Post-Truth, Alt-Health

post-truth

Frequency of the word “post-truth” in news stories according to Google Trends (spike is in Nov. 2016)

Since the 2016 election, the term post-truth has become the subject of countless essays, news pieces, and YouTube videos. Facebook and other outlets want to censor “fake news” (and therefore become the arbiters of what is true) in response to a year that is being called the “Year Truth Died.” The Oxford Dictionary has declared “post-truth” its word of the year.  It is interesting how deluded people have become to think that they can decide what is true or untrue. As I have said before, this is merely hubris.

Most of the stories and posts that I see on Facebook and news websites over the last several years that have bothered me for failing to meet the standard of “truth” are health-related. Naturally, those are the posts I give more attention. If anyone wants to confirm that we have apparently, as a society, become more tolerant of false claims, look no further than the health industry and its associated advertising and pseudoscientific literature. Of course, I am not saying that this has just happened in the last 10 years. It is as old as time itself.

snakeoil

On CNN’s website today, I read this article about apple cider vinegar, promoted by health.com. Health magazine and CNN are both owned by Time, Inc. The article is typical of the type of stories covered on CNN’s health section and in magazines like Health. It’s author is Cynthia Sass, whose many popular books promote unscientific methods of dieting and other questionable nutritional tripe (“lose eight pounds in just four days”). You might say she’s a part of the Alt-Health movement, pun completely intended. But her particular brand of nonsense isn’t up for consideration for censorship for being “untrue,” I guess because it makes a lot of money for CNN and others.

The Alt-Health industry is characterized by false claims and shoddy pseudoscience that is designed to bilk people out of billions of dollars. The use and interpretation of evidence-based medicine is tough enough as it is. Even when well-designed, randomized, placebo-controlled clinical trials are available, there is still much analysis and interpretation to be done to understand what to do with that evidence. When it comes to diet and the dietary industry, this problem is immensely more difficult. There are few randomized, placebo-controlled trials. Anecdotal evidence and testimonials are standard fare. Most published studies consist of retrospective, observational data or prospective studies that are poorly controlled and poorly powered. Where positive data do exist, often the effects are either focused on the wrong outcome or the magnitude of effect is insignificant. Finally, there are huge economic incentives in the industry to mislead consumers.

Economic incentives? Yes, indeed. International ‘Big Pharma’ had sales in 2014 of roughly half a trillion dollars worldwide. The value of the food industry is at least 10 times that size and very competitive, with companies trying to edge each other out on something other than price, since industry margins are already so low (I should note that US Big Pharma sales are about $236B yearly). Current growth in the food industry comes from niche-markets, which are often created and fueled by spurious health claims, like organic food, gluten-free, fat-free, sugar-free, whole foods, etc.

Organic food sales alone in the US were nearly $50 billion last year. The poorly regulated supplements and vitamin industry is worth something more than $61B per year in the US. And consumers get very little in return for this money. These sales are driven directly by predatory, slick salesmanship and pseudoscience. Facebook feeds are awash with snake oil and quackery (I saw this on Facebook, for example). Because the Internet is used for this marketing, a Google search for scientific evidence about diet and dietary supplements is almost assured to be heavily biased and probably false, with most results coming from someone with something to sell. Since a lot of pseudoscientific supplements and Alt-Health products are sold through multilevel marketing schemes, then small, personal webpages and Facebook posts that number in the millions exist giving anecdotal endorsements to products that the endorser stands to gain from financially.

‘Big Pharma’ has become a buzz-word for these salesmen. Big Pharma – bad, Natural – good. But the profit margins are much higher in the health foods, vitamins, and supplements industry. This industry does next to nothing in the way of research or safety testing. They spend nothing on FDA approval and the most unscrupulous companies in the industry usually just go bankrupt if they get hit with a lawsuit. But even large, mainstream companies are in on the act. Whole Foods, for example, has the highest profit margins of any grocery chain in America, raking in the cash while implying to its consumers that the food it sells in somehow “healthier” than that of its competitors.

Back to the article about apple cider vinegar. An accompanying slide show describes “15 superfoods for the Fall.” A superfood, according to Wikipedia, is a marketing term and is not used by nutritionists and nutrition scientists. In other words, it’s fake news designed to exploit you out of your money. In fact, the European Union has made it illegal to market foods using this term. I wonder if Facebook will label all articles about superfoods as ‘junk science’ or ‘disputed’ or ‘fake’? I see at least one promoted article about superfoods per day. CNN, for their part, has decided to present this fake science as truth.

This particular article reports on two studies which claim that drinking apple cider vinegar both lowers blood sugar and makes you skinnier! Just an ounce a day delivers both of these miracles! The reporter says that this is based on “some solid research.” She goes on to speculate that it might also improve gut health (the latest buzz-word) and concludes by recommending that you drink two teaspoons of organic apple cider vinegar mixed with a teaspoon of organic honey mixed in a cup of warm water each day. I always like my acetic acid to be organic – specifically, two carbons per molecule (nerdy joke).

This type of reporting on scientific issues is common on CNN, Fox News, and hundreds of other sites. The quality only goes down when it comes to blog sites like Huffington Post. Did you detect any bias or selective presentation of data in this vinegar piece? (Please don’t read it.) If this is how scientific evidence is reported on, how can we expect “fact-driven” reportage on issues involving less clear areas like sociology, economics, foreign policy, current events analysis, etc?

