Healthy Skepticism: High Fructose Corn Syrup

Recently a friend and colleague of mine lost a noticeable amount of weight and I asked him about it. He told me that he had recently switched over from regular soda to a so-called “throwback” soda that is, as he put it “healthier because it has real sugar instead of high-fructose corn syrup.” He further explained Pepsi throw backthat he has lost 12 pounds since he made the switch and that he feels a lot better now. I must admit I was pretty impressed by the fact that he lost weight by changing his corn-syrupy ways.

Corn syrup is believed by many to be very unhealthy and is often accused of being a major player in the rise in obesity that has occurred since the 1970s. Of course I am skeptical of the claims made about corn syrup because, at least as far as weight management goes, the evidence still indicates that calorie balance (what you consume compared to what you burn) is of the greatest importance. This colleague of mine, however swore by his plan and further there was obvious visible evidence that he had lost weight…I could see it with my own eyes.

Based on that conversation and the general fact that this colleague is a smart guy whose judgment I am inclined to trust, I found myself believing that there may be some truth to the corn syrup claims. The next day, however, I ran into him at the gym. We started talking and he told me that when he decided to give up corn-syrup he also had decided to start working out and that he was now also using an app on his phone that helped him track his Caloric intake so he can avoid eating too much. I asked him if he thought it was possible that the exercise and Calorie restriction might be why he’s lost weight and feels so much better rather than just the corn-syrup. He said it was possible but that he didn’t think so, he felt extremely confident that it was in fact the corn syrup.

Whether corn-syrup is bad for us is debatable (about which more in a bit), however it is very important to remember why, when wading through information on this or any scientific topic, testimonial or anecdotal evidence has very little value as scientific evidence. Anecdotes like the one offered to me by my colleague (who is very astute and intelligent) often seem convincing.  However, particularly with health matters, it is easy to misalign cause and effect. A subtle yet pervasive reason for this is something called the Fallacy of False Cause, an oft made mistake in which we assume that two events are causally connected.

a rooster crowingIf, for example, I observed that every morning, just before sunrise, a rooster crowed then concluded that it was the rooster crowing that caused the sun to rise, I would be committing this fallacy. Okay so this example seems a bit far-fetched but think about my friend who, while he gave up corn-syrup, also reduced his Caloric intake, started exercising, and lost weight, then concluded that his weight loss was attributable to the lack of corn syrup rather than all of his hard work and discipline. This despite the fact that research has proven time and again that eating less and exercising more is the most effective path to healthy weight loss.

High-fructose corn-syrup (HFCS) was developed in the 1960s and has since been increasingly used in the food supply as a sweetener because, in the U.S., it is significantly cheaper than cane or beet sugar. HFCS is not meaningfully different in composition or metabolism from other fructose-glucose sweeteners like sucrose (otherwise known as refined sugar or just sugar) but it does account for roughly 10% of the Calories we consume daily in the U.S. and for roughly 42% of added sweeteners in the food supply,  which is quite significant.

HFCS

There has been a substantial amount of research on the topic of HFCS. In a 2004 review, Bray and Colleagues point out that the consumption of HFCS has increased substantially since its introduction and conclude that this increase may play a role in the rising levels of obesity. While this is a well-written review with sound conclusions it’s important to note that the authors blame an increase in HFCS consumption for the rise in obesity. This does not provide any damning evidence against corn-syrup as a food; it merely shows that we are consuming too much of it. Further, in a 2007 review by Forshee and colleagues the authors point out that the ratio of fructose to glucose in the U.S. food supply has not appreciably changed since corn syrup was originally introduced, they further conclude that based on the available evidence, HFCS does not contribute to weight gain and obesity any differently than other nutrients do. These conclusions are supported as well in separate reviews by White, and by Moeller and colleagues.  

Based on the available evidence it is clear that HFCS can indeed lead to caloric imbalance when we consume too much of it. However the same could be said of “natural” sugar.  There is not a lot of doubt that HFCS is a pervasive ingredient in many processed foods, however to assume that it is the cause of obesity because it is inherently hazardous, rather than factoring it in to the big picture is a more subtle, and perhaps more disruptive example of the fallacy of false cause.

Healthy Skepticism: Genetically Modified Foods

In my recent post on Organic foods I came to the somewhat ambivalent conclusion that, though there is not a lot of evidence to support the idea that there is a huge tangible benefit of an organic diet over a conventional one, it is nonetheless a healthy diet. My only caveat was that we should not mandate the organic methods because those processes lead to a smaller yield on some important crops. One of the biggest arguments made in favor of Organic agricultural methods, however, is that there is potential danger in many of the genetically modified crops that are used for world-wide food distribution.

bigstock-Food-4708340The debates surrounding Organic food and Genetically Modified (GM) foods are often conflated indicating a belief that evidence in support of Organic foods is also evidence against GM foods. It is not. Though these are related issues they are indeed separate; evidence that supports organic health benefits says nothing at all about whether GM crops are harmful.

