How Skepticism (not Cynicism) Can Raise Scientific Standards and Reform the Health and Wellness Industry

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Nicholas B. Tiller Institute of Respiratory Medicine and Exercise Physiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA

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Stuart M. Phillips Department of Kinesiology, McMaster University, Hamilton, ON, Canada

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Superstition and pseudoscience extend back to the dawn of civilization. In Mesopotamia—the birthplace of writing and recorded history—illnesses were “treated” by offering amulets and incantations to the evil spirits believed to have inflicted disease in retribution for the “sins of mankind” (Retief & Cilliers, 2007). The Ancient Greeks thought that gladiator blood could cure epilepsy and infertility; they at least had the good manners to wait until a gladiator had fallen in battle before rushing to the field to drink from the open wounds (Moog & Karenberg, 2003). In Ancient Rome, surviving gladiators would use a tool called a strigil to scrape sweat and dirt from their bodies to sell in vials to women of the upper classes to use as face cream (Finan, 2021). Beliefs remained steeped in superstition throughout the Middle Ages. In 14th century Japan, urine therapy was often used to “treat” asthma, diabetes, hypertension, and cancer (Savica et al., 2011). The practice endured well into the Renaissance. Later, traveling medicine men toured the Old West, espousing miraculous healing properties of oil they claimed had been extracted from the Chinese water snake. It wasn’t until the emergence of analytical chemistry in the early 1900s that the tincture was inspected and found to contain no active ingredients, forever synonymizing the term “snake oil” with deceptive marketing and health care fraud (Figures 1 and 2).

Figure 1
Figure 1

—An advert for Clark Stanley’s Snake Oil Liniment, circa 1890. Stanley sold his snake oil preparation across the West until federal investigators, acting on the Pure Food and Drug Act of 1906, found that it contained mineral oil, a fatty oil believed to be beef fat, red pepper, turpentine, but no actual snake oil. Image in the public domain.

Citation: International Journal of Sport Nutrition and Exercise Metabolism 33, 3; 10.1123/ijsnem.2023-0037

Figure 2
Figure 2

—Other liniments, like this from The Great Yaquis, claimed to be pure rattle snake oil. Image in the public domain.

Citation: International Journal of Sport Nutrition and Exercise Metabolism 33, 3; 10.1123/ijsnem.2023-0037

These “therapies” appear primitive when viewed through the lens of modern science. We are fortunate to benefit from technologies our ancestors could never have imagined, enabling us to determine, often to a high degree of accuracy, which interventions are useful and which are not. But pervasive mis/disinformation, lax consumer regulations, and blunted critical faculties have allowed health and wellness snake oil merchants to endure, even thrive. Today, they sell ineffective fad diets, supplements, exercises, complementary and alternative medicine, garments, gadgets, and other quick fixes, many marketed on baseless claims and pseudoscience. The products and services that find their way into mainstream practice could have devastating consequences for population health, clinical practice, and high-performance sports (Tiller et al., 2023). Moreover, while some vendors suffer consequences for their misleading claims (see Table 1), most do not. As scientists, we have a responsibility to help reform what has become a harmful health and wellness paradigm.

Table 1

Manufacturers Facing Consequences for False and/or Misleading Health and Wellness Claims

ProductCreatedManufacturerClaim(s)Consequence(s)
Perkins’ Metallic TractorsCirca 1795Elisha and Benjamin PerkinsCures inflammation, rheumatism, and pain in the head and faceExpelled from the Connecticut Medical Society for being “a user of nostrums”
Clark Stanley’s Snake Oil LinimentCirca 1890Clark StanleyCures pain and “lameness,” among many other ailmentsFined $20 (Pure Food and Drug act of 1916) for “misbranding and false representation”
Activia Yogurt1987DanoneRelieves irregularity; prevents colds and fluFined $21 million by FTC for deceptive advertising; class-action lawsuit
Multivitamin supplementsCirca 1994Greenlife Wellness/Naturecare WellnessPromotes general healthClosed by Insolvency Services (United Kingdom) for false claims; manipulative sales tactics
Vitamin Water2000Coca-ColaPromotes healthy joints; reduces risk of eye diseaseFined $2.7+ million in class-action lawsuit for misleading claims
SENSA dietary supplementCirca 1996Alan HirschPromotes satiety, promotes weight lossFined $26.5 million by FTC for misleading advertising
Power Balance bracelet2006Power BalanceImproves balance and agilityCorrective messaging; court-ordered consumer refunds for misleading advertising
New Balance “toning” sneakers2010New BalanceIncreases calorie expenditure; increases muscle activation; tones muscles of the lower limbsClass-action lawsuits ∼$5 million for false advertising
Shape-Ups “toning” sneakers2010Sketchers USAPromotes weight loss; strengthens and tones musclesFined $40 million by FTC for deceptive advertising claims
Green Coffee Bean capsulesCirca 2012Applied Food Sciences Inc.Promotes weight loss; promotes fat lossFined $3.5 million by FTC for baseless weight loss claims
Premium Green Coffee pillsCirca 2015Sale Slash LLCPromotes weight lossFined $43+ million by FTC for misrepresenting product effectiveness; fake endorsements
Luminosity “Brain Training” program2007Lumos LabsPrevents Dementia/Alzheimer’s; improves work/school performanceFined $2 million by FTC for deceptive advertising

