HYPE IN MEDICINE AND HEALTH Medical Myths vs old wives tales, who is the snake oil dealer?
More than ever, in the age we live in, we need an umbrella that can protect us from the downpour of information. Even if we cover our ears, we cannot avoid the news and have difficulty determining which is right from which is misleading or hype. The areas of food, nutrition and medicine that all directly concern our health are undoubtedly the areas where we fall into this trap most often. Every day, we encounter loads of information in the media that can trigger our fears or cause us to change our views.
I have previously shared the success of the Sabri Ulker Food Research Foundation children’s books. By collaborating with Sok markets, they have brought almost a million books that educate children about healthy nutrition and healthy living. In addition to this project, the foundation in order to convey accurate and scientific information in the field of nutrition and healthy living to every segment of the society and eliminate information pollution has begun introducing internationally renowned books in the field of medicine and nutrition in Turkish for adults. The first book of the series, TIPTA VE SAGLIKTA BALON BILGILER (HYPE: A Doctor’s Guide to Medical Myths, Exaggerated Claims and Bad Advice – How to Tell What’s Real and What’s Not), has recently been published a few months ago, “says Begum Mutus, General Manager of the Sabri Ulker Foundation, in the preface of the book.
Known for her work at Harvard and UCLA, Professor of Medicine, Nina Shapiro states that the reason she was encouraged her to write this book is because many people do not know where to look for unbiased, reliable advice, and that the uncontrolled and rapid spread of false information on the Internet has left people shocked and confused. She calls it “the dark and light sides of search engines” and also discusses “should you Yelp your doctor’. I think we should stop diagnosing ourselves with what we pick up from healthcare sites, just as many of us are now backing away from folk medicine or old wives tales. However, maybe our doctor should contact us in a way that we are used to on the Internet, because the communication habits of society are evolving rapidly. Of course, I am now grateful to my doctors who communicate with me on WhatsApp and offer consultations via remote meetings.
Information that we believe will always be valid and that we consider to have a critical value for our health suddenly loses its validity. For example, low-fat products were thought to be helpful for dieters; until it was discovered that sugar, not fat, could be the basis of obesity.
In the past, we had to bury ourselves among the dusty pages in libraries to access information, and now with a click of a mouse, the world is revealed to us by Mr. “Google”, which we consult on everything from health to food, and was added as a verb to both Oxford and Merriam-Webster’s dictionaries in 2006.
While writing this book, Shapiro was impressed by a friend who had just visited Turkey and even came to our country to promote the book. She emphasizes that the constantly circulating allegations are mostly exaggerated, misleading, haphazard research, or a juggling designed to hunt the vulnerable and adds, “As in any profession, the medical field is full of fear traders and scammers who set their order on fear of illness or those simply seeking to be healthy. The purpose of this book is to keep you alert to the truth about popular health advice and provide an attentive, reliable guide to whether you are a diligent health consumer or patient. We’ll look at ways to understand what is actually real from what is hype’.
In the book, important issues such as conspiracy theories, risk management, correlation versus causation, and what is accurate, repeatable and well-designed research are discussed. Then, answers are presented to questions that confuse most people; is there such a thing as the best scientifically proven diet? Is gluten really that bad? Can detox be toxic? Does sugar feed cancer cells? Since when did organic become an “awesome” product keyword?
Even well-educated people can make conflicting choices when it comes to health, nutrition, and medical choices. While some people worry about consuming foods containing additives, they do not mind sending text messages or not wearing seat belts while driving. However, these actions come first among the causes of death in accidents.
As soon as a person believes something, he becomes blind to evidence to the contrary and does not easily change his mind. This is called the “Curse of First Faith“. As a result, our attention diverts from real risks, and our incorrect decisions that we shape with artificial fears can increase.
In fact, we cannot blame the internet for being fooled by the hype. Over a century before the Internet, Clark Stanley built his own reputation by convincing people of the miracles of snake venom. Stanley argued that the medicinal mixture originated from an Indian doctor’s secret recipe and was a panacea. However, in 1917, the hype collapsed when federal agents discovered that Stanley’s miraculous medicine was a fraud, consisting of some kind of snake oil, some beef tallow, and a little bit of red pepper. Stanley was out of business, but the term “snake oil dealer” is still used there today to denote all kinds of fraud.
The book also touches upon the importance of risk perception. Often times we understand what the real risk is only after it happens to us; the widening of the gap between real risk and perceived risk pushes us to make the wrong decisions. Medical treatments, for example, all carry risks, but the benefits of treating the ailment may overshadow the risks that may arise from not doing so. Similarly, carcinogenic substances that occur during disinfection of water may pose a risk, albeit very low, but water that is not disinfected will cause masses to die. Conspiracy theorists inflate the health risks that actually do not exist or are very low.
