About a year ago, right after The Decision Tree book came out, I realized that a concept I touched on in the book had far larger potential. The Feedback Loop, it struck me, had potential as a framework for improving human behavior throughout our lives. Indeed, feedback loops could be put into action beyond health, into areas such as productivity, energy consumption, and other categories where human behavior plays a pivotal role.

So it only took me 15 months, then, to tap out the article that is now the cover story in the new issue of WIRED: The Feedback Loop: How To Get Better At Anything.

This is a classic tech/trend piece, but one that I’m especially proud of, because I think it represents some thinking that goes way beyond my meager brain. It is, as much as anything I’ve ever written, very much in the zeitgeist in Silicon Valley. The idea is simple: Tracking our behavior can help us improve it. (This is the essence of the Quantified Self meetups that my pals Gary Wolf and Kevin Kelly have curated). But the opportunity today is profound: New sensors can help us track our behavior more readily than ever before – and, moreover, that tracking can extend beyond the Silicon Valley crowd to the population at large. Feedback loops can be incorporated into all sorts of experiences and tools, and can be readily understood by all sorts of people. Thus, all of a sudden, a rather geeky idea starts to get rather universal. And that means SCALE, and that’s where it starts to get interesting.

One thing I was sorry about in the Wired story was that I couldn’t give full voice to the vast historical and contemporary context of feedback loops, exploring their roots in 18th century engineering and 20th century military strategy and contemporary philosophy and behavioral science. There is a HUGE amount to talk about in terms of feedback loops – where they come from, what they draw on, what they help us with today, and what they might enable tomorrow.

In other words, there’s a lot more to say here. It’s almost like there’s another book in it….

Enough about patients: What is a doctor to do?

In the past few months, since The Decision Tree book came out, I’ve had the privilege to talk with many doctors about the opportunity and challenge of engaging patients in their own health. Some physicians, not surprisingly, have been suspicious, and even hostile to the idea that patients have a role to play. But thankfully, those have been rare exceptions. Most doctors I’ve spent time with have been eager to hear about new tools that might engage their patients, and they’ve been eager to share well-earned advice on where there’s work to be done. It has been a delight and an education to talk about the potential of healthcare with these physicians who are, after all, doing the hard work of providing medical care every day.

A high point in my continuing education came a couple weeks ago, when I was invited to speak at the Minneapolis Heart Institute Foundation‘s Fall Nursing Conference, where I met a number of nurses who are eager to help patients gain some control over their health. A few days later I gave a lecture on patient engagement at the University of Minnesota Medical Center. The invitation came from Dr. David Rothenberger, an esteemed surgeon who has consistently emphasized the importance of innovative thinking in medicine. Dr. Rothenberger also runs a program for physicians with promising leadership potential, and part of my day involved talking with them about the changing nature of clinical medicine, and the challenge of engaging patients in their healthcare.

These were good doctors, deeply motivated to help their patients, and there was scant resistance to the notion of an empowered patient who might seek to engage in their care and treatment. Indeed, they seemed to relish the opportunity to work with such patients.

But as they shared their experience in the clinic, it was clear that empowered patients in the model of ePatient Dave are the exception. Most of us aren’t so savvy, nor so motivated, to roll up our sleeves and drive our care decisions.  Most patients don’t ask to see their records; most patients don’t take their drugs as prescribed; most patients don’t research their treatment options (though most seem to use the Internet); indeed many patients don’t actually do what their doctors advise at all. Most of us don’t follow the basics of good health: get exercise, eat properly, avoid stress. Just judging by the national obesity rate, too many of us squander our chances to improve our health, and the result is what medicine unfortunately calls “non-compliance” – the failure to follow doctors orders. These good doctors of Minnesota see non-compliance every day in their offices and they are frustrated and baffled by it. As we spoke, it became clear that they were searching for some way to get through to those patients who don’t do what they surely know they should.

In part, this frustration was fueled by the increasingly use of pay for performance measures where doctors are scored and evaluated by their patient outcomes. Though I am in favor of pay-for-performance as a strategy for reducing costs and emphasizing health over illness, it’s evident that there’s lots of work to do getting the metrics right. Too often, it seems, physicians are scored by absolute measures without taking into account their patient demographics or the delta between where a patient entered their care. This blunt measure incentivizes doctors to selectively churn through patients, dropping the unhealthy ones who don’t follow orders (or never accepting them as patients in the first place), and it has the opposite of its intended effect.

