[UPBEAT MUSIC]
Shumita Basu, Narrating: Hi there. For this last episode of 2022, we're throwing it back to our archives. This is from our series "Think Again," which first ran over the summer. It was all about re-thinking old ideas about our relationships, work, personal lives, and exploring new ones. If you're considering a new year's resolution about your health, this episode is for you. I hope you enjoy it.
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Basu, Narrating: This is "In Conversation" from Apple News. I'm Shumita Basu. Today, how to navigate wellness culture and decode junky health science.
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[INQUISITIVE MUSIC]
Basu, Narrating: A few weeks ago, an article was circulating online. Maybe you saw it on social media. It was about a health study done in London that claimed a ban on junk food advertising led to almost 100,000 fewer people becoming obese, and that it could end up saving Britain's National Health Service 200 million pounds.
Aubrey Gordon: Uh, [LAUGHS] what? I don't know that you can prove that there were 100,000 people who were going to become fat and because you took down these billboards, they're not fat.
Basu, Narrating: Now, when you think about it, it doesn't really make sense, does it?
Gordon: That is, like, a long chain of events that you gotta go, Okay, they were gonna see the billboards. How do we prove that they were gonna buy the thing? How do we prove that the thing was gonna make them fat? How do we prove that there were a hundred thousand of the people who were gonna see the thing, buy the thing, and it was gonna make them fat? There is sort of so much missing from that line of logic.
Basu, Narrating: The person that you're hearing debunk this study is Aubrey Gordon. She spends a lot of time doing this exact thing on the podcast "Maintenance Phase" with her co-host, Michael Hobbes.
Michael Hobbes: Every week there's gonna be some new study and it's gonna show something surprising, and the findings that are a little bit against what you thought you believed, those generate clicks, and the most important lesson is to try to zoom out from those studies and try to look at how they fit into the bigger picture.
Basu, Narrating: On the show, Aubrey and Michael sift through studies and fads, and they try to figure out what's sound science and what's just junk, and they've made some pretty surprising discoveries along the way…
Gordon: Like snake oil actually works.
Basu, Narrating: And that Kombucha might taste good but…
Gordon: Not a lot of evidence that it hurts, but also not a lot of evidence that it helps.
Basu, Narrating: And that celery juice, well…
Gordon: [LAUGHS] No. Just no. My answer to that is absolutely not.
[MICHAEL BLOWS RASPBERRY]
Basu, Narrating: For this episode in our "Think Again" series, all about how to re-imagine work, home, relationships and more, I sat down with Michael and Aubrey to talk about re-imagining our relationship to health. We spoke about what happens when health information is delivered to us like we're consumers, instead of just people, and how we can be smarter about deciphering headlines and studies.
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Basu: I will say one of the joys of listening to the show is that you two are… How do I put this? You're, like, methodology enthusiasts, to put it mildly. I find it so entertaining the way that you talk about and pick apart, you know, studies and stats, and maybe you can share with us some of your favorite tips for spotting red flags in things like this, in studies, in news articles, health science news.
[AUBREY AND MICHAEL LAUGH]
Gordon: One of the big ones that we've talked about on the show is-- a favorite of health and wellness journalism is to make an absolutely wild claim and then put a question mark in the headline about it. [LAUGHS]
Basu: Ooh.
Gordon: So, like-- [LAUGHS] So, famously, there was a diet drug in the nineties called Fen-Phen. It was a combination of existing drugs. It was pulled from the market because it caused heart problems and filled people's lungs with fluid, and people just died doing this diet drug, right? There was a huge cover story and the headline was "The new miracle drug?" Where you're like, No, it's, like, killing people. Don't-- It's-- And in the article, they address it and they say, Well, it could be really risky and really dangerous, but if it makes you thin, it's probably worth it.
Basu: Oh, my goodness.
Gordon: Like, fully just in the article, right? Like, so I would say question marks in headlines, ooh, real red flag.
Hobbes: Yeah, you can say anything if you put a question mark after it.