One of the cunning of those who lead people with misleading information is the use of the terms “being connected” and “related” outside the scope. The fact that there is a coincidental relationship between two events does not necessarily mean that they have a cause and effect relationship. For example, the number of people running marathons and the frequency of obesity have grown like an avalanche in recent years. So can we say that marathons cause obesity? Of course not, because this is just a correlation. “Cause” is the most difficult to prove. One hundred percent correlation is required for this.
Here Dr. Shapiro provides a deeper example in her writing: “It may seem like a cause has emerged in a laboratory setting, but this cause relationship may not be seen in humans. There are many easy ways to show that a component is toxic in the laboratory environment; however, such an effect will not necessarily apply to the human body. A very simple example is our old friend table salt, whose chemical name is sodium chloride (NaCl). Leaving aside the heated debates over the positive and negative effects of salt in the diet, salt consists of two simple substances, sodium and chlorine, and both as standalone are among the deadliest elements. Sodium is a substance that explodes when it comes into contact with water. Our hero sodium doesn’t just kill cells; it can blow up laboratories too. Chlorine is a substance found in swimming pool disinfectants and bleach. It can be toxic in high enough doses. However, enough sodium chloride, in other words salt, is the indispensable taste of our lives. In another example, the fact that a substance found in okra destroys breast cancer cells in in-vitro (glass petri dish) studies does not mean that okra is a proven anti-cancer drug. “
In other words, a factor shown to be caused by laboratory conditions may not have any effect on humans. And even an ingredient / food referred to as “healthy” may be toxic depending on the dose; For example, you could die if you drink too much water.
Terms such as “natural, organic” are heroized, while substances that are actually innocent are cast off in terms such as correlation, relation, connection, and cause. The words chemical, additive, and even plastic have been turned into an explosive horror hype. On the other hand, accepting that natural and organic equals “healthy / safe” is always wrong and open to abuse.
Professor Shapiro argues that the term organic when it comes to food is one of the worst mistakes of our time that automatically creates a better perception. For example, the mold aflatoxin, which can be found in nuts, is technically organic, but it is among the deadliest substances on our planet.
Contrary to common perception, organic products do not contain more nutritional value than non-organic ones. In a study published in the journal Annals of Internal Medicine in 2012, hundreds of different studies were examined to see if organic foods are healthier than their conventionally produced counterparts. As a result, it was found that there was no difference in the health outcomes of people eating conventional foods and those eating organic foods.
One of the issues occupying our agenda is gluten, which is demonized. It is really surprising that this substance, which has been in our food for thousands of years, was suddenly demonized. Dr. Shapiro says don’t be afraid of gluten unless you have celiac disease, and even points out the risks of gluten-free diets for nothing.
Another wrongly demonized example, monosodium glutamate, or MSG, is also included in the book. In fact, the “Chinese-restaurant syndrome” associated with MSG discovered in Japan became famous in a 1968 letter published in the New England Medical Journal. However, despite decades of studies, there is no evidence to suggest that MSG causes symptoms or others in Chinese restaurant syndrome. In fact, there is no chemical difference between the glutamate ions in the MSG we consume and the glutamate ions that occur naturally in our body. Did you know that we were first introduced to this substance found in breast milk? So what do you find naturally in many foods like tomatoes, peas, parmesan, Roquefort cheese or mushrooms?
There are also those who are unknowingly prejudiced. For example, many frozen fruits / vegetables have the same, or often higher, vitamin and fiber content than their fresh counterparts. Because, unlike similar ones that are collected before they are fully ripe in order to withstand the long journey before reaching the point of sale, fruits / vegetables collected for freezing are both at the peak of their maturity period and are immediately shocked when they arrive at the factory. You cannot prevent the loss of nutritional value in products that you take into your home and try to freeze them with the cracking of the cell membrane. These are significantly more affordable than their fresh counterparts, especially during off-season periods. Many consumers ignore the frozen fruit and vegetable department, they only buy what is called fresh. However, frozen products can be more advantageous in terms of nutrition, as well as being more economical and longer storable.
On top of all this confusion, there is also the question of how much we will get caught up in which scientific research. When the British Medical Journal evaluated all of the new articles published each year, it found that an average of 6% was sufficient to make sense. So 94% of these impressive works are not well designed.
In fact, it is inevitable that we will come across studies pointing to the opposite, especially in an area where controlled human experimentation is sometimes unethical and often very difficult, such as food and nutrition. For this reason, we need to melt all these in a pot and look at the institutional views (WHO, FAO, EFSA, FDA, European Heart Foundation, etc.). When I compare the scientific information in international scientific guides with the information in the media headlines, I compare the situation to the turtle rabbit race. As in the well-known fairy tale, the turtle (scientific opinions) always wins.
