Better Health Care Newsletter – September 2023 | Patrick Malone & Associates P.C. | DC Injury Lawyers

Ah, wellness! Such a positive word! Such a noble aspiration for all of us!

And such an opportunity for hucksters, hokum and high jinks in the eternal battle to separate Americans from their money.

Some of the extreme practices marketed by the wellness industry would be worth a chuckle, if they weren’t so costly and potentially dangerous.

The self-proclaimed gurus of good living are escalating their claims, and blurring the boundaries between bona fide, beneficial science versus profiteering and quackery.

Healthy skepticism and a big dose of common sense can keep savvy consumers from falling prey to the too-good-to-be-true allures of buzzy, health-related hokum. Here are key takeaways for those wanting true wellness without the hype.

Some women have decided it makes sense to believe a Hollywood star and stick a lump of egg-shaped jade in their privates to improve their sexual lives. Some men have believed they could boost the natural benefits of sunlight by exposing their sphincters to it in a practice known as “perineal sunning.” Doctors and digestive specialists for years have sought to disabuse patients of the idea that regularly flushing the colon with gallons of various liquids has the usefulness claimed by advocates of colonics.

Devotees swear by blood-sucking leeches for regular, beautifying “blood detoxification,” and others have experimented with having their own blood processed and re-injected into their faces via dozens of small, painful needle pricks, aka a restorative, beautifying “vampire facial.”

The woo woo about wellness — often propounded now by celebrities— may seem to be not only extreme, but everywhere. Indeed, the New York Times reported it has become ubiquitous:

“You can’t browse a grocery store or pharmacy without being subject to flashy labels that promote health benefits. In the beverage aisle, for example, you might find ‘prebiotic’ sodas that supposedly support ‘gut health.’ In the beauty department, you’ll see ‘medical-grade’ serums, ‘probiotic’ facial creams and ‘skin detoxing’ treatments. Go to the supplements section for promises of ‘immunity support,’ ‘hormone balance’ and ‘energy enhancement,’ among other things.”

The newspaper says that advertising and marketing whizzes know they can get consumers to buy wellness offerings by hyping them with squishy medical or scientific claims. These assertions are bolstered by purported research or seemingly persuasive endorsements, with scientific or medical terms tossed in to add to their gloss.

Scienceploitation is the telling portmanteau that debunking expert Timothy Caulfield, a Canadian health and law policy researcher, has developed for the exploding hype, the New York Times reported. He is one of a growing number of serious folks who are sounding alarms about how medicine and science get misused to promote what has become by some measures a $1.5 trillion global industry.

Everybody’s got an opinion. That’s easy and cheap. What’s hard and expensive is to do rigorous, reliable medical-scientific research. And even harder is reliable research in subjects like nutrition, exercise, and wellness. They’re rife with human “confounding” factors. Failing to control for these can undercut even the best-intentioned research.

The gold standard of medical-scientific study is the randomized clinical trial. In this research, experts spend major time and effort in advance of any experimentation to drill down on precisely what they hope to learn — and to remove variables and surprises that can sway findings. This includes careful selection of prospective subjects, having big enough populations for testing, using control groups, and blinding researchers to which participants are getting experimental therapies and which are getting inactive “controls.”

But when it comes to subjects like nutrition and exercise, controlling the variables is almost impossible. Researchers can’t, for example, lock down large numbers of test subjects to see everything they consume or to record their every activity, especially for any length of time. Instead, they too often must rely on participants’ unreliable memories to fill out diaries.

Even if researchers can get accurate intake and output data from trial participants, such information still might be lacking. Big time. As skeptics of nutrition research have pointed out, humans consume 250,000 different foods and 300,000 edible plants. How would it be possible to determine that one of these or a handful of them were especially beneficial? And exactly which of these foodstuffs’ myriad components — potentially a few chemicals or even molecules— were determinative in a supposed major benefit? Decades of nutrition research, especially on common substances like coffee and alcohol, have produced a tide of shifting information on pluses and minuses of human edibles.

