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The Rise of Snake Oil In America

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The financial burden of snake oil

Prickly snake oil seeds are taking root in the soil of our broken healthcare system. Consumer discontent and feelings of helplessness are the manna of charlatans – and they are growing fat in our lean times. Unprecedented opportunity for promotion via the Internet, coupled with chronically short audience attention spans and generalized patient exhaustion (from the treadmill of life) are creating the perfect climate for the spread of pseudoscience.

I must admit that I had turned a blind eye to the whole pseudoscience movement until fairly recently. I figured it was harmless enough – placebos that might engage peoples’ minds in a more optimistic view of disease. But little did I realize that this tumor on the face of medicine would become life threatening to the advancement of science and truth.

Take for example the money that Americans spend on weight loss supplements – 1.3 billion dollars per year, and yet the American Academy of Family Physicians has found no evidence to support the use of a single one. That’s more money than the World Health Organization’s annual budget, and more than Great Britain spends on cancer research in a year. The supplement industry in general rakes in 20 billion dollars a year, which is more than the total amount spent by the US government in the wake of hurricane Katrina.

And what do snake oil salesmen think of this colossal waste of resources? Why, they’re touting it as a new era of enlightenment of course. They weave in “all natural” products, “mindfulness” practices, and “detoxification” programs into a comprehensive feel-good message that is a soothing balm to anxious souls. In reality they are leading the public down a garden path towards a false wellness nirvana, fleecing them as they go, and sowing seeds of mistrust for science-based medicine.

The rise of snake oil salesmen

The strongest potion in the snake oil salesman’s repertoire is the placebo. Placebos are treatments that work based solely on the power of suggestion. A so-called placebo effect occurs when a patient’s symptoms are altered in some way (i.e., alleviated or exacerbated) by an otherwise inert treatment, due to the individual expecting or believing that it will work. If a snake oil salesman is to become truly successful, he must build a case for his wares through anecdotes and testimonials. To obtain these, he must be a master of the power of suggestion, cultivating a small number of “true believers” from which to conjure evidence for the effectiveness of his oil. He need not convince the majority, a small minority of passionate believers will do. As Mark Twain writes, “The most outrageous lies that can be invented will find believers if a man only tells them with all his might.” Therefore, a common denominator with many snake oil salesmen is charisma and charm.

Once the charlatan has developed his small but passionate following, and some miracle cure anecdotes, he will then start playing the role of a victim. He will look for individuals who are willing to challenge his pseudoscientific claims, and then cry out to his loyal followers that he is being persecuted. He will use racism imagery to describe an illusionary bias against himself and the “good” that he is trying to do for those who are open-minded and willing to forsake “paternalistic” science. His followers will be further emboldened to carry the banner of this “downtrodden hero” as they continue to fall for his under-dog psychology.

The snake oil salesman, of course, will not gain traction with key opinion leaders in medicine, so he is left to draw from the Hollywood celebrity pool to further evangelize the masses. Medical leaders will roll their eyes and ignore his obvious pseudoscience, much to the detriment of the general public who have a hard time discerning science from pseudoscience. The charlatan then points to the medical profession’s silence as “proof” that they cannot deny his claims, further convincing susceptible listeners.

Then years later as snake oil salesmen realize that there is further strength in numbers, they gather together to form the first snake oil union. They create a continuum of oily treatments, gathering anecdotes and testimonials from one another in pseudoscientific “meta-analyses” to further strengthen their assault on science and reason. They find wealthy donors and benefactors who are impressed by their growing numbers, and match them with cash-strapped academic centers who will desperately accept funds for any vaguely scientific purpose. The snake oil team now has won a respectable platform from which to grossly inflate statistics about public use of “alternative medicine” (lumping “prayer” into the list of therapies which, combined together, would have you believe that over 60% of Americans are using alternative therapies like homeopathy).

Snake oil goes mainstream

Now that the very same snake oil that medical experts didn’t wish to dignify with a response is being promoted by academic centers, we are obligated to fund research into the potential therapeutic uses of these placebos, wasting countless millions in government funding to study implausible therapies. With a critical mass of snake oil believers, few dare to challenge the wisdom of this approach, and have become passive observers in a downward spiral that is harming the credibility of the very centers founded to promote objective scientific inquiry.

Can good science separate the wheat from the alternative chaff? Yes, but the problem is that few people seem to care about truth any more. While the American Academy of Family Physicians demonstrates that no single weight loss supplement is recommended for public use, the public is spending 1.3 billion dollars per year on these very supplements. Why? Maybe the AAFP is not reaching the public with their message, or maybe people are simply unable to resist the sweet lure of false promises?

