[ed. note: Michael Jorrin, who I like to call Doc Gumshoe, is a longtime medical writer (not a doctor) who writes about non-financial health and medical issues for us a couple times a month — this time, he’s covering one of the many over-hyped health ads for “secret” supplements and treatments that we all see every day, much like we cover the over-hyped “secret” investment ads most other days. Enjoy!]
I take these on partly because they’re entertaining – for me, certainly, and for you, I certainly hope. I have to remind myself to disaggregate the manner and style and method of the promotion from the actual substance of whatever it is that is being promoted. The promotion might be ludicrously over the top, grotesquely exaggerated and pitifully lacking in sense and reason. But there might, just might, be at least some merit in the purportedly miraculous cure.
On the other hand, if the cure/treatment really does reliably work, and if there is bona fide data to substantiate that, then why does the promotional material so frequently slip over the dividing line between reason and lunacy? My personal prejudice – and I freely admit that it’s a prejudice and not a studied conclusion based on lengthy analysis of data – is that there’s an inverse relationship between the frequency and intensity of the advertising and promotion of a product or service and the quality of the product itself. Hershey’s chocolates, for example, never saw any need to advertise, but the lousiest beers always seemed to advertise the most. So the mere fact that I cannot access the internet without being instructed to go to websites that promise to give me secret information that will save my life, raises my suspicion index by several orders of magnitude.
The templates for these promotions are strikingly similar.
- The dire warning. They invariably lead off warning us against stuff we regularly consume or activities that we regularly engage in. These dire warnings are meant to be somewhat startling; thus, for example, they avoid telling us to quit smoking. Since we knew that already, it won’t capture our attention. But one presentation explains to us that we must never ever eat any bakery product, whether from the supermarket shelf or from our nifty corner bakery. Baked goods contain evil ingredients, i.e., wheat and sugar!
- The eminent physician. The presumed spokesperson is a physician with impeccable credentials, frequently on the faculty at a highly respectable medical college or on staff at a top hospital. He or she is a member of the right medical societies and can cite laudatory comments from patients and also from colleagues. How could we doubt this wise, caring individual who is looking out for our well-being?
- The grave error or oversight committed by the Medical Establishment. At some point, all the experts made a gross blunder. They overlooked a crucial clue that would have led them to the miracle treatment, or they insisted on an explanation for a disease or condition that was just plain wrong. Thus, if we blindly heed the recommendations of Mainstream Medicine, we are Headed for Trouble!
- The natural remedies that, unfortunately, are too difficult or too expensive for normal people to follow. The physician-spokesperson names several substances that can ward off the evils that threaten us. These substances are contained in a number of naturally-occurring but uncommon or rare plants or animals, or perhaps even minerals. The spokesperson then acknowledges that, although they might cure what ails us, subsisting on a diet of these rare substances is, in practical terms, impossible.
- The near-miraculous benefits of those supplements derived from those substances, but the great difficulty of getting the correct amounts of each, in the correct proportions, and of the ultimate purity. The spokesperson names those supplements, but warns that most of those little bottles of those substances on the shelves of your supermarket or drug store are highly unreliable. For example, probiotics are named in many spiels as being very valuable, but the presentation hurries along to make the point that in most probiotic preparations that you can buy, almost all of the beneficial bacteria are dead and therefore useless.
- Fortunately, there is one totally reliable, trustworthy source for the correct formulation of the near-miraculous natural healing elixir. The physician-spokesperson vouches for the honesty, integrity, and beneficent disposition of the manufacturer of this miracle healing agent, and the presentation segues to how you can get it for a quite reasonable price.
So let’s move on to the specific miracle cure that prompted me to do this piece.
Fighting off the Cardiac Killer
The lengthy presentation starts out by taking dead aim at the Framingham Heart Study, which is an act of brazen iconoclasm, guaranteed to capture your attention. If you’re going to score points by making a frontal assault on the medical establishment, the Framingham study is an ideal target. The specific charges leveled against the study were that it ignored HDL cholesterol, and that it recommended a diet based on excluding cholesterol-rich foods, such as butter, eggs, cheese, and red meat. All I can say in response to that is, “not so fast!” Strictly speaking, the second item in that docket is false, since Framingham did not get into the business of formulating and recommending a specific diet. The first part, ignoring HDL cholesterol, might have been true up until about thirty years ago. But to evaluate that bill of attainder, we have to take a closer look at what the Framingham study did, and also at the historical evolution of our understanding of cardiovascular risk.
When the Framingham Study started, in 1948, the concept of specific cardiovascular risk factors had not yet come into being. It was thought that as people got older, they were more likely to die of heart attacks, and that was about it. Blood pressure was known to increase with age, and that was considered normal. In fact, the “normal” diastolic blood pressure marker was “100 plus your age,” and there were no drugs available for the chronic management of what we would today consider hypertension. As for cholesterol, it had been identified as the main constituent of the plaques that clog our arteries as long ago as 1913, when a couple of Russians found that feeding egg yolks to rabbits resulted in the rabbit version of human atherosclerotic plaque. However, it had also been learned that cholesterol in the diet of these rabbits did not by itself inevitably produce the villainous plaque; some rabbits, like some humans, could consume cholesterol and avoid atherosclerosis. And other animals, particularly rats, can consume cholesterol and not form arterial plaque. The issue remained in doubt, and to some degree, still remains in doubt.
The Framingham Heart Study recruited 5,209 adults from the town of Framingham, Massachusetts, and followed them annually. The original Framingham cohort was enlarged at several points, and the children and grandchildren of the original cohort are now being studied. After about ten years, some of the risk factors specifically identified by the study were that cigarette smoking, hypertension, elevated serum cholesterol, and obesity were strongly linked to higher cardiovascular risk, while exercise was linked to lower cardiovascular risk. That may seem rather obvious at this point, but back in the 1960s, it was new information, and the strong statistical correlations between those risk factors and heart disease emphatically confirmed what some observers had suspected for a long time, but had been unable to substantiate.
And that, believe it or not, is where the “Cardiac Killer” promotion takes aim at