Note. FTC =  Federal Trade Commission.

According to Laplace’s Principle, “The weight of evidence for an extraordinary claim must be proportioned to its strangeness” (Gillispi et al., 1999). Carl Sagan said it more pointedly: “Extraordinary claims require extraordinary evidence.” Commercial health and wellness claims, tending to be both extraordinary and supported by little-to-no evidence, violate the principles of Laplace and Sagan at nearly every turn. The most appropriate way to navigate the industry is, therefore, with a healthy dose of skepticism. However, skepticism should not be confused with cynicism (to routinely dismiss assertions out of hand) or contrarianism (to hold a contrary position by default); nor should we allow the misunderstood and stigmatized form of skeptic, due to its common prefixes “climate change” and “vaccine,” to discredit its true meaning.

To be skeptical in science is to judge the validity of claims based on objective, empirical evidence, or at the very least, to withhold judgment until such evidence is at hand (Normand, 2008). “It is a capital mistake to theorize before one has data,” wrote Arthur Conan Doyle as everyone’s favorite detective, “Insensibly, one starts to twist facts to suit theories instead of theories to suit facts.” Essentially, skepticism is about asking important questions to discern an “objective truth.” But the competency with which we achieve such objectivity depends on how well we understand and mitigate our biases; how well we understand and prioritize the scientific method above the conclusions we subconsciously desire; and the depth and reach of our scientific, media, and social media literacy. Note that humans do not have these skills ingrained. Logic and reason evolved for navigating hypersocial groups and for pattern recognition, not for unraveling the tangled web of consumerism, bad science, and social media that has emerged from the rapid cultural shift of the past few decades. Being a responsible skeptic, therefore, requires a comprehensive set of critical thinking skills that, like any other, can only be acquired through diligent study, refined and honed through frequent use.

Unfortunately, there has been little emphasis on critical thinking in the overcrowded curricula of our educational institutions. When critical thinking is taught, it is rarely before students reach university. Then, it is often paired indiscriminately with Research Methods, despite data showing that Research Methods failed to reduce the prevalence of false beliefs, particularly those related to pseudoscience (Dyer & Hall, 2019). It is also the case that while many of the most prominent skeptics have been revered scientists (e.g., Carl Sagan, Richard Feynman, Stephen Jay Gould), a grasp of scientific facts and concepts is only weakly related or completely unrelated to pseudoscientific beliefs (Goode, 2002; Johnson & Pigliucci, 2004). Thus, even a science education may be insufficient to provide immunity against mis/disinformation and bias. This may explain why it is troublingly common for clinicians to become homeopaths, physiotherapists to become chiropractors, and nutritionists/dieticians to advocate ineffective supplements and fad diets. We must avoid a similar fate by not assuming we are immune to flawed and misinformed beliefs. Critical thinking skills are not for other people.

For most individuals, a degree of self-directed study of skepticism and critical thinking is probably warranted. Fortunately, there are numerous resources, several of them essential, that can be used to sharpen critical faculties, including books (e.g., Carl Sagan’s The Demon-Haunted World, James Randi’s Flim Flam, Michael Shermer’s Why People Believe Weird Things, Ben Goldacre’s Bad Science); magazines (Skeptical Inquirer, The Skeptic, Free Inquiry); lectures (by Steven Novella, Susan Blackmore, Stephen Jay Gould); podcasts (The Skeptic’s Guide to the Universe; Geologic; Body of Evidence; Point of Inquiry); and debates (those pitting theology against secularism usually offer lucid examples of good and bad logical construct). Engaging in skeptical discussions with friends and colleagues is another practical way to identify and mitigate weaknesses in forming reasonable arguments.

