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Copyright © 2008. University of California Press. All rights reserved.

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press,
 THE HEALTHY SKEPTIC
Copyright © 2008. University of California Press. All rights reserved.

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The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 THE HEALTHY SKEPTIC
CUTTING THROUGH THE HYPE ABOUT YOUR HEALTH

ROBERT J. DAVIS, PHD

Copyright © 2008. University of California Press. All rights reserved.

UNIVERSITY OF CALIFORNIA PRESS

BERKELEY LOS ANGELES LONDON

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 University of California Press, one of the most distinguished university
presses in the United States, enriches lives around the world by advancing
scholarship in the humanities, social sciences, and natural sciences. Its
activities are supported by the UC Press Foundation and by philanthropic
contributions from individuals and institutions. For more information,
visit www.ucpress.edu.

University of California Press

Berkeley and Los Angeles, California

University of California Press, Ltd.

London, England

© 2008 by Robert J. Davis

Copyright © 2008. University of California Press. All rights reserved.

Library of Congress Cataloging-in-Publication Data

Davis, Robert J., 1963–

The healthy skeptic : cutting through the hype about your health /
Robert J. Davis.
p. cm.
Includes bibliographical references and index.
isbn 978-0-520-24918-9 (cloth : alk. paper)
1. Health education. 2. Consumer education. 3. Health products.
4. Quacks and quackery. 5. Health—Information services. I. Title.
ra440.5.d38 2008
613—dc22 2007037341

Manufactured in the United States of America

17 16 15 14 13 12 11 10 09 08
10 9 8 7 6 5 4 3 2 1

This book is printed on Natures Book, which contains 50% post-

consumer waste and meets the minimum requirements of ansi/niso
z39.48-1992 (r 1997) (Permanence of Paper).

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 FOR MY MOTHER
AND
IN MEMORY OF MY FATHER
Copyright © 2008. University of California Press. All rights reserved.

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 This page intentionally left blank
Copyright © 2008. University of California Press. All rights reserved.

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 CONTENTS

Introduction: Health Sellers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

1. Says Who? How We Know What (We Think) We Know . . . . . . . . . 13

2. The News Media: Eat This! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
3. Diet Books: Don’t Eat That! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
4. Advertisements: Take a Supplement! . . . . . . . . . . . . . . . . . . . . . . . 75
5. Government Campaigns: Watch Your Cholesterol! . . . . . . . . . . . . 93
6. Celebrities: Get Tested! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Copyright © 2008. University of California Press. All rights reserved.

7. Health Groups: Wear Sunscreen! . . . . . . . . . . . . . . . . . . . . . . . . 127

8. Consumer Activists: Beware of Chemicals! . . . . . . . . . . . . . . . . . . 145
9. Anti-Aging Doctors: Don’t Get Sick, Don’t Get Old, Don’t Die! . . 163
10. Guaranteed! Overpromising on Prevention . . . . . . . . . . . . . . . . . 183

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 www.CartoonStock.com
Copyright © 2008. University of California Press. All rights reserved.

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 INTRODUCTION
HEALTH SELLERS

early all of us can point to particular moments, often seemingly

N inconsequential at the time, that ended up affecting our lives in

profound and lasting ways. For me, such an instant came during
my sophomore year of college and involved, of all things, milk.
When the topic somehow came up at lunch one day, I bragged to
friends that my highly enlightened family had always shunned whole milk
and restricted ourselves to 2 percent, the type that’s low in fat. Basking in
my own virtuousness, I couldn’t stop there. As they downed their glasses of
Copyright © 2008. University of California Press. All rights reserved.

whole milk, I advised my friends that they would be smart to follow my

example and switch to 2 percent.
Overhearing all this was a know-it-all kid from New Jersey named
Marty. “Actually,” he said, inserting himself into our conversation, “2 per-
cent milk is not really low in fat.”
“Yes, it is,” I shot back. “It says so on the carton.”
Armed for battle, Marty didn’t miss a beat: “Well, the carton lies. The fat
content in 2 percent is closer to whole milk than to skim milk. If you want
low fat, you need to drink skim or 1 percent.”
My friends watched in silence. Now it was my turn. Unable to present
any facts to refute Marty’s argument, all I could come up with was, “I think
you’re wrong.”
That afternoon, I headed to the library in search of the truth. (Believe it

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 2 I NTRO D U CTI O N

or not, young readers, there once was no Internet, nor were foods required
to have nutrition labels.) Poring over the dusty pages of a nutrition text-
book, I discovered, much to my chagrin, that a glass of 2 percent milk has
about 5 grams of fat, compared to 8 grams in whole milk and nearly 0 in
skim. Know-it-all Marty, it turned out, knew exactly what he was talking
about.
How was it, I wondered, that Marty was so well informed, while I, the
son of a doctor (as if this had any relevance), had been in the dark? What
else did I not know about diet and health? I started to read everything
I could get my hands on. The more I learned, the more intrigued I
became—and the more I came to question what I thought I knew. In time,
my newfound interest in health would become a passion, both personally
and professionally.
That quest to get to the truth, born of my humbling exchange with
Marty, continues to this day. It’s what motivates me as a health and medical
journalist. And it’s the driving force behind this book.
Everywhere we turn, it seems, we’re bombarded with information about
how to stay healthy: Have some green tea. Take an aspirin. Eat soy. Cut out
carbs. Avoid plastic bottles. Take antioxidants. Use hormones. Don’t use
hair dye. Get tested. Meditate. The list goes on and on.
If there’s one complaint I hear more than any other from viewers and
readers, it’s that they’re overwhelmed and uncertain about what advice to
Copyright © 2008. University of California Press. All rights reserved.

believe. One woman summed it up this way: “I consider myself above aver-
age in paying attention to items concerning health. . . . But there is such a
glut of junk information, it is really difficult to sort out the good from the
bad.”
It would be nearly impossible to write a book sorting through every sin-
gle claim about health and wellness. There are simply too many, and new
ones emerge every day. But it is possible to equip you to become your own
health information detective, so that you can identify the motives and
“weapons” of those who are disseminating advice and verify whether there’s
adequate evidence to back up their claims. With a better understanding of
who’s behind the information and where to go to check it out, you’ll be in
a stronger position to determine what’s believable and what’s not. That’s
what being a healthy skeptic is all about.

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 I NTRO D U CTI O N 3

SELLING HEALTH
Certainly, the practice of urging people to lead healthier lives is nothing
new. In 1928, a prominent public health official named Dr. Herman
Bundesen called for a new approach to health promotion. (Though that
term can have different meanings, I use it in this book to refer to efforts to
educate and encourage the public to adopt healthful practices. I call those
behind such efforts “health promoters.”) Bundesen, recognizing the ascen-
dancy of mass media, advertising, and marketing in American culture,
urged that they be harnessed to improve public health. In a speech titled
“Selling Health––A Vital Duty,” he said to his colleagues: “My plea is that
you live health, talk health, sell health, and think health. Sell it alike to
young and old. Sell it by example and precept; by good health news pub-
lished in the right way; through the press; by the motion picture, the radio,
slogan and poster, or in any other way you will. But sell it.”
Today, the “selling” of health has far surpassed anything Bundesen likely
ever imagined. Television, radio, newspapers, magazines, books, newslet-
ters, and the Internet inundate us with the latest ways to be healthier and
live longer. Companies blast us with ubiquitous advertising for foods, bev-
erages, drugs, vitamins, herbs, and other products that promise to keep us
healthy. Doctors and diet gurus preach the virtues of their particular well-
ness and weight loss regimens through books, media appearances, and lec-
tures. Spas, fitness facilities, and “longevity” clinics promote regimens
Copyright © 2008. University of California Press. All rights reserved.

intended to boost our health. Celebrities on health crusades advise us, as do

consumer activists and health groups. Government health agencies issue a
steady stream of alerts, advisories, pamphlets, and public service announce-
ments, all intended to prevent disease and promote wellness. Even the rel-
atively staid Centers for Disease Control and Prevention (CDC) has an
entire center devoted to what it calls “health marketing.”
Fueling this explosion of selling is our seemingly insatiable demand for
ways to stay healthy. Baby boomers, not content to passively accept illness,
disability, and death as their forebears often did, have led the way in trying
to head off, or at least delay, the inevitable.
Our changing health care system has also helped stoke demand. Previously,
people got information about health and wellness mainly from their doctors.
But now, with only a few minutes allotted to see each patient, most doctors

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 4 I NTRO D U CTI O N

have little time to discuss matters like diet, exercise, or environmental hazards.
And in many cases, physicians aren’t especially knowledgeable about such
subjects; their training generally involves how to fix problems, not prevent
them. As a result, people have increasingly turned elsewhere for guidance.
Advances in the science of wellness have played a role, too. With
prevention-related research receiving greater visibility, prestige, and fund-
ing during the past few decades, we’ve seen an explosion of knowledge
about the possible causes of various conditions and the best ways to reduce
our risk. And more knowledge means there’s more than ever to sell.
There are also more opportunities to sell, thanks to the rapid prolifera-
tion in recent years of consumer publications, cable channels, and, of course,
the Internet, which has given health selling the unprecedented reach and
power it has today. One wonders what Dr. Bundesen would make of it all.