Hobbes: I would also say anytime you hear the term "self-reported" is usually a big red flag. One thing that-- This is one of the ones that, like, we knew it was bad, but we didn't know it was this bad, that any studies that you read, again, something like people who drink coffee in the mornings are 6% less likely to get prostate cancer, whatever it is, all of those studies, essentially, are based on something called food frequency questionnaires, which is a multiple-choice test that you take, and oftentimes it has hundreds of items, and it's like "How often do you eat tomatoes? Sometimes, never, often, every day," right? And "How often do you eat chocolate?" "How often do you drink coffee?" and everything else. But the problem with those things is, like, if you actually try to think it through, it's like, Well, wait a minute, how often do I eat tomatoes? Like, I just don't know. And there's-- It's actually really hard to test how much people are eating of things because none of us are very good at remembering. And so when you speak to scientists, they're like, Oh, we're just kind of feeling around in the dark. We're getting a couple little associations, it might lead somewhere sometime. But then when you talk to people, they're like, Oh, my God, I have to eat blueberries now. And it's like, that's not really what experts are saying.
Basu: Yeah. Yeah. What do you two understand about the origin story behind all of these studies? I guess I'm curious to know, you know, like, who's doing them? Who's funding them? Who is stripping the nuance from them? Is it unintentionally leading to bad consequences or intentionally leading to bad consequences?
Hobbes: I think that malign intentions are fairly rare. I think there's much less, like, twiddling mustache, brown envelopes full of cash being handed from Coca-Cola to public health schools. I don't think that kind of thing really happens, or at least it doesn't happen in that form. I think most people are acting from a good place and a place of wanting to help. But I think that oftentimes that version of wanting to help leads people to jump to conclusions, like, a little bit too fast, right, and to kind of cut a few corners and to turn off a little bit of their critical faculties. And when you just sort of lubricate the jumping of conclusions, like, ten times down the line from researchers to media to food companies to whoever, by the time it gets to the general public, we're getting this very simplified and oftentimes borderline misinformation view of what we can and can't say with confidence about health. And so I think when it comes to these studies and the kinds of things that were being sold by, you know, food companies and fitness companies and all this kind of stuff, I think there is, like, there's a profit motive behind a lot of this stuff. And something that we confront on the show a lot is that a lot of what Americans think we know about health and wellness actually comes from marketing. Like, most of what you know about electrolytes and hydration probably came from a Gatorade ad.
Gordon: I think the other thing to know here is that there is, like, in addition to those profit motives, right-- We talked at one point about Weight Watchers International is owned by a Belgian sugar baron. [LAUGHS] Oh, I wish I was kidding! I wish I was kidding.
[MICHAEL LAUGHS]
Gordon: So there are definitely people also who have bad motives or who are only in this for profit, right, and who are not sort of in it for your health. I mean, I think the other thing to flag here is that, you know, over the last few years, we've had some really interesting sort of political conversations about misinformation and disinformation and how that flows. And I think quite a bit of health and wellness information that we get is through one giant game of telephone, [LAUGHS] right, so that by the time you hear it from your friend, it has been through 18 different permutations and has sort of, you know, gotten escalated in all these wild ways, and it's, like, not particularly accurate anymore, if it ever was. I mean, I think we found some polling when we talked about celery juice, which was sort of a craze that was started by a guy who considers himself to be a medium-- psychic medium who's working with a spirit from the future to give him health information…
Basu: So, in other words, a medical doctor.
[MICHAEL LAUGHS]
Gordon: Absolutely! Accredited, trustworthy, nothing but the best. But most people who drank celery juice regularly thought it was a recommendation from a doctor, right? That folks were not really tracing that origin story. So we sort of get these disembodied little factoids, and that all seems really worth picking apart.
[MYSTERIOUS MUSIC]
Basu, Narrating: Okay. So far, Aubrey and Michael have identified at least three things we can do to be smarter about spotting junk science when it comes to our health. One, question the headlines that you see in the media. Two, be skeptical of studies that are based on self-reported data, like what you eat. And three, if you hear a health claim second or third hand, go find out its origin story to see if it came from a reputable source in the first place. Now, fourth, and this is a big one, challenge the old script about what it means to be fat, because that sets the tone for a lot of health-speak.