This is not an easy topic to research because there is evidence to support high-level arguments on both sides of the issue. However, it appears as though opinion on the matter often divides along the same line as the politics of the individuals making the argument. This is terribly unfortunate and can have a very negative effect on public discourse. Science is its own entity and does not adhere to political party lines.

Monsanto logoAn example of political dispute lies in the perception of Monsanto. This is one of the major producers of genetically modified foods and to many on the left it is an example of a purely evil enterprise while many on the right are reflexively defensive of Monsanto and therefore simply dismiss any evidence that may show potential problems with food production or public health.  Whatever side of the argument you are on, vilifying Monsanto is neither a benefit to public education nor to science. Neither is there any benefit in portraying them as saintly. Monsanto is a company like any other company; they have a business model, a product, and they want to make money. While they should most certainly be held accountable if they are negligent in reporting any potentially harmful effects of any of their processes or products, it is unrealistic to assume that they are an inherently evil or an inherently benevolent organization.

Even when the debate doesn’t degrade into partisan arguments it is hard to sift through the wealth of evidence to make sense of the information. In May of 2013 the journal Nature ran a series of articles to help shed some light on the topic. I am going to look at one article by Natasha Gilbert because, while she does seem from the outset to be opposed to GM foods, she approaches the topic with a respectable amount of moderation.

Genetic modifications are made to plants to increase crop output by making them resistant to disease, pests and parasites, and harsh climates among other things. According to many industry advocates, GM foods have increased agricultural production by $98 billion U.S dollars and prevented an estimated 473 million kilograms (that’s over a billion pounds) of pesticides from being sprayed. To this end, it might be safe to assume that advocates on both sides of the argument would find some common ground. However, that is not the case. According to Gilbert there are numerous complexities that have been overlooked by this industry that zealously promotes the above facts despite questionable or inconsistent evidence. Gilbert says that there are three pressing socio-environmental concerns that come to the forefront in the GM foods debate.

Amaranthus_palmeriThe first concern is that GM crops have led to herbicide resistant weeds. There is apparently evidence to support this claim. In the 1990s GM cotton was developed to be resistant to glyphospate (otherwise known as Roundup®), which is the herbicide used to kill Palmer Amaranth, a weed that can be very damaging to cotton crops. Evidently the combination of GM crops and glyphosphate worked very well for a time but then ceased to be effective. According to Gilbert,”The herbicide crop combination worked spectacularly well – until it didn’t. In 2004, herbicide-resistant amaranth was found in one county in Georgia; by 2011, it had spread to 76.” It was estimated that farmers were losing half their crops to weeds.

Now this is certainly a vivid example that will definitely rile someone who doesn’t like GM crops, Round upit even riled me a bit, but it is important to remember that herbicide resistance can happen in non-GM crops as well, and while there may well be better evidence to support this, the above information does not show whether the herbicide resistance occurs as a result of the GM crops transferring their glyphospate resistance to the amaranth or as a result of the weed adapting to repeated exposure to the herbicide, which happens frequently in changing ecosystems. According to Lingefelter and Hartwig (pg 18), depending on the herbicide family and weed species, herbicide resistance can occur within 5 to 20 years. Well within the time-frame described above. Again it may well be that the Palmer Amaranth in the example was altered through cross-contamination. My point is that we can’t tell from the above example.

Gilbert’s second pressing concern is that GM cotton has driven farmers to suicide. This is a rather alarming claim that seems to warrant serious investigation. According to Gilbert, however, it is a rumor that began when Vandana Shiva, an environmental activist, made the claim that “270,000 Indian farmers have committed suicide since Monsanto entered the Indian seed market. It’s a genocide.” This information has indeed been satisfactorily disproven. Research shows that between 1997 and 2007 the number of suicides did rise from 100,000 to 120,000 but that the number of suicides among farmers actually remained somewhat constant at about 20,000 per year (Gruère, G. P., Mehta-Bhatt, P. & Sengupta, D ). These suicide numbers are alarming statistics in their own right but since Monsanto did not begin selling GM seed in India until 2002, five years after the increase began,  it is clearly incorrect to blame them for the problem.