THE HEALTH PROMOTION “INDUSTRY”

It’s no secret that many of those engaged in selling health are out to make
a buck. Or big bucks. Economist Paul Zane Pilzer estimates that the well-
ness industry will be worth $1 trillion by 2010, as baby boomers spend
more and more on products and services that promise to promote longer
and healthier lives. In a book instructing readers “how to make a fortune in
the next trillion dollar industry,” Pilzer writes that “a few wellness entre-
Copyright © 2008. University of California Press. All rights reserved.

preneurs . . . will emerge as the billionaires and media darlings of our new
century. Hundreds of thousands more . . . will become millionaires.”
For other health sellers, the driving force isn’t money but attention. By
promoting a particular cause, they can burnish their reputations and en-
hance their careers; or, if they lead an advocacy group, they can boost its
visibility. Others simply want to improve public health. Perhaps they’re
driven by evangelistic zeal, resembling Bundesen in viewing the selling of
their particular cause as a “vital duty.” For still others, there’s a combination
of altruism and self-interest at work.
Given their varying motives, disparate sellers such as product marketers,
diet book authors, consumer activists, and government health officials prob-
ably don’t think of themselves as having much in common. Some would
even take umbrage at being lumped together with others whom they con-

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 I NTRO D U CTI O N 5

sider far less ethical or high-minded. But the fact is that regardless of what
drives them, all are involved in basically the same pursuit: trying to influence
what we know, believe, and do when it comes to our health. For consumers,
who are constantly bombarded with health-related advice from all direc-
tions, the messages are often indistinguishable. In essence, these sellers are
all part of a massive health promotion “industry.” And, yes, as a health jour-
nalist—and the author of this book—I am certainly a member of it.
Sellers in this industry have to compete for consumers’ attention in a
crowded and competitive marketplace of goods and ideas, where it’s usually
necessary to have a loud voice and bold claims to be heard. Whether the
message is in the form of a news report, an ad, or a slogan for an awareness-
raising campaign, sellers strive to make it simple and unambiguous, lest con-
sumers tune it out and focus their attention elsewhere. To convey complex
scientific information in this environment, health promoters may resort to
oversimplifying or sensationalizing. They may not necessarily lie to us, but,
like anyone else trying to sell something, they don’t always tell us the full
truth, either. Instead, what we may get, even from individuals and organiza-
tions with the most altruistic of motives, is hype, half-truths, and spin.
Sometimes, it’s perfectly obvious we’re being spun: think TV infomercials
for ab-flattening exercise machines or Internet ads for waist-shrinking herbal
supplements. Generally, we recognize sales efforts like these for what they
are—propaganda by manufacturers to entice us to buy products—and we
Copyright © 2008. University of California Press. All rights reserved.

know not to take them as gospel. But in many more cases, it’s not so clear
what health promoters’ agendas might be or how they might be stretching
the truth in order to influence us. In fact, some sellers are invisible, working
behind the scenes to sway us so that we are not even aware of it.

HORMONE THERAPY HYPE

The selling of hormone replacement therapy serves as a classic example—
and a cautionary tale—of how the health promotion industry can lead us
astray. The story begins with Dr. Robert Wilson, a gynecologist whose
1966 best-selling book, Feminine Forever, called menopause a “staggering
catastrophe” that turns a woman into a “castrate,” a “shrunken hag,” and a
“dull-minded but sharp-tongued caricature of her former self.” Replacing

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 6 I NTRO D U CTI O N

lost estrogen, he said, could head off these horrors and keep women
youthful-looking and “adaptable, even-tempered, and generally easy to live
with.” An excerpt from Wilson’s book in Look magazine helped add to the
buzz, as did articles in women’s magazines that included statements such as
this: “There doesn’t seem to be a sexy thing estrogen can’t and won’t do to
keep you flirtatiously feminine.” Thanks to such hype, sales of the leading
estrogen replacement drug, Premarin, skyrocketed. Unbeknownst to the
public, though, Wilson’s book and his foundation, which promoted hor-
mone therapy, were funded by Premarin’s manufacturer, Wyeth-Ayerst.
The drug’s popularity temporarily waned in the 1970s after reports that
it increased cancer of the lining of the uterus. But its reputation was reha-
bilitated when doctors determined that this problem could be addressed by
combining estrogen with another hormone, progestin. Sales climbed again
in the 1980s when hormone replacement therapy (HRT) was promoted for
a new use: preventing the bone-loss disease osteoporosis. An awareness-
raising campaign, funded by Wyeth, warned women about the devastating
effects of bone loss and advised them to see their doctors.
Meanwhile, some research was suggesting that hormones might also
prevent heart disease. Though the studies revealed only an association, not
cause and effect, the news media often mischaracterized the evidence as a
slam dunk. As Barbara Seaman wrote in her book The Greatest Experiment
Ever Performed on Women: “The press, whether through intentional, drug-
Copyright © 2008. University of California Press. All rights reserved.

dollar-fueled deceit or simple negligence or oversight, continued for years

to advocate as virtual fact a connection between heart and hormone.”
As preliminary evidence emerged that HRT might also prevent other
conditions, ranging from arthritis to Alzheimer’s disease, media reports
breathlessly played up these benefits while giving short shrift to possible
risks, including breast cancer and blood clots. An article in Newsweek went
so far as to exclaim that “years of research have painted [HRT] as the clos-
est science has ever come to putting youth in a little oval tablet.”
Enthusiastic pronouncements like these were encouraged by a steady
stream of press releases and other materials from public relations firms that
manufacturers had hired to promote HRT’s benefits. Prominent experts
who were unabashed cheerleaders for HRT added to the frenzy. For exam-
ple, one well-known obstetrician-gynecologist, appearing on NBC’s Today

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 I NTRO D U CTI O N 7

Show, gushed that “if there was a similar medication that could do the same
for men that [HRT] does for women, it would be in the cabinets in the
bathrooms of every home in America.”
Other doctors expressed their irrational exuberance through books with
titles such as Estrogen: How and Why It Can Save Your Life. In one such
book, the authors could barely contain their excitement in describing hor-
mone therapy as a virtually risk-free preventive panacea:
It is safe today. In fact, it is better than safe. . . . It will cut your risk of
heart disease in half and prevent osteoporosis, the brittle bones dis-
ease. All indications are that it delays or prevents the development of
Alzheimer’s disease and improves age-related memory loss. It can
prevent macular degeneration, an eye condition that can cause blind-
ness, and the onset of cataracts. Most important, according to the
foremost experts in the field, it will not put you at higher risk of
developing breast cancer.

What the public typically didn’t know was that this book’s co-author, Dr.
Lila Nachtigall, and some other frequently quoted HRT experts were the
recipients of speaking fees, research grants, or other funding from pharma-
ceutical companies, including Wyeth. The drug maker also paid celebrities
such as Lauren Hutton to sing the praises of hormone replacement. In a
story in Parade magazine, the former supermodel (who was featured on the
Copyright © 2008. University of California Press. All rights reserved.

cover) called estrogen “my No. 1 secret” and proclaimed that “if I had to
choose between all my creams and makeup for feeling and looking good,
I’d take the estrogen.”
But not everyone was jumping on the bandwagon. Some doctors and
health groups expressed skepticism, pointing out that while HRT’s ability to
control menopausal symptoms and prevent thinning bones was well estab-
lished, many of the other purported benefits were not. And it wasn’t clear,
they warned, that the risks were as minimal as many assumed.
Though their voices were generally drowned out by those of HRT
enthusiasts, the skeptics were eventually vindicated by a landmark federal
study known as the Women’s Health Initiative. In 2002, the government
announced it was halting the huge randomized clinical trial (the most
definitive type of study, capable of showing cause and effect) because HRT

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 8 I NTRO D U CTI O N

was doing more harm than good. Women taking combination hormone
therapy were less likely to have hip fractures and colon cancer than those on
placebos—but they also had a small increase in their risk of heart attacks,
strokes, and breast cancer. Later findings would show that they were also
more prone to develop dementia.
Still, this was just one study (albeit the largest and most definitive to date)
and involved just one type of HRT. Contrary to what some concluded, it did
not prove that HRT was worthless or harmful for all women. But it did poke
a huge hole in the HRT enthusiasts’ case that most postmenopausal women
should take hormones because the benefits far outweighed the risks.
The news that HRT was not all it had been cracked up to be came as a
bombshell to many women, who felt confused and betrayed. They won-
dered how the advice they had heard for so long from so many people could
have been so wrong. The answer, according to best-selling author Dr.
Susan Love, was that “we made observations and developed hypotheses—
and then forgot to prove them.” Or, as women’s health advocate Cynthia
Pearson put it, the belief that hormones could prevent disease was “a tri-
umph of marketing over science.”

