July 17, 2025 • 29 mins
Dr. Bobby unpacks the surge of health hype—from red light therapy to NAD⁺ boosters—and empowers listeners to stay curious yet skeptical using science-backed tools and critical thinking.
Are claims like “boost your mitochondria” or “natural detox” real breakthroughs—or today’s version of snake oil? Dr. Bobby explores why health hype is everywhere, why we’re vulnerable to it, and how to sift compelling theories from proven treatments. He outlines examples of widely accepted beliefs that ultimately didn’t hold up to rigorous scrutiny. Inserting stents to open clogged arteries seemed sensible, but studies like the COURAGE and ORBITA trials found no added benefit over medical management (NEJM).
Dr. Bobby then turns to newer fads. Claims around NAD⁺ boosters (like NMN or NR), red light therapy, PRP for knee pain, and hydrogen water often rely on plausible-sounding mechanisms or mouse studies—but currently lack human RCTs to back them up. While these ideas may sound promising, human trials are either missing or preliminary.
Why does this hype persist? Financial incentives are everywhere: the U.S. spends over $5 trillion annually on health, and the supplement market alone is worth $150 billion. Influencers, professionals, and even well-meaning providers may promote approaches they financially benefit from. As patients, we’re often eager for solutions to symptoms like fatigue or anxiety—especially when conventional medicine doesn’t have a satisfying answer. This opens the door for pseudoscience, placebo effects, and the viral spread of misinformation.
To navigate this environment, Dr. Bobby outlines seven action steps. First, demand human evidence: ask if a treatment has been tested in RCTs, replicated, and proven in diverse populations. He recommends Examine.com for non-biased supplement research and revisiting his episode on evaluating health headlines (#22). Second, follow the money—financial conflicts should raise your skepticism. Third, be alert to hypey language like “miracle cure” or “doctor secrets”—phrases designed to manipulate, not inform. Fourth, understand the placebo effect, especially with vague symptoms. Fifth, ask questions: “Compared to what?” “In whom?” “For how long?” “With what risks?” These shift the focus from excitement to real evaluation. Sixth, adopt what Dr. Bobby calls the mindset of a curious skeptic—open to ideas, but insistent on evidence. Finally, he urges listeners to consult evidence-literate doctors who will explore with you, both mainstream and emerging treatments with a critical eye—see episode #20 for more on choosing the right provider.
Takeaways: Ask, “Has this been tested in people?” before jumping on a health trend. Beware buzzwords and financial conflicts—science, not sales, should guide your decisions. Embrace curiosity, but anchor it in real-world evidence to truly live long and well.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
everywhere you turn, someone is claiming a miracle
cure for your health Newsupplements, special diets,
curing your microbiome orrepairing your mitochondria.
The theories or mechanisms orstories seem compelling.
(00:23):
Or stories seem compelling, butis this just today's snake oil
salesman selling somethingwithout rigorous evidence to
support it?
Can we avoid getting drawn intothese theory or expert-based
approaches?
Can we become curious butskeptical?
(00:43):
Let's find out.
Hi, I'm Dr Bobby Du Bois andwelcome to Live Long and Well, a
podcast where we will talkabout what you can do to live as
(01:03):
long as possible and with asmuch energy and vigor that you
wish.
Together, we will explore whatpractical and evidence-supported
steps you can take.
Come join me on this veryimportant journey and I hope
that you feel empowered alongthe way.
I'm a physician, ironman,triathlete and have published
(01:28):
several hundred scientificstudies.
I'm honored to be your guide.
Welcome, my dear listeners, toepisode number 44.
Why is there so much hype inhealth?
Now you may have heardplant-based diets are the best
(01:52):
or are wounded mitochondria arethe problem, or is it food
allergies is the problem, cancerpatients shouldn't eat sugar or
most chronic chronic diseasesdue to the microbiome?
Have you heard of miracle curesecrets?
Doctors won't tell yousomething that boosts immunity,
(02:17):
or natural detox.
Well, many of these healthclaims could sound plausible or
even convincing, and they mayexcite us.
However, I generally findthere's no credible evidence to
support claims like this.
I also worry when chiropractorsor naturopaths push nutritional
(02:41):
supplements, or dieteticianspromote things outside of their
area of expertise and evenfunctional medicine doctors that
claim that inflammation ornutritional deficiencies or
allergies are the cause for allof our symptoms.
You know, as my grandmothersaid, if it sounds too good to
(03:03):
be true, likely it isn't true orthere's a newer version of this
one.
Just because something makessense biochemically or is
biologically plausible doesn'tmean it works in real life.
And we'll talk about thingslike well, mitochondria may be
(03:28):
important, they may get damagedas we get older, but that
doesn't mean treating themsomehow will improve our fatigue
.
Or that magnesium is used inevery cell of our body.
Well, that doesn't mean yoursymptoms will improve if you
take magnesium.
(03:49):
This topic is not new.
Think of the snake oil salesmenin the 19th century.
They claimed.
