8,39 €
Mehr erfahren.
- Herausgeber: Hammersmith Health Books
- Kategorie: Ratgeber
- Sprache: Englisch
- Veröffentlichungsjahr: 2021
Health scams come in all shapes and sizes from the suppression of side-effects from prescription drugs to the unproven benefits of 'traditional' health practices, taking advantage of the human tendency to assume good intentions in others. So how do we avoid being deceived? Professor of Nursing, Bernie Garrett, explores real-world examples of medical malpractice, pseudo and deceptive health science, dietary and celebrity health fads, deception in alternative medicine and problems with current healthcare regulation, ending with a simple health-scam detection 'kit'. And he looks at how these practices and ineffective regulations affect our lives.
Das E-Book können Sie in Legimi-Apps oder einer beliebigen App lesen, die das folgende Format unterstützen:
Ähnliche
iii
ii
The book is dedicated to health professionals and science and technology geeks everywhere.
Contents
About the author
Bernie Garrett is a professor at the University of British Columbia (UBC) School of Nursing with over 35 years of experience in both critical care nursing and nursing education in the UK and Canada. He is a registered nurse and holds a PhD in information science, and a number of specialist clinical and educational qualifications. He has authored several science and clinical textbooks, chapters in edited books as well as numerous research papers. His work is underpinned by a passion for health science and technology, and he holds provincial and national awards for his work in furthering nurse education. He is an Inaugural Fellow of the Canadian Nurse Educator Institute, and lives in Vancouver, British Columbia. viii
Acknowledgements
As with any venture of this nature, I am standing upon the shoulders of giants, and owe a huge debt of gratitude to numerous researchers, authors and practitioners whose work has helped inform this work, many of whom offered constructive critique. Firstly, a big shout-out goes to Tim Caulfield, who proved inspirational with his own work, and also a great source of encouragement. Secondly, thanks for inspiration and ideas to all those in the science and evidence-based health posse who are consistently challenging badly-evidenced therapies, poor practice, pseudoscience and health nonsense, including in no particular order: David Nunan, Edzard Ernst, Paul Offit, Ben Goldacre, Steven Novella, Simon Singh, Harriet Hall, Joe Schwarcz, Johnathan Jarry, Jennifer Gunter, Linda Girgis, Mark Crislip, Kimball Atwood, Scott Gavura, David Gorski, David Colquhoun, Stephen Barrett, Clay Jones, Jon Hislop, David Robert Grimes, Trisha Greenhalgh, Yoni Freedhoff, the Friends of Science in Medicine and Sense About Science organisations and of course, Bill Nye and Brian Cox. Additionally, thanks to several folks from alternative medicine who offered constructive suggestions and have challenged and critiqued their own professions (often with detrimental effects on their own livelihood): Matthew Bignall, Samuel Homola and Britt-Marie Hermes. Thanks are also due to my nursing colleagues who have provided support and encouragement over the years, including: Sally Thorne, Elizabeth Saewyck, John Oliffe, Paul Galdas, Paul xOng and Martin Lipscomb. Also, thanks to the University of British Columbia for continuing to champion academic freedom, to the University of Portsmouth, who originally employed me as a lecturer, and Oxford Brookes University for supporting my PhD studies. Additionally, many thanks to Roger Cutting for his unerring science advocacy, and Georgina Bentliff at Hammersmith Books for editing advice. Also, cheers to Public Service Broadcasting who provided much of the soundtrack to my writing activities over the last few years. Finally, love and thanks to my long-suffering family for putting up with me over the course of writing this book.
Section I
Wellness is not something you can buy2
Chapter 1
The art of the con
In 1404, King Henry IV of England signed a law making it an offence to create gold and silver out of thin air, known as the ‘Act Against Multiplication’. Clearly, some rather strange ideas were afoot during the early Renaissance. Most people think of alchemists as crazed and fraudulent mediaeval experimenters trying to turn lead into gold, but in fact, a major part of their work focused on finding an ‘Elixir of Immortality’, essentially a potion to prevent ageing. Alchemists believed in the principle of transmutation, in that substances could be changed from one thing to another, and similarly in terms of health, illness changed to wellness. Much bad-press was received by alchemists, primarily arising from the fact the field was inundated with cheats and imposters who swindled unsuspecting people who had turned to them in desperation over their health and financial problems. These ideas were initially very popular, and persisted for several centuries, and even some of the great luminaries of the Enlightenment, such as Roger Bacon and Isaac Newton, were self-confessed Alchemists. Nowadays, modern science dismisses most of alchemy as pseudoscience and many of those early beliefs have been proved incorrect. Nevertheless, some important advancements arose from the early work of alchemists, such as enhanced processes of distillation and other important discoveries that led to the progression of chemistry. 4
The Act Against Multiplication was eventually repealed in 1689, after lobbying by the early chemist Robert Boyle. However, as an analogy to the current state of health science with regard to deception, there are some interesting parallels with these ancient alchemists. Unfortunately, even though healthcare knowledge and practice have improved immensely over the last century, healthcare remains riddled with deceptive practices and charlatans, probably more so than any other human enterprise. Separating the valuable from the worthless in terms of health practices has become more and more difficult, and this provides the focus for this book, where we explore some of the key areas of deception that influence modern healthcare practice.
Health is something that all of us have a vested interest in one way or another, but unfortunately deception in healthcare seems an ever-growing problem in modern life; something that the COVID-19 pandemic illustrates all too well. After a long career working in healthcare, I still never cease to be amazed by the number, ingenuity and sheer audacity of the latest health scams, and the variety of different forms of health deception is quite remarkable. In this book, we will explore a number of them, and the reasons why one might be inclined to engage with them. Over the years these have included: big pharma scandals, fake doctors, useless surgical procedures, counterfeit drugs, fake diagnoses, magic diets, millionaire health gurus, alternative health cons, Nobel laureates who went off the rails, celebrity health scams and even the marketing of radioactive toothpaste. The COVID-19 pandemic has also provided an opportunity for a new set of scams. Much of this growth of health deception has been fuelled by the development of the Internet and social media, and so we will also explore how this has helped support a growing range of successful deceptive health enterprises. However, the writing of this introduction has prompted a reflection on why I became so interested in all of this perverse activity in the first place.
