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The Power of Magical Thinking

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The most outrageous lies that can be invented will find believers if
a man only tells them with all his might.

–Mark Twain

I’ve always liked the term “magical thinking.”  I first discovered it in medical school when
we were learning about normal childhood development.  There is a period of time (about ages 3-6) in
which all children believe in magic – things that are not possible or rational
appear plausible to them.  I suppose that
Peter Pan is based on this psychological window – when children grow too old
they can’t go to Never Never Land anymore because they lose their ability to
fly (aka believe in magic).

As adults, we often remember our childhood fantasies with
fondness.  We relive the experience with
our kids, and enjoy the carefree wonder that comes along with fully believing
in implausible things.  In general,
magical thinking is an enjoyable part of childhood.

But there is a more sinister form of magical thinking – and
that develops when adults abandon reason for implausibility.  We see this in medicine quite a bit, as it is
the soil in which the proverbial snake oil salesman can grow his thorny weeds.  Preying on fears in a vulnerable victim, the
snake oil salesman leads the person down a common garden path of partial
truths, twisted facts and sheer lies.
Here are some of his favorite tactics:

  1. Trust
    “Your doctor is keeping
    important (if not life-saving) treatment options from you.”  Snake oil salesmen love to write books with the
    following titles “What your doctor won’t tell you about X.” or “New
    scientific break through X that your doctor doesn’t know about…”  This tactic is meant to break the trust
    between physicians and their patients, causing second guessing and
    unnecessary rifts.  More often than
    not, your doctor doesn’t know about treatment X because it’s so ridiculous
    that they wouldn’t give it a second thought or the medical community has
    already disproven it.
  2. Conspiracy
    Snake oil hucksters love
    to tell you that the government (or your hospital, or your pharmacist, or
    your health plan, or your healthcare provider) is conspiring against you
    with the pharmaceutical companies (or your health insurance, or your
    doctor, etc.) to prevent you from getting the care you need or to coerce
    you into getting treatment that you don’t need.  Conspiracy theories are ubiquitous in
    the snake oil world and they are the most obvious red flag identifier in
    their arguments.  So if the next
    treatment option you’re considering is promoted with arguments that it’s
    best for you specifically because the evil government/pharmaceutical
    company/hospital/doctor is trying to prevent you from taking it  – be very wary indeed.
  3. Playing
    the victim.
    When rational
    scientists poke holes in the snake oil salesman’s pitch, his favorite
    argument is “I’m being attacked and suppressed by those who don’t want YOU
    to know the truth. This proves that what I’m saying is true – why else
    would they want to silence me!?”
  4. Making
    you feel inferior.
    The snake oil
    salesman loves to point to the “wild success” of treatment X in Europe, Asia, or any other country than your own.  He wants you to feel that you’re late to
    the party, and that everyone else is ahead of you and has already been
    enlightened.  You feel ashamed of
    your ignorance and want to get in on something that has thousands (perhaps
    millions) of foreign supporters – so it must be safe/true/right.
  5. Pseudoscience
    To give their snake oil an
    air of credibility, the salesman will use medical-sounding words to
    describe its purported mechanism of action. This is where the salesman can
    really work his art into the minds of magical thinkers.  The more convoluted and implausible the
    story, the more magical it is – and the better able to capture imaginations.
  6. A secret cure. Diseases can be crippling and devastating, leading people to despair.  The most serious and life threatening diseases (especially if there is no known cure) are the favorite target of snake oil salesmen.  Desperation breeds magical thinking, and opens the door to all kinds of false promises on the part of hucksters who have no qualms making money on fruitless “cures.”  They often pitch their snake oil as a secret cure that only a select few people know about (or have access to).  If a disease has no known cure, you can be 99.9% sure that a promise of a “secret cure” is an unconscionable ploy to gain financially from the suffering of others.

And so, dear readers, one must never underestimate the power
of magical thinking.  It is the bedrock
of bad medicine, can lead people away from life-saving therapies, and will
continue to exist for as long as people are willing to entertain the arguments
of the snake oil huckster.  Sadly, I
predict that snake oil will be around for as long as human suffering exists –
and it will inflict its venom most effectively on the ignorant, desperate, and
vulnerable.  It can be vanquished,
however, on a case-by-case basis by its only natural foe: the scientific
method.  Hold fast to evidence based
medicine, and you will avoid much of the pain of pseudoscience, thorny lies,
and snake oil.  I will be there with you,
fighting the good fight.