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Hobbes: Well, I feel very strongly that there's two things that people need to know about this. I would say the less important thing is that the health impacts of fatness are less clear cut than you think they are. The more important thing is that it doesn't matter. People are being mistreated, people are being treated horribly in society. You don't actually care about people's statistical mortality risk when you decide how to treat them on, like, a person-to-person level. And nobody would actually say, in, like, a zoomed-out way, that people with worse health should get worse treatment by the medical system. Like "I want them to be treated terribly by doctors if they're in poor health," right? Like, that doesn't make any sense.
Gordon: I don't know, you guys. I want my healthcare going to the people who need it the least. [LAUGHS] I don't know about you guys, I want it going to people who have never needed to see a doctor.
[MICHAEL AND SHUMITA LAUGH]
Hobbes: Yeah, I think show your six pack before you go to the doctor, only then will you get seen.
[SHUMITA AND AUBREY LAUGH]
Gordon: So, I would say all of that is true, and I would also say that the levels of bias that fat people experience in trying to access healthcare are through the roof. The number of stories that we have seen from fat people who sought out medical attention often for years, five, eight, ten, 15 years of trying to get healthcare, and what they get from healthcare providers is "Come back when you lose weight," "It's probably because of your weight," and then only years later find out that they had a massive tumor that was cancerous, right? Or that they had some chronic health condition that was going untreated and has worsened significantly in that time. But when we talk about fat people and health, culturally, we draw a straight line from your body to your health outcomes, and we don't look at any of the stops along the way of: what happens when you try to get healthcare? Well, a lot of fat people feel super ignored or judged, some fat people are refused care by healthcare providers. That happened to me at one point. I saw a healthcare provider who refused to touch me, and I will absolutely never forget it. That if we're not also talking about the astronomical levels of bias that exist amongst healthcare providers, that appear also to be strengthened through their training in healthcare systems, then we are doing ourselves a real disservice, right?
Basu: Yeah. Yeah. I'll say another topic that you frequently return to on the podcast is dieting. All kinds of diets. Diet culture at large. I think that the question a lot of people have, which feel free to tell me this is the wrong question, is: how do I understand whether this diet is for me? So, how would you respond to that?
Gordon: [LAUGHS MANIACALLY] Uh, one, do you have a history of eating disorders?
Gordon: Then two, the answer is no diet is for you, please stop. Oh, please stop. That's step one. That's my first one. I will say most people diet-- Sometimes people diet to solve, like, gut issues or to address specific health issues that they're facing. Many, many, many people diet to lose weight. It is worth knowing that time and time and time again, meta studies and sort of the largest-scale research that we have, shows that there is not a diet that leads to long-term sustained weight loss. There are many, many, many diets that will lead to short-term weight loss and then long-term terrible self-esteem when you eventually regain weight, right? But it is worth knowing and starting from the assumption that a diet is not going to work and that they need to go above and beyond to show you that they will, and they probably can't, right? They probably can't.
Hobbes: I mean, one of the things I think-- kind of a stereotype about shows like ours and, kind of, people who are advocating for better treatment for fat people, you often hear that, like, Oh, they think it's fat-phobic to go on a diet, or like, They think it's fat-phobic to go to the gym or whatever. And like, I think something that we try to make a very clear delineation about on the show is that like, we don't really do a lot of scolding of people for their personal habits. I think it's a normal thing to do to go on a diet in January, it's a normal thing to do to make a New Year's resolution to lose ten pounds. We all swim in these waters as a culture, right? And so I'm not really here to, like, scold people for doing that stuff, but I also think that there's an industry that is basically set up to make the same promises to people and effectively lie to them about the results, and that is something that we're interested in criticizing. Like, you know, who has power in this situation, the person selling the diet or the person going on the diet? Study after study after study shows, regardless of the diet, regardless of-- This is something I've learned from Aubrey is that there's really only, like, four diets in the world, right? It's like-- There's the cut-out-all-calories. There's cut-out-a-food-group. There's eat-the-same-food-over-and-over-again. Liquid diets.