All of us are shaped by our life experiences, and in reflecting 5on all of the factors that have influenced my own interest in this curious aspect of health, there are many; but I guess one in particular stands out. As an 18-year-old I was finishing up high school in 1970s’ England. My parents had divorced a few years earlier and my mother had embarked on the world of dating as a mature woman. I can only imagine that this must’ve been quite a harrowing process in the pre-internet world. She had started corresponding with a man who was currently residing in an open prison in Somerset in the UK as a part of a ‘Write to Prisoners’ charitable activity. I have no idea how she got into this, but even as a somewhat naïve teenager, I considered this probably wasn’t the best way for her to find a new suitor. Apparently, the gentleman she was writing to, ‘Jeff’, was a local businessman who had run afoul of the taxman and was now spending a couple of years at Her Majesty’s pleasure to make amends. His incarceration was now coming to an end and his release imminent. My mother had started to visit him at the prison and also offered to be a named responsible person for him to visit as he started to make supervised trips out. Eventually, he was released and they continued their relationship. I finally met him when they had been seeing each other for about three months. He seemed quite charming, even to a somewhat angsty teen who naturally distrusted any adults and was keen to steer well clear of anything to do with his mother’s love life.
My two older brothers and sister also felt he might be a somewhat sub-optimal new partner for our mother, and were keen to size-up this new man in her life. They visited one weekend to check him out. He seemed quite charming, and regaled us all with tales of his successful business ventures before his downfall, how his tax evasion had all been rather an unfortunate lapse of judgement, and how he had lost most of his investments in the process, including his beloved Jaguar. He was apparently now a reformed man rebuilding his business empire, and keen to reassure us that he was a genuine good egg, 6much akin to Toad of Toad Hall in Kenneth Grahame’s Wind in the Willows, I couldn’t help thinking. He also covered the bill for a quite expensive lunch for us all, and had also been generously bestowing various favours upon our mother, including jewellery, flowers and fine dining. Although we all remained somewhat suspicious, our mother seemed very happy, and Jeff appeared financially very secure. Their relationship flourished over the coming months.
At the time we lived in a small council flat, and one day Jeff came to visit to take my mother out for a dinner date. Whilst she was getting ready, he struck up a conversation about the month I had spent in Germany a few years ago on a school exchange as he had heard I collected German stamps. As a part of our school’s German language programme. I had participated in this student exchange when I was 16, and stamp-collecting had been a hobby of mine as a kid. I had long since given this up as it was considered by my peers as being mortally uncool by this stage of adolescence, but the collection was in the bookcase and included some fairly rare items, some stamps over 80 years old procured from Hannover flea markets, and examples from the 1920s German hyper-inflation era where simple postage stamps cost thousands of Deutsche Marks; in 1923 a US dollar was worth 4,210,500,000,000 German Marks!2 It also contained some Nazi stamps and post-war examples, so was historically quite curious. I hadn’t looked at it in ages, but recall my father had once advised me to hang on to it as he thought it could turn out to be quite a valuable collection in time. Jeff asked to see them, and looked suitably impressed when I fished it out.
A month later I had started at college and moved away to Portsmouth. One weekend, shortly after I had arrived, I got an urgent phone call from my older brother saying all was not well at home and I needed to make a visit to see our mother as soon as possible. You can probably guess what is coming. Jeff had absconded with all of my mother’s jewellery, quite a bit of 7cash, and anything else of value that he could lay his hands on, including my brother’s car. He had lent it to Jeff the previous weekend as Jeff had said he had a friend who was interested in buying it. My mother was devastated, not only because since her divorce she had few assets of any value in any case (she worked full-time in a retirement home as a cook to make ends meet), but also because she felt she had let us all down. She had not told anyone Jeff had disappeared for over a week since he vanished, and she had lent him a large part of her life-savings. He had told her he needed some money to tide him over as his assets were invested in some business deal. She couldn’t believe she had been so easily duped. At first, I thought I could not possibly have had anything of value left at home Jeff might have taken, but then I had a thought; sure enough, when I checked my remaining belongings, my old stamp collection was gone.
Once the police got involved it turned out Jeff was not a businessman at all, but actually a serial con-artist. He had pulled this trick a few times, and currently there were at least three other women in exactly the same position, all of whom he had been visiting since his release. He had borrowed from one to give the impression of wealth to another, and so on in a cycle to keep his scams afloat. To this day it seems careless to me that the prison did not check that the women he was visiting on his supervised days out from prison were not fully aware what he was actually in prison for. Privacy issues notwithstanding, it would seem they had some responsibility for transparency in this to the public. Anyhow, as Jeff was not exactly a criminal genius, the long arm of the law caught up with him a few months later, but none of our things were ever recovered. Astonishingly, at his trial he claimed he had simply borrowed the money and items from his ‘girlfriends’, and couldn’t see how he had really done anything wrong.
It is easy to say we all should have known better, but the fact remains despite all our misgivings, a whole family of people 8gave a guy they knew as a convicted felon who had just been released from prison the benefit of the doubt. Why? Because it is human nature. People can be easily manipulated as even though we may dwell on negative thoughts more in general, we naturally prefer to believe in something positive rather than negative and that there is more than the evidence might suggest; we mostly also tend to be forgiving. These are typical qualities of being social beings, and the traits that con-men like Jeff rely on as part of their ‘art of the con’.
