Magical Thinking Abounds in the "Anti-Aging" Marketplace
We humans have been shaped by past evolutionary processes to be very good at identifying patterns - and to enjoy doing so, such that we will spent significant investments in time and effort in this task. Pattern recognition was so important to evolutionary success back in the early days of humanity that it was acceptable to suffer the downside: our tendency to see patterns where there are none, and the limitations of our pattern recognition when applied to complex or random systems. We are adapted to pattern recognition in a "fire burns X, so it will burn Y", "the stars will do this next year as well" range of experience - we do not do well for much more complex situations.
Magical thinking - or "non-scientific causal reasoning" - is well-documented and understood consequence of the nature of our hard-wired ability with (and desire for) patterns. It can be found at the roots of magical activities in a wide range of traditions and cultures. These activities spring from common human urges, traits and societal structures, and so are remarkably similar at root, for all their varied details:
Magical thinking is a term used by some scholars to describe non-scientific causal reasoning (ie superstition). James George Frazer and Bronislaw K. Malinowski said that magic is more like science than religion, and that societies with magical beliefs often had separate religious beliefs and practices. Like science, magic is concerned with causal relations, but unlike science confuses correlation with causation. For example, someone may believe a shirt is lucky if he had won a bowling competition in it. He will continue to wear the shirt to bowling competitions, and though he continues to win some and lose some, he will chalk up every win to his lucky shirt.
According to Frazer, magical thinking depends on two laws: the law of similarity (an effect resembles its cause), and the law of contagion (things which were once in physical contact maintain a connection even after physical contact has been broken). These two laws govern the operation of what Frazer called "sympathetic magic", the idea that the manipulation of effigies or similar symbols or tokens can cause changes to occur in the thing the symbol represented. The use of voodoo dolls is a typical example of sympathetic magic. Others have described these two laws as examples of "analogical reasoning" (rather than logical reasoning).
The scientific method is the cure for problems caused by magical thinking, such as a lack of progress towards better lives, and all the limitations - dramatic or trivial - that stem from an incorrect understanding of the way in which the world works. To make progress happen, you must tackle complex systems in a methodical way: propose, explore, test, verify, record, repeat. But that requires more work than merely guessing, and so there will always be some market for those willing to take the "shortcut" to the wrong answer. When the wrong answer doesn't have clear, obvious and rapid bad consequences attatched to it, magical thinking will prosper. Such is the downside of human enonomic preferences - there is always a market for "incorrect" when "incorrect" is sold more cheaply than "correct."
So how does this fit in with the practice of medicine - in the broadest sense of the term, as any attempt to develop and apply technology or technique to health? Here's an article from way back in the Committee for Skeptical Inquiry archives:
To distinguish causal from fortuitous improvements that might follow any intervention, a set of objective procedures has evolved for testing putative remedies. Unless a technique, ritual, drug, or surgical procedure can meet these requirements, it is ethically questionable to offer it to the public, especially if money is to change hands. Since most "alternative" therapies (i.e., ones not accepted by scientific biomedicine) fall into this category, one must ask why so many customers who would not purchase a toaster without consulting Consumer Reports shell out, with trusting naivetë, large sums for unproven, possibly dangerous, health remedies.
The answer, I believe, lies in a combination of vigorous marketing of unsubstantiated claims by "alternative" healers, the poor level of scientific knowledge in the public at large, and the "will to believe" so prevalent among seekers attracted to the New Age movement.
It's a decade on from the date of writing - so much changes in detail, but people are still people. You don't have to wander far at all into the modern "anti-aging" marketplace to see magical thinking in the sales materials.
The wider business community - including a great many fraudulent and frivolous ventures - views "anti-aging" as a valuable brand and a demonstrated way to increase sales. At the worse end of the scale, this leads to snake oil salesmen, "anti-aging" cremes that may or may not make your skin look younger, and infomercials that tout the "anti-aging" benefits of exercise machines. Broadly, and very charitably, we can look at these varied definitions of anti-aging as meaning "to look and feel younger in some way" - which has no bearing on how long you live or how healthy you actually are.
Magical thinking is often accompanied and obfuscated by pseudo- or irrelevant science, so as to be made to appear more like the sort of work that comes out of the scientific community. Here is a good example of the type:
One key ingredient is a soybean cuticle extract that the company claims stimulates the body's production of a protein to slow aging. Orlane says its product is based on studies of the longevity of Okinawans, whose fish and soybean diets have been credited for the large number of centenarians on the Japanese island.