Nonetheless, there is a growing movement in medicine to reclaim scientific territory stolen while we shrugged passively at the snake oil lobby. Blogs like Science-Based Medicine and Respectful Insolence are uniting physicians who believe in the importance of objective scientific inquiry as the foundation for the best therapeutic decision-making.

As the healthcare budget crunch looms, further pressure will be placed on providers and pharmaceutical companies to demonstrate the efficacy of their treatments in order to be eligible for coverage. This will be a boon to scientific medicine, as therapies that actually work will (by budgetary necessity) be preferentially selected for reimbursement. While Big Pharma undergoes further scrutiny, they will also turn to science to demonstrate the utility (or lack thereof) of their drugs. Therefore, those in search of truth will not be completely thwarted by pseudoscience.

Yet patients are free to pay out-of-pocket for any number of alternatives to scientifically proven medicine. I predict that further healthcare access limitations will drive more people to look for placebos than ever before, much to the detriment of those who have diseases that are treatable or curable through proven therapies. I worry far more about missed therapeutic opportunities than the dangers of the snake oil itself.

So my final advice is this: eat a well-balanced, calorie controlled diet, engage in regular exercise, stay within a healthy weight range, sleep well, participate in loving relationships, don’t smoke, do drugs, or drink in excess. At least 60% of your medical problems will be prevented if you do these things. You do not need to waste your money on supplements and snake oil – put that money into a savings account that you can access in case you become seriously ill and your insurance doesn’t cover all the best, evidence based care that you need.

Do not tithe to the snake oil salesman. Resist the dulcet tones of the false promises. Save your money to do good, and listen to your own voice of reason.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Conversations At The Spa

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As some of you faithful readers of Dr. Val may know – I’m a huge fan of massage.  Consider it my
addiction, I suppose – it could be worse! And so it may come as no surprise that I had a massage every day of my vacation (7 days in Southern California – sorry I haven’t been blogging as much lately).  Yes I’m well and truly tenderized from head to toe.  But I have to say that some of the therapists’ chatter was quite amusing to me.  I was unsuccessful at completely removing my doctor hat during the experience, and tried not to look quizzically at them as they explained what they were up to and what I needed.

Those of you with healthcare backgrounds may especially appreciate this dialog:

Therapist (scrutinizing my back as I’m face down on a
table): have you seen a chiropractor recently?

Dr. Val: Um, no.  Why?

Therapist: Well, two of your ribs are out.

Dr. Val: They’re ‘out?’
Where did they go?

Therapist: A chiropractor can put them back for you so your
muscles won’t pull in the wrong direction.

Dr. Val: Will a chiropractor be able to fix this
permanently?

Therapist: No, you’ll have to keep going.  (Adds some eucalyptus lotion).  This will bring your red blood cells to the
surface, and the cooling brings white blood cells to the area.

Dr. Val: (considering what a collection of white blood cells
actually do – yuck).  Hrmph.  That’s a nice massage technique.  What are you doing?

Therapist: I’m using my elbows to stimulate repair cells.

Dr. Val: Ahum…

Therapist: You have lactic acid build up in your shoulders
so we have to flush the toxins out with special oils.  You should also drink a lot of water.

Dr. Val: What sort of toxins?

Therapist: Like, dirt and metals and stuff that you’ve been
exposed to.  You might have eaten fruit
with pesticides on it.  Do you eat
organic food?

Dr. Val: Sometimes.

Therapist: Oh, you should only eat organic food.  Then you won’t have as many toxins built up.

Dr. Val: How do I know how many toxins I have in my body?

Therapist: Well, your shoulders are really tight and your
ribs are out so I think you probably have a lot.  You’ll need a lot of massage and you need to
see a chiropractor.  The oils I used on
you will have a calming effect, though.
You’ll probably sleep really well tonight.

Dr. Val: I see (inhaling, exhaling).  I hope I do.

** 15 minutes post massage – back at the hotel room **

Husband: You smell funny – like an almond.

Dr. Val: That’s “the calming oil that flushed the toxins out
of my body” today.  I have to drink
water.

Husband: Well we’re driving 2 hours up to L.A. so don’t drink too much or we’ll have to
stop along the way.

Dr. Val: The therapist said 2 of my ribs were out and that I
need to see a chiropractor.

Husband: There’s nothing wrong with your ribs.  Don’t be silly.  Why do you keep getting these massages?

Dr. Val: They feel good.

Husband: I could give you a back rub for free.