More than anything, the conversations underscored what I’d known but hadn’t frankly given much thought to: how difficult and vexing it can be to care for patients. Doctors have a hard job, and I am personally deeply awed by their tenacity and perseverance. As one physician noted, “90 percent of my job is education, and I have no training for that. What I learned in medical school only counts for a fraction of what I’m actually doing every day.” Talking to patients, encouraging patients, getting them on board with the task of improving their health is all about cajoling, persuasion, and lots and lots of education. And that’s a daunting thing.

Every doctor, no doubt, has their own quiver of techniques to address this. Places like Sermo help flush some of these strategies out. But it would be disingenuous of me to advocate for patient engagement so vociferously if I didn’t consider the other side of the equation: How physicians might successfully engage their patients. So drawing on the insights of Dr. Rothenberger and his ace stable of practitioners, and inspiration gleaned from the cardiology nurses of Minnesota, I’ve put together a humble five-point prescription for doctors and other care-providers: Five things they should seek to give every patient, strategies to tap the most underutilized resource in medicine, their patient.

1) Transparency: The all-knowing-physician is a myth that no longer serves patient nor doctor. It sets up false expectations for patients, who often come away from the doctor’s office without the definitive diagnosis or treatment, and it holds the physician to an impossible standard of perfection. Better that everyone lay their cards on the table. Physicians might share what they know about a patient’s condition or course of treatment –  and also make clear what they don’t know. When mulling a course of treatment, let the patient know what the range of choices is, and then explain why the recommended course seems to make the most sense. The presumption that patients can’t handle ambiguity, that they can’t parse probabilities, is entirely wrong. Life is ambiguous, it is uncertain, and we all inherently understand that. Outside of medicine, we experience it every day. Making the ambiguities evident, shining a light on the dark, so to speak, lets patients reckon with their health just as they do with other parts of life.

2) Repetition: For doctors and nurses, the hospital or clinic is their office. They’re used to it. It’s routine. For patients it’s anything but. White coat syndrome extends way beyond higher-than-usual blood pressure. Every comment from a doctor or nurse is charged, every word choice studied for inflection. But that doesn’t mean we’re actually grasping what the doctor is saying. Even if our needs are minor, for patients the doctor’s office is charged with anxiety and fear. That look on our face? It means you’ve lost us.

And then, when we’re out the door, anything we did understand is gone. I know this personally:  I have listened deeply to a suggestion that I take an over-the-counter medication, and then, by the time I get to Walgreens, blanked on the dosage and frequency my doctor suggested. Anything that’s not written down – i.e., everything except a prescription – is going to be lost. If your patient doesn’t bring a pen and paper, write your advice down for them.

3) Resources: It’s no surprise that I think patients should get full and immediate access to their records, notes, and lab tests. Even if the patient can’t make heads or tails of it, it’s an important gesture of reciprocity, partnership and, I would argue, ownership. This stuff is ours. But there are other resources that a doctor can help their patients with. I’m not talking brochures and pamphlets – I’m talking about the Internet (again). In part this is simply pragmatic. Patients are going to go there in search of more information and answers, and they might as well start where their doctor suggests they do. And there’s no reason this shouldn’t augment the doctor’s care; they’re already overworked and pressed for time. Use the outside world, identifying informative websites and online support groups.

And about the Internet: Physicians should flush out this elephant in the room. You know your patient is already on there, doing all sorts of research. What they find may not be relevant, but it’s filled their heads with ideas. Even if they don’t come in with papers and print outs, they’ve already got preconceived notions about what’s wrong and what they might do. Get it on the table. Ask patients what they’ve read online about their condition (this is quid-pro-quo transparency). Listen. And then, if necessary, explain why it doesn’t pertain. Even the most misguided patient has taken a worthy first step towards engagement – they care about their health. Start there and use it.

4) Patience: Just because patients don’t do what you tell them to, that doesn’t make them irrational. They may have what, to them, seem like perfectly reasonable reasons to ignore their doctor’s advice. Understanding these reasons, flushing them out, can be a way to pursue other, more promising approaches. Conversely, just because patients may not do what they should doesn’t mean they’ve given up, that they’ve decided to live in ill health. Failure is a part of life, and it certainly is a part of our health (witness the eight or so times it takes a smoker to successfully quit). But humans are resilient creatures, we are persistent, and helping patients understand that they can make their way towards better health with a few missteps comes as a great relief. Take it from a Catholic: Going to the doctor’s office is very much like going to the confession booth, and in both places the confessor is probably embarrassed to tell the full story. Diffusing that anxiety, forgiving the missteps, can be a great motivator.