"They lived to their 100s and died wrinkle-free," said Naz Toloui, Orlane's vice president of sales and education.
Japan's Kanebo boasts an even more unusual ingredient. Its "Sensai Premier" eye cream - priced at $320 for 0.5 ounces - is infused with Koishimaru silk extract, from delicate silk cocoons that are half the size of normal silk cocoons. Kanebo, founded almost 120 years ago as a textile-manufacturing company, began producing soaps containing silk in the 1930s after noticing that silk workers' hands were soft. Kanebo claims that the Koishimaru silk extract stimulates the skin's production of hyaluronic acid, a component of connective tissue.
Those two above are examples of sympathic magic at its finest - A and B are somewhat the same, so it must work, right? Some people will believe enough in any new such proposal to spend resources, and other, better-educated people rightly estimate that they'll make money from investing in the beliefs of the the first group. Once it all gets going, you'll see a self-sustaining industry with the resources to expand the pool of consumers through (mis)education, and which comes to employ more and more true believers in key positions.
Many such interesting follies of human endeavor populate this world, growing organically from evolutionarily selected traits of the human mind. One might almost consider it a sort of species-level antagonistic pleiotropy - except that that would be magical thinking.
But none of this is going to help anyone to live a longer, healthier life. For significant healthy life extension you need the scientific method, modern biotechnology, a geared-up, dedicated and funded research and development community, and widespread recognition that the rapid development of real, modern medical science is the only viable path forward. Manipulating human biochemistry - identifying and repairing the root causes of aging - is simply too complex for any other way to succeed.
Technorati tags: anti-aging, life extension, magic, science
While I agree with the sentiment, and know first hand that we do see too much snake oil (especially in skin care), there are legitimate companies out there which, by applied magic, may inadvertantly progress the real science.
Just consider the large number of advances in science, not just in medicine but in all fields, that have happened not by reasoned scientific method but by accident, fate, casual observation or that magic you wrote about.
What's needed is a balance in thinking, and a recognition that while scientific method is an exceptional tool for validation, it has a poor track record when it comes to creativity and shifting the paradigm.
Some comments and criticisms:
This review ignores the bulk of research in anti-aging that comes through the American Academy of Anti-Aging Medicine (A4M)and the Life Extension Foundation. While there are snake-oil salesmen promoting anti-aging remedies, just as there are untrue and dangerously misleading claims in the pharmaceutical industry in spite of the US FDA (or because of it), the fact remains that much anti-aging research and the products of that research (supplements, for example) have actual value.
I agree that individuals should use more scientific thinking when evaluating claims of manufacturers, whether their products are health supplements or medications. I agree that magical thinking and so forth are misleading. However, the statement, "modern medical science is the only viable path forward" is dangerously magical. Let me explain:
If I understand this statement correctly, the author proposes that, when it comes to our health and longevity, we should, basically, "trust the doctor." That is, trust in medical science and its interpreters (the physicians in daily practice) to advise us truthfully and reliably when it comes to approaching the problems of aging. Everything else, it is implied earlier, is unreliable and "superstitious."
On trusting medical science: I had occasion to research the overall safety and efficacy of conventional medicine. I spent 16 years in the effort. My search began when my family doctor said that he was taught in medical school that only 10-15% of all medical procedures were actually tested scientifically as to their safety or efficacy; that 85% of what doctors do is of unproven safety and efficacy. I could not believe this, but other doctors confirmed this.
I sought the source of this figure, since it was difficult for me to believe in it. I found that it was based on a US Congressional report of the Office of Technology Assessment in the early 1970s. This 120+ page report's purpose was to evaluate the safety and efficacy of the then-current medical technologies. It contained no such conclusion! In fact, its conclusion was that they needed more research to come to a conclusion.
However, buried in the middle of the report was the only statistic: 10-15%. It did NOT refer to the entire field of medicine, it referred to a single, small study performed in England, not even in the US, in which a handful of doctors examined the outcome of a few drugs on a small number of patients. 10-15% efficacy was the outcome of that single study--and was not meant to apply beyond that. The point is that medical schools had been MISQUOTING that report--and portraying the wrong idea about the efficacy of the entire field of medicine--in medical schools in the US and Canada for over THIRTY YEARS! Any freshman in college knows that, before quoting something, a good scholar always goes to the original source. In this case, the medical schools failed to do that for over three decades and apparently those students in all those schools just "believed" what they were taught. How "scientific" was that? How disappointing about your chosen career--after paying all those thousands of dollars--was that terrible belief?
