My social media, the internet and my guilty pleasure, Words with Friends, have been inundating me with advertisements showcasing this year’s greatest deals this holiday season. Since I am a medical student, the artificial intelligence algorithms curating my ads have been choosing for me various health and wellness-related devices and subscriptions. Oddly enough — and I’m not sure what this indicates about my Google search history — I have been presented with a preponderance of promotions from what I like to call pseudo-medicine.
Neither evidence-based nor standard, pseudo-medicine refers to ideologies and practices that pertain to health and disease but fall outside the realm of scientific medicine. Crucially, pseudo-medicine, as suggested by its etymology from the Greek pseudes for ‘lie’ or ‘deceit,’ draws upon medicalized language and purported physiology to trick consumers into buying a product. These practitioners are rarely actual physicians, but more commonly naturopaths or other self-designated health experts, and almost always go by “Dr. FirstName.”
One product recently peddled to me from a naturopath’s website claimed that his method could cure most cases of irritable bowel syndrome (IBS) in less than seven days. His secret is a false claim that — and I’m paraphrasing — most practicing physicians are unaware that the major cause of IBS is small intestinal bacterial overgrowth (SIBO). And his product — spoiler alert, not the antibiotic Xifaxan (rifaximin) — alleges to resolve this. In reality, while SIBO is most certainly one of the contributing etiologies in IBS, it is by far not the most prevalent cause. In fact, the best estimate of SIBO in patients with IBS appears to rest at four percent as measured by jejunal aspirate. This is an example of medical misinformation and gives false promise to IBS sufferers. Regardless of scientific validity, some patients may actually receive some relief from this product as about forty percent of IBS patients respond favorably to even a placebo.
While the self-proclaimed ‘cure’ for IBS is based, however loosely, upon physiologic studies, other more outlandish products exist. For example, another naturopath (not a physician), is marketing her tea to treat a disparate variety of ailments. Referencing stress responses, inflammatory cytokines and the hypothalamic-pituitary-adrenal axis and linking these to the development of cancer and autoimmune disease, she believes that coffee is toxic to the body. She claims that by switching from coffee to tea — specifically hers — one can avoid the deleterious effects of the evidently poisonous substance that is coffee. Once again, this is medical misinformation that is in stark contrast to the abundant research linking coffee to a host of positive health outcomes, including longevity.
Both Dr. SIBO and Dr. Tea are guilty of employing medicalization to sell their products. By invoking SIBO and stress responses, they appear to be drawing from Western biomedicine and its foundation in scientific evidence. To the medically-trained ear, such rhetoric is discarded as pseudo-scientific gobbledygook. But to the medically-uninformed, the utilization of ostensibly medical verbiage conveys a degree of legitimacy. However, this approach is deceitful as it deliberately markets to a target audience with low health literacy in order to sell a product.
An additional concern is the safety of such products. Unregulated as they are, these supplements are not under FDA monitoring and lack any enforceable way to evaluate the safety or even their actual composition. Additionally, there is no study of the potential toxicity from interactions with other medications. Conversely, there is extensive evidence from independent groups revealing the high levels of contaminants found in supplements.
I recently took a survey from an advertisement that promised to diagnose me as either serotonin or dopamine deficient based on a ten-question survey. Based on the results, the company, which was independently owned and claimed to support wellness naturally, would then provide me with a monthly supply of the depleted natural chemical. Since dopamine deficiency is the hallmark of Parkinson disease and serotonin deficiency is a gross oversimplification and misunderstanding of depression, I was intrigued and amused. Thus, I completed the questionnaire and was — to my immense surprise — deemed serotonin deficient. I decided to opt out of a monthly twenty-dollar fee for serotonin syndrome delivered to my doorstep, but I imagine others without a medical background would be less discerning. These people may fall victim to this scam and be at risk for significant harm.