As competent skeptics and critical thinkers, we can challenge the current health and wellness model, particularly its reverence for fitness influencers and disdain for legitimate experts. We must first ensure we are not inadvertently promoting or giving platforms to unproven/disproven ideas. Try and cleave space for doubt in your preconceptions and subject them to intense scrutiny before disseminating them to clients, colleagues, and students. This shortens the reach and shelf life of biased or erroneous advice. Second, proactively challenge baseless claims and pseudoscience when they arise in the “public square.” The clinical oath primum non-nocere (first do no harm) not only compels scientists and practitioners to administer reasoned and evidence-based advice but also to rally in removing absurdity and falsehood from circulation so it cannot contaminate decision making. Misinformed beliefs can be challenged through corrective messaging (debunking), and this is most effective when messages are rational, fact-based, and supported by valid sources (Tiller, 2022). Third, in line with critical thinking lore, we must educate others on how to think rather than what to think. This axiom obligates teaching basic critical appraisal but also exploring more nuanced strategies like “prebunking” and “inoculation theory”—the notion that individuals can be protected against persuasive attacks on their attitudes by exposing them, in advance, to weak forms of mis/disinformation (Compton et al., 2016). We have an array of pragmatic tools at our disposal.

Lastly, an important note about extending skepticism to our work and the methods we use to test our hypotheses and validate our interventions. As scientists and skeptics, we lean heavily on findings from scientific research. As David Hume asserted: “In our reasonings concerning matter of fact, there are all imaginable degrees of assurance … . A wise man, therefore, proportions his belief to the evidence.” Unfortunately, our assertions, however well-intentioned, are only as accurate as our procedures of scientific inquiry. Kinesiology and its related disciplines, despite making enormous strides in knowledge since their inception, are still relatively young. In our view, the field has become reluctant to acknowledge its methodological shortcomings. Data show that publication pressures, competition for grant income, and an overemphasis on quantitative performance metrics (e.g., h-index) have incentivized questionable research practices. As a consequence, the discipline suffers from inflated false positivity rates, diminished scientific quality and rigor, and a profound replication crisis (Tiller & Ekkekakis, 2023). Embracing the ethos of scientific skepticism may be the first step toward lasting reform: encouraging a culture shift in research to emphasize quality rather than quantity, and moving the field toward improved standards of practice across domains.

To conclude, science has rendered many fanciful gadgets and snake oils obsolete, confining them to the history books (see Figures 15), only for such products to be replaced by the nostrums of today. In fact, pseudoscience now thrives in commercial culture and wherever critical faculties are found wanting. Much of the proliferation of pseudoscience has been compounded by social media and the erosion of expertise (Nichols, 2018). Even the sacred domain of scientific research is not immune. Scientific skepticism, with its emphasis on process and objectivity, ethics and humility, is a viable solution, but only if we strive to further understand its principles and independently integrate its tenets into educational curricula, scientific research, and professional practice. As a collective, we can then share in the urgent tasks of challenging baseless claims in health and wellness and holding manufacturers to account for their sensational rhetoric. Do not leave this important work to others. Only by having the courage to confront health and wellness pseudoscience will we alter the paradigm and reverse the current emphasis on marketing over science.

Figure 3
Figure 3

—In addition to traditional snake oil, other nostrums like ‘powdered unicorn horn’ were sold as cure-alls well into the 1900s. Image courtesy of the U.S. National Library of Medicine.

Citation: International Journal of Sport Nutrition and Exercise Metabolism 33, 3; 10.1123/ijsnem.2023-0037

Figure 4
Figure 4

—Dr Scott’s Electric Corset generated an “exhilarating, health-giving current,” able to quickly cure nervous debility, spinal complaints, rheumatism, paralysis, liver and kidney troubles, and “all other diseases peculiar to women.” Image courtesy of the New York Public Library.