When it comes to human endeavors, rigorous study of wellness products or services need to account for important basics like research subjects’ age, sex, and gender. Who wouldn’t look askance at beneficial claims for an item promoted for seniors but tested only on 20-something Olympians?

Be on the lookout for these tipoffs of puffery, which we’ve compiled from reputable news sources listed at the end of this section.

Extravagant ingredient lists, with frothy assertions about the value of vitamins (C! D!), minerals (copper!), and other substances (activated charcoal!). Makers don’t say how much of each magical-sounding item is included, nor do they attest to the quality of additives or their purported benefit in what is often minuscule quantities.

Fancy mumble terms that advertising and marketing departments sprinkle lavishly (with legal departments’ grudging assent). What exactly is meant when an item boosts, supports, assists, or enhances a supposed benefit? What backs up an assertion that something is clinically tested, research-backed, doctor-recommended or evidence-based? OK, granted, the product label itself may not have room for citations, but the seller’s website certainly does.

Mysterious sources and low numbers: Who did the testing, research, or advising? An industry group, someone paid or backed by the product maker or service provider, or rigorous independent experts? How many participants were studied (that magical N number, and it better be significant), how, and for how long? To get a fuller fill on how to be skeptical about medical-scientific research, check out an earlier newsletter on this topic (click here).

Absence of bona fides from federal regulators and respected health institutions and organizations. Can the product, as the Federal Trade Commission recommends, survive a simple online search for its name along with terms like review, complaint, or scam? Does an item or service get addressed specifically by the federal Food and Drug Administration, federal Centers for Disease Control and Prevention, the National Institutes of Health, or the Consumer Products Safety Commission? Is it discussed by groups like the American Heart Association, the American College of Cardiology, the American Medical Association, or the American College of Physicians?

What does your primary care doctor say about a wellness product or service? What does your pharmacist advise about health-related items you want to buy?

Financial experts, on occasion, advise impulse spenders to put their credit cards on ice — literally. Putting the card in a plastic cup of water and stashing it in the freezer might seem extreme. But the sentiment is a good one in signing up for health-related services and products. What’s the rush? That paycheck was hard earned. Don’t let it fly out of hand just because of a conversation with the fit guy at the gym, a really cool social media post, or an eye-catching display at the mall.

How will you measure the outcomes of your use of a product or service? How long will you give it to show results? Are there alternatives to it that are less costly, demanding, invasive, and painful? Six months from now, if you skipped this item would you regret it — or even notice that you did so?

Lots of questions, yes, and very few satisfying answers.

We pulled these questions from a series of articles in respected news media outlets. A rising number of media sources have raised concerns about sketchy promotions and excessive claims. Examples include articles linked here in these publications: the New York Times, the Independent, Insider, Refinery 29, JSTOR Daily, the Washington Post, and the New Republic.

In all things moderation. That’s not a bad starting credo for individuals considering wellness products and services, experts say.

But moderation is absent from a lot of the current books about exercise, diet, beauty, and fitness.

Timothy Caufield’s provocative, pertinent, and popular takedowns include Is Gwyneth Paltrow Wrong About Everything? The Cure for Everything, and Relax Dammit!: A User’s Guide to the Age of Anxiety. Christy Harrison, a writer, trained dietitian, and self-described former wellness fad follower, has put out The Wellness Trap. One news article says it delves into “multilevel marketing schemes, the millennial aesthetic, QAnon, scammers, Silicon Valley, and the anti-vax movement … She portrays wellness culture as a vortex where people’s time, money, and actual well-being are subsumed by a wildly profitable industry. Its ubiquity creates so many entry points that any kind of person, including Harrison herself, can get sucked in.”