In exploring the growth of health scams, alternative health trends and fake health news over the last few years, I have witnessed these same characteristics in play repeatedly. It is not a matter of gullibility, but of people taking advantage of the human predisposition to like simple answers to complex questions and certainty rather than doubt, and to want to believe providers of health products and services are trustworthy and have your best interests at heart.1 In the current climate of mistrust in authority, it is these same traits that lead people to buy into a whole raft of doubtful health trends and misinformation, from the health ideals of celebrities such as Oprah Winfrey, to the inexplicable health advice from some doctors such as Mehmet Oz, Andrew Wakefield or Joseph Mercola. Like Jeff, many of the people engaged in these activities will argue they are doing nothing wrong, but simply selling services and goods people want, or revealing the real facts in the face of conspiracies to cover up an underlying truth. This unerring sense of infallibility and self-righteousness is one characteristic of these people that should be a red flag to us all.
Curiously, the disgraced doctor Andrew Wakefield is also a prime example of the changing nature of public trust in our institutions. At one time, being struck off the medical register in any country would have been the kiss of death for a career as a public health advocate. However, he was struck off the UK Medical Register for deception in 2010, but remains a hero to 9many for his ongoing support of the links between the MMR vaccine and autism (now comprehensively proven false (seepage 261). He has successfully reinvented himself using the narrative of the brave scientist fighting against the narrow-minded medical establishment, acquired a celebrity girlfriend, and cast himself as some sort of postmodern Galileo.3 He was even invited to Donald Trump’s inauguration ball, and made an appearance in two anti-vaccination propaganda films (Vaxxed 1 and Vaxxed 2) – quite the reversal of fortune.
Although the majority of health professionals are good and honest people, after 35 years of working in professional healthcare I have also seen my share of dishonest practices: doctors and nurses who lied, drug companies that used deceptive marketing to sell products, and all sorts of alternative health practitioners selling fake remedies for profit. I decided that deceptive healthcare practices and the reasons why people engage in them offered a fascinating area to research further. Some colleagues actually advised me against doing this at the time: ‘Don’t go there, it’s a rabbit hole!’ they said, suggesting raising my head above this particular parapet would not bode well for my career. Yet, I found I was irresistibly drawn to trying to understand the nature of healthcare deception, and why intelligent and talented people end up engaging with it. So, I started work researching in this area, exploring health scams, medical fraudsters, celebrity wellness gurus and the weird world of alternative healthcare. It is a fascinating subject and there is no shortage of material in what seems to be a boom business. 10
Chapter 2
Are we obsessed with our health?
I really shouldn’t have looked at Twitter this morning, I considered as I sipped my morning coffee one rainy January morning here in Vancouver, BC. The morning’s stream was full of the usual bizarre health stories: dodgy doctors, Big-Pharma scandals, magical detoxes to restore wellbeing and vitality, vaccination conspiracy theories, mom’s odd health tips, miracle diets and sound-baths that promise to increase your health and happiness – overall, more weirdness than you might expect to find in an episode of Stranger Things. Most of us have fallen prey to some aspect of this over the years, maybe buying a health product that guaranteed to provide miraculous results, or following some dubious health advice from friends or family. As I pondered this latest collection of bewildering health news over my coffee, I still wondered why society seemed increasingly obsessed about heath and ‘wellness’ these days when, in terms of public health (pandemics aside), we have probably never had it so good. In general, as both physical and mortal beings, we are naturally concerned with our welfare and those of our families, friends and wider society to a significant extent. With new diet fads, detoxes, health and fitness plans and wellbeing programmes now everywhere we turn, it is evident that being healthy has morphed into a lucrative commercial enterprise in modern society. But, maybe a good place to start is to consider how we actually define health. 12
What do we mean by ‘health’?
In terms of human wellbeing, health was defined by the World Health Organization (WHO) in 1946 as not merely the absence of disease or infirmity, but a state of complete physical, mental and social wellbeing. This definition persists to this day, but has been argued as somewhat vague and also unattainable for many. For example, the physician and author Peter Skrabanek once joked this was a state only achievable at a moment of mutual orgasm!4 In 1984, a WHO discussion proposed moving away from viewing health as a state towards more of a framework that presented health as a process. This was exemplified in the 1986 Ottawa Charter for Health Promotion. Their definition stated that health is:
The extent to which an individual or group is able to realize aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources, as well as physical capacities.5
This definition exemplifies the complexities in defining health, and how complex factors combine together to affect the health of individuals and communities. These are also known as the determinants of health. It is clear that whether people are healthy or not is determined by both their circumstances and the environment where they live and/or work. These determinants of health include: our physical environment, our social and economic environment, and a person’s individual characteristics and behaviours. We certainly can’t control many of the determinants of health, but should recognise that factors such as economics, gender, education and access to public healthcare services have a significant impact on public health.
Although there is a specialty of preventative medicine and all doctors engage in health promotion, modern medicine remains 13primarily focused upon illness and disease rather than health. Medical textbooks remain largely focused on ways the body and mind go wrong, and how to correct this, and medical research likewise remains chiefly disease focused. Contemporary medicine has put huge efforts into producing classifications of disease, and in mental health psychiatrists have identified thousands of ways in which our minds can go wrong. This has led to the label of allopathic medicine being frequently applied by alternative health advocates, suggesting medicine is simply focused upon symptom and pathology treatments, and flawed as it is not focusing on the holistic health of the person. However, this is a somewhat inaccurate and pejorative description of medicine used by its critics, as medicine is not by any means simply focused on symptomatic treatment or the suppression of pathophysiological processes. It is also only one profession working in modern multidisciplinary healthcare, where nurses, pharmacists, physiotherapists and multiple other professions work together to try to ensure a holistic approach to health is achieved. The biomedical approach focusing on illness has also resulted in massive health advances over the last century, but it can also lead us to unrealistic expectations in terms of personal health. In reality, the absence of disease remains something of an illusion. Using modern diagnostic techniques, including genetic profiling, biochemical analysis and imaging, every one of us can be found to have some dysfunctional element or be dis-eased in some way.