THE WHOLE TRUTH?

This kind of misleading health selling, often from sources we trust, isn’t
Copyright © 2008. University of California Press. All rights reserved.

unique to HRT. We encounter it every day regarding all kinds of issues.

Consider, for example, these statements:

Eating walnuts or chocolate can help ward off disease.

Going on a diet will make you healthier.
Early detection saves lives.
Sunscreen prevents skin cancer.
High cholesterol is a killer.
Taking vitamins is beneficial.
Commonly used products contain harmful chemicals.

We hear such pronouncements so often that few of us think to question

them. But, in fact, they’re not really facts. They’re half-truths—oversimplified
assertions with a kernel of truth, some that are based on less than definitive

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 I NTRO D U CTI O N 9

evidence and others that don’t apply in all cases. Yet all are being peddled as
absolute truths by various sellers in the health promotion industry.
In the chapters that follow, I dissect these notions and others like them,
showing how they’re misleading and who’s behind them. After providing
some historical perspective on health promoters in chapter 1, along with
guidance on how to assess health studies, I devote each succeeding chapter
to a different area of prevention and a particular type of health seller that is
a major force in that area. For example, chapter 2 looks at how the news
media, our primary source of information about nutrition, uncritically
report industry-funded research and overstate the health benefits of partic-
ular foods. Chapter 5 explores how a huge government health campaign,
which has been instrumental in shaping our society’s agenda on cholesterol,
relays oversimplified messages that don’t apply equally to everyone.
Chapter 8 examines how consumer activists, who have led the way in rais-
ing awareness of environmental hazards, cause undue alarm over dangers
from chemicals and distort our health priorities.
As you read in these and other chapters about some of the surprising
ways we’re being spun, note that the methods and motives from each exam-
ple apply to more than that particular area of health. For instance, the news
media regularly rely on industry-backed information for stories regarding
not only food but also pharmaceuticals, dietary supplements, and weight
loss products.
Copyright © 2008. University of California Press. All rights reserved.

Also keep in mind that most areas of prevention typically have multiple
sellers offering similar advice. I limit my focus in each chapter to one health
topic and one type of health promoter in order to illustrate how various
players operate to influence us. While each example represents just a slice
of reality, I hope that, taken together, these slices give you a comprehensive
picture of the health promotion industry—who’s part of it, what drives var-
ious players, how they present information, and, most important, how you
can think more critically about what they tell you.
Though I comment throughout the book on the credibility of specific
claims, my real aim is to help you make such determinations for yourself.
To that end, each chapter concludes with a list of trustworthy sources of
information—science-based, spin-free books, newsletters, and Web sites
you can consult to check out specific claims or learn more.
My intention is not to provide an A to Z encyclopedia of prevention and

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 10 I NTRO D U CTI O N

wellness. Plenty of topics that would appear in such a guide, ranging from
smoking to vaccinations, are not addressed here. Instead, I have chosen
issues that I think best illustrate the workings of the health promotion
industry. In discussing them, I’ve tried to cite the most current science at
the time of this writing. But because the field of prevention is constantly
evolving, it’s possible that by the time you read this, some of what I’ve writ-
ten may be superseded by new information.
One more caveat: I’ve restricted my focus to individual behavior
choices—things you can do (or not do) to try to stay healthy. Many public
health experts will tell you there’s much more to prevention than this. Our
environment—and by that I mean not only our air and water but also var-
ious social and economic forces—helps determine how healthy we are.
Some in public health argue that there’s too much emphasis on personal
responsibility. Instead, they say, the priority should be to create societal
conditions that are more conducive to good health. For example, rather
than just urging people to eat better and exercise more, they push to make
healthful foods more affordable and communities more exercise-friendly.
By focusing exclusively on individual behavior choices, I don’t mean to
imply that environmental and social forces don’t matter. I’m simply trying
to respond to reality. For better or worse, there’s a growing push for peo-
ple to take personal responsibility for their health, a trend fueled by the rise
of “consumer-driven” health care and pressures to contain health costs
Copyright © 2008. University of California Press. All rights reserved.

(though not everyone agrees that prevention ultimately saves money).

Millions are trying mightily to follow the advice they get from the health
promotion industry. My goal is to help us do so more intelligently.

CYNICISM VERSUS SKEPTICISM

None of us wants to be gullible, of course. But as we try to avoid being
duped, we also have to be careful not to fall prey to cynicism—the belief
that all health promoters are either liars or fools and that we shouldn’t lis-
ten to any of them. That’s not the truth, and it’s certainly not the message
I want you to take away from this book.
Plenty of health promoters whom I take to task also provide sound
information that can potentially benefit your health. That’s why you’ll see,

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 I NTRO D U CTI O N 11

for example, consumer activists criticized in one chapter but commended in

another. It’s easy to demonize entire groups—whether drug companies,
government agencies, or journalists—and automatically dismiss anything
they say. Some who fancy themselves skeptics, including many inhabitants
of the blogosphere, have such a mind-set. But they’re not really skeptics;
they’re cynics.
A healthy skeptic carefully and critically evaluates each piece of advice,
taking into account not only its source but also the science behind it.
Unquestionably, that demands more from us than cynicism does. As Dr.
Marcia Angell, a former editor-in-chief of the New England Journal of Medi-
cine, has observed: “Cynicism is much easier than skepticism because it re-
quires 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.”
Being either gullible or cynical can negatively affect our health. By
believing everything—or nothing—we hear, we may fail to take the right
steps to stay healthy. There’s no question that measures such as exercising,
eating a healthful diet, wearing a seat belt, getting vaccinated, not smoking,
and not drinking in excess can reduce the risk of illness, injury, and prema-
ture death. Indeed, how we live can have a great impact on overall health
and longevity. The CDC estimates that more than one-third of all U.S.
Copyright © 2008. University of California Press. All rights reserved.

deaths are attributable to unhealthful behaviors. It’s therefore imperative

that we, both as individuals and as a society, take prevention seriously and
make sure our actions are driven by the best information we can get. Too
much is at stake to let ourselves succumb to cynicism or be swayed by spin.
As a health journalist, I’m inundated every day with pitches from all
kinds of sellers trying to get their messages across. Some of their ideas are
clearly worthwhile; others are downright crazy. The majority fall some-
where in between. Having to sort through this cacophony of claims forces
me to draw daily on that lesson I learned long ago from know-it-all Marty:
verify before you buy what’s being sold. Being a healthy skeptic has not only
made me a better journalist, I believe, but also allowed me to make better
decisions regarding my own health and given me confidence that I’m on
the right track. It’s my hope that this book can help do the same for you.

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 Copley News Service/Mike Thompson
Copyright © 2008. University of California Press. All rights reserved.

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 CHAPTER ONE: SAYS WHO?
HOW WE KNOW WHAT (WE THINK) WE KNOW

n the film The Road to Wellville, Anthony Hopkins plays Dr. John Harvey

I Kellogg, the legendary health promoter whose surname is now synony-

mous with cereal. The doctor, portrayed as a buck-toothed, bowel-
obsessed fanatic who pushes daily enemas as the antidote to just about
everything, brags (if that’s the right word) that “my own stools . . . are
gigantic and have no more odor than a hot biscuit.”
Adapted from the satiric novel of the same name, the movie shows
patients at Dr. Kellogg’s Battle Creek Sanitarium engaged in all kinds of
Copyright © 2008. University of California Press. All rights reserved.

bizarre practices, including rhythmic laughing, exercising in diapers, and

sitting in electrically charged tubs of water. (In the process, one patient dies
of electrocution.) The scenes, fictional but not far from reality, poke fun at
Kellogg’s silly ideas and the gullibility of so many people, desperately seek-
ing good health, who embraced them.
Though the film’s entertainment value is debatable—the movie is filled
with bathroom humor and flopped at the box office—its lessons about
health promotion are profound. It reminds us of how far we’ve come in our
quest for wellness and, in many ways, how little some things have changed.
One notable difference is the rationale for health recommendations. In
previous eras, appeals for healthy living were based on religion, morality,
pseudoscience, anecdotal observations, or the personal experiences of health
promoters. Today, in contrast, health advice is typically attributed to a seem-
ingly more objective and sophisticated source: modern scientific research.