I decided to interview the doctor who made that statement about 10-15%. He is credited as being the "father" of evidence-based medicine. He told me he never meant that statement to apply to all of medicine at the time. He said he has been misquoted for years. I asked him to tell me what medicine was based on, if not evidence, back in the 1960s and 1970s (since I was a patient than, I was curious). He said medicine was "all a matter of opinion." He said doctors would meet and compare notes and ask if this or that remedy worked, and they would come to a bit of a consensus. In short, medicine at that time was NOT based on evidence! Evidence-based medicine only began in the late 1960s and became a buzzword in the past ten years or so. The almost weekly headlines about this or that pain reliever or heart medication being taken off the market because of adverse events and death ought to be evidence enough that evidence based medicine is more of a slogan than a reality.
I asked this doctor who started the evidence-based medicine movement what he thought the status of medicine AS A WHOLE was at this time (1999). Ironically, he said that it is only "10-15% proven to do more good than harm." Ironically, the medical schools that had been misquoting him for thirty years turned out to be right by accident (pun intended).
Just to be sure he was correct, I cross-checked against what medical journals on the subject of medical safety and efficacy were saying internationally. I found general agreement with the 10-15% figure (and they were not quoting the father of EBM), one at 20% and one at 40%, but they were exceptions. Even the Cochrane Collaboration whose mandate it is to review every medical study ever written anywhere in search of the best quality studies) did not deviate much from these figures. (Interestingly, Archy Cochrane was a student of the doctor I interviewed.)
The record of medicine's successes are often quoted. But, to balance the record, in light of the above, it should be noted that over 100,000 people die every year in the US alone due to doctors' deadly mistakes. That is more than die of AIDS. This makes doctor-caused death a major killer.
So, the point I am making is that having faith in medical science is a dangerous business for patients and highly profitable for doctors and especially drug companies.
The author of the commentary asks us to trust medical science--which has only a 10-15% chance of being safe or efficacious and an 85% chance of unknown safety and efficacy. If you were given a bottle of pills and its label said: "10% Active Ingredient..., 85% Contents Unknown," would you swallow those pills? Yet, we "swallow" the claims of medical so-called science and our doctors' advice so willingly!
The reviewer asks us to distrust snake-oil salesmen or the greedy purveyors of health supplements who foist unscientific claims on us. Yet, who is the greediest snake-oil purveyor, who has deceived the public most dangerously, voluminously, and profitably--the health industry or the medical-pharmaceutical cartel?
The record shows that drug companies make up to 500,000% profit on a single drug! That all drugs have side effects, and the evidence of their harm has been suppressed by the FDA for years and is just coming out lately, and that most of what physicians do is unproven. How is this happening?
I suggest it is because the real "magician" of the 21st century is the modern medical doctor and the pharmaceutical cartel. I suggest that we have merely transferred our "faith" from magic to medical so-called science, which, based on its own statistics, does not rationally deserve our trust at all.
Having said that, I am aware that many physicians know all of this and are doing their best to find alternatives to drug-based treatment, although their education never prepared them for the disillusionment the public is beginning to experience in relation to drug-and-surgery-based approaches. I know that they realize they have little to offer for chronic pain and actual cure; that they know they are merely treating symptoms in most cases. I know that many physicians went into medicine with a genuine compassion and passion to help alleviate suffering. I know that those physicians, like their patients, will continue to look for a more natural approach to conventional medicine and a solider scientific base.
But the point is, we don't have that now. Our faith--now--is misplaced.
David, I'd ask that you not fall onto the bandwagon of blaming doctors for deaths. It's really an overrated and misrepresented thing.
First off, people under a doctor's care are generally already in a bad state of health, so something could hurt them which wouldn't hurt most others. Furthermore, I can guarantee that poeple's lifespans would be far more limited, and deaths are more rampant, when utilizing the superstitious 'traditional' medicine full of placebos and pseudoscience.
Consider the increase in lifespan due to modern medicine, and ask, wouldn't these people dying 'because of the doctors' already be dead if not for them?
Now, coming down to it, yes, misdiagnoses happen, but that is sometimes an unavoidable thing. Sometimes a condition advances too rapidly to properly test for every single plausible thing, so you need to try things out, and sometimes that has the opposite effect of what you're going for. If you watch House M.D. you'll get a sense of what I mean.