Of course they claimed it wasactually snake oil, but it
turned out most of the time ithad nothing to do with the snake
, but they claimed that theirpotions or their salves that you
would put on your skin wouldcure arthritis pain, or they had
(04:12):
powders that cured insomnia orsterility.
Well, that was then.
But how about now?
So many of these exist Now.
There is harm.
Now you might say, well, thisis just kind of fun or humorous,
and certainly the snake oilsalesmen were, you know, 100 or
(04:35):
200 years ago.
But these claims are around usall the time today and there is
harm.
There's five different harmsfrom this type of activity.
The first there's the harm ofwasting your money Green
supplements or intravenousvitamin therapy shops or red
(04:59):
light devices.
They're expensive.
There's the harm.
Second, there's a harm of delayin getting the right diagnosis
or treatment.
So you may get sucked intodoing supplements or trying
these other types of things andyou don't get to the doctor, you
(05:19):
don't get a diagnosis rightaway and you avoid treatments
that could really help you.
Third, the harm of false hope,believing something that frankly
has no support for.
There's also the harm of beingsimplistic about our health.
Yes, we'd all like to take alittle pill and be done with it,
(05:42):
and sometimes that means weavoid the hard work like losing
weight or doing exercise ormeditation or any of the number
of the other things we talkabout on this podcast.
There's also a harm of badscience, which can lead to bad
policy.
So, not many years ago, youngkids were told you shouldn't be
(06:07):
and parents were told you shouldavoid peanuts when kids are
young, and that's led to a lotof allergies peanut allergies in
young people and this was allbased on bad science and
policies that came out of it.
Well, this is the background,today's plan.
(06:30):
I want to provide some examplesso you can get motivated.
This is a real issue that youprobably run across quite a bit.
Next, we're going to talk aboutwhy does this occur?
Why is it that people promotethese kinds of things?
And, secondly, why is it wewant to believe them?
And, most importantly, partthree, what are some action
(06:53):
steps you can take to avoid thistrap?
Well, the first action stepthink about what you've heard
from your friends, from yourrelatives, examples that are out
there, that you read or you seeon social media.
Think about these.
(07:14):
Bring these to mind as we gothrough this discussion.
Well, I always like to beginwith why.
Now, as some of you may know, Ispent my career asking
questions from a health policystandpoint of what does the
evidence tell us that works, andlet's get more of that.
(07:35):
And what does the evidence tellus of what doesn't work, and
let's make sure that doesn'thappen as much.
Save money.
Help patients.
For example, you know what'sthe evidence about who would
benefit from back surgery,because there's a whole lot of
back surgery that doesn't helppeople, costs a lot of money.
When is an MRI scan needed?
(07:57):
Are expensive medications worthit?
I published about 180 articleslooking at the evidence, trying
to figure out how best we shouldapproach these aspects of
healthcare.
So I've always been interestedin it and that's in great part,
why I began the podcast.
(08:19):
It also drives me crazy, andwhatever hair I have left, most
of it is gone because I pull outmy hair when family or friends
are so excited about the latestfad or trend and what they end
up doing is avoiding facing whatthey really need to do.
(08:40):
Oh, I can solve my bloodpressure by taking this herb, or
I can make sure my cholesterolgets better by this other
approach.
Well, frankly, it's putting offthe inevitable.
They're wasting money, they'rewasting time because, in general
, there's no evidence to supportit.
I want you to be curious oropen-minded, but also to be
(09:07):
cautious or skeptical.
I like to call myself theopen-minded skeptic.
I tend to wonder about thingsand whether they actually work,
but I'm open-minded to theevidence.
I want you to be that as well.
Well, before diving into theexamples, I think I need to
(09:27):
explain to you what do I mean.
What does Dr Bobby mean byevidence?
Because if you talk to otherpeople they'll say oh yes,
there's lots of evidence for redlight therapy or why you need
to take magnesium supplements.
For me, evidence is scientificstudies done in people, ideally
(09:53):
randomized, controlled trials,where they compare one approach
to another and it's blinded, soone person gets a placebo, one
person gets the real thing.
But there can also be goodobservational studies, but
rigorous, peer-reviewed evidence.
Well, what evidence is not atheory or mechanism, plus an
(10:18):
anecdote, plus an expert pushingit?
Well, what do I mean by that?
So maybe there's a theory.
Well, your knee pain is causedby loose bits of cartilage
floating around in your knee andremoving it will help you.
So that's the theory, andtheory sounds good to me.
(10:40):
If you've got little things inyour knee, that can't be good
for you.
Anecdote my cousin had thatstuff removed and they got
better.
And then you have an expert whosays oh, I do this in all my
patients and they do great.
Well, on this exact issue ofremoving debris from the knee,
(11:07):
when randomized control trialswere done, it didn't work.
Well, other types of evidence,or what people might call
evidence Well, I took red lighttherapy and I took cells and I
put them in the lab and itrepaired those cells, or it
(11:28):
worked in mice.
That's also not evidence.
So you may have a great theoryor a mechanism, there may be
individuals that say it workedfor me and you may have experts
touting it.
It doesn't make it for me asevidence.
What is evidence are going tobe those rigorous studies in
people.
Okay, now for part one.
