#314 - How to Make Health Decisions When the Science Is Unclear | Dr. Anupam Jena & Mike Haney

Most health decisions happen before the science is settled. A study points one way, another points somewhere else, experts disagree about what matters, and even strong population-level evidence may not tell you what will happen to you.

In this episode, Mike Haney talks with physician and economist Dr. Anupam Jena about how to make decisions under that kind of uncertainty. The goal isn’t to find a single hierarchy of evidence or a perfect source to trust. It’s to understand how much weight to put on any one piece of information, when personal experimentation can actually teach you something, and how the potential downside of an intervention should change the amount of evidence you demand before trying it.

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What We Cover:

• Why even a high-quality study should rarely change your mind by itself
• Why a meta-analysis is only as useful as the studies that go into it
• What randomized trials can establish, and where they can still fail to apply to real life
• How to judge whether a study’s outcome is actually meaningful, not merely statistically significant
• When N-of-1 experiments can help, and how they can fool you
• A practical framework for deciding whether an intervention is worth trying: potential harm, quality of evidence, biological plausibility, and cost

🎙️ About the Guest:

Dr. Anupam Jena is the Joseph P. Newhouse Professor of Health Care Policy at Harvard Medical School, a physician at Massachusetts General Hospital, and an economist whose research uses natural experiments to uncover unexpected influences on health and medical care. He is also the host of Freakonomics, M.D. and co-author of Random Acts of Medicine.

📍What Dr. Anupam Jena & Mike Haney discussed:

• 04:04 - Why taxi and ambulance drivers die least often of Alzheimer's
• 09:20 - Why half of people still skip a free heart medication
• 13:02 - Why the headlines on coffee keep reversing
• 14:55 - Judge the study on its merits, not on who funded it
• 17:43 - Why even a high-quality study should rarely change your mind
• 23:04 - Why a cold plunge trial cannot separate the bath from the belief
• 26:19 - Why a meta-analysis is only as useful as the studies inside it
• 27:15 - What a randomized trial can establish, and where it still fails in real life
• 33:53 - The coin-flip test for whether a study shows cause and effect
• 36:25 - Absolute risk, relative risk, and what "significant" leaves out
• 43:06 - When an N-of-1 experiment can teach you what a trial cannot
• 46:02 - Getting better does not mean the experiment worked
• 53:55 - Harm, evidence, plausibility, cost: is it worth trying?

🔗 Helpful Links:

• Dr. Anupam Jena — Harvard Medical School profile
• Random Acts of Medicine — Anupam B. Jena & Christopher Worsham
• Freakonomics, M.D. https://freakonomics.com/series/bapu
• Alzheimer’s mortality among taxi and ambulance drivers (BMJ, 2024). Hypothesis-generating, not evidence that driving prevents Alzheimer’s: Read the BMJ study
• Marathon road closures and cardiac mortality (NEJM, 2017): New England Journal of Medicine

Watch the conversation: https://youtu.be/k9XI7ym7iP8

Find us on YouTube: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://youtube.com/levelshealth?sub_confirmation=1⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

📲 Connect:

Connect with Dr. Anupam Jena on https://x.com/AnupamBJena

👋 Who we are:

Levels helps you understand your metabolic health with personalized data, expert guidance, and tools that connect your daily choices to measurable changes in your body. Our goal is to help you make better decisions about food, exercise, sleep, and long-term health.

Look for new shows every month on A Whole New Level, where we have in-depth conversations with thought leaders about metabolic health.