This article originally appeared on MedPage Today and was written by Andrea Love, PhD, and Katie Suleta, DHSc, MPH, MS. The original version can be found here.
Healthcare is typically defined by three areas: prevention, diagnosis, and treatments. As a physician, your goal is to recommend science-based practices to prevent adverse health events, like heart attacks and infectious diseases. You expect that the tests you order have been scientifically validated and assess real problems. You prescribe and recommend science-based treatments that will help to stabilize or cure your patient's condition(s).
For all the credentialed and trained healthcare experts operating within the confines of evidence-based healthcare, there are practitioners in the wellness world operating in parallel without training or education. For every medication that's undergone clinical trials for safety and efficacy, multiple supplements haven't, yet claim to treat the same symptoms. For every preventive health recommendation, there is a detox or enema claiming to accomplish the same goal.
The wellness industry is blurring the lines of what healthcare is, and it's confusing patients and providers alike.
Health and Wellness Technology
Healthcare technology is rapidly advancing, which changes where healthcare happens. Today, FDA-approved tests are available over the counter for HIV, chlamydia, SARS-CoV-2 (COVID-19), and more. Now, there's an app for prescriptions for contraception and antidepressants, which previously required in-office appointments. Medical advice can now be provided via telehealth, allowing providers to see more patients with limited resources.
Technology has improved the ability to manage certain conditions with convenience.
Unfortunately, pseudoscience rides the coattails of some of that technology. The $5.6 trillion global wellness industry also responds to patient complaints and desires. While the wellness industry has brought attention to the multi-dimensionality of health and well-being, it has a more nefarious side too. Wellness companies use the same strategies as evidence-based medicine to sell tests for diseases that don't exist and treatments that don't work, recommended by individuals who aren't qualified.
As a provider, your guidance should be informed by rigorous scientific research. You expect performance to be better than a placebo. You expect to see peer-reviewed papers and results from clinical trials. The wellness market does not operate under these constraints or adhere to safety standards. Under the guise of "prevention" and "root cause treatment," unsupported and potentially dangerous claims can be made without evidence.
This market, which patients and providers are eagerly exploring, has exploded in recent decades as a result of: increased attention toward overall health; the deregulation of dietary supplements; aggressive marketing campaigns by prominent celebrities; and a concerted effort to erode trust in evidence-based medicine. If you can convince your customers that "conventional medicine" doesn't have their best interests in mind, then it's that much easier to sell them on unproven products. Even better? If your customers are providers who will plug your product to their patients.
Scientific knowledge about health and its translation into medical interventions accrues over time. We don't have every answer to everything, and it can be frustrating to feel like you can't provide the care your patients want or need. But acknowledging those limitations isn't a weakness; it's a fundamental part of the scientific method. Wellness companies claim they're offering solutions that "conventional medicine" is ignoring, but that sometimes translates into exploiting providers and patients: patient vulnerabilities, frustrations, and confusion; and provider compassion and lack of time.
Health and Diagnostic Tests
Providers know that when assessing a patient's symptoms and running down a differential, certain tests are warranted to help identify the underlying causes and address them using evidence-based modalities. Under the guise of giving providers more options for patient care, companies offer a myriad of tests that might sound scientific but lack data to support their use.
Tests run the gamut. These days, you can purchase tests that claim to diagnose pseudoscience conditions like leaky gut syndrome and adrenal fatigue. Other tests claim to give insights about longevity like metabolic health, genetic panels, and inflammation markers. Wellness companies in partnership with commercial laboratories even offer tests for medical issues that are real, but the tests use unvalidated methods like urine tests for Lyme disease.
The lines may become more blurred for providers who might not be familiar with regulatory jargon when companies add verbiage to augment the perceived legitimacy of unapproved tests.
For example, the phrase "Clinical Laboratory Improvement Amendments (CLIA)-certified" is often used to make direct-to-consumer tests seem equivalent to FDA-approved diagnostics, but they are not one and the same. CLIA certification merely attests that the laboratory processing clinical samples adheres to specific laboratory procedures. CLIA means nothing about the test being run.
FDA approval of a clinical diagnostic test involves extensive testing, validation, clinical data, rigorous controls, and regulatory and quality oversight in the test methods, manufacturing, and administration. If a company is selling a test that isn't explicitly FDA-approved, it means the results have not been proven to be accurate.
Treatments and Supplements
Passed under the guise of medical freedom (and going hand in hand with the ongoing anti-vaccine movement), the 1994 Dietary Supplement Health and Education Act opened the floodgates to a lucrative market of unregulated dietary supplements. As a result, the shelves overflow with products claiming to boost patient immunity, balance hormones, slow aging, increase brain health, heal the gut, increase metabolism, improve sexual function, and more.
Companies bulk up the perceived legitimacy of these products with buzzy phrases like "science backed" which sound like there might be clinical data, but often refer to Petri dish or animal studies on an isolated ingredient.
When you aren't bound by the regulations and laws of scientific oversight and government agencies, the jargon world is your oyster. Unfortunately, dietary supplements are not as benign as many people have been led to believe. Without the requirement of testing for safety, quality, and efficacy, many supplements are not only ineffective, but potentially harmful.
How to Protect Yourself and Your Patients
The wellness industry has a recipe for success: manufacture health issues, offer tests to diagnose them, and sell unproven and untested treatments to treat them. As clinicians, you can help navigate the deluge of wellness products with empathy while upholding scientific integrity.
- Educate your patients on the differences between claims and data. Science literacy improves health outcomes, and you have a critical role to play.
- Review the evidence on products. We know you're busy, but there's no better way to evaluate them. Definitely don't recommend products you haven't looked into.
- Assess conflicts of interest. Are there profit motives for promoting these products?
- Evaluate the plausibility of claims. While there might be gaps in knowledge for a specific medical condition, it's unlikely we know nothing. Compare the current knowledge with claims being made. Do they align? If not, that should be a red flag.
- Remember that the nefarious parts of the wellness industry prey on people's vulnerabilities. Compassion and active listening go a long way.
Technology is changing where, when, and how healthcare is accessed. But as always, progress is a double-edged sword. The wellness industry leverages the same technology to develop products and services that exploit our desire to take charge of our health. Unfortunately, clever yet unfounded claims can mislead patients and colleagues toward using interventions that might cause more harm than good.
Providers play a critical role in combating the proliferation of pseudoscience to help keep healthcare operating in sound scientific spaces with efficacious prevention techniques, diagnostics, and treatments.
Andrea Love, PhD, is an immunologist and microbiologist with expertise in infectious diseases, cancer, and autoimmunity. She works full-time in life sciences biotech, is the founder of ImmunoLogic, the executive director of the American Lyme Disease Foundation, and writes a monthly column for Skeptical Inquirer.
Katie Suleta, DHSc, MPH, MS is a trained epidemiologist with a background in infectious diseases and health informatics. She works as a regional director of research in graduate medical education for HCA Healthcare, and is a writer for the American Council on Science and Health.