(11:49):
Let me walk through someexamples of hype versus evidence
.
Well, as most of my listenersknow, for decades eggs were
maligned.
They were assumed to be harmfulbecause, in fact, eggs contain
cholesterol.
So here's the theory, and thetheory obviously makes good
(12:11):
sense.
Your plaque in your arteriesthat can cause bad problems are
full of cholesterol.
Well, cholesterol can't be goodfor you.
So eating cholesterol must bebad, and that makes perfect
sense.
But when they did large humantrials and studies, what they
(12:35):
found was that the cholesterolyou eat in an egg or in shrimp
or in lobster, didn't actuallyaffect your blood cholesterol
levels and it didn't affect youroverall health outcomes.
So here is an example we've allsort of lived through where the
(12:58):
hype got everybody to changebehaviors but in the end the
evidence didn't support it.
Well, how about the theory ofclogged arteries cause heart
attack and death and if you wereto find a blockage you need to
open that up with a stent?
(13:19):
Well, when this was tested withrandomized, controlled trials
like the COURAGE trial, theORBITA trial, it showed there
was no benefit to doing thestents over good medical
preventive treatment.
Again, the theory makes perfectsense.
(13:40):
Narrow blood vessels can't begood for you.
Opening up the blood vesselsmust be good for you, but when
they compared it in people withstable symptoms, there was no
benefit.
Okay, how about the theory thatinjecting cement a cement-like
(14:01):
product, not actual cement intovertebral fractures, so
fractures in your spine, willstabilize them and it will
reduce pain?
This was called vertebroblasty.
Again, the theory makes sense.
If we can stabilize thefracture by putting in this glue
(14:21):
, the fracture by putting inthis glue, that's going to
reduce the pain and, as peopleknow, when you get that broken
vertebra it can be really,really uncomfortable for a long
period of time.
Well, when they did asham-controlled trial meaning
some people thought they got theprocedure but didn't, and
compared it to people who hadthe procedure again, no benefit.
(14:46):
So these examples I've justtalked about have been debunked
and they're no longer beingpromoted.
But there's a new set of thesethat are being promoted, so NAD,
nicotinamide, adenosine,dinucleotide boosters like NMN
(15:08):
and NR that you might take as asupplement or as an injection.
It's touted that it slows aging.
Well, what's the theory?
Theory sounds good.
Nad, this molecule helps yourcells to create energy.
Well, that's got to be good.
(15:28):
And as we age, those levelsfall.
Okay.
So now we have a problem.
And they found that if you givethese supplements to mice, it
can boost those levels and themice do better with exercise.
It extends their lifespan.
These are animal models, orwhat are called in vitro models
(15:53):
when it's done in test tubes,human evidence.
There isn't good rigorous,long-term studies showing that
these supplements help us toslow aging or reduce diseases or
whatever.
Well, you've probably also otherhyped claims.
(16:13):
Well, you have knee pain.
You need stem cell injectionsor PRP injections to heal the
cartilage, or are you havingmuscle weakness or neurologic
problems that may be due toinjured mitochondria that need
healing.
Oh, do you have inflammation?
You need hydrogen water?
(16:35):
Or are you suffering fromfatigue?
Red light therapy can help you.
Now, these are all lovelytheories and they may sound
compelling, but, just like theegg situation and the peanut
allergy situation, withoutproper evidence they're not
(16:56):
ready for prime time.
They're not ready for primetime now, likely when the
evidence becomes available.
If it does, they'll never beready for prime time.
So, some examples they're allaround you and, as I said in the
earlier part about this actionstep, think about what you've
heard from friends, from family,that you've read, seen on the
(17:21):
internet.
That sounds amazing.
It sounds plausible.
We wish it were to be true.
Keep that in mind, all right.
Now on to part two.
Why all this health hype?
Why is it abound everywhere wego and why are we likely to
(17:41):
believe it?
Well, there's a number ofthings I want to point out.
First, and not a surprise toanyone, there are financial
incentives.
Health is a huge part of oureconomy.
$5 trillion are spent on health.
So everybody's focused onhealth and trying to improve it
(18:03):
for themselves or for others.
Supplements are a big businessand that's often what you hear
about, probably about $150billion in the US.
Sadly, most health podcastsadvertise supplements or beds
(18:23):
that you'll sleep better in, orwearables, and often the
podcasters are owners of thesecompanies or they get payments
from the companies that makethem.
You'll also see that financialincentives are in your
chiropractor's office or evenyour regular doctor's office,
(18:45):
that they are expanding whatthey offer, what they sell, and
that's also a financialincentive.
There's a saying that if youwalk around with a hammer,
everything looks like a nail.
So even people.
Perhaps it's not a financialincentive, they just think that
(19:07):
removing the bad debris fromyour knee will make you feel
better.
They truly believe it.
Now they probably also do theprocedure and they make money
from that.
I tend to call this self-servingsloppiness, meaning
intellectually, we need to lookat the evidence, and sometimes
(19:28):
we don't look as carefully atthe evidence as we'd like,
because it serves us well tocontinue with a belief that is
not supported by that evidence.