5) Goals: A great impediment to sustained and better health is the fact that we don’t think about it that much. Most doctor’s visits, after all, are about a problem (it bugs me to no end that the intake form at many doctor’s offices, including mine, presumes poor health with the first question: “What is your Chief Complaint?”). Even if that’s why we walked in the door, that shouldn’t be how we walk out. Rather than send patients out with a to-do list, physicians might send them out on a path, with milestones and purpose. Fact is, we do better when we have an objective, when we feel that we’re making progress towards something – that’s human nature. A great way to create engagement about health is to create a sense of purpose, that the drudgery of tasks required – new drugs and new diets – isn’t just managing our health, but is in fact building towards something.

So that’s my prescriptions for doctors. No doubt putting these into action would require, first and foremost, time – perhaps the most precious resource a physician has. But my hope would be that they could be worked into the habits and dialogue that already take place, and that they might make that communication smoother, less fraught, and more productive. I would be eager to hear if there are other strategies out there.

Though the prospect of learning about our DNA might seem wrapped in mystery and intrigue, genetic information is not so different from any other metrics we know about ourselves: Our age, our weight, our blood pressure. With a little scrutiny, any of these numbers can tell us something about our health and ourselves. It’s the same with a genetic scan – it gives us some perspective on our health, though far from the complete picture. It is, in other words, a place to start thinking about how we’re living our lives.

It’s important to remember, though, that genetics is a very new science, and that getting a scan today is the equivalent of buying the first generation iPod – it’s a work in progress, and will get much better as time goes on. There’s a lot that science doesn’t know yet about the exact influence of DNA on our health, and the journey is part of the ride. But it’s a rare opportunity, unprecedented, perhaps, in history, that the general public might be granted unfettered access to experience science as it happens. It’s not something that everyone will be comfortable with, but we shouldn’t underestimate how profound this opportunity is.

So when it comes to choosing a service, beware the hype – and use the same sort of common sense that we use as consumers apply when we choose a bank, a cell-phone provider, or a grocery store. Those companies that promise to give definitive insight into the future, the “if your kids have this gene they’ll be Olympic athletes” sort of promises, are overpromising and exaggerating what science actually knows. They may act as if our DNA was a crystal ball, but the fact is, it’s not: while our DNA has a large influence in our health, it is largely just that – an influence, along with all sorts of other factors like our diet, our environment, and other behavioral factors. Our health, in other words, is an equation where our DNA is just one factor, one input. The legitimate services understand this, and make this clear. Indeed, it’s a selling point for them: the fact that we can respond to our DNA, that we can actually use it to inform the way we live our lives, is part of the rare opportunity we’re being granted. Rather than fear this opportunity, we should consider it as straightforward as any risk we’re alerted to in life.

The fact that DNA is not destiny is, to me, a reason to consider getting a scan: understanding that we can act in response to our DNA, that we can change our lives to minimize the predispositions that our genes may create, should be a source of empowerment and reassurance. Our DNA is just the blueprint for our lives and our health. How much we choose to follow the plans or tweak along the way is up to us.

To me, the role of DNA in our health is no different for most people than any other blood test result or risk factor – it’s a best guess, a probability that we can choose to heed, or can choose to ignore. Medicine is always a numbers game – it’s usually just cloaked in the white-coat authority of a physician.

For those of us who want to get a head start on health, who want to live with a little more purpose and precision, then a DNA scan is a great place to start.

I appeared on KQED’s Forum show this morning to discuss this whole Walgreen’s/Pathway Genomics fallout. Here’s a link to the show:

And here are some quick thoughts:

The controversy seems to have stirred the FDA to assert its authority – and that of physicians – over any and all medical metrics. As readers of The Decision Tree know, I have little patience for the argument that we need doctors as gatekeepers of our genetic information. This isn’t a drug, and this isn’t a device – it’s information about ourselves, as ordinary as our hair color or our waist size or our blood pressure – all things that we can measure and consider without a doctor’s permission.

