Nearly the entire popular health industry—and especially its trendiest parts—is charlatanism. This includes perhaps 95% of its major figures. This is because it relies on the extrapolation from cell culture, animal, epidemiological, and other weak forms of evidence to make suggestions and recommendations about what is healthy, produces longevity, weight loss, etc. This is a method that belongs to the 19th century; it has been shown to be demonstrably invalid by the end of the 20th. It is not scientific and is demonstrably useless or harmful to those drawn in by the pseudoscientific fairytales that result.
We talk here of Peter Attia and Rhonda Patrick; and this is equally true for Michael Greger as it is for Paul Saladino; for David Sinclair as for Ben Greenfield. This list includes almost every single prominent popular health guru for the past several decades. When it comes to the recommendations, all of these figures follow the same speculative method, which is unreliable, wrong, and wastes untold precious time and money. It also kills people whose lives lost will never be recognized as such, in what amounts to mass malpractice.
There are literally limitless positions and recommendations one can generate through selective and creative interpretation of the scientific literature. This is why many of the health gurus seem to disagree with each other: they are each selectively and creatively interpreting the scientific literature in different and conflicting ways. If one can selectively and creatively interpret the scientific literature in infinitely different ways, then this is clearly not science—even when it sounds and looks like science. That this is not science should be obvious to anyone who reflects on this for just a brief moment.
To the untrained eye, the highly plausible-looking health science stories constructed by these figures “make obvious sense” once they are explained over a podcast or blog post. And they are either thought to be so cutting edge that the medical establishment has not yet caught up to them, or so effective that the medical establishment suppresses them for fear of losing business. They are none of these. They are pure invention.
We know this from the published literature. Scientists test highly promising scientific stories that are supported by cell culture studies, animal studies, epidemiological studies, biomarker studies in humans, etc. all the time. These tests are called clinical trials. And we know what proportion of clinical trials succeed and what proportion fail.
Between 2000 and 2015, 86% of all promising drugs failed during clinical trials and 97% of cancer drugs, making for a success rate of 14% and 3%, respectively.
Just 14% of drugs with a compelling case from cell culture, animal, epidemiological, human biomarker, etc. studies are shown to be effective and not harmful. Just 14% of drugs brought to clinical trial after sometimes decades of scientific work, sometimes the culmination of an entire scientist’s career. These are not the mental inventions of guru on the Internet with just a few years of medical school and/or a failed surgery residency or unproductive post-doctoral fellowship, who decided to trawl pubmed and come up with some “amazing new idea” to peddle on podcasts. No, these are the carefully crafted hypotheses supported by the work of dozens of highly specialized and serious scientists. Of which only 14% succeed. And to repeat, that number in cancer: just 3%. THREE PERCENT.
What is the likelihood that the pet hypothesis of a random health guru on the Internet is likely to be right? Is it likely to outstrip those of professional scientists? If so, by how much?
Let uss look at some more data. In a study published in 2003, 101 promising basic science discoveries (from cell culture, animal studies, etc.) published in the most prestigious journals were followed for between 20-24 years, to see if such promising basic science findings predicted similar promise in actual clinical practice. Of these discoveries, only 19 (fewer than 1-in-5) led to a positive clinical trial result, while only 5 become licensed for clinical use, and only 1 became an extensively used therapy commensurate with the promise originally. That is, fewer than 1% of promising findings in the world’s top journals actually translated into clinical care.
At less than 1% of promising findings actually translating, what do you think the odds are that your favorite diet guru in his basement is likely to be promoting a basic science finding with actual relevance to human health?
Let’s look at a similar, more recent study. The authors write: “We searched PubMed for articles that include the search term “cancer” in the title or abstract along with: “highly promising”, “groundbreaking”, “landmark”, or “breakthrough”, which were published between 1999 and 2009.”
What kind of clinical translation was there for such articles? With a median follow-up of 15 years, fewer than 1-in-5 “groundbreaking discoveries” had become an FDA-approved cancer therapy. If such discoveries published in the world’s most hallowed and respected journals are not readily translating into actual therapies, what are the odds that your neighborhood diet guru is doing a significantly better job? Not good—especially when many of the ideas of such gurus have already been contradicted by the very clinical trials that were organized to test such ideas. (Hello Gary Taubes, Peter Attia, and NuSI.)
Let’s take the gold standard: actual medical practice. In one study published in 2011 examining all randomized controlled trials examining established medical practice published in the New England Journal of Medicine, 46% (16 of 35) of such practices were shown to be ineffective by the gold standard of clinical. In another study published by the same group in 2013, this time examining all articles in the NEJM published from 2001 to 2010, 40% (146 of 363) of randomized controlled trials examining standard of care treatments were shown to be ineffective.
If 40% of established clinical practices turn out to be ineffective, surely the rate is even higher for practices that are not established. That is, the rate is likely closer to 1-20%, or the rate at which new basic science findings pass through clinical trials to become new treatments. If this is so, then the fad du jour promoted by leading health gurus is almost overwhelmingly likely to be ineffective and/or harmful compared to a well-designed control group.
This is why the popular health industry, which thrives on promoting such interventions, should be regulated and made largely or entirely illegal: most treatments are, empirically speaking, either ineffective and/or harmful. In the meantime, we should spread awareness and do everything within our power to educate the public on the likelihood that what they are desperate to believe works for health is in fact statistically highly likely to prove of no greater benefit, and of greater harm, and at greater cost, as the snake oil of ye olde.
In future discussions building from this one, we will discuss examples—from supplementation and cancer prevention to orthopedics and psychology—that are highly relevant to the currently prevalent fads being peddled without evidence, to the detriment of the physical and financial wellbeing of those who have been swindled.