All right, financial incentives, why else?
Why would we as patients getexcited about this?
And that is that we want relief.
(19:51):
There's a lot of folks out therewho have unmet medical needs or
chronic symptoms thattraditional medicine doesn't
seem to solve.
You know how common do we hear?
Or we feel oh, I got low energy, I'm not sleeping well, I have
a lot more anxiety, I have achesand pains, and their regular
(20:17):
doctor, the regular part of thehealthcare system, may not have
answers for them.
So when we hear about a theoryor a mechanism that makes sense,
oh, you're fatigued, it's dueto the mitochondria.
The mitochondria create energyin your body and as you age or
(20:38):
as you get illnesses, themitochondria become impaired and
we have a way to treat thosemitochondria and you will feel
better.
Or similar theories that relateto the microbiome.
Now, I'm not trying to saymitochondria are unimportant and
I'm not trying to say themicrobiome is never important,
(21:01):
but the theories and how peoplepromote it is way beyond what
the evidence says.
And we want this relief.
And we hear somebody else whotried it and it worked.
Look, as we've talked about,there is a placebo effect.
So part of what you hear maynot be that it actually works.
(21:24):
Despite the wonder of theory,it is.
But, frankly, the placeboeffect.
And then if it works for oneperson, they tell others.
So the third part of this is anamplification process.
You tell your friends, you tellyour family.
It goes out on social media.
(21:44):
There may be catchy buzzwordsthat suck you in oh, it's a
detox, or it's anti-aging, orit's the next breakthrough.
Look on social media.
You can say anything you want.
There's no fact checking onInstagram or Facebook or Twitter
and people may cherry picklittle nuggets of data to
(22:09):
support what they want to say.
So beware.
Okay, so I've given you someexamples in part one.
We've talked a little bit inpart two about why is it that
all of this hype is out thereand why we might believe it.
Now we're on to step three.
What can we do about it?
(22:32):
What are the action steps thatyou might take to help you and
to protect you from some of this?
Help you and to protect youfrom some of this.
Okay, number one listen to thetheory, be curious, but demand
(22:55):
human evidence.
So here's the action item foryou.
Ask the question has this beentested, this theory, in a
randomized controlled trial inpeople, not just in mice or test
tubes?
Has it been replicated?
Has somebody else shown thesame thing?
Very often, breakthroughfindings are never shown to work
.
The next go-round Were theresults seen in many different
(23:17):
populations and looking atpeople over time, what's the
evidence?
Good science stands, theevidence of time, the test of
time and scrutiny.
If you're interested, you canlisten to my episode on whether
to believe health headlines.
That's number 22.
I also like the websiteexaminecom.
(23:41):
Also like the websiteexaminecom.
No, I'm not a financial part ofit at all, but I use it.
It's very helpful forsummarizing evidence on
nutritional supplements andthings like that.
All right.
Next thing, to protect yourself.
Follow the money.
Action item number two ask whobenefits.
(24:02):
If I believe this is true, isthe person who is promoting this
theory also selling somethingthat would be a red flag?
Conflicts of interest areeverywhere and there may be
financial ties between theperson who's pushing it, the
(24:23):
product or treatment, and whenthat happens, their objectivity
may be distorted.
Now, this happens not just onhucksters on Instagram, but even
our professionals that we go tosee to care for us.
So we have to be aware of that.
Third, be wary of buzzwords onsocial media.
(24:47):
So here's your action itemnumber three Are there red flag
phrases?
Miracle cure secrets thatdoctors won't tell you?
It boosts your immunity or it'sa natural detox?
Phrases may excite us, but thatisn't science, all right.
(25:11):
Number four understand theplacebo effect can be very
powerful.
People may feel better.
That doesn't always mean thatthe treatment actually was what
caused it, especially when youhave vague symptoms that tend to
(25:33):
go up and down and you mightattribute it to what treatment
somebody said you should try.
Action item number four listento my episode 28 on placebo.
It might help you, okay.
Fifth ask good questions.
So here's your action item.
Number five Replace thequestion did it work with,
(25:54):
compared to what?
Did they have a comparisongroup?
In whom, in what kinds ofpeople, over what time period,
and were there any risksassociated with that?
This shifts the conversationfrom just jumping in with
excitement to really probingrisk-benefit trade-offs and
(26:18):
whether there is enough evidenceto believe it and whether there
is enough evidence to believeit.
Number six be a curious oropen-minded skeptic, as we've
talked about Action item.
(26:38):
Don't just say no and rejecteverything, but ask for rigorous
evidence.
Now, not all theories turn outto be wrong.
So we talked about eggs.
High cholesterol has beenassociated with heart disease,
so lowering cholesterol mighthelp us.
Well, that gave rise to thedevelopment of statins, an
incredibly important medicine inour toolbox, and it's been
(27:02):
shown to reduce heart attack,extend years of life in numerous
, numerous RCTs.
So it was a theory and it wassomething people got excited
about, but then we have theevidence to show that it works.
Okay, last action area Talk toan evidence literate provider.
(27:28):
So what's the action here?