The third pressing concern is that transgenic DNA is spreading to other plants. In 2002 a paper was published in Nature by David Quist claiming that genetic analysis revealed that corn in Oaxaca, Mexico was tainted with DNA that was used to express transgenes that make Monsanto corn insect and glyphospate resistant. Quist and colleagues speculated that this resulted from the local corn having cross bred with GM corn and become tainted. This led to a large media blitz for the people of Oaxaca and led many to blame Monsanto for tainting Oaxacan culture, where corn is considered sacred. The problem was that when other researchers tried to replicate Quist’s results they weren’t able to do so. Further there were many criticisms of the methods used by Quist and his team. Ultimately the editors of Nature, while not retracting the Quist study, did state that “In light of these discussions and the diverse advice received, Nature has concluded that the evidence available is not sufficient to justify the publication of the original paper.”

Based on the above three cases it’s relatively easy to see that the evidence is somewhat nebulous on both sides of the debate making it easy to interpret the information in a way that confirms what we already believe. This is confirmation bias and it is prevalent in all decision making.  In our search to find answers to important questions such as these, none of us has an opinion that is free of bias. The fact that there is contradictory or inconsistent evidence is likely an indication that we aren’t asking the right questions. This phenomenon is not new but in fact has been recognized for over 50 years.

In 1960, P.C. Wason conducted an experiment where he observed how we come up with and then test our own conclusions (Wason, 1960).  In his study, he presented subjects with a triplet of numbers then asked them to figure out the rule that was used to generate the sequence (is the sequence all even numbers, all odd numbers, all consecutive numbers?). The subjects then tested their proposed rules by suggesting additional triplets, after which they were told whether their suggestions were consistent with the actual rule.

What Wason found was that his subjects only looked for number triplets that were consistent with their preconceived rules. For example, if the subjects were given the triplet 2-4-6, they were likely to assume that the numbers were successive even numbers. They would then go on to test whether this hypothesis was true by coming up with several different combinations of successive even numbers. If however, the actual rule were simply that the next number had to be higher than the one before it, these subjects, for their lack of testing any alternatives, would conclude that they were correct, when in fact they weren’t.

So what does an old cognitive psychology experiment have to do with GM foods? Well, the debate about GM foods is carried out by humans and, for better or worse, that means it will always be driven as much by a desire to be correct as it is by the spirit of inquiry. So far people on both sides of the argument seem to have generated hypotheses that are consistent with some of the evidence but as of yet we haven’t found reliable answers. This is likely because the debate only appears to consider whether GM foods are a natural hazard or if that notion is complete nonsense; a false-dichotomy if ever there was one.  Very little consideration appears to be given to the idea that there might be another more accurate conclusion, like the presence of smaller, yet potentially manageable risks associated with GM foods.

Based on the evidence it may prove to be true that GM crops can transfer DNA to non-GM plants of the same species and perhaps even across species leading to herbicide-resistant weeds. This does present potential problems for food growers. If, however, we are able to feed more people because of GM foods, it is a tough argument to make that we shouldn’t move forward.  There is little evidence that shows that eating GM foods is bad or harmful, which means GM will likely continue to advance as an important branch of food science.

To be honest, when I sat down to research this post, I was strongly in favor of GM foods. Frankly, I still am, however I can’t escape the idea that it’s worth giving some thought to the potential problems associated with herbicide resistant weeds because the estimated annual loss of productivity caused by noxious weeds in 64 crops grown in the U.S. is roughly $7.4 billion. That is substantial amount of money that  has the potential to drive up food costs by a significant amount. I wish there were an easier answer to the question of whether we should simply let GM foods move forward unregulated or if we should monitor them with suspicion but there isn’t at this point. We have to continue to weigh the evidence while doing our best to dodge that problem of confirmation bias.

References:

  1. Gruère, G. P., Mehta-Bhatt, P. & Sengupta, D. Bt Cotton and Farmer Suicides in India. Discussion paper 00808 (International Food Policy Research Institute, 2008).
  2. Wason, P.C. On the failure to eliminate hypotheses in a conceptual task. Quarterly Journal of Experimental Psychology, 12, 1960; 129-140. URL http://dx.doi.org/10.1080/17470216008416717

Healthy Skepticism: Fruit Flies and Organic Food

As a self-styled scientific skeptic I often need to remind myself about confirmation bias. This is the very human tendency to seek out the evidence that confirms what we already believe and ignore evidence that disagrees with our existing opinions and beliefs. I had to remind myself of this earlier this week when I read about a well-conducted study that provides evidence that organically grown food may have some benefits over conventional foods. The evidence is not absolutely conclusive but it is compelling nonetheless.