Nevertheless, this complexity in the nature of health, and the availability of new health technologies, has meant that healthcare has become one of the highest growth industries in the world today. Over $200 billion was generated last year in healthcare revenues in the United States alone.6 In response to increasing public demands alongside the traditional healthcare production sectors of the life sciences, biotechnology, pharmaceuticals and healthcare equipment, a corresponding growth of healthcare 14services has also occurred. Aside from national public health programmes with nations attempting to improve the health of their citizens, in more economically developed countries, a corresponding growth in the consumer health sector has also occurred, including a social trend towards what has become known as the ‘wellness’ industry.
The wellness industry
When I was young, wellness wasn’t particularly trendy or cool. Indeed, the nearest most of my friends and I ever came to preventative health and self-care was likely to be our irregular dental check-ups. Whilst eating a balanced diet and active recreation were certainly promoted, and there were plenty of sporting facilities, swimming pools and the odd gym, spas and natural health stores were a rarity. Today, these are commonplace in any city or major town in Europe or North America. According to the Global Wellness Institute (a self-styled institute that promotes the industry), the global wellness industry is worth around $4.2 trillion USD, and has surpassed both the pharmaceutical and diet industries (which are considered separately). Wellness sectors include healthy eating, nutrition, weight loss, fitness, preventative medicine, the spa industry and alternative healthcare (although most wellness definitions try to avoid the inclusion of medical therapeutics). Even though the wellness industry is booming, whether it’s actually having any impact on public health is highly debatable. Its popularity has certainly proved beneficial for those working in this field (most of whom are independent practitioners), but compared with established health professions (doctors, nurses, dentists, physiotherapists, dietitians etc.) it remains relatively unregulated. The industry also targets the more affluent parts of society, as it requires customers with disposable income in order to thrive. It is also noteworthy that this social trend of wellness 15is actually making some people unwell. It has perpetuated unrealistic ideals of health and body-image for most of us, and has given rise to a new golden age of deceptive healthcare and scams as this book will show.
‘Wellness syndrome’ is one example, described by Andre Spicer and Carl Cederstrom in their 2015 book of the same name as: ‘when you become conscious of your own health to the point that it provokes anxiety and guilt, in other words you develop an unhealthy relationship with your body’. They highlight the negative effects of being obsessed with wellbeing and health and describe how we can become so self-conscious about whether we take care of our bodies as well as we should, that we begin to live constantly feeling anxious and nervous about our health. The wellness industry provides a socially acceptable way to engage in thoughts of body dysmorphia and obsessive health behaviours, telling us which bodies and lifestyles are good and which are bad. Many advocates live their lives reading celebrity health websites, watching their shows, buying essential oils, drinking alkaline water, grounding their chakras, getting acupuncture, detoxing, taking homeopathic remedies and opening their ‘third eye’, believing they are engaging in personally meaningful health practices. Nevertheless, it is important to recognise the modern wellness businesses providing this are firmly focused on health as an arena for commercial gain, rather than being driven by any desire to promote spiritual or traditional healing. Often such purveyors of wellness products and services suggest an ancient, traditional or indigenous basis for their merchandise without any integration of the complex systems of beliefs and traditions of the cultures from which they arose. Most of the wellness practices employ unrealistic, idealised and trendy stereotypes of health, typically promoting the idea of able-bodied, thin, cisgender, stress-free, blissfully wealthy people. Anybody who possesses those attributes is seen as healthy, providing an unattainable goal for most people, and an ongoing source of revenue for those 16working in the field. In this respect, health is certainly a socially constructed concept.
Some might see this as a cynical interpretation, but public health services and the wellness industry are very different kettles of fish. People may find themselves discouraged by the failures of modern impersonal medical systems to resolve our contemporary health issues and seek alternatives. However, those alternatives more often than not present other issues and also often rely on predatory business models, as we shall see. Imagine a store that sells products with vague descriptions of what they do, how they work, based on a set of unconfirmed beliefs, with no warranty, and where if they do not work as suggested you are advised to try more of them or something else. If your local car dealer were to operate in this way, they would likely not last long. However, in wellness there are no absolutes, no meaningful guarantees, no professional requirements to use scientific evidence, and little regulation in the marketing of wellness products and services. This growth of the wellness industry and alternative healthcare is a huckster’s dream and has led to the significant growth of health scams.
Science in the age of alternative facts
Another contribution to this new era of health scamming is the ongoing decline of trust in science and the return of belief-based narratives. Much of this has been fuelled by a perception that science has failed to address major societal issues, including many health problems. Whilst massive decreases in infectious diseases, infant mortality and smoking-related health issues have occurred together with improvements in cancer and cardiovascular disease statistics, chronic conditions such as asthma, allergies and autism have increased. While the age of popular science is now long-passed, scientific progress and 17research into these issues is ongoing. However, an interesting irony has arisen in how science is now negatively viewed by many, compared with how much it is depended upon in our increasingly technological world.
