks he is reluctant to accept.
In defense of Skip
Sadly, he would be justified because as a society, we have made Skip’s nightmare scenario plausible: He tells us there’s no meat, but there is meat, Lucy gets sick, we sue Skip and the restaurant, and Skip becomes jobless, possibly bankrupt, and maybe unemployable. You know it could happen this way and so does Skip, so he behaves accordingly. In fact, noncommittal answers have become automatic for him. This behavior has become part of his deeply embedded internal survival programming.
… noncommittal answers have become … part of his deeply embedded internal survival programming.
If we’re serious enough about wanting the soup, we could ask Skip to check with the kitchen staff and find out for sure. Armed with a definitive answer from the chef—the only person who knows 100% for sure—Skip can now safely convey to us an accurate one-word answer, acting as merely the chef’s messenger.
Without gaining access to the chef, Lucy would have to gamble based on inconclusive information. What we have here is a lack of resources—there’s only Skip. And he is not a good information source because of the fearful environment we’ve created. We’re stuck.
Is coffee good for me?
The story of Skip and the soup illustrates one end of a continuum. Now let’s look at the other end: an abundance of resources and too much information. Instead of soup, let’s consider the often maligned and equally revered beverage that’s near and dear to my heart: coffee. The question is again simple:
Is coffee good or bad for me?
I suppose I could go back to the restaurant and ask Skip, but I have many, many other resources for coffee. And if I’m serious about changing my behavior based on the answer, I’ll make the most of all available resources. Once again, I need one of those elusive single-syllable answers. So where do I begin?
Coffee: ask the experts
In no particular order, I’ll start with my ENT, who is now fully vested with me, having examined my ears, nose, and throat. The latter has given me some trouble lately, which seems to be related to reflux, which is apparently worsened by (among other things) coffee. Dr. ENT says, “No more coffee,” and without hesitation I say, “Nice theory, doc. Not gonna happen.” He also said to drink fewer colas, and with that I’ll comply, so I feel vindicated.
Dr. ENT says, “No more coffee,” and without hesitation I say, “Nice theory, doc. Not gonna happen.”
In any case, another of my many highly regarded doctors recently listed coffee consumption as a way to greatly minimize or reduce the risk of prostate cancer onset or recurrence. Music to my ears! Even better, to have this benefit I apparently must drink at least four cups daily. Excellent! I am now adhering to at least one doctor’s advice.
Two doctors: one says “bad,” the other says “good.” So far, it’s a tie.
But I really do want an answer. To break the tie, I do some online research. Shooting for the bullseye, I google “is coffee good or bad for me?” There are over a quarter billion results for that question. Well, I’m retired and have time to tackle the list. Here are today’s first four results:
To be sure, the main benefit of coffee for me is simple: I like it. I find that it relaxes me and gives me great pleasure. Until it is shown to have an indisputable dire consequence similar to that of smoking cigarettes, I will continue to drink it—probably four or more cups a day.
Bottom line: I now know a lot more (but not everything) about how coffee could be helpful or harmful to my health, and I still don’t know whether I should drink it. But I do.
How should I treat my cancer?
It might seem like quite a leap from soup and coffee to cancer, but with a cancer diagnosis we must confront the same fundamental issue. The consequences are more significant, but the challenge is the same. How do we find the right answer to an important, unavoidable question? In this case, it might be phrased like this:
Which of the available cancer therapies is best for me?
This is not a yes-no, good-bad question. It is multiple choice of tremendous complexity. Regardless, with a cancer diagnosis or recurrence, choosing an answer is unavoidable. And when it’s our question, we can’t help feeling that it somehow must be answerable.
Cancer: ask the experts
So we ask our urologist, who happens to be Skip’s brother, Dr. Kantsay. He gives us our list of options. We are pleased to know there are choices, and now we want him to tell us the right one. But like his brother, he won’t commit for much the same reasons. What if he’s wrong?
Kantsay might tell us which therapies other patients have been happy with. He could even indicate his support for whatever decision we make. But he’s not going to put his neck on the legal chopping block and pick one, even if he privately feels certain about which is best. We’d like him to ask his team of experts in the kitchen—radiologists, physicists, oncologists, urologists, dosimetrists—and then relay their answer. But this is life or death, not soup, and even the team won’t commit.
We decide to seek a second opinion, hoping for a definitive answer—and we get one. We see Dr. Kutter, who turns out to be a distant cousin of Kantsay. Dr. Kutter is likewise a urologist, as well as a surgeon specializing in performing radical prostatectomies. He explains why surgery is the gold standard for treating prostate cancer, and doesn’t hesitate to recommend it. While Kutter sounds convincing, the bias is not hard to spot, and we are left no further ahead.
In fairness to the doctors
To be fair to Dr. Kutter and others like him, we must not equate their bias with their motive. They may sincerely believe that surgery—or whatever the bias may be—is the gold standard, and best for us. Of course, some may have ulterior motives, but I suspect they are the exception.
To be fair to Dr. Kantsay and our many unbiased doctors, we must allow the possibility that even the best of them might not have the answer we need. They’re not necessarily withholding information out of fear; they just don’t know. They are in the same boat we are.
… some questions have no clear answer. And others have several legitimate, but differing answers.
Worse yet, some questions have no clear answer. And others have several legitimate, but differing answers. Dr. Kantsay might not be able to give us our answer because there is none, or there are too many. Either way, we’re not going to like it, and will undoubtedly move on to the next step.
Cancer on the Internet
We’ve spoken to Kantsay. We’ve heard from Kutter. Now we’re on our own, and it’s up to us and Google. With keywords “best prostate cancer treatment” we are rewarded with over a million results. Feeling a little pressed for time, we try to only consider credible sources.
We are surprised to discover additional options that were not on the original list provided by Dr. Kantsay. We find that combinations of therapies are also options. Our research is leaving us even more confused and torn.
Like coffee, we quickly discover that even credible sources disagree on which cancer therapies are good or bad, let alone which is best for me. We research and read until we’re weary, and find ourselves again knowing a lot more than we did, but still lacking the ultimate answer. Yet, we must decide.
Between a rock and hard place
In trivial matters and serious ones, we often find ourselves stuck between too much information and too little guidance. We find plausible-sounding justification and support for diametrically opposed conclusions. We encounter objective experts who are understandably afraid to commit or just don’t know, and biased ones who sadly will, often with genuine conviction.
In trivial matters and serious ones, we often find ourselves stuck between too much information and too little guidance.
When we try to sort out the mess ourselves, we drown in a sea of data, statistics, and opinions that offer justification for virtually any position we ultimately decide to take. Finally, we might even have to accept the infuriating reality that either we’ll never know which answer was right, or that the right answer is currently unknown, or even unknowable.
Nevertheless, life goes on and for better or worse, we must make decisions. Soup, coffee, or cancer therapy—it’s up to us. Sometimes we’ll be wrong, sometimes we’ll be right, and sometimes we’ll never know. Such is life.
So do the best you can. Take your pick, make your choice, don’t look back, and have a happy new year!
DISCLAIMER: Skip, Dr. Kantsay, and Dr. Kutter are fictitious. If you happen to know anyone with those or similar names, rest assured my characters are not them. If you know anyone with different names but similar attitudes or behavior, I won’t be surprised.