Citation: International Journal of Sport Nutrition and Exercise Metabolism 33, 3; 10.1123/ijsnem.2023-0037

Figure 5
Figure 5

—Elisha Perkins claimed that his ‘metallic tractors’ could cure inflammation, rheumatism, and pain in the head and face. Despite being exposed as a fraud by British Physician John Haygarth, public support for the metallic tractors remained steadfast, thanks in part to refutations like this from Benjamin Perkins, son of Elisha Perkins. The elder Perkins was eventually expelled from the Connecticut Medical Society for being “a user of nostrums.” Image courtesy of the U.S. National Library of Medicine.

Citation: International Journal of Sport Nutrition and Exercise Metabolism 33, 3; 10.1123/ijsnem.2023-0037

References

  • Compton, J., Jackson, B., & Dimmock, J.A. (2016). Persuading others to avoid persuasion: Inoculation theory and resistant health attitudes. Frontiers in Psychology, 7, 122. https://doi.org/10.3389/fpsyg.2016.00122

    • PubMed
    • Search Google Scholar
    • Export Citation
  • Dyer, K.D., & Hall, R.E. (2019). Effect of critical thinking education on epistemically unwarranted beliefs in college students. Research in Higher Education, 60(3), 293314. https://doi.org/10.1007/s11162-018-9513-3

    • Search Google Scholar
    • Export Citation
  • Finan, C.C. (2021). Ancient Rome (X-treme facts). BEARPORT Publishing Company Incorporated.

  • Gillispi, C.C., Fox, R., & Grattan-Guinness, I. (1999). Pierre-Simon Laplace, 1749–1827: A life in exact science. Charles Coulston Gillispie, Robert Fox, Ivor Grattan-Guinness. The Quarterly Review of Biology, 74(3), 331332. https://doi.org/10.1086/393172

    • Search Google Scholar
    • Export Citation
  • Goode, E. (2002). Education, scientific knowledge, and belief in the paranormal. Skeptical Inquirer, 26(1), 2427.

  • Johnson, M., & Pigliucci, M. (2004). Is knowledge of science associated with higher skepticism of pseudoscientific claims? The American Biology Teacher, 66(8), 536548. https://doi.org/10.2307/4451737

    • Search Google Scholar
    • Export Citation
  • Moog, F.P., & Karenberg, A. (2003). Between horror and hope: Gladiator’s blood as a cure for epileptics in ancient medicine. Journal of the History of the Neurosciences, 12(2), 137143. https://doi.org/10.1076/jhin.12.2.137.15533

    • PubMed
    • Search Google Scholar
    • Export Citation
  • Nichols, T. (2018). The death of expertise. Oxford University Press.

  • Normand, M.P. (2008). Science, skepticism, and applied behavior analysis. Behavior Analysis in Practice, 1(2), 4249. https://doi.org/10.1007/BF03391727

    • PubMed
    • Search Google Scholar
    • Export Citation
  • Retief, F.P., & Cilliers, L. (2007). Mesopotamian medicine. South African Medical Journal, 97(1), 2730.

  • Savica, V., Calò, L.A., Santoro, D., Monardo, P., Mallamace, A., & Bellinghieri, G. (2011). Urine therapy through the centuries. Journal of Nephrology, 24(Suppl. 17), S123S125. https://doi.org/10.5301/JN.2011.6463

    • PubMed
    • Search Google Scholar
    • Export Citation
  • Tiller, N.B. (2022). From debunking to prebunking: How skeptical activism must evolve to meet the growing anti-science threat. Skeptical Inquirer, 46(5), 4045. https://skepticalinquirer.org/2022/08/from-debunking-to-prebunking-how-skeptical-activism-must-evolve-to-meet-the-growing-anti-science-threat/

    • Search Google Scholar
    • Export Citation
  • Tiller, N.B., & Ekkekakis, P. (2023). Overcoming the “ostrich effect”: A narrative review on the incentives and consequences of questionable research practices in kinesiology. Sportrxiv. https://doi.org/10.51224/SRXIV.273

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Phillips https://orcid.org/0000-0002-1956-4098

Tiller (nicholas.tiller@lundquist.org) an Associate Editor for IJSNEM and is corresponding author, https://orcid.org/0000-0001-8429-658X

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  • Figure 1

    —An advert for Clark Stanley’s Snake Oil Liniment, circa 1890. Stanley sold his snake oil preparation across the West until federal investigators, acting on the Pure Food and Drug Act of 1906, found that it contained mineral oil, a fatty oil believed to be beef fat, red pepper, turpentine, but no actual snake oil. Image in the public domain.