Dr. Val: It’s not the same, though.

Husband: Why, because I don’t tell you your ribs are out of
whack?

Dr. Val: Well, they have a proper table…

Husband: I don’t understand you.

Dr. Val: But you like almonds (hugs him).This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Facing Our Own Mortality: Richard Dawkins and Alternative Medicine

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On the recommendation of several members of the blogosphere, I’ve been watching a new British TV Series called “The Enemies of Reason” hosted by Richard Dawkins, a noted atheist and evolutionary biologist at Oxford.  The series offers a skeptical review of the claims of alternative medicine practitioners, strung together with Michael Moore-like skill, and designed to showcase the fringiest believers as they concoct wild, pseudoscientific explanations for the mechanism of action of their therapies.  It is entertaining and whimsical – though Dawkins himself appears dogmatic and cold as he ultimately builds a case for science as a religion.

Although I agree with Dawkins on many points, I think his approach is somewhat superficial and unnecessarily adversarial.  Instead of unmasking kookiness and labeling people as “enemies of reason,” I think it would be more interesting to ask: why are people seeking out pseudoscience?  What is the deeper need that scientific medicine is not satisfying?  Why are billions spent on alternative therapies?  (Please note that the “alternative therapies” that Dawkins evaluates include things like quantum homeopathy, magnetic healing, angelic guidance, and other treatments that don’t have evidence-based underpinnings.)

I think that at the very heart of the matter is that we humans want to feel in control.  For millennia we’ve been conjuring up bizarre theories in order to believe that we can influence our destinies and our health.  Just take for example the elaborate Egyptian religious myths (health was controlled by one’s ka which required regular food and drink offerings – not to mention all the elaborate embalming rituals to influence a good afterlife).  All of these rituals provided the Egyptians with a sense of control over their lives, deaths, and reincarnations.  I’m not entirely sure that we humans today are much different in our desire to control our lives.  We just manifest it in other ways.

Ironically, science feeds pseudoscience – the more we know, the more definitive we can be about a disease or its prognosis – and the greater the desire to buck against that.  And so as we advance in medical understanding, it is not surprising that there is renewed interest in magic as a means of influencing our clinical course as the inalterable progression becomes clearer and clearer.  Add to that the fact that the physician-patient relationship has been undermined by a series of unfortunate historical circumstances (the rise of health insurance middle men, decreasing reimbursements, administrative red tape, etc.) and you have a group of dissatisfied patients with chronic diseases that have predictable complications – all seeking alternative outcomes at the hands of any compassionate person who promises to give them some control back.  Of course, our “quick fix” culture also gives rise to a preference for simple solutions, rather than complex (though effective) ones.  Is there any wonder that snake oil has emerged as a major player in this climate?

Dawkins makes the convincing argument that certain alternative medicine practices rely entirely upon the placebo effect.  If this is the case, practitioners of these therapies cannot admit that their remedies are placebos – in so doing they would undermine their potential effects.  Therefore, one cannot expect a rational response from them when confronted with evidence that their strategies do not work or are implausible.  For the remedies to have a perceived effect, they only need to be believed in by the recipient.  The millions of dollars spent by the National Health Service and National Institutes of Health attempting to uncover the mechanism of action of implausible therapies (such as homeopathy) will not influence the millions of faithful believers who turn to such practices for their health.  I suppose that once the placebo effect has been scientifically proven, only the skeptics will be convinced by the data.

In the end however, Dawkins’ “war” is not between the evidence based medicine camp and the placebo based medicine group, it’s really an internal battle that each of us faces about our own mortality.  The process of coming to terms with health and disease is uniquely personal – some want to be (as Dawkins puts it) coddled, others want the cold hard facts.  As for me, all I want is for patients to be able to make informed decisions, not to be misled about therapeutic safety or efficacy, and not to be guided away from known effective treatments and towards known ineffective treatments.  I suspect that this is what most people want as well.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

You Should Report Adverse Drug and Supplement Reactions

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How do we know when a drug, supplement, or herbal remedy causes harm?  Most people assume that clinical trials provide the only mechanism for determining adverse outcomes but actually, consumers can report concerns directly to the FDA as well.

Did you know that the FDA accepts reports from consumers and healthcare professionals alike on their website, MedWatch Online Reporting?

Herbs, supplements, and “natural” medicines are bioactive substances that many people use to treat diseases and conditions.  They are not regulated for safety and efficacy, and are only now being scrutinized for accuracy of their contents.  Since we’re behind the ball on rigorously testing supplements (though it’s great that NCCAM is evaluating as many of them as their resources allow), it’s important for consumers of herbs and supplements to report adverse outcomes (like allergic reactions, harmful side effects, etc.) to the FDA.  How else will your fellow consumers find out about these unwanted side effects?

