Welcome to Impact Factor, your weekly dose of commentary on a new medical study.
I’m Dr. F. Perry Wilson.
This week, we’re taking a break from our usually scheduled programming to talk about
Goop.
No not this goop.
Not this goop.
This goop.
Goop, Gwyneth Paltrow’s lifestyle brand is coming to your living room via Netflix
with “The Goop Lab” – where Gwyneth and her crackerjack team look at various wellness
topics.
Now, I want to make it clear, that I like Gwyneth Paltrow.
If Gwyneth wants to invite me to the Oscar’s, I’m in.
Party at her Brentwood Estate?
Sign me up.
But Goop… see Goop bothers me a bit.
Here’s why.
Goop is not your typical lifestyle brand hawking makeup and 10 tips to make sex outstanding.
I mean, it is.
But a huge part of its business model relies in selling products based on dubious health
claims - you may remember the kerfuffle that resulted from Goop’s “jade vaginal eggs”
marketed to improve sexual functioning.
Currently, the site sells a variety of herbal remedies in very classy, medical-appearing
packaging.
Here is Goop’s “perfect attendance” supplement which purports to offer “immune
support”.
Note the careful avoidance of terms that would imply it is intended to treat, cure, or prevent
any disease which would subject the substance to FDA scrutiny.
Goop is part of a nearly 200 billion dollar complementary and alternative medicine market.
And, honestly, the size of that market is an indictment against the conventional medical
industry.
For many conditions – I’m looking at you low back pain – conventional therapy is
limited, costly, or with significant side effects.
Doctors don’t have enough time to really get to know their patients, to understand
what’s going on beneath the surface level.
CAM providers offer more than weird lotions and energy manipulation.
They offer a sympathetic ear, hope, and understanding.
And yes – some patients heed that siren song of CAM – side-effect free curative
treatments – and forgo conventional therapy.
This is a problem.
A JAMA Oncology study matched 258 cancer patients who used CAM to 1032 who did not.
7% of the CAM group refused surgery, 34% refused chemotherapy, and 53% refused radiotherapy.
Perhaps not surprisingly, five-year survival was significantly lower in the CAM group.
So yes, there are some people who avoid necessary care because they pursue a care modality that
appears safer to them and they pay the price for it.
There are other adverse effects of CAM therapies.
A New England Journal of Medicine study examined ER records to determine that about 23,000
ED visits per year are due to adverse effects of supplements – often these were due to
the cardiovascular effects of weight-loss or energy-products.
But people end up in the ED all the time for problems with conventional medications too.
In reality, most people integrate herbs and supplements into the rest of their medical
routine without adverse effects.
Many patients don’t tell their doctors about their uses of herbs and supplements, which
is a problem that may increase the risk of drug interactions.
Of course, given that a study evaluating supplements at large chain stores found 4 out of 5 didn’t
contain the product they claimed to, even if a patient tells us what they think they’re
taking, it may not help.
Better regulation and oversight would go a long way to make supplements safer, but honestly,
this is still not really what bothers me about companies that sell CAM, companies like Goop.
It’s something a bit deeper.
It’s that their business model depends on sowing doubt about the very scientific method
upon which we’ve built modern medicine.
They substitute anecdote for analysis.
They appeal to the use of a product throughout history as adequate evidence of its safety
and efficacy.
I am thankful we’ve moved away from this approach, lest the lead tableware the Romans
preferred still be found at our dinner tables.
We are, in part, to blame for the rise of companies like Goop.
We’ve dropped the ball, and left the emotional and psychological needs of our patients at
the door in service of our need to see 50 patients a day to make ends meet.
In the vacuum we’ve created, all sorts of people, from the true believers to cynical
hucksters will step in.
But even in the best light, the CAM-selling companies need to bear some blame.
They do better when patients trust their doctors less.
They embrace the anti-expertise, anti-intellectual milieu we’ve found ourselves in and paint
conventional docs like me as pharmaceutical company shills at best, sociopathic mass murderers
at worst.
Still, it remains my firm belief that if we can recapture the spirit of community with
our patients, if we can spend more time looking at them and less at a computer screen, more
time listening and less time billing, they will come back to us if for no other reason
than, well, our medicines work.