Number seven See if you canexplore a topic like this with
your doctor.
Does your doctor take the timeto do that?
Does your doctor have aninterest in that?
So before jumping in and saying, oh, this supplement, I must
take it, or this new thing, Imust try it, talk to your doctor
(27:51):
.
See if your doctor will exploreit in this kind of way.
And, if you're interested,listen to my episode, number 20,
on do you like your doctor?
Okay, time to wrap up.
Look around you.
Do you find claims that seem tobe too good to be true?
(28:11):
I suspect the answer will beyes.
Perhaps.
Be that curious but open-mindedskeptic.
Try out the seven action stepsthat I just talked about and let
me know about topics you'd likeme to explore.
Are there things that you thinkare hype, that you would like
(28:34):
me to investigate and share withyou what I learned?
Well, I hope we all live longand well, not based on hype, but
on what really works, based onevidence.
Until next time, goodbye.
Thanks so much for listening toLive Long and Well with Dr
(28:58):
Bobby.
If you liked this episode,please provide a review on Apple
or Spotify or wherever youlisten.
If you want to continue thisjourney or want to receive my
newsletter on practical andscientific ways to improve your
health and longevity, pleasevisit me at
(29:18):
drbobbylivelongandwellcom.
That's Dr.
As in D-R Bobby.
Live long and wellcom.
everywhere you turn, someone is claiming a miracle
cure for your health Newsupplements, special diets,
curing your microbiome orrepairing your mitochondria.
The theories or mechanisms orstories seem compelling.
(00:23):
Or stories seem compelling, butis this just today's snake oil
salesman selling somethingwithout rigorous evidence to
support it?
Can we avoid getting drawn intothese theory or expert-based
approaches?
Can we become curious butskeptical?
(00:43):
Let's find out.
Hi, I'm Dr Bobby Du Bois andwelcome to Live Long and Well, a
podcast where we will talkabout what you can do to live as
(01:03):
long as possible and with asmuch energy and vigor that you
wish.
Together, we will explore whatpractical and evidence-supported
steps you can take.
Come join me on this veryimportant journey and I hope
that you feel empowered alongthe way.
I'm a physician, ironman,triathlete and have published
(01:28):
several hundred scientificstudies.
I'm honored to be your guide.
Welcome, my dear listeners, toepisode number 44.
Why is there so much hype inhealth?
Now you may have heardplant-based diets are the best
(01:52):
or are wounded mitochondria arethe problem, or is it food
allergies is the problem, cancerpatients shouldn't eat sugar or
most chronic chronic diseasesdue to the microbiome?
Have you heard of miracle curesecrets?
Doctors won't tell yousomething that boosts immunity,
(02:17):
or natural detox.
Well, many of these healthclaims could sound plausible or
even convincing, and they mayexcite us.
However, I generally findthere's no credible evidence to
support claims like this.
I also worry when chiropractorsor naturopaths push nutritional
(02:41):
supplements, or dieteticianspromote things outside of their
area of expertise and evenfunctional medicine doctors that
claim that inflammation ornutritional deficiencies or
allergies are the cause for allof our symptoms.
You know, as my grandmothersaid, if it sounds too good to
(03:03):
be true, likely it isn't true orthere's a newer version of this
one.
Just because something makessense biochemically or is
biologically plausible doesn'tmean it works in real life.
And we'll talk about thingslike well, mitochondria may be
(03:28):
important, they may get damagedas we get older, but that
doesn't mean treating themsomehow will improve our fatigue
.
Or that magnesium is used inevery cell of our body.
Well, that doesn't mean yoursymptoms will improve if you
take magnesium.
(03:49):
This topic is not new.
Think of the snake oil salesmenin the 19th century.
They claimed.
Of course they claimed it wasactually snake oil, but it
turned out most of the time ithad nothing to do with the snake
, but they claimed that theirpotions or their salves that you
would put on your skin wouldcure arthritis pain, or they had
(04:12):
powders that cured insomnia orsterility.
Well, that was then.
But how about now?
So many of these exist Now.
There is harm.
Now you might say, well, thisis just kind of fun or humorous,
and certainly the snake oilsalesmen were, you know, 100 or
(04:35):
200 years ago.
But these claims are around usall the time today and there is
harm.
There's five different harmsfrom this type of activity.
The first there's the harm ofwasting your money Green
supplements or intravenousvitamin therapy shops or red
(04:59):
light devices.
They're expensive.
There's the harm.
Second, there's a harm of delayin getting the right diagnosis
or treatment.
So you may get sucked intodoing supplements or trying
these other types of things andyou don't get to the doctor, you
(05:19):
don't get a diagnosis rightaway and you avoid treatments
that could really help you.
Third, the harm of false hope,believing something that frankly
has no support for.
There's also the harm of beingsimplistic about our health.
Yes, we'd all like to take alittle pill and be done with it,
(05:42):
and sometimes that means weavoid the hard work like losing
weight or doing exercise ormeditation or any of the number
of the other things we talkabout on this podcast.
There's also a harm of badscience, which can lead to bad
policy.