MedWatch also welcomes reports about adverse outcomes from prescription and OTC medications, medical devices, or cosmetic products.  I think this is an underutilized resource and could greatly improve public safety if we all pitched in and reported concerning events when they happen.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

The Power of Positive Thinking

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Norman Vincent Peale wrote a bestselling book in the 1950’s,
“The Power of Positive Thinking.”  I read
it a few years ago and found it to be a tad simplistic but it had an undeniable point: a positive attitude is important in
life.

In my last post I described the dangers of magical thinking
– since it opens the door to pseudoscience-touting snake oil salesmen.  But now we will turn our attention to
positive thinking – a favorable psychological condition.

There is no doubt that there is a mind-body connection that
affects health.  “Type A personalities
are known to engage in behaviors that increase the risk for heart attack;
anxiety and perceived stress can cause higher output of adrenaline and
cortisol, and in turn contribute to inflammation, atherosclerosis, heart
disease, sleep disturbances, and weight gain.
Depressed individuals (for example) are more likely to suffer from pain
syndromes
, and may have impaired immune function.

Because our mind influences the health of our body, it is
physically therapeutic to focus attention on peace of mind as a preventive
health measure.  And in so far as
techniques are developed to reduce stress, decrease mental anguish, and improve
psychological wellbeing – they are helpful in keeping the body in a healthier
state.

Now, the temptation is to
exaggerate the benefits of peace of mind – that one might be able to avoid
cancer (for example) with the right attitude, which is blatantly false.  So this is where positive thinking and
magical thinking can be confused.
Magical thinking ascribes excessive value to a treatment, while positive
thinking understands the limitations of treatments and yet respects the reality
of the mind-body connection.

Let’s consider back pain, for example.  A magical thinker would look for the “secret
cure” for their back pain, and turn over every stone – fully anticipating that he would discover a miracle solution that others don’t know
about.  He would read books promising the
ultimate back treatment “that your doctor doesn’t want you to know about” and
would spend a great deal of money on treatments that have been
rumored to have some benefit in treating back pain (without any supporting evidence).  The magical thinker is vulnerable to snake
oil, and would rather risk thousands of dollars on experimental treatments than
consider traditional modalities first.

A positive thinker, on the other hand, will realize that
back pain is difficult to treat, has variable causes, and responds to different
therapies based on an individual’s unique circumstances.  A positive thinker would have a realistic
view of recovery, would accept the limitations of therapeutic options, but
would focus on his abilities rather than his disabilities and look for ways to
make the best of his current circumstances.
He would actively participate in physical activity, perhaps join a support
group, get good rest and engage in a healthy lifestyle while working towards a
brighter tomorrow one step at a time.

Definitions for clarity:

Snake oil is a treatment whose efficacy is knowingly exaggerated by those who wish to turn a profit on its sale.  E.g. diet pills that will “miraculously correct morbid obesity in a matter of weeks.”

A placebo is a treatment that has no known plausible mechanism for a physical effect – but may affect the individual through the mind-body connection.  E.g. a sugar pill that is substituted for a pain killer may cause a patient to experience his pain differently, though there is no active ingredient in the pill.

An untested treatment is neither snake oil nor a placebo but could be used as either under certain circumstances.  It is simply a proposed intervention of unclear clinical significance.  There are many of these currently undergoing scientific review, and it takes patience to analyze their potential efficacy and safety.

A magical thinker is a person who is willing to accept snake oil as a valid treatment option for his condition despite a vast preponderance of evidence to the contrary.  Magical thinking is belief-based, rather than evidence-based.  Many very good and reasonable people are tempted to adopt magical thinking under duress.

A positive thinker is a person who choses to look for the positives in all circumstances, and approaches health with a can-do attitude.  Realistic and yet optimistic, the positive thinker will focus on abilities rather than disabilities – and reach out for support as needed to optimize his psychological well being.

All of this is simply to say that a positive attitude, peace of mind, stress reduction techniques and a healthy lifestyle are an important foundation for good health.  Placebos are most relevant for influencing psychological well being or pain perception (obviously they’re not appropriate for treating infections, type 1 diabetes, and the like), and magical thinking and snake oil are dangerous hindrances to wellbeing.  Stay positive and protect yourself from snake oil salesmen.  Knowledge is power. There are voices of reason to guide you here at Revolution Health.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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