Thankfully, many of the products like anti-SIBO pills and anti-stress tea come from small startup companies with limited following. The same principle applies, however, to some more prominent individuals and groups. Dr. Axe, for example, is not a medical doctor. Rather, he is a naturopath whose website of ‘medical’ topics and health store receive substantial online traffic. He, too, is notorious for medicalized language and invoking pathophysiologic mechanisms that do not pass the medical ‘sniff test’ but sound legitimate to the untrained ear. Similarly guilty of such false advertising is Joseph Mercola, who is a well-known vaccine critic, a proponent of homeopathy for autism and, of course, a salesman for myriad supplements and homeopathic remedies.
I have previously written about Dr. Oz, another person guilty of such medicalized manipulation to a degree arguably more egregious than the others, given than his credibility is bolstered by his extensive, legitimate and impressive education and training as a cardiothoracic surgeon and professor of surgery at Columbia University. In addition to his past involvement endorsing medically unfounded supplements, he is also a promoter of homeopathy and Reiki.
Perhaps, most unfortunately, the patient populations targeted by such individuals are those with challenging and chronic symptoms difficult to both diagnose and treat. These include disorders like irritable bowel syndrome, fibromyalgia, chronic fatigue and pain syndromes, post-concussive syndromes and migraines. One physician’s website claims that he can treat a number of unrecognized diagnoses such as electromagnetic hypersensitivity syndrome, which has been disproven multiple times by double-blinded stimulation-sham trials and is thought to represent a nocebo response. Another unrecognized disorder that he claims to treat is broken mommy syndrome, described as fatigue, stress, pain and other symptoms following childbirth, which is likely normal postpartum adjustment at the least or, at worst, major depressive disorder with peripartum onset.
Patients with these nonspecific, diffuse symptoms who lack objective findings often fall through the cracks or are actively dismissed by the health care system. Consequently vulnerable and desperate, they are willing to try anything. Thus, it is especially shameful that these patients are targeted by people who claim to know all of the answers and hold the panacea in their hands despite lacking any evidence to support their claims.
This same disgraceful approach is commonly used to market products advertised as ‘cures’ for autism spectrum disorder. These are pseudo-medical groups that claim to be able to ‘reverse’ autism and give desperate parents false hope by oversimplifying and misrepresenting preliminary research. This has become so widespread in autism spectrum disorder that the Food and Drug Administration (FDA) has warned parents to watch out for such fictitious claims. Cancer patients are similarly targeted, and the FDA has warned companies and consumers about “bogus” cancer treatments.
Such public admonition is essential as widespread pseudo-scientific propaganda is truly a life and death matter. A recent survey found that nearly forty percent of Americans believe that cancer can be cured solely through alternative therapies. In reality, those who choose such and forego conventional therapies have a 250 percent increased risk of death. Since a large percentage of the population does not trust advice given by the Centers for Disease Control, FDA and other government-sponsored health care institutions, federal condemnation of pseudoscience, while necessary, is not sufficient.
Fortunately, some individual physicians are also taking it upon themselves to educate the public. Zubin Damania, MD (of no relation) is an outspoken advocate for evidence-based medicine and crusader against pseudoscience. Using his alias and internet celebrity name, ZDoggMD, Dr. Damania has spoken extensively about this topic. For example, he recently produced a video highlighting how pseudoscience purveyors have hijacked and misconstrued MTHFR mutations.
It is very easy in the ages of technology, social media, prevalent health care distrust and “fake news” for anyone to claim expertise on a topic and proclaim themselves experts. With a bit of marketing skills, quasi-medical amphigory and a ‘cure’ to sell, I could easily establish myself as Dr. John. Then, I could peddle my magical cure-all for fatigue, brain fog, chronic pain, GI distress and headaches based on my own individual analysis of the hottest research that other docs “don’t know about” or “don’t want you to know about!” However, this approach is truly a self-serving one and does a tremendous disservice not only to the medical system, but also to patients with real symptoms and individual suffering. It offers false promises and reassurances to patients who actually need comprehensive biopsychosocial care.
And so, I reincarnate the Biblical jeremiad for our purposes and admonishment: Beware of practitioners of pseudo-medicine. They come to you in physicians’ white coats but in actuality are mere salespeople.