Barbara Ehrenreich, holder of a Ph.D. in cellular biology and long a trenchant social critic, wrote Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer. It is a brutal rip, reported in the late part of her life (she died a few days after her 81st birthday last year), on science, medicine, exercise, and wellness. As the Washington Post review reported:

“Ehrenreich takes us into the world of wellness, where, from CrossFit to gluten-free diets, we obsessively follow the latest trends that promise eternal health. She traces this ‘surge of interest in physical fitness’ to the 1980s, when disillusionment with the failure of the 1960s counterculture movement led to an inward turn, a type of self-involvement ‘where if you could not change the world or even chart your own career, you could still control your own body.’ For women, accustomed to decades of societal domination, ‘” control over one’s body’ could be understood as a serious political goal.”’ Jane Fonda led the charge with her massively popular aerobics videos, accompanied by the rise of a multibillion-dollar empire of gyms and fitness centers. There are obvious social class dimensions, as working out became ‘another form of conspicuous consumption’ while ‘unfit behavior like smoking or reclining in front of the TV with a beer signified lower-class status.’ (Never mind, she notes, that the poor are too busy working to have time to exercise.)”

While consumers globally drop huge sums to be healthier, fitter, and happier, the expert counsel on staying healthy has remained relatively consistent, direct — and less expensive and demanding than the faddists. A brief reprise:

• Don’t smoke (cigarettes, cigars, marijuana) or vape.
• Eat less and consume more plants, nuts, and sustainable fish. Cut down the fast and ultra-processed foods you eat, as well as salt, sugar, and fat. A well-balanced diet will provide most people with all the vitamins and nutrients they need — without pricey, unneeded supplements.
• Use intoxicants sparingly.
• Move as much and often as you can. Take the stairs. Walk around the office, the store, your house, and the neighborhood. The clamor for elaborate exercise routines probably translates better for most of us this way: Don’t worry about competing at pro levels.
• Get lots of restful sleep.
• Slash the stress, finding more quality time, instead, with family, friends, and others. Relationships — strong, central ones, as well as many other kinds — are crucial to our mental and social well-being, experts say.
• Another important relationship to cultivate: Being OK with just who you are. If your loved ones or folks you respect give you the side eye and question how you leap from one hot wellness trend to another — aerobics, hot yoga, marathon running, forest bathing! — or if they assure you that you look great just as you are, listen up.

Our maker decided it was not just fine but a virtue to have each of us be different. Some of us will be admired for our great looks, others will be standout athletes. Some of us will be slight in stature but big on brains. Some of us will wrestlle with weight, and others will be chronically ill and struggling. We can do stuff that improves our health and our sense of well-being. We have options. Be happy with yourself — and stay well!

What does it matter? “Hey, it can’t hurt, and it might help, so … “

Advocates for health and wellness products and services entice consumers to spend freely, partly by arguing that it is cost-beneficial to drop a few dollars to feel or look better. That tube of youth-enhancing salve or those libido-boosting pills aren’t that expensive, right?

Think again. Consider that experts estimate that Americans forked over $50 billion in 2021 for vitamins and other over-the-counter supplements — much-promoted add-ons that years of research have been shown to be unneeded.

Most folks get all the vitamins and nutrients they need from a healthful diet or from routine activities like a daily stroll in the sun. But a giant industry has sprouted to push demand for supplements. OK, even if consumers decide they want a daily multivitamin, why must they run up a $700-a-year bill for them, when the New York Times reports they can get something just as good for $15 annually?

Unnecessary spending is a whopping problem in U.S. medicine altogether, as people in this country spend more than $4 trillion annually on health care — roughly 1 in every 5 dollars of the nation’s gross domestic product. Nearly 1 in 4 of us have unpaid medical bills or debt. At the same time, federal officials say that almost 4 in 10 adults in this country would suffer real hardship if they suddenly had to cover an emergency $400 expense.

Americans, critics correctly say, do not need to be saddled with worthless costs to improve their well-being.

Sketchy wellness products and services also harm people. Some sun-seekers exposing their nether parts suffered painful, serious burns. Doctors also share with each other sad stories about patients who get sucked in by wellness hype — to the detriment of their health, as a New York Times Opinion article by a California ob-gyn reported:

“Every doctor I know has more than one story about a patient who died because they chose to try to alkalinize their blood or gambled on intravenous vitamins instead of getting cancer care. Data is emerging that cancer patients who opt for alternative medical practices, many promoted by companies that sell products of questionable value, are more likely to die.”

