I’m not a doctor. I’m someone who decided to change my habits using evidence-backed information and went looking for it where it exists. What follows came from that experience, not from a theory.

In another piece, I described Assembly Cost: the toll the reader pays to bring together scattered pieces that have already been published and are already sound. This problem is different and comes afterward. Let’s assume that one is solved: the place exists, every topic is complete, nothing is missing. I arrive, find the twenty pieces organized, read them all, and still can’t act.

The difference between the two costs can be stated in one line. Assembly Cost is how much work it takes me to put the message together. The Rigor Penalty is how much work it takes me to decide which part of that message deserves a place in my life. The first is solved by building a place. The second isn’t.

The easy version of this argument would be to say that rigor loses because misinformation spreads faster. I’m not arguing that, and neither is the evidence. Budak, Nyhan, Rothschild, Scheufele, and Tucker reviewed what is known about the harms of online misinformation in Nature and found that exposure to false and inflammatory content is low and concentrated in a minority who were already seeking it; they point to the belief that average exposure is high as a common misconception. I’m also not arguing that good doctors don’t give practical advice. They do, and many are excellent. The problem lies somewhere else.

The Problem Isn’t the Piece, It’s the Sum

There is a doctor who makes videos about the properties of foods. They are true. Each video, on its own, is rigorous and even actionable: this food has these properties, incorporate it. Twenty videos later, I’m left with twenty foods that all sound important and a question none of them answers. I have three meals a day, not twenty slots. Which one displaces which? Which one actually moves the needle and which one is rounding error? And if I can only incorporate three, am I harming myself by leaving seventeen out?

Another doctor makes a video about the ten thousand steps. They debunk it, and rightly so, because the number never had the basis people attribute to it. But I walk away with one fewer rule and nothing to replace it. Worse: I don’t know whether the nuance applies to someone like me. Do I make an appointment to clarify? With what question? Is this worth taking up a consultation?

These are three different failures, and none of them is nuance. What’s missing is the budget: advice accumulates, life doesn’t, and no one ranks things by impact or tells you what to sacrifice. What’s missing is the applicability test: no one says who this is for and who it isn’t. What’s missing is the threshold: whether this deserves a consultation and what question to bring with you. Without those, uncertainty isn’t resolved; it gets filed away.

The one I find most interesting is the budget, and there is evidence pointing in that direction even though it doesn’t come from the place I’m looking at. Wilson, Albarracín, and colleagues conducted a meta-analysis of 150 reports of interventions targeting multiple behaviors in smoking, diet, and physical activity, and found a curvilinear relationship between the number of recommendations and behavioral and clinical improvement: a moderate number produced the greatest level of change. Beyond that point, adding correct recommendations within an intervention stopped improving the outcome and could make it worse.

It’s important to be clear about what that work does and doesn’t study. It examines designed behavioral-change interventions, not doctors publishing videos, feeds, passive exposure, or a reader assembling information on their own. Applying it to public content is my extrapolation, not the authors’.

That said, there is one detail in the study that makes it difficult to ignore. The curve was steeper when the samples were likely to have low motivation to change: when interventions targeted populations that weren’t patients, when they were implemented outside clinical settings, when they were delivered by community facilitators rather than experts, and when delivery was group-based rather than individual. That isn’t the same as a feed, but it points in an uncomfortable direction: the penalty for accumulating recommendations is greater precisely in contexts that resemble public communication more closely and the consultation less closely. I’m putting this forward as a hypothesis. If it turns out to be true, the channel where recommendations accumulate most is precisely the one where pruning them matters most.

Albarracín, Wilson, and colleagues returned to this same body of research in Health Psychology Review and also found that interventions produced more change when recommendations of a single type predominated, and that in diet and physical activity, recommendations asking people to stop doing something outperformed those asking them to start doing something. The authors themselves describe this finding as unexpected. It is a clue about what public advice might look like.

One caveat is worth making explicit: much of the available evidence on the number of recommendations comes from the same research program, that of Albarracín and her colleagues, who also authored the review of behavioral determinants that I cite later. These are top-tier publications and I have no reason to doubt them, but a finding replicated by several independent groups would carry more weight than one replicated by the same group.

This reframes the comparison with the snake-oil salesman, and I say that carefully because it isn’t the same asymmetry I described in the other piece. There, the seller wins because they finance the connection between their pieces. Here, they win because their system is pruned. They deliver a few rules that fit together, and a small, wrong system can be executed while twenty correct pieces cannot. It’s not that the doctor has worse content. It’s that they publish everything that is true, and everything that is true doesn’t fit.

Why the Message Arrives the Way It Does

It would be convenient to attribute this to a clinician’s mental habit, trained to qualify every statement and remember that individual responses vary. In a consultation, that is patient safety and non-negotiable. But reducing it to a training tic would be unfair and false, because nuance isn’t always a choice: there are compliance requirements, professional bodies, employers, and liability. Much of what we see isn’t an acquired reflex but an institutional constraint that doctors cannot remove by themselves. The snake-oil salesman isn’t a better communicator. They’re someone playing without the constraints the other person is required to operate under.