Truthfully, I am not sold on the idea that the benefits of organically raised food extend anywhere beyond marketing. However, this has always been a tough topic for me to discuss because there are a lot of people whom I like and respect that swear by the “Organic” lifestyle. Furthermore a diet that is rich in vegetables and lean meats, whether organic or not, and low on foods that don’t have a lot of nutritional value other than calories, is likely to be a healthy diet.

Should_I_Choose_Organic_Foods

The reason I think it is worth evaluating is that organically grown food is much more expensive the conventional food, making it inaccessible to many, which has public health implications. The elevated cost, at least in the U.S., is a result of the increased cost and labor involved in adhering to the USDAs guidelines for organic certification. In reality the criteria for displaying the Organic label differ worldwide, but typically for foods to be considered organic they need to be grown without synthetic pesticides, fertilizers, and without the routine use of antibiotics or growth hormones. Organic livestock needs to be fed organically grown feed (that meets the aforementioned standards) and be provided with access to the outdoors and the freedom to move about.

Whether there is an actual health benefit or not is, at this point, somewhat irrelevant from an industry perspective because clearly we believe it in the U.S.   According to the USDA , the Organic Food Industry has grown immensely over the last 15 years.  In 1997 the sales of Organic foodstuffs was $3.6 billion but by 2008 the market had boomed and sales increased to $21.1 billion.  It didn’t stop there, 2011 data from the Organic Trade Association placed the value of the organic food industry at $29 billion. I have no problem with an industry making money, that’s how the economy works; however when I see that much money involved I do tend to be very skeptical of that industry’s claims, particularly where health is concerned.

Organic trade association logo

So back to the article that tested my skepticism.  It was published by Chhabra and Colleagues and was an experiment that evaluated the benefits of an Organic diet on Drosophila Melanogaster fruit flies. Okay, so fruit flies are not human but they do have short lifespans and so make it easy to study the effects of various things on longevity among other things. Further, much of what we have learned about genetics and human physiology over the years began with research on Drosophila Melanogaster so they have been repeatedly validated as a good preliminary model for research on animal physiology. What the authors did was raise separate groups of fruit flies on either diets of conventionally grown bananas or bananas that were grown organically.

Drosophila melanogaster

They found  that  the flies on the organic diet lived for a longer period of time and had improved fertility. This is a significant finding. What is even more interesting about it is the study’s lead author Ria Chhabra was a high school student when this paper was published. According to Tara Parker-Pope who edits the Well Blog for the New York Times, Chhabra came up with the idea for this study after she heard her parents arguing about the worth of organic foods. Now while it’s true that one study such as this certainly can’t completely answer the question about the value of organic foods, Chhabra deserves many accolades for her scientific approach to the problem!

While Chhabra’s study is compelling,  the results can’t be directly translated to humans. In fact, there have been numerous studies done on the value of the organic food for humans and the results have been mixed. However, in a 2012 Meta-Analysis published by Smith-Spangler and colleagues that looked at health outcomes, nutrient levels, and contaminant levels, the authors concluded that the available published literature does not contain significant evidence that organic food is healthier than conventional food.

So despite some interesting evidence demonstrating the benefits of Organic Food on Drosophila Melanogaster (and despite my worries about confirmation bias) there still is, to my mind, not enough evidence to support the claims we often hear about Organic food. However,  there really is no harm to be done in consuming an organic diet if you can afford it, it is generally a healthy diet. Further, if you do eat organically raised livestock you can rest in the knowledge that these animals are likely to have lived a better life than their factory-farmed counterparts, which is, by itself, a worthwhile aim.

There is one vital caveat, however, and that is that for some very important crops, organic methods provide a smaller yield than conventional methods. Therefore if we mandate that businesses use organic processing methods, then we will likely drive up costs and potentially reduce access to food for a large number of people. As a consequence, our well-intentioned attempts at improving public health could end up having exactly the opposite affect.

Dr. Oz, Psychics, and Bad Science

If you have been following the news lately you know that Amanda Berry (along with Gina DeJesus and Michelle Knight) was recently found alive after being kidnapped in 2003. This is a happy story  but there is an element of it that highlights an important issue regarding the benefits of scientific skepticism when it comes to our mental health. Amanda Berry’s Mother who, sadly passed away before her daughter was found, sought solace and information by consulting “psychicSylvia Browne on a 2004 episode of the Montel Williams show. Browne bluntly informed Berry’s mother that “She’s not alive, honey.” Browne further went on to state that she envisioned Amanda’s Jacket in a dumpster with DNA on it. She is now rightly, being discredited by the media as a fraud. Browne is indeed a reprehensible hack but that is not why I am writing about her; the event itself does a lot to illustrate that people who style themselves as “psychic” are either delusional or self-serving hucksters who prey on other people’s grief. I therefore didn’t really see a need to comment on it until I saw a video from the Dr. Oz show. Where, according to Dr. Oz,  they were conducting a groundbreaking experiment on Theresa Caputo, the so-called Long Island Medium.