I’m amazed, in many ways, that this discussion continues to be perpetuated in terms of “can people handle the truth?” – because that line of argument is flawed in so many ways. I’ll offer a few: 1) People are more capable of handling genetic information (and other health information) than they’re given credit for. 2) Most doctors aren’t experts in genetics anyways. 3) If you wait for doctors to give us this information, we’ll be waiting for something like 17 years. 4) This is our information, about us, and we own it as much as we own our thoughts and our values. 5) We may want to ask doctors or genetic counselors about what our DNA means – I’m not saying it’s easy to understand – but that’s entirely our choice.

I’m sincerely fearful that, now with Congress deciding it wants to inspect this stuff, that the FDA will feel obligated to regulate and shut us off from what is rightfully ours. To me, getting access to this information is a civil rights issue. It’s our data.

Some in the government see things clearly here. Donald Berwick, President Obama’s nominee to run CMS – the agency that oversees Medicare and Medicaid – has defended the rights of patients to own their information. The FDA is now run by the well-regarded Peggy Hamburg, who I have only heard great things about; in a brief conversation with her last year, I was struck by her fair-mindedness and belief in the ideals of transparency and greater consumer empowerment. My hope is that she sees the light here. She’s written about how the FDA is a public-health agency, particularly in terms of “risk communication”; well, one of the reasons we communicate risks is to allow people to take responsibility and act in ways to minimize our risks. It’s the basis of preventive health. That’s precisely the potential of personal genomics, and to squash that would have a net effect of undermining the public’s health.

The FDA doesn’t have to use regulation like a hammer to squash innovation and the opportunity for people to use genetics to take control of their health. They can help foster innovation and issue some basic guidelines that recognizes information is a powerful tool, and one that rejects intermediation and paternalism.

I’m crossing my fingers.

David Leonhardt has a smart column in today’s NYT that takes on the “more care is better” idea with some cold, hard facts. Leonhardt frames his story on the idea that we need to say “no” a lot more, starting with CT scans, and more.

It’s not just CT scans. Caesarean births have become more common, with little benefit to babies and significant burden to mothers. Men who would never have died from prostate cancer have been treated for it and left incontinent or impotent. Cardiac stenting and bypasses, with all their side effects, have become popular partly because people believe they reduce heart attacks. For many patients, the evidence suggests, that’s not true.

Advocates for less intensive medicine have been too timid about all this. They often come across as bean counters, while the try-anything crowd occupies the moral high ground. The reality, though, is that unnecessary care causes a lot of pain and even death.

Being the economics writer, Leonhardt’s focus is on keeping costs down, but there are benefits for individual patients here, too. It’s worth remembering that a lot of this care comes in late-stage disease, when the margin for improving lives is slim – in fact, when late-stage interventions can often be detreminental to life.

We tend to think that throwing more resources at a problem can solve it, but just as that doesn’t work in technology – see the myth of the man-month – so it can be ineffective in healthcare. But actually convincing people that they’re wrong on this point – which we feel in our bones, despite the evidence – will take some work.

UPDATE: A nifty comment on the same article from Health Beat: “…An increased focus on learning to communicate risk and benefit effectively and by ramping up the patient’s role in decision-making will be far more important in reducing health care costs than learning to “say no.””

One of the great humdingers in the current debate over healthcare reform is the duplicitous role of technology in increasing costs. Sophisticated medical technologies save thousands of lives every year, giving us scans that spot tumors early and devices that keep our hearts beating and our blood flowing.

But these miracle technologies come with a paradox. In nearly every sector of the economy, technology drives costs down – just as your digital camera gets cheaper and better every year, so technology drives down the cost of manufacturing, the cost of retailing, the cost of research. But for some reason, in healthcare, technology has the opposite effect; it doesn’t cut costs, it raises them. In fact, medical technologies – from CT scans to stents to biologics – are a significant factor in the 10% annual growth rate of healthcare spending, a rate that’s nearly triple the pace of inflation. (Overall, the US is now estimated to spend a stunning $2.7 trillion on healthcare in 2010.)

This was made clear once again last week, when a Massachusetts state audit found that healthcare costs rose 20% from 2006 to 2008, largely because of new imaging technologies. The single largest increase was for digital mammography, a new – and expensive – way to screen for breast cancer.

What’s going on here? Why can’t technology work its magic in healthcare, the way it does in the rest of the economy?