Gordon: Yeah. Low carb, low fat. There you go. The end. [LAUGHS]
Hobbes: And so we just end up, like, repeating them and I think the main thing, if I was pressed to give actual diet advice or, like, to give the kind of, you know, individual advice, I would say something that, like, anyone who promises you that you're gonna "kickstart your weight loss" or do, like-- do a weekend of only cabbage soup at the beginning, or do this thing where you just don't eat any carbohydrates for one month and then switch into the maintenance phase or whatever, all of those people are lying. [LAUGHS] There's no such thing as jumpstarting your weight loss, there's no such thing as kickstarting weight loss. You're gonna lose weight and then you're gonna gain it all back, and you're gonna feel really bad about yourself and it's gonna harm your metabolism. And this is the thing that happens to people over and over again and it's like, whatever someone is selling you, just skip right to the maintenance phase part, 'cause that's the actual diet. And whatever the crash diet start thing-- First of all, don't trust anybody who's telling you to do something unsustainable for a short period of time because it's a self-esteem nightmare, it's a lifestyle nightmare, just don't do it.
[PENSIVE MUSIC]
Basu: I'm gonna say the word that I don't think we've actually said yet until now, which is wellness. Like, the wellness industry. I feel like maybe that's what we're talking about when we say the profit makers, the bad actors, right? It's the things that fall under the capital-W wellness industry. It has become, as you obviously know, so, so lucrative. According to one estimate last year, the global wellness market was worth more than $1.5 trillion, and that's "trillion," with a "T."
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Hobbes: At least two thirds of that is Gwyneth.
[AUBREY LAUGHS]
Basu: [LAUGHS] Goop, yeah. The goop-ification, the celebrity-led marketing campaigns. What do people lose when they are spoken to as consumers instead of people with bodies who would like to be alive?
Hobbes: That's a bleak way to put it but good. [LAUGHS]
Gordon: That is a great, dark question. [LAUGHS]
Basu: Somehow thought it would be right up your alley.
Gordon: I think this is gonna get existential and darker, which is-- I mean, I think part of what you lose is a sense of, like, what is reliable information and what is not, right? Like, what is, you know, sort of hard-and-fast, proven, and replicated scientific knowledge and what is marketing, right? And you sort of, I think, lose contact with all of the social messages that come along with wellness world, right? Like, one of the most profound messages that we get from the wellness industry is that being healthy is a virtue and it's an earned virtue, which also invites astonishing levels of judgment aimed at disabled people, at chronically ill people, right, that sort of-- Consequently the assumption is then you must have done something wrong if you're sick or if you're disabled, which is really gnarly and dark, and is also something that gets leveled against fat people all the time, that most thin people look at me and see someone who has sort of wretchedly failed, right, rather than seeing me as a person who was always fat, which I always was. Uh-oh! It wasn't like I deviated from thinness at some point, I was a fat little kid and I'm a fat little adult.
Hobbes: A fat little lady.
Gordon: Fat little lady. [LAUGHS] And I think, like, we lose sight of the biases that replicates within us and the ways that we become messengers of bias and exclusion, rather than a welcome wagon, rather than-- sort of the ways that we see ourselves as, like, egalitarian, and kind, and compassionate, and all that sort of stuff. I think there are some very subtle and very unsubtle ways that the wellness industry really preys on our fear of disability and also preys on our-- the way that we've been culturally primed for bias against people who we don't think, quote-unquote, "look healthy."
Basu: Mm. Mm. I really like that answer. Really appreciate that answer.
