The Influence of Belief on Medication Effectiveness

In a kind of meta cross-over with our Decoding Academia series, we're going to decode a journal club discussion between two well-known health optimisers: Dr. Peter Attia and Dr. Andrew Huberman. So you get to listen to two academics talk about two other academics talk about academic papers... we know...

We've already been introduced to the bulging biceps and morning sun-drenched routines of Huberman elsewhere but this is our first introduction to Peter Attia, MD. Attia is a former ultra-endurance athlete and a physician in the field of longevity and performance, a podcaster (who isn't amirite?!?) and author of "Outlive: The Science And Art Of Longevity".

Attia introduces us to a paper that casts doubt on the supposed general life-extending properties of a diabetes drug called Metformin. This is a drug that is apparently very well known in the biohacker/life extension communities and one that Attia administered to himself for a number of years despite the rather preliminary evidence. This is the first of many indicators that both gentlemen are certainly on the bleeding edge of self-medicating experimentation, doggedly pursuing the elusive goals of huge pectoral muscles, minds that laugh at the concept of cognitive decline, and bodies that will live... well for a lot longer than Matt and Chris!

We get to hear about week-long starvation regimes, medications that take the edge of pizza and doughnut binges, dealing with month-long nausea from self-dosing experimental treatments, and frequent prick-blood tests all for the sake of optimising, optimising, optimising...

Huberman's paper (a preprint, actually) falls more into the "big, if true" category - although he seems fairly confident himself. Does *believing* you are getting a treatment generate the relevant physiological and neurological effects in the body that could mean we can bypass the need for certain pharmacological substances entirely, including some vaccines?!? Based on the results of a small-N, fMRI study that reports mixed results, Huberman muses... maybe! Or how about those other small-N studies, with p-values hovering suspiciously close to 0.05 that report other counterintuitive findings? We will leave it to Huberman to explain.

But the bad stuff aside, Huberman and Attia (especially Attia) actually do a pretty decent job talking about how to approach research papers and some of the pros and cons of different approaches. Chris and Matt thus have ample opportunities to give credit where credit's due and demonstrate that they are the fair-minded souls everyone knows them to be!

In any case, it's an interesting peak into an alternative health optimiser world. It seems to be a rather "serious" hobby a bit like body modification or tattoos. But who are we to judge? Matt likes cultivating succulent plants and Chris is into eating sushi in lush forests. So biohacking, self-experimentation for longevity? Well, at least it's an ethos.

Also featuring, an introduction that covers Irish history, the most humble guru in the gurusphere, and our very own theory of guru cringeosity!

Links

• Journal Club with Dr. Peter Attia | Metformin for Longevity & The Power of Belief Effects
• The Most Arrogant thing Bret Weinstein has ever said? Bad Stats Thread
• Keys et al. (2022) Reassessing the evidence of a survival advantage in Type 2 diabetes treated with metformin compared with controls without diabetes: a retrospective cohort study.
• Bannister et al. (2014) Can people with type 2 diabetes live longer than those without? A comparison of mortality in people initiated with metformin or sulphonylurea monotherapy and matched, non-diabetic controls
• Perl et al. (2022) A thalamic circuit represents dose-like responses induced by nicotine-related beliefs in human smokers