Scientific journalism should require some critical assessment of the data and it’s implications, not just cherry-picking of any claim made that agrees with the author’s opinions. Ms. Sass did not practice scientific journalism, so let’s spend just a minute and do the work she should have done.

One study she cited showed lower blood sugars in the morning, if the participants ate a piece of cheese with some vinegar the night before. The study involved 11 participants (yes, eleven!) with Type 2 Diabetes, eight of whom took medications for it (why even try to have a homogenous group?). They recorded their fasting blood sugars for three days taking nothing at night, then for three days taking water with an ounce of cheese, and finally for three days taking the same cheese with 2 tablespoons of apple cider vinegar. The cheese and water group reduced fasting sugars by 2% (P=0.928) and the vinegar and cheese group reduced sugars by 4% (P=0.046). Yup, that’s the solid research the reporter was talking about. The study doesn’t account for the margins of error in glucometers, doesn’t strictly control for dietary and activity levels of the participants, doesn’t know what medicines the patients were on or when and how much the participants took, and, yet, the authors have the gall to conclude that the observed effect of vinegar was significant. I won’t waste much more time analyzing this paper, but suffice it to say I have seen middle school science projects more worthy of publication. Eleven unmatched people for 3 non-controlled days? Oh, and that P-value of 0.046? It wasn’t compared to the placebo arm (water and cheese). Hmm. Sounds legit.

The second paper she cites claims that apple cider vinegar improves insulin sensitivity in people who are insulin resistant or who have type 2 diabetes. This “solid research” paper included 8 controls, 11 people who were supposed to be insulin resistant, and 10 with type 2 diabetes. They were assigned to drink either a vinegar, water, and saccharin concoction followed by a bagel or a “placebo drink” followed by a bagel. They then did the opposite the next week. Interestingly, for people who think that a smidgen of vinegar is so powerful, we aren’t told what was in the placebo drink. They found “slightly improved” insulin resistance in the type 2 diabetes group. Oh, the P-value you ask? It was 0.07. Solid research!

The CNN writer also claims of this study, “People with pre-diabetes improved their blood glucose levels with vinegar by nearly half, while people with diabetes cut their blood glucose concentrations by 25%.” The paper makes no such claims about this at all, but rather it seems that the CNN expert was confused by the paper’s report of the comparisons of the fasting blood sugars in the three groups to one another (the control, pre-diabetics, and diabetics) with no claim that this was related to vinegar but rather the disease. Oh, the rigors of writing for Health magazine and CNN.

What about the weight gain claim? Those claims are supported with a link to this paper which studied the effects of force-feeding acetic acid to fat mice. I am not even going to comment on the complete non-relevance of this paper to any of the CNN claims. But there is one last follow-up paper in humans that the author cites. The study was conducted in Japan and consisted of giving subjects three versions of a drink that had variations of seven different ingredients, one of which was vinegar (and the placebo with no vinegar had lactic acid!). The rest of the paper is just as shoddy, with inappropriate controls, incorrect statistical methods, and false claims of significance. If you must know, the low dose group gained weight and body fat, and the high dose group lost, but none of it was statistically significant.

I could go on, but this type of analysis is typical of the vast majority of science reporting that appears on news websites. Interestingly, the papers cited are from 2004, 2007, and 2009. In other words, none of this was “news” anyway, but rather it was selective picking through the literature to support a narrative the author had already written. She might have missed this excellent 2014 review of the literature on vinegar. The authors lamented:

The use of food additives of natural origin to treat disease has increased significantly in recent years, despite a lack of evidence showing medical benefit. … Diabetic patients are 1.6 times more likely to use complementary and alternative medical products than nondiabetics. Moreover, obese individuals, who are usually unwilling to reduce their daily caloric intake, are often prone to use dietary gimmicks or alternative products that promise weight loss and beneficial metabolic effects.

The review is quite fair and exhaustive and concludes that the positive literature about vinegar come only from low-quality studies; they also believe that there is a significant publication bias in the area. They state that no health claims can currently be made about vinegar. Do you think CNN would publish those conclusions in a piece promoting superfoods, turmeric, and other nonsense? Of course not. Every single “news” outlet is more interested in click-bait and ad sales than facts.

Is this constant publication and promotion of health lies harmful? Of course is it. From Dr. Oz to The Doctors and the vast majority of health reporting on every major website, almost all we see are stories similar to this one on vinegar. They encourage patients to do ineffective things for their health problems (often promoting the idea the medical field is bad) and they take their money. It is the lower form of charlatan who preys on the weak and infirm to make a buck. I didn’t have to look hard for the vinegar story, I actually just went to the CNN Health page and picked the newest story. Such analysis could be performed every day. Where is the fact-checking?

We don’t live in a post-truth world. That’s just the meme of the month. Humans have always cared little about facts in every walk of life, it just became more talked about in politics this year. Nothing has changed. Do we care about facts? Every day hundred of thousands of doctors in the United States, who choose not to follow evidence-based guidelines, prove that they already live in a “post-truth” world where facts are irrelevant. Patients who spend hundreds of billions of dollars on the Alt-Health industry live in a post-truth world. But this world has been here from the very beginning of time and it isn’t going away.

So should Facebook get rid of the Alt-Health junk from my feed? Nah. I like a good laugh, and I don’t believe in censorship – I believe in effective persuasion. I am frustrated by but not afraid of the anti-vaxxers, the home-birth VBACers, the flat-earthers, etc. Censorship usually has the opposite effect than the one the censors desire. Want someone to read a book? Ban it. Instead of suppression, we should provide some competition of ideas.