The Healthy Skeptic
Posted by medconsumers on December 31, 2008
The Healthy Skeptic (University of California Press: 2008)
Sometimes it’s the opening anecdote that draws you into a book. In the introduction of The Healthy Skeptic: Cutting through the HYPE about your Health, author Robert J. Davis describes a youthful encounter that jump-started his own quest for truth. It was the early years of the low-fat-diet-for-all heart disease prevention message to the public. A college student at the time, Davis bragged to friends that his “highly enlightened family” (father a physician) shunned whole milk and drank only 2%, the type that is low in fat.
Another student challenged him saying, “2% milk is not really low in fat.” Incredulous, Davis cited the claim on the milk carton to support his contention. “Well, the carton lies; the fat content in 2% is closer to whole milk than to skim milk,” countered his challenger. “If you want low fat, you need to drink skim or 1%.” A trip to the library to consult a nutrition textbook led Davis to the conclusion that the other student was correct. “A glass of 2% milk has about five grams of fat, compared with eight grams of fat in whole milk and nearly zero in skim.”
Thus, the stage is set for the message of The Healthy Skeptic. Do your own searching for the evidence to support health claims. Davis, a health journalist and teacher at Emory University’s Rollins School of Public Health, makes a clear distinction between skepticism and cynicism. The former demands much more of us. He cites this quote from Marcia Angell, former editor-in-chief of The New England Journal of Medicine:
Cynicism is much easier than skepticism because it requires no distinctions. We needn’t distinguish between reliable evidence and unreliable evidence, between big dangers and small ones, between likely effects and unlikely ones, between the reasonable and the bizarre. Yielding to cynicism over skepticism is therefore an easy way out.
Thanks to the Internet, searching for reliable evidence is much easier today. The Healthy Skeptic does much of the research for you, taking on some of the most common health messages about foods, beverages, drugs, vitamins, herbal remedies, sunscreen and other products that bombard the public, mostly by way of the news media. Sometimes the hype is obvious; for example, the selling of yet-another exercise gadget in one of those middle-of-the-night infomercials.
Too often, however, it’s not so obvious that you are viewing a sales pitch. Exhibit A is the notorious video news releases, or VNRs, used for years by TV stations large and small. The VNR can look like an objective news item; for example, a reporter interviewing a physician who comes across as an independent expert about a new superfood or drug. VNRs are, in fact, what Davis calls “propaganda disguised as news,” bought and paid for by the company that makes the product. Sometimes that fact is mentioned briefly at the end of the VNR; sometimes it isn’t.
Celebrity pill-pushing can be mistaken for morning show chitchat. Years ago, actress Kathleen Turner did a round of TV and print interviews, discussing her “battle” with rheumatoid arthritis. Her mention of a helpful Web site in each interview came across as information-sharing—that is, until it was revealed in 2002 that Turner was a well-paid spokeswoman for Immunex, a bio-pharmaceutical company, which along with Wyeth, makes the RA drug Enbrel. The recommended Web site was theirs.
There was a backlash in the media after Turner was outed as an industry-funded shill. Now such financial arrangements are usually disclosed during the “interview,” but as The Healthy Skeptic notes, it can be acknowledged so quickly and offhand that the disclosure can go unnoticed.
In a section entitled, “Sunscreen Science,” we learn that sunscreens have become a $500 million-a-year business since these products were introduced in the early 1970s. But increased sunscreen use has not reduced the rate of melanoma, the deadliest form of skin cancer. In fact, studies have produced conflicting results about their most important protective benefit.
Some studies found sunscreen use decreases the rate of melanoma; some found usage increases the rate of melanoma; and others showed no effect either way. On the other hand, there is clear evidence that sunscreens protect against squamous cell carcinoma, which can be disfiguring but rarely fatal. As for basal cell carcinoma, the least dangerous and most common type of skin cancer, there is little solid evidence that sunscreens reduce its risk.
You are not likely to hear these uncertainties from your doctor. The leading supplier of information about sunscreens to the public as well as health professionals is the Skin Cancer Foundation. Despite its seemingly non-commercial name, Davis says the Foundation’s list of corporate benefactors reads like a “who’s who of sunscreen manufacturers”.
This small book does not simply expose such things as the “iffy assertions” of doctors who practice anti-aging medicine; the lack of definitive evidence about calcium’s benefit to bone health; the overselling of prevention and the exaggerated dangers of high cholesterol. It also provides a way of assessing public-health messages, their funding sources, and most important, the quality (or absence) of the supporting evidence.
(Disclosure: The Center for Medical Consumers is described as a “trustworthy source of information” in the chapter about cholesterol.)
Whether you choose to be a cynic or a skeptic is entirely up to you.
Maryann Napoli, Center for Medical Consumers© 2008