So, not many years ago, youngkids were told you shouldn't be
(06:07):
and parents were told you shouldavoid peanuts when kids are
young, and that's led to a lotof allergies peanut allergies in
young people and this was allbased on bad science and
policies that came out of it.
Well, this is the background,today's plan.
(06:30):
I want to provide some examplesso you can get motivated.
This is a real issue that youprobably run across quite a bit.
Next, we're going to talk aboutwhy does this occur?
Why is it that people promotethese kinds of things?
And, secondly, why is it wewant to believe them?
And, most importantly, partthree, what are some action
(06:53):
steps you can take to avoid thistrap?
Well, the first action stepthink about what you've heard
from your friends, from yourrelatives, examples that are out
there, that you read or you seeon social media.
Think about these.
(07:14):
Bring these to mind as we gothrough this discussion.
Well, I always like to beginwith why.
Now, as some of you may know, Ispent my career asking
questions from a health policystandpoint of what does the
evidence tell us that works, andlet's get more of that.
(07:35):
And what does the evidence tellus of what doesn't work, and
let's make sure that doesn'thappen as much.
Save money.
Help patients.
For example, you know what'sthe evidence about who would
benefit from back surgery,because there's a whole lot of
back surgery that doesn't helppeople, costs a lot of money.
When is an MRI scan needed?
(07:57):
Are expensive medications worthit?
I published about 180 articleslooking at the evidence, trying
to figure out how best we shouldapproach these aspects of
healthcare.
So I've always been interestedin it and that's in great part,
why I began the podcast.
(08:19):
It also drives me crazy, andwhatever hair I have left, most
of it is gone because I pull outmy hair when family or friends
are so excited about the latestfad or trend and what they end
up doing is avoiding facing whatthey really need to do.
(08:40):
Oh, I can solve my bloodpressure by taking this herb, or
I can make sure my cholesterolgets better by this other
approach.
Well, frankly, it's putting offthe inevitable.
They're wasting money, they'rewasting time because, in general
, there's no evidence to supportit.
I want you to be curious oropen-minded, but also to be
(09:07):
cautious or skeptical.
I like to call myself theopen-minded skeptic.
I tend to wonder about thingsand whether they actually work,
but I'm open-minded to theevidence.
I want you to be that as well.
Well, before diving into theexamples, I think I need to
(09:27):
explain to you what do I mean.
What does Dr Bobby mean byevidence?
Because if you talk to otherpeople they'll say oh yes,
there's lots of evidence for redlight therapy or why you need
to take magnesium supplements.
For me, evidence is scientificstudies done in people, ideally
(09:53):
randomized, controlled trials,where they compare one approach
to another and it's blinded, soone person gets a placebo, one
person gets the real thing.
But there can also be goodobservational studies, but
rigorous, peer-reviewed evidence.
Well, what evidence is not atheory or mechanism, plus an
(10:18):
anecdote, plus an expert pushingit?
Well, what do I mean by that?
So maybe there's a theory.
Well, your knee pain is causedby loose bits of cartilage
floating around in your knee andremoving it will help you.
So that's the theory, andtheory sounds good to me.
(10:40):
If you've got little things inyour knee, that can't be good
for you.
Anecdote my cousin had thatstuff removed and they got
better.
And then you have an expert whosays oh, I do this in all my
patients and they do great.
Well, on this exact issue ofremoving debris from the knee,
(11:07):
when randomized control trialswere done, it didn't work.
Well, other types of evidence,or what people might call
evidence Well, I took red lighttherapy and I took cells and I
put them in the lab and itrepaired those cells, or it
(11:28):
worked in mice.
That's also not evidence.
So you may have a great theoryor a mechanism, there may be
individuals that say it workedfor me and you may have experts
touting it.
It doesn't make it for me asevidence.
What is evidence are going tobe those rigorous studies in
people.
Okay, now for part one.
(11:49):
Let me walk through someexamples of hype versus evidence
.
Well, as most of my listenersknow, for decades eggs were
maligned.
They were assumed to be harmfulbecause, in fact, eggs contain
cholesterol.
So here's the theory, and thetheory obviously makes good
(12:11):
sense.
Your plaque in your arteriesthat can cause bad problems are
full of cholesterol.
Well, cholesterol can't be goodfor you.
So eating cholesterol must bebad, and that makes perfect
sense.
But when they did large humantrials and studies, what they
(12:35):
found was that the cholesterolyou eat in an egg or in shrimp
or in lobster, didn't actuallyaffect your blood cholesterol
levels and it didn't affect youroverall health outcomes.
So here is an example we've allsort of lived through where the
(12:58):
hype got everybody to changebehaviors but in the end the
evidence didn't support it.
Well, how about the theory ofclogged arteries cause heart
attack and death and if you wereto find a blockage you need to
open that up with a stent?
(13:19):
Well, when this was tested withrandomized, controlled trials
like the COURAGE trial, theORBITA trial, it showed there
was no benefit to doing thestents over good medical
preventive treatment.
Again, the theory makes perfectsense.
(13:40):
Narrow blood vessels can't begood for you.