Science and the media
The media coverage of science has become polarised. Popular media often advocates for the benefits of science, and new forensic science and science-fiction shows arrive on our screens virtually every week. At the same time, a return to nature, the dangers of technology, conspiracy theories, the evils of the industrial-military-technological complex and Big-Pharma narratives pervade the Internet. Although we now live in a world that relies on science and technology to fulfil our daily needs, some academics question the fundamental principles of science and its value to society. People who put belief in expert opinion or other authorities frequently reject scientific findings in favour of testimonial, dogma or what are often referred to as ‘other ways of knowing’. Naturopaths and media figures, such as Deepak Chopra (page 252) and Gwyneth Paltrow (page 256), tell people to ignore scientific evidence and trust in their vital energy and intuition in making their health choices. Many therapies, health machines, nutritional supplements and traditional folklore remedies proliferate without substantive evidence of benefits (other than monetary benefit to those who sell them). These therapies are usually supported by personal theories, beliefs and ideologies, rather than evidence, often promoted under the guise of recognising ancient wisdom or even ‘new-science’. Nevertheless, many people swear by these remedies, and the public uptake of alternative medicine has increased significantly over the last few decades.7,8,9 The reasons for this are complex, but an increasing suspicion of science by the general public has certainly been a contributing factor. 18
The growing misunderstanding of science has been compounded by incompetent and sensationalist reporting, and stereotyping in the media. This makes it difficult for researchers to get their work understood. Advertisers frequently make use of science to promote products (typically in iconic white lab coats), but science is frequently portrayed as nerdy, boring and difficult, whilst scientists are typically portrayed as either nerds, mad/evil villains, boffins, impersonal geniuses, eccentric loonies or morally negligent. A good example of this sort of imagery can be seen with the popular CBS comedy show The Big Bang Theory, and a quick flick through the latest Netflix offerings will reveal numerous others. Ultimately, such pop-culture typecasting of science and scientists does have an impact on public views and confidence in science, and in science-based healthcare.
During the current pandemic this has also been evident with the portrayal of immoral scientists rushing untested products to market for profit by the anti-vaccination movement. Additionally, the political manipulation of messaging, misusing science to suit particular agendas, has always occurred; an example is Donald Trump’s 2018 doctor’s letter claiming ‘His physical strength and stamina are extraordinary’; another is his use of a personal physician’s support to justify his experimental COVID-19 treatment.10,11
The modern anti-science movement and alternative facts
An ongoing educational shortfall in science education in schools, together with growing anti-science narratives in social media, certainly hasn’t helped in the ongoing rise in health scams and fraud. Shortly after I and my family moved to Canada, we attended a weather-themed primary school science fair at my daughter’s school. Like many in her class, she had built a rain gauge and been recording precipitation in our garden over a 19month. As it was a science project, we, and a number of the other kids participating, were then somewhat surprised when one of her classmates received a prize for a poster explaining rainbows were caused by ‘god’s tears’. Certainly, it was a colourful and creative entry and we can understand a desire to reward all the kids for their contributions, but this was possibly not the best example of meteorological science to set for a school class. Without a good understanding of what science is and is not, it becomes difficult to discriminate effectively between a sound hypothesis and hyperbole. Currently, scientific illiteracy is not a major impediment to success in business, politics, the arts or, as we shall explore, even a career in healthcare.
The idea that science cannot explain everything and is flawed, and so we should turn to traditional or alternative narratives to explain phenomena which should be regarded as equally valid, has become increasingly accepted, even in many university departments as a part of postmodern thought. However, whilst certainly inclusive, it is also rather problematic as an approach to preventing errors in practical applications. One of the great advantages of a scientific approach is that, rather than telling us what to think, it provides a self-correcting process that tells us how to think and test our ideas against the real world. Reverting to ancient or alternative knowledge does not do the same, and instead can move us into a situation where we attempt to make the real world match our beliefs, rather than the reverse. Ancient health explanations were the cutting-edge of knowledge at their time, but were frequently wrong, as they were based upon understanding of how the body worked in a time before we even had a rudimentary understanding of electricity. Few people today would be impressed by their physician suggesting that one of their children’s ‘four humours’ was out of whack, probably the black bile, giving rise to a melancholia. As a part of Greek or even Shakespearean cosmology, that might be an expectation for the level of knowledge at the time, but we have long-since 20dropped these ideas as a useful explanation of bodily functions.
We also now live in the age of mass communication and alternative facts that often run contrary to established scientific truths. Here, truth is seen as a relative commodity, dependent on your viewpoint. Former White House Press Secretary Sean Spicer’s grossly inaccurate statement about the attendance numbers of Donald Trump’s inauguration was seen as a perfectly acceptable alternative to photographic evidence to the contrary by many of his followers. Alternative facts are not really anything new, they’ve been used throughout history, usually by those in power to maintain control or further their own agenda. Classic examples include the notions that Jesus was a Caucasian man, slavery was good for black people, Jewish people were the cause of Germany’s pre-war problems, HIV/AIDS was a gay problem and Iraq had weapons of mass destruction. This sort of thing was also the stock in trade of the ancient Greek sophists, who made a living out of rhetoric and popular public speaking. Whilst evidence to the contrary eventually overturns most false arguments in time, often they persist far longer than they should, and sometimes even return after a long period of absence.
Perhaps the most surprising alternative fact with a resurgence of late has been that of the flat-Earth movement, which has had a new spike of interest following the rapper B.o.B. making an argument on Twitter about a flat-Earth in 2016. This was followed by a GoFundMe campaign to research it. The US Flat Earth Society was also recently reported to have posted that it had ‘members all around the globe’ on Twitter. However, given the preponderance of ironic and parody accounts it has become impossible to tell if even this is genuine or not.