13

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 14 SAYS WH O?

While not infallible, it can nevertheless be a powerful tool—unavailable to

our ancestors—that helps us discern what’s true and what’s not.
But too often, health promoters misuse, misrepresent, or disregard
research altogether, and we unquestioningly accept what we’re told, just as
Dr. Kellogg’s followers did. If you need evidence of this, look no further
than the New York Times best-seller list. One of the most popular health
books in recent memory is Natural Cures “They” Don’t Want You to Know
About, by Kevin Trudeau, a TV infomercial huckster who has been sued by
the federal government for making bogus claims and has served prison time
for credit card fraud. Though he assures us that “there are more than 900
studies proving the basis [sic] premises in this book,” his chapter on pre-
vention, titled “How to Never Get Sick Again,” includes a smorgasbord of
scientifically unsubstantiated directives. Among them: get your colon irri-
gated; eat bee pollen; sleep on a magnetic mattress pad; don’t use deodor-
ant; avoid air conditioning; throw away your microwave oven; stay away
from clothes dryers; don’t eat for up to a month; and use a machine that
“rebalances” your bodily energy.
When we fall for flapdoodle like this, there’s little to separate us from
those misguided souls in The Road to Wellville at whom we laugh. The joke,
it seems, is on us. But by gaining some basic knowledge of research and
applying a little critical thinking to what we’re told, we have the power to
keep history from repeating itself.
Copyright © 2008. University of California Press. All rights reserved.

HEALTH PROMOTION HISTORY HIGHLIGHTS

For some perspective on where we find ourselves today, it’s helpful to take
a brief look at some health promoters of the past, many of them colorful
characters like Kellogg who attracted large followings. As you read through
this history of human folly (and occasional wisdom), note the parallels with
many modern-day teachings as well as the changes over the centuries in
how health promoters have justified their ideas.

ANCIENT WISDOM AND PERSONAL EXPERIENCE

Our journey begins nearly 2,500 years ago with the physician Hippocrates
(ca. 460 bc–ca. 377 bc), who recognized and wrote about the influence of

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 SAYS WH O? 15

diet, exercise, and environmental factors on health. The Greek physician

Galen (ad 129–ca. 199), heavily influenced by Hippocrates, formally codified
rules for healthful living, which required attention to six “nonnaturals,” as
they became known: air; motion and rest; sleep and waking; food and drink;
excretions; and passions and emotions. In all areas, moderation was key.
These principles continued to hold sway in the mid-sixteenth century,
when the Italian nobleman Luigi Cornaro (ca. 1466–1566) wrote a widely
circulated series of essays on wellness and longevity, Discourses on the Sober
Life. The author, who penned the works in his 80s and 90s, tells how he had
previously led an indulgent lifestyle that nearly killed him at age 40. In what
might be described as a Renaissance version of Extreme Makeover, he then
adopted a regimen based on the nonnaturals, strictly limiting his consump-
tion of food and wine and avoiding extreme heat and cold, fatigue, and bad
air. Adhering to such rules, Cornaro claimed, gave him physical strength,
mental clarity, and inner peace as well as immunity to all diseases.
Invoking the “eminent physician” Galen, Cornaro called himself a “liv-
ing witness” to the truth of the doctor’s teachings. He pointed to his own
experience as proof that everyone—even those with a “bad constitution”—
could avoid illness and infirmity through proper living. He even promised
that anyone who followed his example could live to at least 100—a mile-
stone he achieved himself, give or take a few years. (Accounts of his exact
age at death vary.)
Copyright © 2008. University of California Press. All rights reserved.

Similar rationales were prominent in the writings of George Cheyne

(1671–1743), an obese Scottish physician who became famous, ironically,
for his diet advice. His popular manual An Essay of Health and Long Life, first
published in 1724 and reprinted in multiple editions and languages, was
organized according to Galen’s principles, with each chapter corresponding
to a different nonnatural. In extolling the virtues of moderation, Cheyne
also rooted his advice in the ancient philosophy of Aristotle, who advocated
the golden mean, or nothing in excess. “If men would but observe the
golden mean in all their passions, appetites, and desires,” Cheyne wrote,
“they would enjoy a greater measure of health than they do . . . live with less
pain, and die with less horror.”
Echoing Cornaro, Cheyne cited personal experience as another basis for
his recommendations, informing his readers that “I have consulted nothing
but my own experience and observation on my own crazy carcass.” His car-

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 16 SAYS WH O?

cass tipped the scales at 450 pounds, and Cheyne suffered from repeated
bouts of physical and psychological ailments. He recovered (eventually drop-
ping to a svelte 300 pounds) after adopting a relatively spartan diet similar to
the one he recommended.

“TRUST ME, I’M A DOCTOR”

But Cheyne also justified his advice in another way: as a physician, he
claimed to have an expert understanding of the body’s inner workings.
Heavily influenced by the natural philosophy of Isaac Newton, Cheyne
envisioned the body as a hydraulic machine that could be understood
through mathematical calculations. He believed that the machine consisted
of pipes, or “canals,” through which juices flowed and that keeping the liq-
uids thin and moving was “the great secret of health and long life.” Thick
and gooey juices supposedly led to disease and death.
Based on these notions, Cheyne offered a contemporary rationale for
Galen’s ancient rules. For example, he recommended against oily, fatty foods
and those with strong odors and tastes because, he reasoned, their particles
stuck together more readily and thickened the fluids. Likewise, Cheyne wrote
that exercise was essential for keeping the juices flowing. He was especially
partial to horseback riding, which he said was capable of “shaking the whole
machine, promoting a universal perspiration and secretion of all the fluids.”
Copyright © 2008. University of California Press. All rights reserved.

Even though he had no empirical evidence to support his ideas, Cheyne

assured readers that his notions had been confirmed through “infinite exper-
iment, and the best natural philosophy.”
Medical authority was also the basis for advice in the first U.S. consumer
health periodical, which debuted in 1829. Called the Journal of Health and
edited by “an Association of Physicians” (which actually consisted of just two
doctors), the twice-monthly publication focused on “air, food, exercise, the
reciprocal action of body and mind, climate and localities, clothing, and the
physical education of children.” The authors, influenced by the French med-
ical theorist François Broussais, believed that irritation of the stomach—
which supposedly could result from overstimulating foods, beverages, emo-
tions, or exertion—lay at the root of virtually all medical conditions. Thus
they recommended a plain diet of fruit, vegetables, and breads, along with

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 SAYS WH O? 17

small amounts of meat. Cleanliness and moderate exercise were in; tobacco
and extreme emotions were out.
The Journal of Health began during the presidency of Andrew Jackson,
an era characterized by rising democratic participation and declining defer-
ence to elite authority. That authority included the medical profession,
which at the time lacked real cures and instead prescribed ineffective (and
sometimes deadly) measures like bloodletting, vomiting, purging, and
administering toxic substances such as mercury. Many people, wisely leery
of such treatments, were turning instead to alternatives, including botani-
cal healing, homeopathy, and self-care. The journal’s editors, trying to stem
this tide, denounced such practices and stressed the essential role of the
trained physician—whom they called the “only competent judge” of dis-
ease. Apparently, this was a message the public didn’t want to hear: four
years after its launch, the Journal of Health went out of business.

GOD’S LAWS
About the same time, Sylvester Graham (1794–1851), most often remem-
bered as the grandfather of the Graham cracker, was rising to prominence.
A Presbyterian minister and gifted orator who began his career giving anti-
alcohol lectures, he soon broadened his focus to health habits. Unlike the
editors of the Journal of Health, Graham was not part of the medical estab-
Copyright © 2008. University of California Press. All rights reserved.

lishment and made no attempt to defend it. In fact, he was disdainful of

doctors, declaring that “all medicine, as such, is itself an evil.”
While others before him had invoked God’s laws as a source of their
ideas, Graham went further, turning health promotion into a moral cru-
sade. He taught that by living temperate lives according to God’s laws of
health—rules that just so happened to coincide with God’s moral laws—
human beings could achieve physical perfection, create heaven on earth,
and hasten the Second Coming of Christ. It was a “morally binding duty,”
Graham’s disciples believed, to study and obey the laws “which God has
established for the perpetuation of [humankind’s] existence.”
Under Graham’s principles of disease prevention, which he called “the
Science of Human Life,” just about everything considered immoral was
now deemed unhealthful—and that included sex. Warning that sexual

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 18 SAYS WH O?