One should always be critical of those you rely on, and that includes the medical establishment, but while you should certainly pay attention to the deaths, look into the doctors it happens under, and find out why it happened and remedy it, do not use that tragedy of reality to malign modern scientific biomedicine or its practitioners, because if you really want to stack things up, they're way ahead.
Judging from the responses, I should have tacked in an extra paragraph or two to explain my interpretation of the excerpt from the CSI article. I'm sure the author there was all for the full-on FDA process - I'm not. Rather, I'm for using the scientific method and engineering rather than magical thinking. My opinions on regulation are probably fairly clear by now.
My point is that comparatively little of the "anti-aging" marketplace, from a dollar amount perspective, is particularly scientific - I'm thinking more along the lines of the examples given in the post rather than the supplement folk at this point. Cherry picking studies and other forms of abuse at the supplement end of the market comprise a whole different range of sins, not really within the scope of this post.
Here, I'm pointing the finger at those who are basically making stuff up, cloaking it in the slight appearance of science, and presenting it as truth. That is a very different thing from the explorations of engineering, or the validation of the scientific method, and has nothing to do with aspects or the state of regulation.
Thank you for your comments (re: my December 25, 2006.)
The statement that medicine is only 10-15% proven to do more harm than good comes from my interview with the acknowledged "father" of evidence-based medicine, Dr. Kerr White, in 1998 and 1999 in connection with an expose on our British Columbia (Canada) Medical Association, published in BC and documented on my website http://www.thewritestuffservices.com.
I was also thinking of worldwide figures on the safety and efficacy of medicine that I found in American, Canadian, and European (English) sources. No figure I found was higher than 40% and the usual spread was in the 10-15% range, just as Dr. White said.
Time magazine cited a numerical figure of 99,000 deaths due to doctors in, I believe, 1999. Another figure in, I believe, the Journal of the American Medical Association was about 210,000 deaths in the US. (I would have to go back and check to be certain.) The main point being that iatrogenic deaths (doctor-caused deaths) is on a magnitude of a true epidemic.
The trust element is difficult to explain. If your car had only a 10-15% chance of the breaks holding on an icy road, would you drive it? If you had an investment that was predicted to have only a 10-15% chance of making a return, would you invest? If your baby had an 85% uncertainty rate of being born alive, would you feel uneasy about that? And, as I said, if a pill or other intervention had an 85% uncertainty rate as to whether it did harm or good, would you swallow it? That is the situation in modern medicine. Why do we trust those odds?
No snake oil for me. Fish oil! I've been taking 15,000 --- 20,000 mg/day for ten years and now at age 72 have relatively wrinkle free skin and none of the Big Four diseases. Of course a Dr. Weil-based diet and gym routines of cardiovascular and weight training plus daily mental gymnastics (as an inventor in the field of audio engineering) contribute. Just to cover the bases I take CoQ10 and curcumin also.
(This site is new to me and I hope a post of my simple (fad?) regimen does not clash with the otherwise very thoughtful entries based on the scientific method. Could be my "good luck"---so far---is 90 per cent genetic.)
I'm just going to point out a few things:
1. Doctors are primarily paid to fix things when things go wrong in your body. This means that they are great if you are near death and need an engineered solution to get rid of your infected pancreas, traffic accident, knife wound or whatever.
Doctors are not really paid to extend your healthy lifespan although they do a little of this. I don't know many doctors that won't tell you to lose weight or to stop smoking, but in general they don't tell you how to run your life to live as long as possible- the highest paid ones in particular are there to remove neuroendocrine tumors, do chemotherapy etc. etc.
2. Anti-aging is going to essentially be biological engineering which is something new that doctors don't do and don't have a particularly good reason to do since it involves so much legal risk. I don't know how things are going to pan out, but I do suspect that there are going to be at least some doctors in life extension in the future, especially nanomedicine, but that the general pressure for life extension is going to come from lay people, scientists & companies. No current practicing doctor is, for example, going to tell their patients to start knocking out Nf-kB genes in their body no matter what the theoretical benefits. Maybe I'm wrong, I don't think I am.
3. The general public is mostly deficient in vitamins & minerals. It's Kurzweil, the scientist, who takes a bunch of supplements. It's not fair to blame supplement manufacturers when one of the biggest evangelicists of transhumanism takes millions of dollars worth of supplements. A modestly informed consumer who finds himself in the supplement aisle is much more likely be to buying omega-3's and vitamin D, than cocoon silk from okinawa or whatever it is you imagine supplement manufacturers to be pushing. The life extension foundation, by the way, typically cites more science than this site which I think validates them and kurzweil for the most part.