Alternative facts seem to run counter to the notion that a fact is a piece of information based on an objective reality, and rely on the idea that any piece of information has implicit values attached. Philosophers have been making such arguments for at least 2000 years, but these ideas have been taken up significantly 21to devalue science and often to promote health scams. Whilst science is definitely not value-free in the way it is implemented, the fundamental principles employed in public healthcare and the modern evidence-based practice movement rely on a belief in the value of evidence rather than theory to support practice. This basically opens up three choices to those who wish to sell a product or service which has no scientific basis for health benefits:
promote an anti-science argument that science cannot explain the metaphysical nature of the product,suggest that science has yet to catch up with the well-known benefits of the product,manufacture bad-science designed to support the product.Sometimes all three techniques are used together in a kitchen-sink approach to provide an alternative narrative in a health scam, but all are fundamentally designed to make us buy something, and also designed to make us trust the person selling it. 22
Chapter 3
Trust me, I am not a doctor
In 2010 an Angus Reid Opinion Poll in Canada revealed an increasing number of Canadians did not trust their doctors.12 In 1966, more than 75% of Americans reportedly trusted their physicians, whilst in 2014 only 58% of people agreed that doctors could be trusted, and more recent international studies have also suggested that trust in physicians is declining.13 In the 2014 Ebola crisis, less than one-third of Americans said they trusted public health officials to share complete and accurate information.14 Nevertheless, public healthcare professions still remain at the top of all professions in terms of perceptions of honesty and ethical standards overall, and nurses came out above medical doctors in both 2018 and 2019 Gallup polls.15
Deceptive divisions
As discussed earlier, a common justification given for the rise in trust in wellness and alternative health practitioners is that contemporary ‘Western’ healthcare is fixated on curing disease, whilst what has been termed ‘non-allopathic’ healthcare (based upon ancient and traditional remedies) focuses on holistic care, which is also argued to be what consumers really want. In actuality, this is rather an oversimplification of the complexities of modern healthcare and medicine. Firstly, there is really no 24Eastern, Western, Southern or Northern Medicine; there is just bio-physiological medicine which is based on scientific evidence (drawn from multiple global sources) and other medical traditions which are based upon alternative sociocultural traditions. The argument is usually used to imply an overly simplistic binary rhetoric of ‘modern Western science’, being bad, vs ‘ancient Eastern philosophy’, being good. Even a cursory deconstruction of this reveals a naïve anti-science agenda. Although still a widely popularised meme, any credible historical scholar will attest this is a poor reflection of the development of modern science, completely ignoring Asian and Middle-Eastern contributions to science.
Science is universal, and its methods contributed to by numerous cultures. In Section IV, I will explore how the term ‘alternative medicine’ is also something of a misnomer because it suggests a false dichotomy between two kinds of medicine, scientific medicine and alternative medicine. Science-based healthcare has become one of the greatest successes of human development, because of a focus on establishing evidence of efficacy of interventions. Anything that can be demonstrated to have a positive impact on people’s health, be it herbs, diets, exercises or new drugs, becomes a part of it, irrespective of where it arises. For example, many drugs and practices have developed from traditional remedies such as Indigenous people’s use of willow bark containing acetylsalicylic acid for pain (now available as aspirin), or by their treatment of scurvy through conifer-needle tonics, which actually contain high volumes of vitamin C. Sometimes, it takes time for beneficial new health practices to become adopted and less useful practices discarded, but medical science is rapidly advancing and changing the way we live. This raises the logical question of why we should want to seek alternatives to it. In this book I will explore some explanations that aim to answer this question.
Secondly, as discussed earlier, the term ‘allopathic’ medicine 25is usually used as a pejorative term to discredit any health science that employs the use of pharmacologically active agents or surgical interventions to treat pathophysiologic processes. Although there is some truth in the fact that the majority of medical treatments are aimed at specific physiological issues, and acute care services are designed at resolving disease and illness, the myth of allopathic medicine completely ignores the nature of modern medical care, primary healthcare services and the role of nursing in the system. Modern medical care is not simply focused on cure, or single organs or systems, and preventive medicine is practised by all physicians to keep patients healthy.
The role of nursing is typically ignored in arguments over allopathic modern medicine. As a nurse, I know that many people do not really understand what we do, but the whole ethos of nursing is about caring for the whole person, including their personal, psychosocial, family or community health needs. As nurses outnumber physicians by about five to one around the globe, the assumption we have no real influence in the healthcare system, or are simply hand servants of the medical profession, is misleading.
Promoting distrust
The idea that people are taking their health into their own hands and are interested in health promotion is certainly a positive thing, but such arguments used by the wellness and alternative medicine movement largely signify an argument for mistrust in scientific healthcare, whilst some providers imply they have specialist esoteric knowledge and can provide additional health benefits not available through public systems. In essence, people’s trust in scientific healthcare and doctors appears to be declining, and even the title ‘doctor’ does not carry the same weight of expert authority as it used to. In the age of online diploma mills and private alternative-health-professional colleges, the reality 26is a professional wellness or alternative health qualification is easily obtained. Unfortunately, there is practically no meaningful regulation of these schools in much of Europe and North America, and it is a case of ‘buyer beware’ (see page 226).
Modern medicine is horrid
Like most human endeavours, modern medicine is indeed flawed and most of us do not enjoy a visit to the doctor or dentist. It usually involves a trip to noisy chaotic clinics or offices, with unpleasant diagnostic procedures, and mixing it up with lots of people who are ill. Let’s face it, modern medicine is usually very disagreeable. To paraphrase Winston Churchill, modern medicine is probably the worst possible form of healthcare, apart from all the others we have tried. Although modern scientific healthcare and medicine have achieved numerous successes, most notably reduced infant mortality, prevention and treatment of infectious diseases and life-saving surgical procedures, all contributing to an increased lifespan, there are also numerous areas where problems remain. The treatment of chronic diseases and combating stress continue to be challenging. Cancer is still a major killer.16 New strains of bacteria and viruses arise and antibiotics become less effective with resistant strains evolving, and issues of quality assurance with medical errors and adverse events make the headlines on a daily basis. Arguments citing the failures of medicine are frequently used as a justification for ignoring medical advice in favour of alternative sources of health knowledge.
Many of these criticisms of modern healthcare are spread by proponents of the wellness movement through modern social media, and the contemporary anti-vaccination movement is an interesting case in point, being one that was highlighted by the World Health Organization as ‘a top threat to global health in 2019’.17 The warning came after a 30% spike in measles cases 27had occurred internationally following drops in the uptake of childhood vaccination against the disease, including in several countries where the virus had been virtually eliminated.