The_Dr._Oz_Show_logo

Dr. Oz is a trained surgeon so he should have a solid understanding of science and the scientific method but he has a history of subverting reality in order to get ratings. Nevertheless he is seen by millions daily and has a potentially large influence over a large number of people. The “groundbreaking experiment” was conducted on the Dr. Oz show by Dr. Daniel Amen who performed a Single-Photon Emission Computerized Tomography (SPECT) scan on Caputo  and asked her to do a “reading” on an audience member and indicate when she was receiving a message from a deceased person. SPECT scans have numerous legitimate clinical uses and are very useful for imaging blood flow through an organ or organ system. Blood flow through an organ, however, tells us nothing about whether there is communication with the great beyond. Further the fact that they looked for activity after she claimed to be experiencing something is backwards. For the experiment to have been even somewhat valid they should have been able to see it first WITHOUT her telling them that she was speaking to the dead. They were simply confirming their own beliefs when they associated increased blood flow with psychic activity. In point of fact that could just be the part of her brain that gets active when she is cold-reading an audience.

 
Science deals with testable theories and the way to ensure that a hypothesis or theory is testable is to make sure it is falsifiable. I know that this sounds counterintuitive but a hypothesis that is so general that it is always true and can thus be applied to any situation is actually useless. For example, say that I offered you a magic pill and told you that it will make you become physically fit but that it is only effective if you completely believe that it works. If you take it and don’t get fit, it must be that you don’t truly believe. I can always blame the pill’s failure to work on the fact that you didn’t believe in it. If, you were to object and say that you did believe it, I would merely say that if you had believed, it would have worked. Since it is unfalsifiable I can always justify my hypothesis no matter what the outcome. This is how psychics and mediums work! They say they are talking to dead loved ones and if you don’t feel the presence of your loved ones you must not have believed in the first place.

When  people like Caputo, Amen, and now apparently Dr. Oz conduct  tests with scientific-looking equipment that does not test what they claim it does, they are doing nothing more than proffering pseudoscientific nonsense, which is damaging to public health and well being. Remember that increased blood flow to an area of the brain just tells you that the area is more active, it does not tell you why. Unfortunately to those who believe, I simply don’t see it because I don’t believe it; my skepticism is ruining it for me.  To that I say remember this: although gravity is a scientific theory I am free to doubt its existence. Doing so does not, however, diminish its effect on me; it works whether I believe or don’t believe. Real facts are true whether you believe them or not.

Finally let me be clear that I do not mean to imply any disrespect to those grieving individuals who seek out psychics. I lost my Dad two years ago to cancer and the grief of that still periodically Boot-Stomps me in the face. I would love a chance to communicate, even indirectly, with him at least one more time. I know from experience that it is almost impossible to be rational while grieving. The sad fact is that these self-styled “mediums” are acutely aware of this. People like Sylvia Browne, Theresa Caputo, John Edward, James Van Praagh, among the many others are nothing more than predatory, self-aggrandizing frauds who don’t deserve a bit of the attention they receive and certainly shouldn’t be taken seriously by anyone.

Healthy Skepticism: Why is the Scientific Method Important?

All of the advances made in public health, medicine, and nutrition within the past century have been achieved through scientific experimentation and observation: all of them. Therefore familiarity with the scientific method has particular bearing with regard to health-related topics because these are areas that have immediate application to our daily lives. Furthermore, the fact that a lot of us are interested in these topics results in a huge number of heavily marketed hypotheses, some of which have some plausibility, many of which do not.

The scientific method is an elegantly simple process that is also the best way yet discovered to separate the truth from wishful thinking. The practice involves a series of steps:  first you observe something and develop a hypothesis, which is a conditional explanation of what you have observed, then use it to make predictions. Next—and this is the most important part—you gather evidence to test those predictions by using either experiments or further observations. Finally, you amend the hypothesis then repeat the testing process; you keep doing this until you minimize the differences between your predictions and the actual observations. Lastly you have your conclusions reviewed and replicated by your peers in order to make sure that your interpretations of the observations are sound. If you are fortunate enough to gain consistency between your experiments and your predictions the hypothesis becomes a theory, which is often used in the vernacular to mean an incomplete or untested idea but in scientific terms is actually a well-supported structural framework that can be used to explain observations and to make predictions. That’s it! While it is certainly true that science gets more convoluted as you dive deeper into it, at its core it always follows these simple rules.