In my next post I will describe the power of positive
thinking – which has value in medicine, as do placebos.  I will explain the difference between the
placebo effect and snake oil, an often confused but important distinction.

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

New FDA Rule Raises Bar for Supplement Industry

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Well, hooray for the FDA.  On August 24th a new rule will be phased in, requiring all supplement manufacturers to demonstrate that their products contain the ingredients listed on their labels (nothing more, nothing less).  This rule will help to reduce contamination issues (some supplements have been found to contain dangerous levels of lead, bacteria, and other contaminants) and false advertising (some supplements don’t contain as much of an ingredient as the label claims).

This is really good news, and better late than never.  Although some manufacturers were already conforming to this rule (kudos to them), this will require compliance for the rest of the companies out there who have been misleading the public about the contents of their supplements.

Some say that this rule doesn’t go far enough to ensure the safety and efficacy of the contents of the supplements, and that these bio-active ingredients should undergo the same degree of testing as pharmaceutical products.  Unfortunately, studying all the supplements for efficacy would be an enormous and extremely expensive task that is totally cost-prohibitive.  At this point, the best we’ve got is NCCAM, and they are slowly grinding their way through a long list of supplements that are purported to be useful for the treatment of various conditions.  They are systematically reviewing them to see if indeed they produce the desired effect, without any undesired effects.

And so at this point, let the buyer beware – supplements may or may not be as helpful as the manufacturer claims, and they may not be as side-effect free as they suggest either.  But soon you’ll at least be able to know that they don’t contain toxic chemicals, heavy metals, or dangerous bacteria – and that’s a giant step in the right direction for public safety.This post originally appeared on Dr. Val’s blog at

Globalization Poses Health Risks

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The global economy is a mixed blessing – while we may
benefit from access to less expensive goods and services, by using them we rely
on the quality standards of their country of origin.  In an alarming expose, the New York Times
reveals how far behind China
is in the application of quality and safety standards to their food and
pharmaceutical products.

I have voiced concerns in this blog before about the
melamine/pet food scandal and the implications it may have for humans, as well
as the fact that many Chinese citizens trust western medicine over their own
traditional practices for matters of serious illness.  But this latest Times article has further
described the risk that counterfeit Chinese products can pose to the global community:

Toxic syrup has
figured in at least eight mass poisonings around the world in the past two
decades. Researchers estimate that thousands have died. In many cases, the
precise origin of the poison has never been determined. But records and
interviews show that in three of the last four cases it was made in China, a major
source of counterfeit drugs.

“Everybody wants to
invest in the pharmaceutical industry and it is growing, but the regulators
can’t keep up,” Mr. Zhou said. “We need a system to assure our safety.”

… Families [in Panama] have
reported 365 deaths from the poison, 100 of which have been confirmed so far.

When it comes to your health and the safety of the medicines
you use, you’re only as safe as the weakest link in the manufacturing or regulatory
process.  Prescription medications are
carefully regulated in the US,
but there is no such oversight in the herb and supplements market.  So buyer beware…  Check out places like to get
some objective information about safety before you pop those “health pills.”

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

Herbal Remedy May Reduce Urinary Tract Infections?

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The number one Google news item today is a report of a mouse study (published in Nature Medicine, but apparently still embargoed to the public as it is not listed on their website) that suggested that an herbal supplement could (in combination with antibiotics) “eradicate” urinary tract infections.

In usual fashion, the buzz preceded the science, and now we have thousands of people on the lookout for forskolin (a root extract of coleus) tablets from the local health food store. Do these have any possible merit?

A recent review of the literature about this herb was conducted by the good docs at Harvard, and turned up “no conclusive evidence for its [forskolin’s] use for any health condition.”

My friend Dr. Charles also read the reports of this “miraculous” new cure – which posits that recurrent urinary tract infections are caused by pockets of bacteria that hide inside bladder walls. Dr. Charles rightly points out that there are many different points of entry for bacteria, and that an herb which (and we don’t know that it even does this) relaxes bladder walls would surely not affect the alternate routes of entry, hence it cannot be curative in all cases.

So my friends, I’m sorry to say that there is little justification for enthusiasm yet. But we will follow the research with interest, in case human subjects do indeed show benefit in the future.

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

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