excess caused debilitation, he advised healthy married couples to limit their

sexual activity to once a month. Sex outside marriage was even more inju-
rious, he reasoned, because it was more exciting. Worst of all was mastur-
bation because it involved the imagination and therefore inflamed the
brain, leading to insanity.
Graham claimed that exercise could keep sexual urges in check, as could
a nonstimulating diet, which he recommended for everyone. Meat was for-
bidden, as were mustard, pepper, soups, cream, butter, pastries, tea, and cof-
fee. Graham had special contempt for store-bought white bread, as he
believed that stripping bran from flour rendered bread overly stimulating.
Instead, he extolled the health virtues of old-fashioned, homemade bread
baked with whole-grain flour—what became known as “Graham flour.”
(Ironically, leading brands of Graham crackers are today manufactured with
the type of refined flour Graham abhorred.)
Graham stopped lecturing in 1839, but his cause continued under the
leadership of Dr. William Alcott (1798–1859), a prolific author of advice
manuals for both adults and young people. Alcott’s message generally mir-
rored that of Graham, though he went even further in portraying himself
as a “medical missionary” who was spreading God’s gospel of health. For
example, defending the idea that people should restrict themselves to
monthly sex, he acknowledged that the stricture was unpopular and seemed
“rigid.” But, he asked rhetorically, “Am I at fault, in announcing it? I cer-
Copyright © 2008. University of California Press. All rights reserved.

tainly did not make the law. At most, I am but its interpreter.” He was, like
Moses, simply revealing God’s laws.
At the same time, Alcott tried to debunk the popular notion that sickness
and death were God’s will. “It is much easier, or at least much lazier,” he
wrote, “to refer all our ills and complaints, as well as their unfavorable ter-
minations, to God or Satan . . . than to consider [ourselves] as the probable
cause.” This idea of human control over health—that it was possible,
indeed obligatory, for human beings to achieve perfect health—was central
to Graham’s ideology. It grew out of a larger American phenomenon of the
early nineteenth century, the Second Great Awakening, a revivalist move-
ment that challenged the Calvinist concept of helpless human beings whose
destiny was entirely up to God. Instead, evangelists preached, people had
the power and the duty to eliminate the evils they faced—including dis-
ease—and thereby achieve salvation.

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 SAYS WH O? 19

GOD SPEAKS
Another product of the Second Great Awakening was the Seventh-Day
Adventists, a religious group that focused on preparing for Christ’s Second
Coming. Its leader, Ellen White (1827–1915), stressed the importance of
following God’s laws of health, teaching that violating them was akin to
breaking the Ten Commandments. But unlike Graham and Alcott, who
had become aware of such laws through books, intuition, or observation,
White announced that she had been enlightened directly by the Lord.
In a series of “visions”—trancelike experiences in which she claimed to
see angels, Jesus, and Satan—White supposedly learned that tobacco, tea,
coffee, meat, butter, eggs, cheese, rich foods, and uncleanliness, among
other things, were harmful. In her writings and lectures, she often gave
physiological explanations for the rules God had revealed to her. For exam-
ple, she wrote that meat was hazardous because it transmitted disease and
stirred up animal passions.
Though White insisted her views had come from God and were “inde-
pendent of books or of the opinion of others,” her pronouncements bore a
striking resemblance to those of Graham, Alcott, and other like-minded
health promoters. She appeared to borrow especially heavily from a physi-
cian and preacher named Larkin Coles, the author of a popular health ad-
vice manual, Philosophy of Health. An analysis of White’s writings by histo-
rian Ronald Numbers reveals how she frequently lifted passages almost
Copyright © 2008. University of California Press. All rights reserved.

verbatim from Coles’s work without attribution.

White was also influenced by James Jackson, who ran a health facility in
Dansville, New York, known as Our Home on the Hillside. There, Jackson
combined Graham’s health regimen with hydropathy, an unorthodox heal-
ing method using water as a cure-all. After visiting Our Home, White had
a vision that Adventists should establish their own health institution. In
1866, the Western Health Reform Institute (later renamed the Battle Creek
Sanitarium) opened its doors in Battle Creek, Michigan.

SELECTIVE SCIENCE
A decade later, White tapped then 24-year-old Dr. John Harvey Kellogg
(1852–1943) to head the institute. He would remain there for 67 years
and would become, in the words of medical historian James Whorton,

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 20 SAYS WH O?

“the most formidable reformer of American living habits of the twentieth

century.” During the doctor’s long career, medicine would experience re-
markable progress, becoming a true science. Unlike White, who had no use
for orthodox medicine, Kellogg embraced it, even boasting that he was
years ahead of other doctors in incorporating the latest ideas and practices.
But in reality, he did so selectively, adopting only those theories that he
could apply—or twist—to lend credence to his preconceived notions.
Kellogg, the son of a devout Adventist, was first drawn to those notions
as a teenager. As an apprentice typesetter for White’s husband, James, who
ran the Adventists’ publications division, Kellogg worked on a series of
health advice pamphlets that included writings by Ellen White, Sylvester
Graham, and others. Intrigued at what he read, he delved further into the
works of Graham in his spare time and became a vegetarian.
Sent to medical school by the Whites, he found that many of the ideas
he’d been exposed to under their tutelage were considered nonsense by
mainstream doctors. Still, Kellogg clung tenaciously to those beliefs, form-
ing bonds with professors whose ideas were compatible with his own.
It was a pattern that continued throughout his entire career: Kellogg
looked to modern medical science to validate the dogma passed down to
him from White and Graham. To lend his old ideas an air of scientific
legitimacy, he gave them a new name, “biologic living.” And he latched on
to any scientific theory that might somehow support his cause. For exam-
Copyright © 2008. University of California Press. All rights reserved.

ple, he readily adopted the germ theory as it was just starting to gain accep-
tance and used it to further his arguments against eating meat. In one
“experiment,” he “proved” that beefsteak contained more harmful germs
than barnyard manure.
Likewise, Kellogg championed the theory of a Russian zoologist who
argued that bacteria from decaying protein in the colon entered the blood-
stream and “poisoned” the body. Kellogg attributed this phenomenon,
known as autointoxication, to eating meat and claimed that it caused a wide
range of conditions, including skin problems, depression, and liver damage.
The solution consisted of a high-fiber, vegetable diet, combined with colon
irrigation to promote multiple daily bowel movements.
In his writings, Kellogg often cited the opinions of other physicians to
bolster his ideas, including his draconian views on sex. For example, his sex

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 SAYS WH O? 21

and marriage manual quoted several “eminent” and “learned” medical

authorities to make the case that too much marital sex could be harmful,
leading to everything from sore throats to consumption. But his harshest
denunciations were aimed at masturbation, which he called “the most dan-
gerous of all sexual abuses.” As evidence, Kellogg cited the “testimony of
eminent authors,” one of whom opined that “neither the plague, nor war,
nor small-pox, nor similar diseases, have produced results so disastrous to
humanity as the pernicious habit.”
To head off this horror, Kellogg invoked yet another so-called expert, Dr.
O.W. Archibald, superintendent of the Iowa Asylum for Feeble-Minded
Children, who recommended sewing the foreskin shut over the penis in
order to make an erection impossible. Another suggested remedy, which
Kellogg described as “almost always successful in small boys,” was perform-
ing a circumcision—without anesthesia. For female offenders, he recom-
mended applying acid to the clitoris, which he found to be “an excellent
means of allaying . . . abnormal excitement.” Apparently with a straight face,
Kellogg denounced other (presumably less severe) anti-masturbation mea-
sures as scientifically unsound, warning readers to beware of “pretentious
quacks” who offered them.
Bolstering Kellogg’s claims to being on the cutting edge of science were
his numerous inventions, which included everything from surgical instru-
ments to meat substitutes. But his most famous creation was ready-to-eat,
Copyright © 2008. University of California Press. All rights reserved.

flaked cereal, which he developed with his brother Will. (Eventually, Will
formed his own cereal business, which became the Kellogg Company that
exists today.)
Through the force of his personality and his penchant for self-
promotion, Dr. Kellogg managed to gain enormous fame and respect as a
medical authority, despite his selective use of science. During his long
career, he wrote nearly 50 books, edited a magazine called Good Health, and
gave thousands of lectures across the country to both professional and lay
audiences. Over the years, his Battle Creek Sanitarium (or the “San,” as it
was known) attracted the rich and famous, including Henry Ford, Thomas
Edison, and Amelia Earhart, among its more than 300,000 guests.
A name surely familiar to visitors at the San after the turn of the century
was Horace Fletcher (1849–1919), known as “the Great Masticator.” A

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 22 SAYS WH O?

friend of Kellogg’s, Fletcher championed the notion that the secret to

health was chewing food until it liquefied. Declaring that Fletcher “had
done more to help suffering humanity than any other man of the present
generation,” Kellogg was so taken with Fletcher’s ideas that he wrote a
“Chewing Song” for his patients and coined the term “Fletcherize,” mean-
ing to chew thoroughly.
A successful businessman and former athlete, Fletcher found himself
tired, sick, and obese at age 40. After adopting his chewing regimen, he
dropped more than 50 pounds within four months and lost 7 inches off his
waist. His ailments and fatigue vanished. To spread the word about his
remarkable success, he wrote, lectured, gave press interviews, and offered
public demonstrations of his vigor, which included backward flips off a div-
ing board, lifting a man on his shoulders, and cycling 190 miles.
Fletcher used his considerable wealth not only to market his health
secret but also to buy credibility from the medical establishment. To sci-
entifically test his theory, he funded “studies” at Yale on his own physical
fitness. In one, the investigator concluded that the 54-year-old Fletcher
had performed “with greater ease and with fewer noticeable bad results
than any man of his age and condition I have ever worked with.”
Fletcher’s explanation was that his interminable chewing prevented solid,
decaying wastes from accumulating in his digestive tract and poisoning his
body. But for the Yale nutrition expert overseeing the studies, the issue wasn’t
Copyright © 2008. University of California Press. All rights reserved.