Where’s the harm?
Another argument that is frequently used in the wellness industry is the notion that, unlike medicine and modern healthcare, at the end of the day their products and services are all generally harmless and support consumer choice in their health. However, this argument is fundamentally flawed; as the old adage goes, aeroplane crashes do not really validate flying carpets. Whilst the majority of these practices may indeed be relatively harmless, the impact of them in terms of public health is actually not very well understood. Levels of risk in healthcare are difficult to quantify, but a significant clinical risk may be considered one where unnecessary harm is a likely outcome of a healthcare practice or choice (taking into consideration current knowledge, available resources and the context of care delivery), compared with the risk of non-treatment or other treatment. To date there is little quality research exploring the nature of the uptake of wellness health products and services in terms of risk, or into the factors that help explain people’s desire to engage in potentially hazardous health practices.
Research has demonstrated that many patients use alternative remedies that are well known to cause serious adverse reactions or drug interactions, such as the use of the aristolochia root or Chinese knotweed.18,19,20,21 Other practices present significant risks in terms of people avoiding well-established effective public healthcare practices, in preference to alternative approaches. For example, the use of homeopathic vaccines in place of medical vaccines is well known to be ineffective. Herbal treatments have also been associated with adverse events through unwanted drug interactions, and psychological harm has also 28been documented where alternative medicine was employed as a substitute for medical treatment.22,23 Serious injuries with physical manipulative alternative therapies such as chiropractic have also been documented, and a 2002 systematic review of the research identified that elderly patients frequently suffered harm from the use of alternative medical therapies.24,25,26
Proponents of the wellness industry and alternative medicine will often contrast these events as rare compared with the huge number of medical errors that occur every year with conventional healthcare. Yet such comparisons are unsound, as we don’t know the incidence of adverse events in these mainly private practices, and by their very nature the majority of customers of wellness and alternative health products and services are adults who are not acutely ill and do not require invasive life-saving interventions. In truth, these practices may be far from harmless, and we don’t have a good handle on the actual risks associated with adopting them. Undoubtedly, many of these practices also involve deception with misinformation (either intentionally or not).
Misinformation and deceptive claims
In California in the USA, a woman died due to a reaction to an intravenous infusion of turmeric prescribed by a naturopath for a skin condition in 2017.27 Though there is no medical condition whatsoever for which intravenous turmeric has been proven as an efficacious therapeutic intervention, it was promoted as an effective cure by the practitioner. In another sad case, a toddler died of meningitis in Alberta, Canada after his parents used coneflowers (echinacea), recommended by their naturopath to boost his immunity, and other natural remedies, instead of consulting a medical doctor. Again, echinacea is not an established effective treatment for meningitis or any infection compared to readily available antimicrobials. In the days leading up to his death, they treated their son, Ezekiel, with other home 29remedies, including maple syrup, water, juice with frozen berries and finally a mixture of apple cider vinegar, horseradish root, hot peppers, mashed onion, garlic and ginger root.28 In British Columbia in 2018, a remedy derived from rabid-dog saliva was prescribed for the treatment of a toddler’s belligerent behaviour; this resulted in professional sanctions against a naturopath from their regulatory body.29 In all of these cases, licensed healthcare practitioners were involved who made seriously inaccurate claims of efficacy for the products they recommended based on claims of their alternative expertise.
In probably one of the most well-publicised cases, in 2014 the self-styled Australian wellness guru, Belle Gibson, claimed she had cured herself of brain cancer through dieting and promoted her healthy cookbook and application The Whole Pantry for cancer patients. The Instagram star had raised substantial funds through sales of the book with the help of her hundreds of thousands of followers and claimed it was going to charity. By early 2015, it was estimated that in excess of $1 million (AUD) had been made in sales of The Whole Pantry. However, it subsequently turned out she had never had cancer and had failed to donate the money, and instead lived a lavish lifestyle on the profits. In the subsequent investigation, Penguin Australia Pty Ltd, the publisher of the book, cooperated with the authorities and agreed to make a $30,000 (AUD) donation to the Victorian Consumer Law Fund, acknowledging that it had not taken adequate steps to verify Gibson’s claims prior to publishing the book. Justice Debra Mortimer found that Gibson’s claims had been misleading and deceptive, and that: ‘Ms Gibson had no reasonable basis to believe she had cancer from the time she began making these claims in public to promote The Whole Pantry book and the apps in mid-2013.’ However, there was insufficient evidence to prove that she was not acting out of delusion. At the time of writing, Gibson has yet to pay the $410,000 (AUD) fine levied by the Australian Consumer Court.30 Sections II, III and IV30of this book explore these and other cases of serious safety issues in depth.
I want to believe
Today, purveyors of deceptive healthcare have capitalised on a growing lack of public trust in science and medicine, and on our unerring ability to want to believe in things beyond the existing limits of scientific knowledge. Of course, science has certainly been misused a lot over the years and certainly has its limitations. Many conditions remain obstinately untreatable and public health services often struggle to meet public demands. On the other hand, wellness and alternative health services offer pleasant and relaxed therapeutic spaces and services generally designed to align with the customer’s beliefs rather than challenge them. Commercial health gurus and celebrity doctors are transforming ancient healthcare practices into aspirational and desirable lifestyles. Movie stars and social media influencers sway our perceptions of health, social status and wealth. The wellness and alternative health movement has become a major industry.