Here is an interesting example for you. Vitamins are very important to life and are defined as organic compounds needed by a living organism. Fat-soluble vitamins (A, D, E and K) can be stored in the liver and adipose tissues until needed, so we don’t need to consume them regularly. We cannot store water-soluble vitamins B and C, so we need to consume them regularly. A few billion years ago, the first life forms were able to produce their own vitamins, but many living creatures, including humans, evolved and lost this ability.
Linus Pauling is a name we associate with the vitamin deception experienced today. He won the Nobel Prize in chemistry in 1954 and in peace in 1962. But this important scientist, with what he did later, sowed the seeds of a worldwide delusion today. In 1965, Pauling wildly embraced a doctor’s recommendation of 3,000 mg of vitamin C per day; that’s 50 times the recommended daily dose of vitamin C (60 mg) for adults!
The vitamin C craze has been going on ever since, although many studies of thousands of subjects in numerous medical centers in the United States, Canada, and other countries did not find any benefit of vitamin C supplementation, or a reduction in the incidence, severity, or duration of the common cold or cold. However, with a regular diet, we can get our daily vitamin C need from food, and this is actually what is recommended. It is said that although some vitamins are indeed vital to our lives and some have preventive effects, most supplements are not necessary.
When Shapiro says that using homeopathy for the placebo effect is your decision, she talks about terrifying examples of putting your health at risk by rejecting or delaying treatments whose reliability and effectiveness are backed by solid evidence. Homeopathic remedies can cause unwanted side effects; they can interact with medications the person is taking, trigger allergic reactions, and contain substances that are of no benefit or, worse, could be potentially harmful.
While our world is still under the influence of the pandemic, the viruses, vaccines and epidemics we are all familiar with are also included in the book. After all, anti-vaccination is also a prime area for conspiracy theories. Until the last pandemic, some people were afraid not of viruses, but of vaccines that protect us from them. Unlike most other health practices, vaccines have learned by living through the crisis that vaccines can have widespread effects beyond a personal decision we make for ourselves or for our family. We all look forward to what the Antivacciners will do if a vaccine is found.
Some people may not develop enough immunity, even if they have all the recommended vaccines. In this case, the issue of herd immunity comes into play. If the majority of a population (i.e. the population) is vaccinated, those who do not have individual immunity will be protected a little as a result of the vaccination of the mass.
Today, everyone is curiously awaiting a vaccine to be found against the coronavirus which the world is struggling with. There have been some outbreaks in the past; Smallpox is an example. Smallpox was declared eradicated in the United States in 1972, after years of worldwide application of the smallpox vaccine. In 1977, there was a single smallpox case in Somalia for the last time, and in 1980 the World Health Organization shared the view that smallpox had been eradicated worldwide. All these are thanks to vaccines which society is artificially scared away from.
Our ancestors saying ‘too much of a good thing is bad’ is undoubtedly valid for almost everything. Even water, which makes up about 66 percent of the human body, can become toxic if consumed excessively by changing the chemistry of your blood. Prof Shapiro refers to this issue in the following words;
“There is no such thing as the best exercise, the best device, the best diet, the best supplement, the best diagnostic test, the best drink, the best skin cream, or the best medical decision. There is no such thing as perfect genetic makeup. Every road that man chooses for his health has more than one turn. At these turns, decisions are made and directions change, and I hope this change happens for the better. As we continue to learn, what we consider ideal or bad for health continues to change. “
Professor Dr. Shapiro, a famous physician in her field, reminds us that a study for experienced scientists, no matter how large or small, is not miraculous, groundbreaking, or game-changing, and warns us to be skeptical when faced with trendy discourses such as miraculous, groundbreaking, and game-changing:
“When you read something that seems incredible, be careful and take time to reflect on it. Because if something looks too good to be true, it probably is,”Shapiro concludes.
This book has been translated into Turkish very successfully. The fact that the translator is a METU graduate food engineer Ebru Akdag dramatically increased the health of the translation. It is very fluid. Ebru Akdag is a successful NGO manager and General Secretary of MUMSAD (Culinary Products and Margarine Industrialists Association). In order to combat information pollution on food, I am curiously following the “food hippie’s hunter” account on Instagram. He recently published a post titled “Poison Squad” explaining how the Food and Drug Law was born in the USA and Prof. Esat Karakaya gave his book titled Dose and Risk in Chemical Food as a reference. Years ago I scanned this book quickly by turning its pages. I found it in my library again and marked it for review. I think this will be the book I will tell you about health and nutrition from now on. This time my book proposal is different from the usual, but after all, it is some of what I’ve personally read, and don’t health and nutritional behaviors affect all of our lives?
(*) Shapiro N, (2018) A Doctor’s Guide to Medical Myths, Exaggerated Claims and Bad Advice – How to Tell What’s Real and What’s Not, St. Martin Press, First Edition.