  • Figure 2

    —Other liniments, like this from The Great Yaquis, claimed to be pure rattle snake oil. Image in the public domain.

  • Figure 3

    —In addition to traditional snake oil, other nostrums like ‘powdered unicorn horn’ were sold as cure-alls well into the 1900s. Image courtesy of the U.S. National Library of Medicine.

  • Figure 4

    —Dr Scott’s Electric Corset generated an “exhilarating, health-giving current,” able to quickly cure nervous debility, spinal complaints, rheumatism, paralysis, liver and kidney troubles, and “all other diseases peculiar to women.” Image courtesy of the New York Public Library.

  • Figure 5

    —Elisha Perkins claimed that his ‘metallic tractors’ could cure inflammation, rheumatism, and pain in the head and face. Despite being exposed as a fraud by British Physician John Haygarth, public support for the metallic tractors remained steadfast, thanks in part to refutations like this from Benjamin Perkins, son of Elisha Perkins. The elder Perkins was eventually expelled from the Connecticut Medical Society for being “a user of nostrums.” Image courtesy of the U.S. National Library of Medicine.

  • Compton, J., Jackson, B., & Dimmock, J.A. (2016). Persuading others to avoid persuasion: Inoculation theory and resistant health attitudes. Frontiers in Psychology, 7, 122. https://doi.org/10.3389/fpsyg.2016.00122

    • PubMed
    • Search Google Scholar
    • Export Citation
  • Dyer, K.D., & Hall, R.E. (2019). Effect of critical thinking education on epistemically unwarranted beliefs in college students. Research in Higher Education, 60(3), 293314. https://doi.org/10.1007/s11162-018-9513-3

    • Search Google Scholar
    • Export Citation
  • Finan, C.C. (2021). Ancient Rome (X-treme facts). BEARPORT Publishing Company Incorporated.

  • Gillispi, C.C., Fox, R., & Grattan-Guinness, I. (1999). Pierre-Simon Laplace, 1749–1827: A life in exact science. Charles Coulston Gillispie, Robert Fox, Ivor Grattan-Guinness. The Quarterly Review of Biology, 74(3), 331332. https://doi.org/10.1086/393172

    • Search Google Scholar
    • Export Citation
  • Goode, E. (2002). Education, scientific knowledge, and belief in the paranormal. Skeptical Inquirer, 26(1), 2427.

  • Johnson, M., & Pigliucci, M. (2004). Is knowledge of science associated with higher skepticism of pseudoscientific claims? The American Biology Teacher, 66(8), 536548. https://doi.org/10.2307/4451737

    • Search Google Scholar
    • Export Citation
  • Moog, F.P., & Karenberg, A. (2003). Between horror and hope: Gladiator’s blood as a cure for epileptics in ancient medicine. Journal of the History of the Neurosciences, 12(2), 137143. https://doi.org/10.1076/jhin.12.2.137.15533

    • PubMed
    • Search Google Scholar
    • Export Citation
  • Nichols, T. (2018). The death of expertise. Oxford University Press.

  • Normand, M.P. (2008). Science, skepticism, and applied behavior analysis. Behavior Analysis in Practice, 1(2), 4249. https://doi.org/10.1007/BF03391727

    • PubMed
    • Search Google Scholar
    • Export Citation
  • Retief, F.P., & Cilliers, L. (2007). Mesopotamian medicine. South African Medical Journal, 97(1), 2730.

  • Savica, V., Calò, L.A., Santoro, D., Monardo, P., Mallamace, A., & Bellinghieri, G. (2011). Urine therapy through the centuries. Journal of Nephrology, 24(Suppl. 17), S123S125. https://doi.org/10.5301/JN.2011.6463

    • PubMed
    • Search Google Scholar
    • Export Citation
  • Tiller, N.B. (2022). From debunking to prebunking: How skeptical activism must evolve to meet the growing anti-science threat. Skeptical Inquirer, 46(5), 4045. https://skepticalinquirer.org/2022/08/from-debunking-to-prebunking-how-skeptical-activism-must-evolve-to-meet-the-growing-anti-science-threat/

    • Search Google Scholar
    • Export Citation
  • Tiller, N.B., & Ekkekakis, P. (2023). Overcoming the “ostrich effect”: A narrative review on the incentives and consequences of questionable research practices in kinesiology. Sportrxiv. https://doi.org/10.51224/SRXIV.273

    • Search Google Scholar
    • Export Citation
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