Opening up the blood vesselsmust be good for you, but when
they compared it in people withstable symptoms, there was no
benefit.
Okay, how about the theory thatinjecting cement a cement-like
(14:01):
product, not actual cement intovertebral fractures, so
fractures in your spine, willstabilize them and it will
reduce pain?
This was called vertebroblasty.
Again, the theory makes sense.
If we can stabilize thefracture by putting in this glue
(14:21):
, the fracture by putting inthis glue, that's going to
reduce the pain and, as peopleknow, when you get that broken
vertebra it can be really,really uncomfortable for a long
period of time.
Well, when they did asham-controlled trial meaning
some people thought they got theprocedure but didn't, and
compared it to people who hadthe procedure again, no benefit.
(14:46):
So these examples I've justtalked about have been debunked
and they're no longer beingpromoted.
But there's a new set of thesethat are being promoted, so NAD,
nicotinamide, adenosine,dinucleotide boosters like NMN
(15:08):
and NR that you might take as asupplement or as an injection.
It's touted that it slows aging.
Well, what's the theory?
Theory sounds good.
Nad, this molecule helps yourcells to create energy.
Well, that's got to be good.
(15:28):
And as we age, those levelsfall.
Okay.
So now we have a problem.
And they found that if you givethese supplements to mice, it
can boost those levels and themice do better with exercise.
It extends their lifespan.
These are animal models, orwhat are called in vitro models
(15:53):
when it's done in test tubes,human evidence.
There isn't good rigorous,long-term studies showing that
these supplements help us toslow aging or reduce diseases or
whatever.
Well, you've probably also otherhyped claims.
(16:13):
Well, you have knee pain.
You need stem cell injectionsor PRP injections to heal the
cartilage, or are you havingmuscle weakness or neurologic
problems that may be due toinjured mitochondria that need
healing.
Oh, do you have inflammation?
You need hydrogen water?
(16:35):
Or are you suffering fromfatigue?
Red light therapy can help you.
Now, these are all lovelytheories and they may sound
compelling, but, just like theegg situation and the peanut
allergy situation, withoutproper evidence they're not
(16:56):
ready for prime time.
They're not ready for primetime now, likely when the
evidence becomes available.
If it does, they'll never beready for prime time.
So, some examples they're allaround you and, as I said in the
earlier part about this actionstep, think about what you've
heard from friends, from family,that you've read, seen on the
(17:21):
internet.
That sounds amazing.
It sounds plausible.
We wish it were to be true.
Keep that in mind, all right.
Now on to part two.
Why all this health hype?
Why is it abound everywhere wego and why are we likely to
(17:41):
believe it?
Well, there's a number ofthings I want to point out.
First, and not a surprise toanyone, there are financial
incentives.
Health is a huge part of oureconomy.
$5 trillion are spent on health.
So everybody's focused onhealth and trying to improve it
(18:03):
for themselves or for others.
Supplements are a big businessand that's often what you hear
about, probably about $150billion in the US.
Sadly, most health podcastsadvertise supplements or beds
(18:23):
that you'll sleep better in, orwearables, and often the
podcasters are owners of thesecompanies or they get payments
from the companies that makethem.
You'll also see that financialincentives are in your
chiropractor's office or evenyour regular doctor's office,
(18:45):
that they are expanding whatthey offer, what they sell, and
that's also a financialincentive.
There's a saying that if youwalk around with a hammer,
everything looks like a nail.
So even people.
Perhaps it's not a financialincentive, they just think that
(19:07):
removing the bad debris fromyour knee will make you feel
better.
They truly believe it.
Now they probably also do theprocedure and they make money
from that.
I tend to call this self-servingsloppiness, meaning
intellectually, we need to lookat the evidence, and sometimes
(19:28):
we don't look as carefully atthe evidence as we'd like,
because it serves us well tocontinue with a belief that is
not supported by that evidence.
All right, financial incentives, why else?
Why would we as patients getexcited about this?
And that is that we want relief.
(19:51):
There's a lot of folks out therewho have unmet medical needs or
chronic symptoms thattraditional medicine doesn't
seem to solve.
You know how common do we hear?
Or we feel oh, I got low energy, I'm not sleeping well, I have
a lot more anxiety, I have achesand pains, and their regular
(20:17):
doctor, the regular part of thehealthcare system, may not have
answers for them.
So when we hear about a theoryor a mechanism that makes sense,
oh, you're fatigued, it's dueto the mitochondria.
The mitochondria create energyin your body and as you age or
(20:38):
as you get illnesses, themitochondria become impaired and
we have a way to treat thosemitochondria and you will feel
better.
Or similar theories that relateto the microbiome.
Now, I'm not trying to saymitochondria are unimportant and
I'm not trying to say themicrobiome is never important,
(21:01):
but the theories and how peoplepromote it is way beyond what
the evidence says.
And we want this relief.
And we hear somebody else whotried it and it worked.
Look, as we've talked about,there is a placebo effect.
So part of what you hear maynot be that it actually works.
(21:24):
Despite the wonder of theory,it is.
But, frankly, the placeboeffect.
And then if it works for oneperson, they tell others.