The hyperbolic bandwagon
Many physicians, established health professionals and alternative medicine practitioners have capitalised on this trend. Undoubtedly, much wellness advice does have value in terms of general health promotion, and some alternative therapeutics do work, but most often not in any clinically useful way compared with conventional therapies. Other therapies and practices simply work due to the placebo effect, which we now know may account for up to 25% of the effect of any medicine. However, the hyperbole that now surrounds most of this industry is nothing short of astonishing. Inevitably, 31most wellness and alternative health offerings involve taking something with some small element of truth in it, transforming it with inflated claims of value in the treatment of an illness or benefits for personal health, and then marketing it with all of the modern tools of consumer culture. In this way, knowledge supporting the value of a simple whole-food, plant-based diet can be morphed into claims of preventing or treating cancer. Some practitioners are clearly well aware of the deceptive nature of the products and services they sell, whilst others have convinced themselves that they have unique cures, and their products and services are innovative, astonishing breakthroughs, despite all evidence to the contrary. Like our con-man Jeff, many who engage in these activities will argue that their behaviour is perfectly reasonable. Nevertheless, the majority of wellness and alternative health practitioners operate on a very different level of integrity from public health professionals, although, as we explore later in the book, they often mimic their educational and practice structures. The result is a self-sustaining business model providing intangible benefits to all but those providing them.
The modern healthcare paradox
We all care about our health at some level, and exploring why we are all susceptible to health misinformation and scams is a fascinating subject. This book is not about the case for or against medicine, wellness or alternative health, nor is it about celebrity influence and social media. It is simply about deception in the healthcare sector, how it works and how to avoid it. It remains a paradox that in our current, high-tech society, we have arrived at a new level of consumer-driven health nonsense fuelled by social media – one that targets the vulnerable and relies on our good nature and human fallibility to sustain deceptive business practices. On the one hand we embrace scientific 32and technological advances that have revolutionised human health and the miracles of modern medicine, whilst on the other we engage in unhealthy lifestyle choices, seek unrealistic wellness alternatives and support the licensing of dubious (and even dangerous) healthcare practitioners. Dissatisfaction with existing public health options can lead to people searching elsewhere for answers, and fundamentally, it is an issue of trust and where we place, or misplace, it.
Section II
Health scams34
Chapter 4
What is a health scam?
Generally, the law defines fraud as the use of deceit, falsehoods or other fraudulent means to cheat a person of property, money, valuable security or any service, and health fraud is on the increase. In the UK, a 2012 report identified it as a significant and growing threat to patient care;104 so much so that the government set up a special Health Authority in 2016 to counter fraud in the NHS and public health, the NHS Counter Fraud Authority (NHSCFA). A 2018 NHS report from the NHSCFA estimated that a staggering £1.29 billion could be lost to economic crime from the NHS alone on an annual basis due to health fraud.105 The UK National Fraud and Cyber Crime Reporting Centre (Action Fraud) also identifies health fraud as a growing and problematic area of criminal activity. They particularly cite a growth in sales of health- and medicine-related products and services that appear to be a legitimate form of alternative medicine, after people receive an email or advertisement promising miracle cures that offer unbelievable results. Typically, fraudsters lead their victims to believe they’ll receive quality products or services for a lower price than they are currently paying, or can provide guaranteed cures for acne, skin blemishes, AIDS, arthritis, baldness, cancer, impotence and weight loss.106 In Canada, where I live, the Canadian Anti-Fraud Centre (CAFC) has documented a significant rise in health-related frauds (or scams as they are 36more commonly known) over the past decade, particularly in the area of cybercrime (criminal offences involving a computer to either commit or target crime). In 2012, only 10 victims of health scams were reported in Canada with a total financial loss of $741 (CAD), whilst by 2018 the figure was up to 332 complaints with $93,935 (CAD) of reported losses. CAFC also notes that these data are likely to represent less than 5% of actual fraud activity, as frauds are largely unreported.
Many dubious healthcare practices, whilst not obviously fraudulent, also exist in a grey area of legislation and remain unchallenged in case law, such as the promotion and/or sale of novel health products by celebrities or qualified health practitioners. However, all health scams involve an element of deception in some form or another, and can largely be characterised as opportunistic commercial gain involving sales of a product or service that is either fake or has a claimed effect with little to no substantive evidence of efficacy.21 Before we look at some key examples, let us explore exactly what deception is and involves.
The nature of deception
Deception itself is an interesting phenomenon and not as straightforward a concept as it might at first appear. In simple terms, it can be considered as acting in such a way as to lead another person to believe something that you yourself do not believe to be true. If we consider deception as the spread of beliefs or statements that are not actually true, this also gives rise to problematic questions about how to verify truth and veracity. Nevertheless, deception can be considered as a simple communication process that always involves two (or more) individuals: the deceiver and the deceived. Deception can also be described as a relational transgression, in that it involves violating implicit or explicit rules of behaviour in relationships 37– honesty and trust, for example. It includes a wide variety of behaviours, but usually results in feelings of betrayal and distrust when discovered, and is generally considered a human characteristic, although it also has roots in evolutionary biology. We might consider the example of animals that deceive through camouflage, or by attracting prey with deceptive lures, such as in the case of the anglerfish.107
Practically speaking, deception is some form of communication, involving distortion or omissions, that serves to misrepresent something that the deceiver themselves knows. It may take one of two forms: one where the deceiver is aware of the deception, and one where they are not. The first form is therefore, intentional (basically, this is the same as lying, as it simply involves propagating a deliberate untruth). The other form is more complex, as it involves some kind of self-deception where an intention to deceive is not necessary. This is different from lying, as here the deceiver has no knowledge that they are intentionally deceiving.
This notion of self-deception remains a complex and controversial idea. Whether it is possible for us to actually deceive ourselves has been a topic of hot debate for both psychologists and philosophers alike. Self-deception can be regarded as the process of convincing oneself of something, and at the same time, not revealing knowledge of this deception to oneself. This requires a person to reject or rationalise away the importance or significance of contrary evidence and logical argument that challenges the deceptive belief the person holds. Therefore, self-deceivers apparently must:
hold contradictory beliefs andintentionally get themselves to hold a belief they know to be false.This presents something of a paradox, because it seems to pose a logically impossible state of mind: expressly, consciously 38