The answer boils down to what’s called “scale” – the notion that technology, thanks to Moore’s law and other exponential improvements, gets progressively cheaper, better and thus more accessible. Cheaper and faster chips, sensors and storage mean that digital technology is constantly scaling up and out, touching the lives of more people. These improvements in cost and power are the democratizing force that has propelled GPS from a military technology to a cellphone feature, and they’re what helps Apple convince us to buy a new iPod every 18 months. Scalability is the secret sauce of the digital revolution.

Except in healthcare. In healthcare, technologies that scale are suspiciously hard to find. There’s no lack of technology, it’s just that they don’t seem to get cheaper and better at the same exponential rate as in the rest of the universe. This is especially strange because CT scans and pacemakers – to take two frequently blamed cost-generators – rely on the same digital technologies that are getting cheaper outside of healthcare.

There are a couple reasons for this. For one thing, there’s far too little price transparency in the medical technology market. Without an open marketplace of prices and services, it’s difficult for hospitals and clinics to know whether there’s a better deal elsewhere, and manufacturers can keep costs high. Secondly and perhaps more significantly, medical technologies still tend to rely on an expert class to actually deploy the technology. GPS may have turned us all into amateur navigators, but CT scans haven’t turned us into hobbyist radiologists. Those highly trained and expensive experts are still needed to actually put the technology to work, making it impossible to entirely automate a process. The result is that technology stays expensive to use, and costs keep going up.

At long last, though, that’s changing, and scalable technologies are coming to healthcare. But there’s a twist: instead of coming from your doctor or hospital, they’re going straight to consumers. Digital monitoring tools like the Nike+ system, which uses a little accelerometer sensor in your running shoe, let people make more informed choices and pursue better health behaviors. And new online decision tools like LifeMath.net, a project of Harvard University’s Laboratory for Quantitative Medicine, take advantage of cheap processing power to crunch data into personalized medical recommendations, making it far more relevant than generic advice (and thus much more likely to result in lasting change, addressing what doctors call “the compliance problem”). These and other tools use technology for what it’s good at. They put the tools directly in our hands, and get us engaged in our health before we need the expertise of specialists.

In the world of insurance and care providers, some folks already understand this, and are way ahead of Washington policy makers in tapping cheap technologies to improve healthcare. In Hawaii, Kaiser Permanente has started a pilot project that churn through its database of patient data to predict which patients might need which tests – and then sends individuals email alerts suggesting they come in for a test or checkup. It’s the same sort of technology that Netflix uses to recommend movies. And the Cleveland Clinic has teamed up with Microsoft to bring self-monitoring tools to patients managing chronic diseases, successfully engaging them in better health behaviors without expensive visits to the hospital.

In the last century, medical technologies ably did their part to extend the life expectancy of the average American to nearly 80 years. It’s time to reassess how we deploy technology in healthcare, and put the digital revolution to work not just for our entertainment, but for our health, too.

The is a cross-post from The Huffington Post.

Great news – The Decision Tree is now available in a Kindle e-reader edition at Amazon.com!

Here’s the link: Decision Tree on Kindle

Whew, what a week.

The Decision Tree debuted to some great acclaim and attention, and I think it’s useful to update some of the highlights here.

Freakonomics blog @ NYTimes.com: A q/a with the Freaknomics blog about decision making, when screening makes sense, and the utility of genetic testing.

Big Money: I Wanna CT Scan Your Hand: An excerpt that discusses how the high price of CT scans adds to healthcare costs.

TheAtlantic.com: The Wonder Drug Myth: Another excerpt, this one about the infrequently discussed miss-rate of drugs.

BoingBoing: An astute read of the book by Bill Guerstelle.

Gizmodo on Sleep Gadgets: A piece I wrote for them about how gadgets like sleep trackers can help us monitor and improve our health.

Also, I’m grateful to power tweets from Tim Ferriss, Dan Pink, Steve Case, Deepak Chopra, and countless others. Hopeful for another big week!

There are patients – and then there are active patients. And some of the people I talked to for my book I’d call very active patients. They have struck out on their own and made radical decisions about their healthcare.

Teri Smieja is one of these heroes. When she learned that she had a genetic risk for breast and ovarian cancer, she embarked on a series of decisions – illustrated beautifully in this excerpt in Wired Magazine – that resulted in her getting two preemptive surgeries.