Fletcher’s chewing but the fact that his subject had (unwittingly) reduced his
protein intake. Further studies, some funded by Fletcher, would eventually
lead experts to lower their protein recommendations. In such a way, Fletcher
had a lasting impact on science. But the practice of Fletcherizing, despite the
popularity and buzz generated by its inventor, died when he did.

ALTERNATIVE “SCIENCE”
Unlike Kellogg and Fletcher, the popular bodybuilding enthusiast Bernarr
Macfadden (1868–1955) didn’t look to the medical establishment for vali-
dation. Instead, he vociferously attacked it, calling it “the science of guess-
ing” that belonged “to the ignorance of the distant past.” Believing that

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 SAYS WH O? 23

germs didn’t pose a threat to healthy people—he privately called Louis

Pasteur, the father of the germ theory, “that French quack”—Macfadden
strongly opposed vaccines as well as the use of medications and surgery. He
accused doctors, especially leaders of the American Medical Association, of
being liars and phonies who cared most about their own financial interests.
Macfadden’s alternative to medicine was his self-invented science, which
he called physcultopathy. Citing his own experiences and those of others to
support his theories, he argued that all diseases stemmed from impurity in
the blood and that they could be prevented or cured through proper living.
That meant a regimen similar to Kellogg’s and Graham’s, except that
Macfadden was not a vegetarian, and he put special emphasis on regular
fasting as a way to eliminate poisons from the body.
The Macfadden wellness regimen was also novel in its emphasis on
fitness and strength over everything else—something reflected in the title
of Macfadden’s highly popular magazine, Physical Culture, and in its motto:
“Weakness is a crime; don’t be a criminal.” Beautiful bodies (often dis-
played scantily clad or nude) were a sign of not only perfect health, he
argued, but also strong character. Having changed his birth name of
Bernard McFadden to one he thought sounded more powerful, he relent-
lessly promoted his own perfectly sculpted physique and vitality as firsthand
evidence for his theories.
An outlandish and irrepressible showman, Macfadden was a master mar-
Copyright © 2008. University of California Press. All rights reserved.

keter of his cause. Like other health promoters of his era, he wrote
prolifically to promote his ideas, authoring or editing almost 150 books and
pamphlets, including a multivolume Encyclopedia of Physical Culture. He was
also a frequent contributor to Physical Culture magazine, just one of many
publications he owned.

FROM BELIEFS TO EVIDENCE

J. I. Rodale (1898–1971), an accountant turned farmer, publisher, and
health promoter, considered Macfadden his hero. Like Macfadden, Rodale
had his own set of idiosyncratic health beliefs, many of which had little or
no solid science behind them. And he too pushed his ideas through the

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 24 SAYS WH O?

books and magazines he published. But unlike Macfadden, Rodale created

a publishing empire that outlived him, and his company eventually came to
offer advice based on more than just its founder’s opinions.
An early advocate of organic farming, Rodale believed that chemical fer-
tilizers and pesticides were harmful to both the environment and human
health. Going further, he opposed synthetic chemicals of all kinds and
warned about health hazards from food additives, plastic utensils, aluminum
cookware, and fluoridated water, among other things. He gave his enthusi-
astic blessing to “natural” food supplements, for which he often made
wildly exaggerated claims: sunflower seeds preserved eyesight; bone meal
could prevent both asthma and cavities; magnesium was a “miracle min-
eral”; and hawthorn berries and vitamin E were “an unbeatable combina-
tion to combat heart disease.” Rodale himself swallowed as many as a hun-
dred supplements a day, including everything from desiccated liver to
dolomite.
Like health promoters before him, Rodale had a fairly lengthy list of for-
bidden foods. At the top was sugar, which he believed caused antisocial
behavior. Milk made people too tall, he believed, and white bread led to
colds. He was no fonder of wheat, whether in bread or cereal. Negative
emotions were also off-limits, an old principle that Rodale took to new
extremes in an article, and later a book, titled “Happy People Rarely Get
Cancer.”
Copyright © 2008. University of California Press. All rights reserved.

To reach such conclusions, Rodale frequently cited testimonials from

readers and results from so-called experiments he conducted by monitoring
himself. But he also read medical journals and cited mainstream research
whenever he could to help make his case. Over time, Prevention maga-
zine—the highly popular health publication he founded in 1950—would
increasingly use this standard as the basis for its advice, moving away from
simply promoting the personal beliefs of the company’s founder and toward
providing more objective and seemingly evidence-based information.

“RESEARCH PROVES . . .”
Indeed, most major health promoters today, whether mainstream or not, at
least profess to base their recommendations on scientific research. In per-

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 SAYS WH O? 25

suading us to follow particular advice, they typically use phrases like “stud-
ies show” or “research proves”—modern-day versions of their predeces-
sors’ exhortations “God wants you to do this” or “it worked for me” or sim-
ply “trust me.” In principle at least, this shift to a more neutral, objective
standard is a positive development, taking us out of the realm of faith and
belief into that of facts and knowledge.
But if you dig beneath the surface a bit, you’ll find that the evidence cited
by health promoters doesn’t always support their claims. Overstating the
strength, certainty, and scope of the science, they may play up studies that
are highly preliminary, poorly conducted, or irrelevant, while conveniently
ignoring those that contradict their case.
Consider, for example, the popular health promoter Dr. Nicholas
Perricone. Through his television appearances and best-selling books
(which include The Perricone Prescription and The Perricone Promise), this
celebrity dermatologist peddles the half-baked idea that inflammation is the
root of all health evils. The regimen he pushes, which is supposed to make
you look younger and live longer, bans a long list of foods, including
bananas, grapes, coffee, carrots, peas, popcorn, oranges, raisins, pasta, pick-
les, and hard cheese. Instead, we’re told to eat wild Alaskan salmon—as
often as several times a day—and down eight to ten glasses of water (not
just any water, but spring water) daily. In addition, Perricone recommends
taking more than twenty-five supplements, many with tongue-twister
Copyright © 2008. University of California Press. All rights reserved.

names, such as benfotiamine and chromium polynicotinate.

Sound familiar? Elements of Perricone’s regimen bear a striking resem-
blance to the spoutings of Sylvester Graham (good and evil foods), John
Harvey Kellogg (a one-size-fits-all theory of disease), and J. I. Rodale (life-
saving supplements). The difference is that Perricone’s books are filled with
references to research studies, giving his ideas the veneer of scientific legit-
imacy. But Drs. Harriet Hall and Stephen Barrett of Quackwatch, an orga-
nization that exposes health fraud, aren’t fooled. Calling Perricone’s rec-
ommendations a “fanciful interpretation of selected medical literature,”
they point out that he “cherry picks possibly supportive studies from the lit-
erature and ignores contradictory studies. He cites lots of lab studies . . . but
few that demonstrate any clinical effects in humans.” In short, they write,
Perricone “has mixed a pinch of science with a gallon of imagination.”

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 26 SAYS WH O?

ASSESSING THE SCIENCE

To assess the legitimacy of claims by Perricone and other health promoters,
it’s important to have at least a basic understanding of how research is con-
ducted and how to interpret findings. When you hear that “studies prove”
something to be true, consider the following eight key questions before
drawing any conclusions. This assessment may require some digging, and
the answers won’t always be available, but the extra effort will pay off by
empowering you to make smarter decisions about your health.