Hobbes: I also think we're in the middle of a period of transition where we're still kind of getting used to what it means to be a society with the internet, and especially a society with social media. And one of the things that we've stumbled into on the show, and we really weren't expecting to, is the way that this health misinformation can be an on-ramp to much worse forms of misinformation. And so some of the rhetoric that we see in wellness, me and Aubrey have started to notice, is kind of a precursor to much darker things. So oftentimes, in these wellness spaces, you see messages like "What doctors don't want you to know," right? And then it's, like, various superfoods or something. Doctors are not trying to harm you. Public health people are not trying to harm you. This is a field that we criticize a lot and it's something-- People don't always get it right, these institutions don't always get it right, but the idea that we have these vast conspiracies of people that are withholding secrets from you that are gonna help you live longer and feel better and be thinner, it's just not true. And it seems like these wellness grifters, like, they inject these messages into your brain as a way to sell you something, like charge you eight bucks for some silly little supplement. And you can say, like, Whatever, a lot of this wellness stuff is like, yeah, you waste a couple bucks on some dumb supplement, like no big deal, right? But those messages kind of bounce around in your brain of, like, Well, what else don't they want me to know? And like, What other kind of networks of people are lying to me? And it gets really conspiratorial really fast. And so I would like everyone to just, like, take down the temperature of the messages that they're giving people of just, like, make health promises, whatever, but people are trying to sell you something with these, like, much darker messages underneath them, and those messages go to other places.
Basu: Hmm.
Gordon: Yeah. I mean, I think one of our clearest recent examples of that one was we did an episode on a TV chef from Australia who started talking about the paleo diet and then started sort of making these wild assertions that the modern diet, which is not paleo, is the reason that people are autistic, which sounds like, uh oh, we're getting into some creepy eugenics’ territory. So I went and read the original book that introduced the paleo diet to the world, which was written in the seventies, and it has long passages calling for more and better eugenics in the seventies, right?
Basu: [SIGHS] Grim.
Basu: Wow.
Gordon: So, like, I think part of what we lose when we're spoken to as consumers is we lose any kind of roots of, like, where does this come from? It comes from really gnarly, pretty bad places.
Basu: How do you, like, decide which companies are selling products that have real benefits and which companies are out to just get your wallet? Like, literally, I wanna know how you, Michael and Aubrey, go into a store and decide to, like, buy sunscreen or whatever. What are you thinking about?
Gordon: I would say on the sort of company's front, I just start from a place of assuming that the claims that they're making on their packaging or in their advertising are designed to maximize their profits, not to provide me with accurate health information, right? So just, like, start from a place of assuming that they're saying what sounds good and what will sell to you, not necessarily what is true or scientifically proven. And honestly, even if they offer, like, percentages. Like, skincare does this all the time. "71% saw improved elasticity and radiance" or whatever. Remember that that stuff is overwhelmingly paid for in-house, right, that they're conducting their own studies and, understandably, they're putting their best foot forward, which means their most sort of-- their boldest claims that are likeliest to make a sale. That's what I would say is my sort of primary lens on this kind of stuff, is start from the place of, like, you're walking onto a car lot, right? Like, you're walking into a car dealership. You're being hard-pitched the way you would be hard-pitched by a used car salesman. Start from that level of, like, skepticism, [LAUGHS] then work your way back to…
Basu: What an exhausting way to walk through the aisles! But yes, I understand what you're saying.
Gordon: Yes, it is totally exhausting. It's totally exhausting, no question. How about you, Mike?
Hobbes: I would say look at the claims that they're making, anything that is, like, "instantly" gonna do this. I think the word "toxins" is usually a red flag, unless they're defining specific toxins that they're dealing with. "Toxins" is just a word that gets thrown around a lot. "Natural" is a word that gets thrown around a lot. There's no statutory definition, which means any company can put it on any product. They can put it on laundry soap, they can put it on bleach if they want to, nobody's gonna tell them not to. So, those are both red flags for me. And also, in general, if you haven't heard of something-- like, if it's the new adaptalytic mushrooms from Nepal or something, it's like, What is that? Right? Things that are just, like, they sound new and cool and you're like "Ooh, that's exotic." But if you don't know what it is, that's probably a good sign that, like, maybe Google it or don't fall for it.
Basu: Yeah, yeah. I wonder if there's go-to sources that you two like to recommend to people for information?