Todd Small is another. A 40-something Seattle father who happens to have multiple sclerosis, Todd first came to my attention when I reported a story about Patientslikeme.com for the New York Times Magazine. At the time, Todd was actively engaged in his medication – he learned from his fellow PatientsLikeMe community members that his dosage for a drug called baclofen was probably too low, and adjusted it accordingly (working with his doctor, I hasten to add).

When I checked back in with Todd recently while reporting the book, I was surprised to hear that he was about to embark on an even more radical decision: he had heard about an experimental stem cell treatment for MS, and was about to give it a whirl. Todd, who admits he’s no whiz at science, couldn’t make out what the research was saying. So he turned to the PatientsLikeMe community. “If somebody could decode this into simple layman’s terms, it would be much appreciated,” he posted in an online forum.

Soon enough, his fellow members did decode the research – and the consensus seemed to indicate that the procedure, though somewhat risky, was a reasonable bet. It was nothing to sniff at: the treatment begins by extracting 400 milliliters—a little more than a can of soda—of bone marrow from the leg. For several weeks, those cells are used to grow more cells, after which the patient returns and about 50 million cells are injected into the spinal column.  The cells seem to repair some of the damaged myelin in the central nervous system, lessening the symptoms of MS. About 60 patients had been treated with the procedure, and 55 had reported major improvements in their symptoms, including a former Canadian golf pro who was able to return to the game.

To Todd, the idea “was a no-brainer,” he told me later. “I just gotta go for it. If I don’t do this, I’ll be kicking myself. And in another year, I’ll have to quit my job at the shop. I have a family. I have two kids. I owe it to them to at least try this.”

Such self-guided research unnerves the medical establishment. That way, they warn, quickly leads to quack cures and dangerous treatments. That’s no doubt true in many arenas. But the power of PatientsLikeMe is that its members take their science seriously. They demand published research, not anecdotes. They’re quick to debunk phony cures and quackery. They consider themselves not just beneficiaries of research, but participants in an ongoing research project.

PatientsLikeMe co-founder Jamie Heywood calls this “personalized research.” On a smartly run, well-organized Web site, patients can play a huge role in informing each other; they can decentralize and distribute information that once was available only through a personal physician. This means that people can share not only their stories but also best practices and results. The crowd can create its own research, becoming what Jamie describes as “an insight engine.”

The same spirit propels CureTogether, a Web site that lets people with dozens of conditions, from allergies to vulvar vestibulitis, track their treatments and symptoms. Like PatientsLikeMe, CureTogether has an insatiable appetite for tracking patient data, and a faith in collaborative insight. “It’s driven by the patients, not by scientists.” Carmichael calls the insights that result from the nearly 7,000 members at CureTogether “collective wisdom.”

PatientsLikeMe and CureTogether can be seen as a direct challenge to physicians’ omniscience: The companies not only let members track their disease progression, they tacitly encourages them to try to turn those progression curves in a positive direction. This is what’s unnerving to many doctors. But it’s also what makes the self-guided approach so compelling. When it’s done with data, when it’s done as a feedback loop, it can actually result in good, more informed decisions.

Not all of these approaches are right for everyone. Constant self-tracking of the sort that PatientsLikeMe requires—updating one’s symptoms and dosages and progress—can be tedious, especially for somebody who already has a chronic illness. And not everyone is the “early adopter” type. But the truth is, you don’t have to be an early adopter to understand the virtues of mindfulness. At their best, Web sites like PatientsLikeMe and CureTogether offer a true middle path—one that has a grounding in science, yes, but also an understanding that we ordinary folk tend to look to each other, rather than textbooks or research papers, for advice on how to lead and improve our lives. The stories we share about our lives, especially stories about our health, can be incredibly powerful.

The key is to combine our affinity for stories and narrative with our capacity for rational decision making. It’s in the combination where there’s relevance, and where there’s relevance, there’s an occasion for action.

Quick snip of my latest post on Huffington Post, which is generating a terrific response today.

Every day, we make dozens of decisions without thinking about them: what to feed the kids, how fast to drive to work, whether to hit the snooze bar. We make most of these decisions without a second thought. We go with our gut.

For other decisions, though, we have to pause, consider our options, and bring our best judgment to bear. This can be uneasy territory — and it can get especially fraught with decisions about our health, when we often lack a strategy for weighing all the information on the table. We’re not sure where to start.

But making smart decisions about our health doesn’t have to provoke anxiety. It turns out we’re well equipped to consider a range of options and make the right call. We just need to keep a few principles in mind.

Read the rest here.