Many popular claims actually follow the scientific method nicely until they get to the point where it becomes necessary to test the purported hypothesis, after which point they rely on argument rather than evidence, which is not scientific.  Even the cleverest arguments can be trumped by meager experimental or empirical evidence.

plaque-aristotle-c3d5Aristotle, it is said, argued that women don’t have as many teeth as men. As the story goes however, he never bothered to check and verify his assertion… men and women do indeed have the same number of teeth (at least on average). The point is that, while reason is important, arguments, no matter how authoritative, eloquent, or how much we want to believe them, are not enough to determine whether a testable hypothesis is correct. Sound reasons or strong intuitions that something ought to be true don’t guarantee that it will be.

An understanding of how to think about what constitutes science is the most important thing you can have to help you sift through the bad health and nutrition information (and all other information for that matter). However, I am not implying that in order to be a sound decision-maker you need to go out and become a lab-coat-wearing scientist, nor am I suggesting that those who are vocational scientists are somehow superior to anybody who is not. I am merely suggesting that we can all benefit in our daily lives if we adopt a scientific frame of mind when we evaluate information.

It is interesting to note that, though we may not initially realize it, we actually encounter practical scientists in many places in our daily lives. Consider, if you will, your auto mechanic. Although most mechanics I have known do not identify themselves as scientists, in fact they are. If I take my car into the shop with no more than a basic description of what is wrong (“it’s making a kerchunking sound every time I shift gears”) it is the mechanic’s job to hypothesize, based on his or her experience, what the problem may be. S/he will then test to see if the hypothesis was correct by fixing this part or that (I can’t really use any good terminology here because I really know nothing about cars). If S/he was right, great, the problem is solved. If not, it’s time to try something different. Mechanics do this until they fix the problem. It could even be argued that they have an advantage over more obvious scientists because they have nothing to gain by clinging to their original hypotheses and so don’t bother justifying why they should have been right; they simply go with the evidence. Now most of us would not take our car to a mechanic who, instead of amending his or her initial hypothesis until the problem was fixed, gave us rationalizations, but many of us have followed the advice of people who do this with our health.

Honourable_Bertrand_RussellBertrand Russell, who was critical of many of the scientific advances of his time (the atomic bomb for example),  nonetheless argued that “the scientific temper is capable of regenerating mankind and providing an issue for all our troubles.” Due to the simple fact that, in my day, I have been taken in by many a health charlatan, it is my goal to spotlight some of the techniques used by these impostors to separate us from our money, and very often, our health and well-being.

Healthy Skepticism: The Great American Medicine Show

When talking about misleading health claims it makes sense to begin with The Great American Medicine show, which, for me at least, calls to mind images of 19th century traveling snake-oil salesmen and old-timey vaudeville numbers.

Snake oil posterThe Medicine show is not uniquely American. It actually is thought to have its origins in the decline of the Roman Empire. In the year 568, the Church banned theaters and circuses throughout all of Europe. Performers then hit the road throughout Italy and formed traveling entertainment troupes. At some point tooth extraction became part of the traveling show and this was the dawn of the medicine show and the birth of the ciarlatano—“one who sells salves or other drugs in public places, pulls teeth, and exhibits tricks of legerdemain.” This, of course, evolved into the word charlatan. The Italian medicine shows had a counterpart in England. English nostrum peddlers were often referred to as stage quacks because the nonsense they spouted from the stage sounded like the quacking of a duck. The nostrum peddlers and the ciarlatanos were the ancestors to the American stage quacks.

In the 1800s and early 1900s, medicine shows were often the only entertainment members of the audience had. Sandwiched between soft-shoe dance numbers and vaudeville-type routines were testimonials performed by the entertainers for manufactured patent or proprietary medicines. The advent of wood pulp paper meant that newspapers could print more issues and had room for bigger advertisements, which changed the nature of marketing profoundly. Patent medicine makers now had a way to reach more people and make their nostrums household names: they ran the first saturation campaigns and were hugely successful.

This success led to the decline of the performing charlatan but not to quackery itself. Print ads broadened the scope of large scale nostrum peddler immensely but that was nothing compared to television. In the mid-twentieth century, television gave the quack an almost unlimited reach across the U.S. and gave the old performing charlatan a new faculty as a pitchman.