As Caufield, the prominent critic of wellness hype, also has argued in one of his Op-Eds:

“[T]here is so much confusing, science-free misinformation circulating in popular culture that it has become increasingly difficult to separate sensible health advice from what should be considered, well, insane … Recently, a woman nearly died as a result of using a homemade IV drip to inject fruit juice. My initial reaction to this horrifying story? I’m surprised it hasn’t happened sooner. We live in an era where the wellness industrial complex — a $4-trillion-a-year industry — recommends regular colonics (don’t do this), the steaming of vaginas (don’t do this), the consumption of activated charcoal (don’t do this), extreme and unsustainable diets and detoxes (don’t do either), the ingestion of massive amounts of supplements (don’t do this), the boosting of your immune system (not really possible and, again, don’t do this), and, yes, the use of IV vitamin therapy.”

The Kaiser Family Foundation conducted one of its respected public opinion surveys, isolating 10 false claims about Covid-19, reproductive health, and gun violence. As the organization reported:

“[R]oughly half to three-quarters of the public are uncertain whether each of the 10 false claims are true or not …This suggests that even when people don’t believe false claims they hear, it can create uncertainty about complicated public health topics.”

The coronavirus pandemic surfaced wild, extreme, and highly politicized views on medicine, health, and public health. Experts say the United States, with political leaders who for months ran a shambolic response to a disease that killed more than 1 million of us, will need years to recover from virulent, fact-free assaults on science and medicine. This included the floating and actual use of untested therapies and counterfactual medical information. The “infodemic” of anti-science medical misinformation, as predicted by the World Health Organization, rages on.

Alas, those who so easily espouse evidence-light wellness ideas too often also embrace destructive, wrong-headed ideas about valuable medical therapies, such as vaccinations that have saved untold lives for centuries now. This is not good.

Big. Flashy. Relentless. Questionable. Those descriptions fit too much wellness hype these days, critics say. They also apply to Big Pharma’s direct-to-consumer prescription drug advertising.

Anyone who spends any time these days watching the TV — yes, that’s you, 60-plus folks — knows about the drug industry’s wall-to-wall pitching of medications for who knows what conditions out there. The idea is simple: Bang the drum for patients about expensive drugs, in the hope of getting them to ask their doctors to prescribe the meds.

The United States and New Zealand are the only two nations on the planet that allow makers such promotional leeway.

In this country, critics have assailed this Big Pharma practice, saying it adds unnecessary costs to the medical system — without providing parallel benefits. Instead, patient advocates say, drug makers deploy big ad budgets for branded products with higher costs and lesser effectiveness. As researchers from Johns Hopkins reported earlier this year in a published study:

“[A] higher proportion of manufacturer promotional spending allocated to direct-to-consumer advertising was associated with drugs rated as having lower rather than higher added clinical benefit and with higher total drug sales …

“Direct-to-consumer advertising may increase patient requests for advertised products and the likelihood of their prescription by clinicians. Allocating a greater share of promotional spending to consumer advertising (vs promotions that target clinicians) may therefore reflect a strategy to drive patient demand for drugs that clinicians might be less likely to prescribe because either there are several similarly effective alternative treatments available or there is a more effective alternative available.”

Critics want lawmakers and regulators to step in to curtail direct-to-consumer drug ads. The government has forced Big Pharma to be more explicit about medications’ side effects leading to stand-up comedy routines on how fast-talking company spokespeople skid over these potentially serious harms.

And though a federal watchdog has noted that this drug promotion has measurable effects in increasing taxpayer spending (for example, with Medicare costs), the promotional campaigns seem only to increase on the airwaves, in print, and online.

Here’s a thought, though: Might companies flogging wellness and hygiene products and services overpower even Big Pharma’s big spends?

Will consumers hit the OFF button on, say, cable channels after getting inundated with ads — extreme in their candor — for stuff like middle-aged men’s libido boosters, deodorant that goes everywhere besides the underarm, toilet tissue with cuddly predators that waggle their backsides, or women’s personal undergarments that make chain mail sound appealing?