So the third part of this is anamplification process.
You tell your friends, you tellyour family.
It goes out on social media.
(21:44):
There may be catchy buzzwordsthat suck you in oh, it's a
detox, or it's anti-aging, orit's the next breakthrough.
Look on social media.
You can say anything you want.
There's no fact checking onInstagram or Facebook or Twitter
and people may cherry picklittle nuggets of data to
(22:09):
support what they want to say.
So beware.
Okay, so I've given you someexamples in part one.
We've talked a little bit inpart two about why is it that
all of this hype is out thereand why we might believe it.
Now we're on to step three.
What can we do about it?
(22:32):
What are the action steps thatyou might take to help you and
to protect you from some of this?
Help you and to protect youfrom some of this.
Okay, number one listen to thetheory, be curious, but demand
(22:55):
human evidence.
So here's the action item foryou.
Ask the question has this beentested, this theory, in a
randomized controlled trial inpeople, not just in mice or test
tubes?
Has it been replicated?
Has somebody else shown thesame thing?
Very often, breakthroughfindings are never shown to work
.
The next go-round Were theresults seen in many different
(23:17):
populations and looking atpeople over time, what's the
evidence?
Good science stands, theevidence of time, the test of
time and scrutiny.
If you're interested, you canlisten to my episode on whether
to believe health headlines.
That's number 22.
I also like the websiteexaminecom.
(23:41):
Also like the websiteexaminecom.
No, I'm not a financial part ofit at all, but I use it.
It's very helpful forsummarizing evidence on
nutritional supplements andthings like that.
All right.
Next thing, to protect yourself.
Follow the money.
Action item number two ask whobenefits.
(24:02):
If I believe this is true, isthe person who is promoting this
theory also selling somethingthat would be a red flag?
Conflicts of interest areeverywhere and there may be
financial ties between theperson who's pushing it, the
(24:23):
product or treatment, and whenthat happens, their objectivity
may be distorted.
Now, this happens not just onhucksters on Instagram, but even
our professionals that we go tosee to care for us.
So we have to be aware of that.
Third, be wary of buzzwords onsocial media.
(24:47):
So here's your action itemnumber three Are there red flag
phrases?
Miracle cure secrets thatdoctors won't tell you?
It boosts your immunity or it'sa natural detox?
Phrases may excite us, but thatisn't science, all right.
(25:11):
Number four understand theplacebo effect can be very
powerful.
People may feel better.
That doesn't always mean thatthe treatment actually was what
caused it, especially when youhave vague symptoms that tend to
(25:33):
go up and down and you mightattribute it to what treatment
somebody said you should try.
Action item number four listento my episode 28 on placebo.
It might help you, okay.
Fifth ask good questions.
So here's your action item.
Number five Replace thequestion did it work with,
(25:54):
compared to what?
Did they have a comparisongroup?
In whom, in what kinds ofpeople, over what time period,
and were there any risksassociated with that?
This shifts the conversationfrom just jumping in with
excitement to really probingrisk-benefit trade-offs and
(26:18):
whether there is enough evidenceto believe it and whether there
is enough evidence to believeit.
Number six be a curious oropen-minded skeptic, as we've
talked about Action item.
(26:38):
Don't just say no and rejecteverything, but ask for rigorous
evidence.
Now, not all theories turn outto be wrong.
So we talked about eggs.
High cholesterol has beenassociated with heart disease,
so lowering cholesterol mighthelp us.
Well, that gave rise to thedevelopment of statins, an
incredibly important medicine inour toolbox, and it's been
(27:02):
shown to reduce heart attack,extend years of life in numerous
, numerous RCTs.
So it was a theory and it wassomething people got excited
about, but then we have theevidence to show that it works.
Okay, last action area Talk toan evidence literate provider.
(27:28):
So what's the action here?
Number seven See if you canexplore a topic like this with
your doctor.
Does your doctor take the timeto do that?
Does your doctor have aninterest in that?
So before jumping in and saying, oh, this supplement, I must
take it, or this new thing, Imust try it, talk to your doctor
(27:51):
.
See if your doctor will exploreit in this kind of way.
And, if you're interested,listen to my episode, number 20,
on do you like your doctor?
Okay, time to wrap up.
Look around you.
Do you find claims that seem tobe too good to be true?
(28:11):
I suspect the answer will beyes.
Perhaps.
Be that curious but open-mindedskeptic.
Try out the seven action stepsthat I just talked about and let
me know about topics you'd likeme to explore.
Are there things that you thinkare hype, that you would like
(28:34):
me to investigate and share withyou what I learned?
Well, I hope we all live longand well, not based on hype, but
on what really works, based onevidence.
Until next time, goodbye.
Thanks so much for listening toLive Long and Well with Dr
(28:58):
Bobby.
If you liked this episode,please provide a review on Apple
or Spotify or wherever youlisten.
If you want to continue thisjourney or want to receive my
newsletter on practical andscientific ways to improve your
health and longevity, pleasevisit me at
(29:18):
drbobbylivelongandwellcom.
That's Dr.
As in D-R Bobby.
Live long and wellcom.
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