In 1950, Dudley J. LeBlanc, a Louisiana state senator and manufacturer of a product called Hadacol, was at the height of his career and had become one of the first documented celebrity pitchmen who was a pitchman before he was a celebrity. Directly after serving in World War I, LeBlanc started his career as a traveling salesman, selling tobacco, shoes, and two of his own patent medicines: Dixie Dew Cough Syrup and Happy Day Headache Powder.  He served on the Public Service Commission and eventually went on to serve in both houses of the Louisiana legislature.  After an unsuccessful campaign for governor in 1932, LeBlanc sold his insurance business and, following the loss of all the proceeds in the stock market returned to the patent medicine business. Finally, in the early forties LeBlanc was afflicted with an ailment that caused his legs and big toe to swell, thus rendering him crippled.

James Harvey Young writes about LeBlanc in The Medical Messiahs (1967):

LeBlanc, during the heyday of his fame, was fond of telling inquiring reporters how it had all begun. In 1943, he said, he got a bad pain in his right big toe. The pain spread to his knees, his arms, his neck. Three different doctors gave him three different diagnoses—gout, arthritis, beri beri. Each treated him without success. While in a New York hospital, he overheard his wife say: “He really is sick. I never saw Dudley so bad. I just don’t know if I’ll ever see him alive again. LeBlanc sought to escape from the hospital. As he hobbled out he met an old friend, another doctor, who told him he looked like “walking death.” Hearing LeBlanc’s symptoms, the doctor offered to cure them. So LeBlanc went with him to his office for an injection. Like magic the medication began to cure his condition. Each shot brought further improvement. LeBlanc was naturally curious. So he asked: “Doc, Whazzat stuff you got in dat l’il ole bottle?”

“Dude, you crazy?” the doctor answered. “You think I give away my secrets to a man in the patent medicine business?”

Several days later the doctor was busy and told his nurse to give LeBlanc his shot.

“She wasn’t so smart as him,” LeBlanc later reminisced. “Nor careful either. She left the bottle on the table. When she finished I gave her that old Southern Chivalry, you know, ‘after you, Gertrude.’ As soon as she turned her back I shoved the bottle in my pocket.”

Taking the bottle to his hotel, LeBlanc read the label, then got some books to find out what the label meant. His injections, he found were mostly B vitamins. “Then I figured to myself,” LeBlanc said, “This is it.”

It is thought that LeBlanc had Beri Beri, which is a neurological disease that is caused by a lack of vitamin B1 and thiamin in the diet. This explains why Hadacol was effective in treating him, as its main ingredients aside from alcohol were B vitamins. Either way, LeBlanc was eventually able to raise Hadacol to the level of cultural phenomenon. A 1951 statement on Hadacol in Newsweek said: “It’s a craze. It’s a culture. It’s a political movement. This all seems very odd when you consider that Hadacol was a tonic that consisted of alcohol, some B vitamins, calcium, iron, phosphorous, dilute hydrochloric acid, and honey.

ImageMuch of LeBlanc’s success could be attributed to his charismatic appeal, “he was a healer of the people, the champion of the working stiff”.  That appeal eventually allowed him to resurrect the medicine show and make it huge for a time. During the late 1940s a caravan of 130 vehicles went on a 3,800-mile tour through the South and played one-night stands in 18 cities.  10,000 fans (for lack of a better word) brought Hadacol box tops as admission to watch the shows—which were emceed by LeBlanc—and were musically entertained with swingin’ tunes like the Hadacol Boogie, and Who put the Pep in Grandma? (Sadly there is no available link to this one, which is possibly my favorite song title ever!) Not to mention the list of celebrities like Mickey Rooney, Minnie Pearl, George Burns, and Gracie Allen, among the other A-Listers of the day who were on the tour. LeBlanc spent a half a million dollars on the extravaganza and the public gladly spent over three million dollars of their hard-earned money on Hadacol with the reassurance that LeBlanc would “send back their money” if it failed to help.

This is all pretty amazing when you consider that Hadacol was marketed as medicine (somebody needs to write The Lipitor® Boogie). One reason for Hadacol’s prolonged popularity may have been the 12 percent alcohol that it contained. Alcohol was a staple ingredient in patent medicine tonics from the beginning, which explains why people often felt better after taking them (Cheers!). However, LeBlanc asserted repeatedly that the alcohol was used merely as a preservative and that if one followed the directions on the bottle he or she should feel nothing in the way of a buzz (I’m paraphrasing here). Nonetheless, Hadacol was about as alcoholic as wine.