It’s worth being precise about what kind of nuance is costly, because not all nuance costs the same. Van der Bles, Van der Linden, Freeman, and Spiegelhalter tested in PNAS what happens to public trust when uncertainty around facts and numbers is communicated, and found that expressing it numerically has a small effect, while verbal formulations that merely announce that uncertainty exists are the ones that reduce trust the most. “Individual results vary” communicates that there is uncertainty, but not how much or what it means for the person reading. An explicit range can make that same uncertainty visible without paying the same trust cost. The distinction separates rigor that protects the reader from rigor that only protects itself.

The Way Out Isn’t More Advice

My own experience gave me the clue here. With food, I don’t operate from a list of twenty foods. I operate from three rules: no refined flour, no added sugars, no partially hydrogenated oils. They look like restrictions but are actually a procedure: when I encounter a product I’ve never seen before, with a label I don’t fully understand, I have three questions to ask it and a decision at the end. I don’t need to know whether that particular product is good. I need to know whether it passes. With movement, I have one rule: move, somehow, in whatever way works. These aren’t complete truths, nor do they pretend to be. They are criteria.

The structural difference between advice and a principle is that advice accumulates and a principle replaces. Advice asks for a new slot in an already full schedule. A principle doesn’t ask for a slot: it changes the criterion by which I fill the ones I already have, and it resolves cases no one has ever explained to me. And there is a second effect that seems even more important to me: advice leaves me dependent on the source, because for case twenty-one I have to ask again. The promise of a principle isn’t to solve case twenty-one. It’s to give me a criterion with which to try to solve it, and, in the process, evaluate the person telling me about it. That is the opposite of the snake-oil salesman’s business model, which needs me to come back.

This isn’t a communicator’s whim. The literature on fast and frugal heuristics has spent decades challenging the idea that a simple rule is necessarily a second-rate solution. Bodemer, Hanoch, and Katsikopoulos argue that in medical decision-making, which takes place under uncertainty and with limited time and resources, heuristics can be more accurate, faster, and easier to apply than more complex strategies, and propose treating them as a legitimate complement to existing decision rules. The classic case from this tradition is clinical: to classify the risk of patients arriving with symptoms of a heart attack, a three-question tree outperformed a statistical analysis of nineteen variables. The claim isn’t that simple always wins, but that simplicity can be optimal depending on the environment. Simplifying well isn’t lowering the rigor. Sometimes it is the most rigorous option available.

Now, two warnings that the argument owes itself.

A principle isn’t a floating truth; it is a useful rule within an environment. My own rule about partially hydrogenated oils demonstrates this. The WHO identifies them as a major source of industrial trans fats and recommends two best-practice policies: a mandatory limit of two grams per one hundred grams of total fat, or a ban on producing and using these oils. Denmark was the first country to legislate in 2003, and countries such as Canada, Thailand, and the United States have banned them. But in its 2023 report, the WHO estimated that around five billion people were still living in countries without elimination policies. In Canada, regulation already applies my rule for me; in much of the world it doesn’t, and that proportion changes year by year. The principle doesn’t expire because it becomes false; it expires locally when the environment changes. Any framework offered to the public should say where it stops applying. That is the boundary between a principle and a slogan: the principle declares its scope, the slogan pretends to cover everything.

And principles don’t buy adherence. Albarracín, Fayaz-Farkhad, and Granados Samayoa reviewed the determinants of behavior in Nature Reviews Psychology and found that knowledge-targeted interventions are among those with the smallest effects, while interventions targeting behavioral skills and habits tend to have the largest. Building judgment isn’t exactly a knowledge intervention — it also involves evaluation and decision-making skills — so that evidence doesn’t tell me what effect teaching principles would have. What it does is prevent me from overpromising. A framework that helps me decide doesn’t, by itself, make me act, and anyone suggesting otherwise is selling something.

What I do argue is different: principles don’t buy adherence; they buy autonomy. They allow you to decide without asking again, and to know whom to trust. In a field where there are as many outdated professionals as there are charlatans, that capacity for judgment is worth more than another instruction. And it connects with what I deliberately left out of the other piece: deciding whom to believe is a separate, enormous cost, which I didn’t claim there. A reader with their own judgment pays it alone.

What Remains

I don’t have a finished solution, and pretending otherwise would be making the same mistake I’m pointing out. The evidence on interventions designed to build judgment is still weak. A Norwegian pragmatic trial evaluated, with 96 parents, a web portal designed to improve public access to evidence-based information and critical appraisal skills, and found slight increases in the use of evidence-based information, critical appraisal, and participation, none statistically significant; the authors themselves acknowledge that the study was underpowered. Kalteis, Steckelberg, Zacher, and Hinneburg mapped 53 critical health literacy interventions described across 81 publications in Health Promotion International, and found that they are concentrated in educational settings, especially with school and university students, and that most address individual appraisal and decision-making skills while other dimensions receive little attention. That detail matters for what I’m proposing: almost everything that has been tested happens in a classroom, with someone who is there to learn. We know very little about the adult who searches on their own because something worries them. The terrain is populated and the results are not conclusive. That gap is both the opportunity and the warning.

What I do know is that the problem exists, that it had no name, and that naming it changes what can be done with it. As long as the friction remains invisible, every professional who experiences it assumes the problem is theirs: that they don’t know how to write, that they don’t understand the format, that social media isn’t for them. It isn’t. It is a condition of the terrain, and it is the uncomfortable form of a question health communication still hasn’t solved: what do you do when rigor requires you to say twenty true things and the person listening only has the capacity for three?

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