1. WHAT KIND OF STUDY IS IT?

Much of the research cited by health promoters comes from the field of
epidemiology, the study of disease patterns and their contributors in popu-
lations. Typically, epidemiological studies are observational, meaning that
scientists measure something but don’t intervene. While such research can
identify probable health risks and benefits, it can’t definitively prove cause
and effect. Types of observational studies include the following:

Population studies. These usually compare groups in different geographic

areas, looking for differences both in disease rates and in some factor or
factors (known as exposures) that might be responsible. An example is
the so-called Seven Countries Study, which found that nations like
Finland, where heart disease rates were relatively high, had higher-fat
diets than places like Japan, where heart disease was less common. The
Copyright © 2008. University of California Press. All rights reserved.

research appeared to support the idea that dietary fat caused heart dis-
ease. The problem with such studies is that the apparent suspect—in
this case, fat—may not be the real culprit. For example, populations who
consume less fat might also get more physical activity, eat more fish, or
have other related characteristics that may actually account for the lower
rates of disease. These extraneous factors, known as confounders, can
make population studies—as well as other observational studies—tricky
to interpret.
Case-control studies. Researchers select two groups that are similar in all
ways except that the members of one (the cases) have the disease in
question and the members of the other (the controls) do not. Informa-
tion is then gathered about the subjects’ past habits to find differences

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 SAYS WH O? 27

that may explain the occurrence of disease. For example, case-control

studies have found that women with bladder cancer are more likely to
have used permanent hair dye than those without the disease. While
this suggests a possible connection, it is not proof. When asked to recall
their habits from years or decades ago, people often have fuzzy memo-
ries. Those with the disease who are searching for a cause may remem-
ber (or think they remember) things that controls don’t. It’s also possi-
ble that the two groups aren’t as similar as the researchers believe.
Perhaps the cases are different from the controls in some way, aside
from the exposure, that affects their risk of illness.
Cohort studies. These studies, in contrast, are typically forward looking.
Healthy people are evaluated for various exposures and then followed
for years or decades to see who gets the disease(s) in question and who
doesn’t. A classic example is the ongoing Framingham Heart Study,
begun in 1948. At the start of the study, 5,000 residents of Framingham,
Massachusetts, who were free of heart disease were questioned exten-
sively about their lifestyle habits and given tests measuring blood pres-
sure, cholesterol, and other characteristics. Periodically over the follow-
ing years, information has been updated and tests have been repeated.
The study has found, for example, that residents who smoke or have
high blood pressure or high cholesterol are more likely to develop heart
disease than nonsmokers or those who have normal blood pressure and
Copyright © 2008. University of California Press. All rights reserved.

cholesterol. Though cohort studies are considered more definitive than

case-control studies, they too have potential drawbacks. Among other
things, keeping track of thousands or tens of thousands of people for
many years is a huge challenge, and if enough subjects fall off the radar,
it can skew the results.

In contrast to observational investigations, other types of studies involve

an intervention by the researcher:

Randomized clinical trials. In these studies, individuals are randomly

assigned to receive either the factor being tested (the experimental
group) or a fake look-alike called a placebo (the control group). Typi-
cally, neither subjects nor researchers know who has been assigned to

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 28 SAYS WH O?

which group—a practice known as double-blinding. The two groups

are then followed for a period of time (sometimes many years) to deter-
mine whether they fare differently. Randomized clinical trials can
confirm or refute associations revealed by observational studies and pro-
vide proof of a cause-and-effect relationship. But even randomized tri-
als aren’t foolproof; a flawed study design can produce flawed results.
What’s more, clinical trials generally are not appropriate for confirming
suspected risks, as intentionally exposing people to potential harm would
be unethical.
Short-term human studies. Like large clinical trials, these studies may
have randomly assigned placebo and control groups. They typically
include relatively small numbers of subjects who are exposed to the fac-
tor in question. After hours, days, or months, researchers measure some
marker, such as the level of a particular substance in the blood, to deter-
mine the factor’s physiological effects. Many foods and dietary supple-
ments believed to confer health benefits are tested this way. While such
research can be valuable by providing hints of an effect on disease, the
evidence is generally considered preliminary. That’s because demon-
strating a short-term change in blood chemistry, for example, is a far cry
from showing a change in subjects’ rates of disease.
Laboratory research. Studies conducted on animals or on human cells and
Copyright © 2008. University of California Press. All rights reserved.

tissues (so-called test-tube research) can help establish hypotheses about

possible risks or benefits that require further investigation in human tri-
als. They can also help corroborate epidemiological findings by provid-
ing a biological explanation. What’s more, lab research can come in
handy when human studies aren’t possible or ethical. Its main advantage
is that researchers can control exactly what happens, eliminating the
impact of extraneous factors that so often plague human experiments. Its
disadvantage is that such research may have limited relevance to human
beings in the real world. A laboratory rat is not a person, after all, and
what causes disease in one may not do so in the other.

In general, here’s how the different types of studies rank in terms of the
credibility of evidence they produce:

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 SAYS WH O? 29

Test-tube research Least credible

Animal studies
Population studies
Short-term human experiments
Case-control studies
Cohort studies
Randomized clinical trials Most credible

2. HOW BIG IS THE EFFECT?

Generally, the larger the effect, the more believable it is. In observational
studies, an association (typically expressed as a “relative risk”) that’s strong
is less likely than a weak one to be influenced by confounding factors. For
example, male smokers are 23 times more likely than male nonsmokers to
die from lung cancer. This relative risk of 23 is so large that no extraneous
factor can probably account for it. But the same can’t be said for the asso-
ciation between breast cancer and alcohol consumption among women.
According to one study, the relative risk of breast cancer among post-
menopausal women who drink is 1.3—that is, they have a 30 percent
greater risk than nondrinkers. (A relative risk of 1.0 means no increase in
risk, a relative risk of 2.0 equals a 100 percent greater risk, a relative risk of
3.0 translates into a 200 percent greater risk, and so forth.) That relative risk
Copyright © 2008. University of California Press. All rights reserved.

of 1.3 is so small that it could be partly or completely due to confounders.

Broadly speaking, many epidemiologists consider any increase in relative
risk under 3 to be relatively small and worthy of extra skepticism, especially
if the finding has not been corroborated by other studies.
In addition to knowing the relative increase (or decrease), it’s crucial to
find out the absolute difference in risk. For example, let’s assume that peo-
ple exposed to substance X have triple the risk of contracting disease Y. At
first glance, this may seem scary. But if you also learn that the prevalence of
this particular disease is one in a million among unexposed people and
three in a million among those who were exposed, there’s less reason for
concern: the absolute increase in risk is just two cases per million, or .0002
percent. It’s an illustration of how the relative risk, viewed in isolation with-
out the absolute numbers, can be highly misleading.

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 30 SAYS WH O?

3. COULD THE FINDINGS BE A FLUKE?

Researchers try to determine the validity of their findings through measures
of statistical significance—an often-misunderstood concept. In research,
the term “significance” doesn’t denote importance or size, as it does in
everyday use; instead, it refers to the role of chance. When results are sta-
tistically significant, there’s only a very small probability—typically less
than 5 percent—that the findings are a fluke. While this provides some
assurance that the outcome was not due to chance, it doesn’t rule out the
possibility completely, nor does it address whether confounders or other
problems may have skewed the results.

4. WHO WAS STUDIED?

To figure out whether findings might apply to you, it’s important to con-
sider who was studied. Researchers often study homogeneous populations
in order to minimize the possible role of confounding factors. But what’s
true for healthy college students or middle-aged white men or post-
menopausal women may not be so for others. It’s therefore important to be
careful in extrapolating findings from one group to another.

5. IS THERE A GOOD EXPLANATION?

Findings from observational studies are more credible if there’s a known (or
at least plausible) biological explanation for them. When studies yield
Copyright © 2008. University of California Press. All rights reserved.

findings that don’t make sense biologically, they should be interpreted with
great caution, especially when the association is weak and therefore possi-
bly the result of confounding factors.

6. WHO PAID FOR THE RESEARCH?

Many studies are funded by organizations with a vested interest in the out-
come, such as drug companies, food producers, dietary supplement manu-
facturers, or consumer activists. Such sponsorship doesn’t necessarily ren-
der the findings invalid, but it does raise the possibility that the study’s
methods or conclusions were either directly or indirectly influenced by the
funder’s agenda. Research supported by more neutral entities such as the
Centers for Disease Control and Prevention or the National Institutes of
Health is therefore sometimes considered more credible.

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 SAYS WH O? 31

7. WAS IT PEER REVIEWED?

To determine whether a research paper is worthy of publication, most jour-
nals—though not all—subject it to the scrutiny of outside experts, who dis-
sect the methodology and the author’s interpretations. Although this process
by no means guarantees that a study is flawless (plenty of questionable ones
make it through peer review), it does add an extra layer of credibility. Studies
are sometimes presented at scientific conferences—and cited by media
reports and health promoters—before full peer review and publication.
Because many such studies end up never making the cut and getting pub-
lished, they deserve to be taken less seriously than thoroughly peer-reviewed
research. The same goes for industry-conducted research that’s shielded
from outside evaluation.