The other, probably more significant, reason for Hadacol’s success comes from the fact that LeBlanc, from the beginning, knew the value of the testimonial, people believed vivid stories from other “everyday folk” over scientific evidence, and testimonials were (and still are) an effective way to get around government restrictions on false claims. If a person who used a tonic claims that it cured his or her cancer, the manufacturer can use the testimonial without actually making the claim. LeBlanc received a good many of his testimonials by way of free samples sent to people along with a form that they were requested to fill out on how Hadacol helped them. The label on the Hadacol bottle only made vague claims about it being useful for “nervousness, indigestion, insomnia, and other minor ills. But people sent in testimonial upon testimonial attesting to the miraculous powers of Hadacol.

LeBlanc was able to turn Hadacol from a successful regional product worth about $60,000 a year into a booming national enterprise. By 1949 Hadacol was bringing in $24 million a year. But alas, good things must eventually come to an end. In 1951 LeBlanc had become something of legend, however by September of that year his company was $8 million in debt, much to the chagrin of investors. LeBlanc was eventually forced to sell the company for $250,000. Ten years after the decline of Hadacol, LeBlanc insisted in an interview with reporters that it was a “very, very meritorious product. Who is to say that people weren’t helped for those ailments? The doctors? Who can believe them? No my friend, there’s still much that is not known about nutrition.”

The end of Hadacol may appear to have signaled the end of the “great” medicine show, but if you look you can see that it is actually thriving these days. Despite the advances made by health scientists over the last six decades, the health and wellness industry is thriving on questionable claims that are shrouded by fancy presentations, testimonial evidence, support from the pseudo-medical communities, as well as flat-out fraud. If you look at modern commercials, it’s easy to see that the medium has changed but the tactics are the same.The examples of the medicine show, Dudley LeBlanc, and Hadacol show that the tactics used by con artists and pseudoscientists have not changed much over time because unfortunately they still work. We still believe that testimonials given by anti-establishment “everyday” folk are sufficient evidence to support claims. Hype and fallacious appeals to authority are used commercially more often than solid evidence. It is ironic that modern charlatans will spend a huge amount of energy berating the scientific community for “keeping the truth away from the public,” and “clouding the facts with too many difficult to understand details,” yet the minute there is a shred of scientific  sounding evidence to support their claim, the words “scientifically proven,” “Clinical studies show…” and other phrases that make it sound to the public like a person in a white lab coat has proven their claim show up all over labels, commercials, and print ads. The effectiveness of these claims indicates that most of us actually do respect science but may be uncertain about how it works or even intimidated by it.

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Exacerbating the problem is that when we are eager to believe in something, the charlatan merely has to tell us what we want to hear, contrive some evidence to back up the claim, and then wait for the financial return. If I could get back all of the money I have given over to ideas that I really wanted to believe that turned out to be implausible or impossible, I’d be in a higher tax bracket. But alas, I have lived and I have learned.

The goal of this post, and indeed of this blog, is to foster a little scientific skepticism about health-related marketing claims. While LeBlanc’s assertions about Hadacol where mostly harmless in their nature, it is important to remember that not all fraudulent claims are harmless. Imagine a cancer patient who decides to forgo scientifically verified therapies in favor of an unproven “natural” therapy then dies because he did so. This may be an extreme example but it never has to happen as long as we approach information like this with a critical mind.

More posts to come…

References


The majority of the information in this post about Dudley LeBlanc and Hadacol can be corroborated in three places:

  1. Anderson, A., Snake oil, Hustlers and Hambones. The American Medicine Show. 2000, Jefferson, NC: McFarland & Company Inc.; and Young, J.H.
  2. The Medical Messiahs. A Social History of Health Quackery in Twentieth-Century America. 1967, Princeton, NJ: Princeton University Press.
    1. The chapter on LeBlanc is available online at: http://www.quackwatch.org/13Hx/MM/15.html.

The Hadacol Boogie  lyrics are as follows:

Down in Louisiana in the bright sunshine. They do a little boogie-woogie all the time. They do the Hadacol Boogie, Hadacol Boogie. Hadacol Boogie, Boogie-woogie all the time. A-standing on the corner with a bottle in my hand, And stepped up a woman, said, “My Hadacol Man.” She done the Hadacol Boogie, Hadacol Boogie. Hadacol Boogie, Boogie-woogie all the time. If your radiator leaks and your motor stands still, A-give her Hadacol and watch her boogie up the hill.  She’ll do the Hadacol Boogie, Hadacol Boogie, The Hadacol Boogie makes you boogie-woogie all the time

I haven’t been able to find the lyrics to Who put the pep in Grandma but if anybody has them or better yet a recording of the song please let me know at petruchio71@gmail.com.  I would be eternally grateful.