N of 1 Experiments are the Most Important Health Technology [N of 1, Part 1]

When the medical system is broken and the wellness industry isn't aligned with your interests, how do you figure out what's right for you? Run experiments yourself, on yourself.

This post distills and expands an earlier discussion on the importance of n of 1 experiments from Building a Better Future for Health & Performance. If you’ve already read that post, you may want to skip to the next post on Designing N of 1 Experiments.

Our Society’s Current Approach is Broken

Our society keeps getting sicker. There’s something wrong with our food. Our lifestyles are poisoning us. The medical system is failing, and trust in it is faltering. Most doctors only get a few hours of training on the most important areas for health, like nutrition and sleep, in all of medical school. They don't have strong incentives outside of prescribing drugs, and they’re stuck with only 5 minutes to spend with you.

Meanwhile, the most appealing messages on health are crafted to sell products, not help you. The internet is full of influencers pushing one size fits all recommendations, short-term fixes that cause long-term problems, and unrealistic ‘must do’ lists. 1000s of supplements and devices claim that they’ll cure your ills and boost your performance.

If you recognize that our current system and most doctors and influencers aren’t incentivized or don’t have the skills to help you, how can you figure out what we should do?

Key Facets of a New Approach

First, we need to recognize that people really are different, so one-size-fits-all advice fails. With no apologies to the zealous influencers from vegan to carnivore and keto, none of these work for everyone; just because something worked for you doesn’t mean it’s right for the rest of us. I see each of these approaches help some people, hurt others, and change from helping to hurting over time for still others. The best approach will vary person to person and often over time.

Second, most of the data we get today is interesting, but ultimately not useful. If your sleep wearable says your deep and REM sleep were down last night, what should you do? If you didn’t intentionally change anything the day before or do something out of the norm, then there’s not much you can take from it about how to sleep better tomorrow. Often, wearables leave you with more questions than answers and ultimately just ‘neg’ you into feeling worse when you get a low score.

There are coaches and experts who can help work through these nuances, but the irony is that unless you’re an expert yourself, it’s difficult to tell who’s good. And even when you find the ‘good ones,’ their services are typically so sought after that they don’t have available appointments or charge rates that are inaccessible to all but the wealthiest clients. I know - I used to charge $10,000/month to work 1-on-1 with clients.

But reading studies will surely show the way, right? Probably not. Very few people have the time to go deep enough in the scientific literature to rationalize the contradictory findings, sniff out the poorly run studies, figure out what to do with mouse data, and identify when scientists are spouting highly technical, but incorrect conclusions. 

Even if you do have the time and enjoy it, would you want to run your life, your company, or your marriage based on the average results of 50 other people, companies, or couples? Probably not. You want to take into account the unique attributes, preferences, advantages, and disadvantages of your specific situation. So, while studies of 50 people who aren’t you may give a sense of whether a drug, a practice, or a diet is better than a placebo on average for those people, the results do not tell you if it will work for you, let alone if it’s the best option for your body, your goals, and your lifestyle. Meanwhile, some of those tools that ‘didn’t work’ in studies were spectacularly effective, but only for a subset of the group. If something only works for 15% of the group studied, even if it works spectacularly well, it will typically show no statistically significant benefit on average, but maybe you’re like the 15%!

Prescription: N of 1 Experiments are the Key

Thankfully, there is a way out of this morass: run experiments yourself, on yourself.

When researchers describe studies, they call the number of people in a study the “n” value. An n of 50 means 50 people participated in the study (sometimes also written n=50). When you run a study just on yourself, we call this an n of 1 (or n=1) experiment. And the beauty of running n of 1 experiments is that you’re no longer hoping a doctor knows what’s right, praying you’ve found the right influencer, or betting on the average results for other people. You’re discovering what works for your unique physiology and goals. 

This approach also turns all the wearables and other testing from a novelty into something extremely useful. If you have a structured experiment, then you do know what you changed and can use your sleep wearable to assess whether you had more Deep and REM sleep this week than last. That’s now useful data.

At the same time, you are no longer stuck if you can’t find a great coach. You can test each recommendation or program, whether you hear about it from a coach or an influencer and see if it works for you. If you find someone that’s consistently recommending winners, you can start to put more trust in them, while still evaluating their next recommendations. It’s “trust, but verify” at its finest.

N of 1 experiments also help us find not only what works physiologically, but what works for our lives. If you put in the effort and still can’t fit something into your life, then it’s probably not right for you. Even the most precise physiological fit for your body doesn’t help if you don’t do it, and since there are rarely quick fixes, we need things that we can stick with for the long term.

With results on how effective an intervention is for your body and your lifestyle, you have the data to decide whether the cost-benefit ratio is favorable for you. Something takes a lot of time and effort, but only a minimal benefit? Probably not worth it. Simple, but you feel much better? Probably worth it, and you can make an educated decision about the ‘in-betweens.’ For all these reasons, n of 1 experiments are the most important health technology — and the path forward when the system around us is terminally broken.

Thankfully, n of 1 experiments are also easier to design and run than many people think. In my next several posts, I’ll cover how to structure optimal n of 1 experiments, the additional benefits they bring beyond being the most accurate and effective way to discover what works for you, and how to design a series of experiments to develop a comprehensive health and performance program tailored to you.

Welcome to the rejuvenated Fount Blog. We’ll be sending out regular content and welcome any comments, requests, or suggestions via blog@fount.bio. Follow me to learn more on Twitter at @andrewherrbio