8. HOW DOES IT SQUARE WITH OTHER STUDIES?

This is perhaps the most crucial question. Rarely is any study, by itself,
definitive. Instead, each is a piece of a puzzle. Only when a sufficient num-
ber of pieces have been assembled does a clear picture emerge. That’s why
interpreting a study requires knowing how it fits with others that came
before it. How does it add to what’s already known? Is it consistent with
previous findings? If it conflicts, why? To get to the truth, it’s necessary to
examine the research as a whole—what scientists call the totality of the evi-
dence. Viewing a study in isolation, like seeing just one piece of a puzzle,
Copyright © 2008. University of California Press. All rights reserved.

can give an erroneous impression.

SHADES OF GRAY
Getting answers to these eight questions can go a long way toward helping
you determine the credibility and relevance of a health claim. But it’s not as
simple as plugging your responses into a formula and calculating the final
answer. Figuring out what to make of a study—or a series of studies—and
how to respond is still a judgment call. For most issues, we don’t have large,
randomized clinical trials that provide incontrovertible evidence, so we have
to make decisions based on something less. Part of being a healthy skeptic
is understanding that studies, when honestly interpreted, don’t always pro-
duce the definitive “yes or no” answers we’d like.

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 32 SAYS WH O?

This can certainly be frustrating. Throughout this book, you’ll repeat-

edly encounter less than conclusive statements such as “studies suggest” this
or “there’s little evidence” of that. You’ll also see references to areas of
research in which some studies show one thing, while others show the
opposite—the classic “coffee is bad for you . . . wait, it’s good . . . no, it’s
bad” flip-flops we so often encounter. If you’re tempted to respond by
throwing up your hands and saying, “I give up,” remember that changing
how you think about health information, which is necessary to becoming a
healthy skeptic, takes time and patience. Rather than demanding black and
white answers, we have to learn to live with, and distinguish among, vari-
ous shades of gray.
How much gray is acceptable can differ depending on the issue and the
individual. For example, to justify taking preventive medication such as
hormone replacement therapy, a healthy woman might rightly look for
ironclad evidence of considerable benefits that greatly outweigh any risks.
But when faced with a potential hazard, she may have a somewhat lower
burden of proof, opting to act before there’s an absolutely airtight case.
After all, no one wants to repeat the mistake of those (including some doc-
tors) who for years refused to accept that smoking caused cancer because it
hadn’t been definitively proven. Whatever the circumstance, however, a
healthy skeptic doesn’t jump to premature conclusions based on evidence
that’s preliminary, weak, or nonexistent.
Copyright © 2008. University of California Press. All rights reserved.

Recognizing that most people don’t like ambiguity, health promoters

sometimes give us simplistic pronouncements—“blueberries fight cancer,”
“high cholesterol is a killer,” “this test will save your life”—that don’t con-
vey the full truth. Instead of balanced assessments of science, which is what
we need to make informed decisions, we get dogmatic decrees.
When we unquestioningly accept such advice, we’re hardly more en-
lightened (despite our illusions to the contrary) than previous generations
who didn’t have the benefit of research. If we’re told that walnuts will ward
off illness, and we believe it without really understanding the evidence, are
we any more savvy than the followers of Sylvester Graham who put their
faith in whole flour simply because he (or God) told them to? If we believe
that cosmetics will give us cancer without scrutinizing the scientific basis for

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 SAYS WH O? 33

such a claim, are we much different from the disciples of John Harvey
Kellogg who believed, based on his assurances, that sex would do them in?
By giving us the unprecedented ability to separate beliefs from facts, sci-
entific research represents the best hope we have—and have ever had—for
determining what really helps and harms our health. It can make us smarter
than our ancestors, but only if we, as healthy skeptics, put it to proper use.

TRUSTWORTHY SOURCES OF INFORMATION

PubMed (www.pubmed.gov), a service of the U.S National Library of
Medicine. PubMed allows you to search for just about any pub-
lished health or medical article according to topic, author, or journal.
You can get abstracts, and in some cases entire articles, free of
charge.
The Cochrane Collaboration (www.cochrane.org). A highly respected
organization that reviews and summarizes evidence on a variety of
health issues.
Health News Review (www.healthnewsreview.org). This award-winning
Web site evaluates the accuracy, balance, and completeness of
news reports about research findings.
Know Your Chances: Understanding Health Statistics, by Steven
Copyright © 2008. University of California Press. All rights reserved.

Woloshin, Lisa Schwartz, and H. Gilbert Welch (Berkeley: Univer-

sity of California Press, 2008). This is an informative, easy-to-
understand guide on interpreting information about health risks and
benefits.
Quackwatch (www.quackwatch.org), a group whose mission is to “com-
bat health-related frauds, myths, fads, fallacies, and misconduct.” Its
Web site includes detailed analyses of numerous questionable
claims.

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 Copyright © 2008. University of California Press. All rights reserved.

© 2004 Randy Glasbergen, www.glasbergen.com

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 CHAPTER TWO: THE NEWS MEDIA
EAT THIS!

f all the reasons I decided to become a health journalist, being pop-

O ular at parties was not among them. It never dawned on me that

immersing myself in topics such as the latest remedies for hemor-
rhoids or the chief causes of foot fungus would endear me to
strangers. Yet I’ve found, much to my surprise, that it often does. As
soon as people learn what I do for a living, they frequently corner me and
start firing away with questions about some health-related issue. And by far
the most common issue is nutrition.
Copyright © 2008. University of California Press. All rights reserved.

Whether the questioners are strangers, friends, relatives, or readers, they

usually want to know which foods are bad for them, which are good, and
which they should be eating more regularly. One friend went so far as to ask
me via e-mail to list the ten most healthful foods so he could stock up on
them. When I replied that instead of fixating on particular foods, he would
be better off focusing on his overall diet and exercising, he wasn’t satisfied.
“Why not try to create a personal diet that includes foods that studies show
best promote health?” he replied. “Every little bit helps.”
This friend is no fool; he’s one of the smartest people I know. Yet, like
many others, he’s fallen for what I call the superfood fallacy: the unproven
notion that specific foods, in isolation, have the power to head off heart
disease, cancer, and other conditions. While the appeal of this idea is
evident—who can resist the allure of a life-prolonging bowl of berries,
after all?—the way it’s being peddled isn’t always so obvious. The food

35

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
 36 TH E N EWS M ED IA

industry, using science and the news media in sophisticated behind-the-

scenes marketing efforts, is successfully spinning us, and in many cases we
don’t even realize it. The U.S. Food and Drug Administration (FDA),
which regulates food claims on labels, is of only limited help in keeping
companies honest. It’s no surprise, then, that even the most astute among
us can be sold on the power of superfoods.

SCIENCE MEETS MARKETING

The relationship between food and health is notoriously complex and
difficult to study. Yet multiple studies over several decades have produced
fairly solid evidence that certain broad categories of foods, including fruits,
vegetables, whole grains, fish, and legumes, may be beneficial.
In recent years, there’s been an explosion of research on particular sub-
stances in these and other foods—everything from alpha-linolenic acid to
zeaxanthin—that might account for the foods’ healthfulness. Though this
line of inquiry is interesting scientifically, it’s still by and large in its infancy.
Because foods contain multiple nutrients, which may interact with one
another and with other foods to affect our bodies in myriad ways, teasing
out the precise effects of a single constituent in one food is tricky business,
to say the least. Consequently, the research is not easily translated (at least
responsibly so) into specific dietary recommendations. But that hasn’t
Copyright © 2008. University of California Press. All rights reserved.

stopped the food industry from using it to promote the idea that so-called
superfoods contain magical ingredients capable of warding off illness.
Take, for example, tomatoes. They and their derivatives, such as
tomato juice, spaghetti sauce, and ketchup, have been touted by industry
as disease fighters because they contain lycopene, an antioxidant that some
research has linked to lower rates of prostate and other cancers. (Anti-
oxidants are substances thought to fight free radicals, which can damage
cells and thereby cause disease.) Not to be outdone, watermelon growers
have promoted their fruit as the “lycopene leader,” pointing out that
watermelon contains more lycopene than tomatoes. Never mind that the
evidence on lycopene and cancer is far from conclusive—not all studies
have found a link—and no one knows for certain how much lycopene, if
any, is beneficial.

The Healthy Skeptic : Cutting Through the Hype about Your Health, University of California Press, 2008.
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