Gordon: Yes. Yes, yes, yes. I would say my number one, if folks are trying to sort through something that's less of a product and more of a phenomenon, like intermittent fasting, like paleo, like whatever they're sort of looking at, right, Cochrane is like an incredible resource. So C-O-C-H-R-A-N-E. They almost exclusively traffic in meta studies and meta-analyses, so they'll go, We looked at 160 studies on intermittent fasting, and when we controlled for all these different variables, when we put them all side-by-side, here's what we found: not much. It is very academic. It is not the most accessible sort of language, but in terms of getting a straight, quick sort of understanding and broad understanding without reading those 160 studies individually, just reading one of 'em, that's the one I would start with. And it often is the one that I do start with. How about you, Mike?
Hobbes: I actually point people to Google scholar a lot. That's actually my first stop when I'm researching episodes. And if you type in "keto" in Google Scholar, you'll probably find something good, especially if it's, like, a meta-analysis or, like, a study of studies. And I also think another good sign is if you go onto Google Scholar and you type in the ingredient or the diet that you're looking at and you don't find much, then the question has to be, Well, then, on what basis are they making the claims on the package, right? If they're saying this works for weight loss, you go on Google Scholar and there aren't really any weight loss study, or maybe there's one study and there were 12 people in it, it's like, Well, then, how can you say that on your package? Right? Then you're in, like, you're trying to sell me something territory.
Gordon: Totally!
Basu: Last question for you all. I'm willing to bet that a lot of people set health goals for themselves that are really aesthetic goals, as we've been talking about for most of this time. A lot of it has to do with "I wanna fit into this," "I wanna be this size," "I wanna look this way." What is your advice for people to help them understand what it is they're really looking for in the big, big world of health science, what their goal really should be going out there and how to find it?
Gordon: I think one thing to look at is to what degree are you imagining specific health outcomes changing and to what degree are you just tapping into this broader idea of, like, "get healthy"? If you're tapping into this broader idea of "get healthy," that's usually just used as a search and replace for "lose weight and be thin," right? If you are entertaining some kind of magical thinking that I think most of us do most of the time when we're on diets, that, you know, if you lose weight, your relationship will be stronger, or you'll find a partner who really loves you and treats you right, or you'll look stunning and everyone will be envious, those are all social outcomes that don't actually need to be tied to the size of your body at all, right? And we have gotta do a better job of disentangling that, and that is hard and complicated and long-term work and boy, do I wish I had a clearer answer. Mike, what would you say about any of that?
Hobbes: I'm actually, like, very magnanimous to people who do this. Who, you know, if you wanna start going to the gym, start doing CrossFit, like, you wanna look good in a bikini for the summer, honestly, I'm not really gonna talk you out of that. Again, it feels mean to me, it's not really what I wanna do with my career as a journalist, either. What I will do is try to talk you out of the impulse that we see over and over again to universalize what happens to your body toward other people's bodies, right? If you go vegetarian and you lose 30 pounds, great, I'm not gonna take that away from you. If that makes you happy, awesome. The thing that I wanna stop you from doing is then becoming an evangelist for that, like, "Have you tried vegetarian?" "Have you gone vegetarian?" "I lost 30 pounds." "Are you gonna go vegetarian?" Then you become this pushy person who acts like everybody else's body is like yours and everybody else's life is like yours, and they have the time and the inclination and the, just, whatever weird genetic gut biome, whatever else is going on, that is gonna give them the same result. So, if you do that kind of stuff, have a blast, but I think the main thing is really just your body is weird. Everyone's body is weird and if it responds to something then great, you found a diet and a lifestyle that works for you and it gives you energy and it makes you happy, awesome. Other people have different experiences.
Gordon: Just think about anytime somebody else has like commented on your body in an unsolicited way. I'm guessing nine times outta ten, it felt real bad. So, like, don't be that guy. You know what I mean? Don't be that guy.
[MUSIC FADES IN]
Basu: Michael, Aubrey, this was more fun than anyone should have talking about junky health science and bad studies. Thank you so much. Thank you for your time, really.
Hobbes: Aye! [LAUGHS]
Hobbes: Thanks for having us!
Gordon: Thank you. This was such a treat.
Basu, Narrating: You can find Michael Hobbes and Aubrey Gordon's podcast "Maintenance Phase" on Apple Podcasts. We'll include a link for you on our show notes page.
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