While it’s true that you can’t judge a book by its cover, you can often learn a lot by looking at its author. In the case of medical bullshit—whether that be a best-selling book, a “miracle supplement” or a “revolutionary new theory on health”—a careful glance at the real accomplishments and actions of the person behind the message should in many cases put you on your guard. As you develop a nose for bullshit, you will find that simply the name of certain self-proclaimed experts may be enough to turn you away. As one example, if I see that Dr. Oz is endorsing a product or book, even if it is not his own, I get a pretty good idea that it is worthless (google “Dr. Oz Charlatan” for some interesting reads). There are several other celebrity experts whose endorsements show up everywhere and, at least for me, stand out like a bright blinking fluorescent sign saying “get your bullshit here.”
Please don’t take this to mean that you should buy anything from someone who seems to be a legitimate expert in their field. As an example, there are a few unscrupulous neurologists with outstanding resumes who wrote bestselling books claiming to cure illnesses that are still incurable. Fortunately, the tips in Part I of this series on the products themselves still apply and loudly sound the bullshit alarm for their work. However, you will be surprised to see how often self-proclaimed experts have no real claim to expertise.
Here’s how to spot an unreliable expert:
1. The expert does not have the correct credentials
Medical bullshit experts flaunt any credentials they have – diplomas, certificates, awards, publications –prominently on their website, flyers, books and office. Having too many credentials may even be a clue to something amiss. Often a careful look will reveal that the credentials on display are not the credentials needed to claim expertise in a field. Some common examples include: having training in one field and claiming expertise in another (e.g. a surgeon who writes a book on nutrition); doing research in one field and claiming expertise in another (e.g. a physicist promoting stem cells); highlighting the fancy school one went to but not what was studied (e.g. a Lyme Disease author who highlights they are a Harvard graduate but neglects to mention that they majored in English); having a degree in a field you’ve never heard of or from a school you’ve never heard of (this of course could be just your lack of familiarity with a legitimate field or school but it would be worth looking up); or in some case buying or simply fabricating a fake degree.
2. The expert goes directly to the press or the public with their initial observations rather than trying to validate them
If you look back at the history of medicine, many of our greatest discoveries came from a chance observation or accident. A core principle of science is that one must be able to replicate and test these observations before we can trust them. In the late 1700’s Edward Jenner noted that milkmaids appeared protected from smallpox. Rather than publish a book about the Dairy Lifestyle or selling udder balm he did two important things. First, he continued his observations until he recognized that exposure to cowpox might be the key to preventing smallpox. Second, he and others carefully tested this hypothesis.1 In contrast, many would-be medical saviors today never test their initial observations, much less carefully validate them, before trying to take them to the press and market.
3. The expert brags about being rejected by the mainstream medical establishment
The idea that there is a monolithic entity, “the medical establishment,” is appealing to some people; what does this really mean? If one is talking about the culture of medicine, there may be some interesting things to say about how healthcare professionals act or what they believe in different contexts. However, if one is claiming that ALL doctors, researchers, hospitals, insurance companies get together to make collective decisions, particularly against a specific individual, that is simply creating conspiracies as a branding strategy. Don’t be fooled. It is next to impossible to get healthcare professionals to agree on almost anything.
Granted, there have been instances where a very major discovery was not immediately welcomed by the mainstream medical community, but the differences between these stories and the majority of bullshit out there is very telling. As an example, the idea that the bacteria H. Pylori could cause ulcers was revolutionary in 1982 because everyone in mainstream medicine at that time “knew” that stress causes ulcers. (2) The two researchers who came up with this idea, Barry Marshall and Robin Warren, had an uphill battle. They did not fight it by retreating to Mexico, writing a book, selling proprietary antiulcer pills, or starting their own clinic. Instead, they did more research, published it in peer-reviewed journals, and found colleagues who would test their results.
It was not just their persistence that paid off, but the fact that they had landed on a major discovery that other scientists could also prove for themselves and that produced obviously great results by doctors treating people with ulcers. By the time Marshall and Warren won their Nobel Prize 20 years later, everyone knew that H. Pylori caused ulcers. I am not aware of any renegade cures from people outside the medical establishment that have turned out to be true or changed practice. If controversial practices are ever independently tested, they are most often proven false and discredited.
4. You’re told by the expert that their ideas or your diagnosis is “too complicated” to understand
If you can’t convince them, confuse them. When someone doesn’t have evidence to support their claims, they often present some vague ideas and then add that the details are too complicated for any but the most brilliant experts to understand. They hope that people will “just take their word for it” rather than press for details. This goes with the notion that experts know things not just that most people don’t know, but that most people can’t know. Pretending that one holds ideas that can’t be understood or shared with others is akin to modern day witchcraft.
Real experts do society a disservice by not treating the person in front of them with respect and explaining things in a way that can be understood. Some experts have a difficult time writing or speaking clearly, some are purposefully trying to hide weak points in their research, some may simply enjoy the power of being an unchallenged expert but none of these are good reasons not to explain ideas clearly.
Regardless of the reasons for not being clear, the end result is the same – a promotion of power for those in the Expertocracy that reinforces a message of helplessness for everyone else. Granted, there are certain things that require specialized knowledge. I don’t understand the complex biochemistry and pharmacodynamics of many of the medications I prescribe. But I do understand other important things about them – the symptoms they treat, what dose to use, and what side effects to watch out for. Similarly, my patients don’t need to know all of the medical science underlying their symptoms (although I would be happy to share what I know if they are interested) but they should understand what treatments are available to manage their symptoms, how those symptoms may affect their lives, and how to plan for the future. I feel the mark of a true expert is someone who can clearly explain what needs to be known. As Albert Einstein said: “If you can’t explain it simply, you don’t understand it well enough.”
5. The expert actively encourages fear
Fear sells. Richard Leask, a representative of the California Chamber of Commerce, was quoted as saying, “if you can’t convince ‘em, confuse ‘em: if you can’t confuse ‘em, scare ‘em.” As a healthcare provider, I do my best to balance being realistic with compassion. If I have bad news for someone, that their disease is progressing rapidly, for example, I have a conversation with that person. They tell me what they want to hear, and I do my best to provide them with the information they need to make the best decisions possible. I also check in with them about difficult emotions, like fear or grief, and explore whether there may still be opportunities for meaning, connection or joy. In contrast, the bullshit artist will focus on the worst, will fan the flames of your fear (often while pretending to offer understanding), and will lead you towards the one best choice for someone in your situation which, coincidentally, happens to be what they are selling.
6. Test results are used tests to sell products
A trick used by mechanics to sell you a new air filter is to pretend to give your car a check-up; meanwhile, they have a horribly filthy air filter on hand that they show you when you come back as evidence that your car needs a new filter and other services. The medical equivalent happens when an alternative doctor orders a large panel of nonstandard tests from an unregulated laboratory. Invariably, these test results show many concerning values or evidence of infections that do not show up on standard testing. These abnormalities, of course, need treatments ranging from supplements and dietary changes to unnecessary antibiotics or even intravenous medications or invasive therapies.
7. The expert is not part of a regulated or established profession or clinic
Many professions, like medicine, counseling or acupuncture, have state boards that regulate the profession and handle licensing and testing. It is never a good sign when an expert dismisses these regulations. Sometimes, the person behind the product introduces himself as doctor, which in the setting of a healthcare implies a medical doctor, but they really hold a doctorate in another field, perhaps philosophy or business. A somewhat newer phenomenon is a medical doctor embracing a new branch of medicine (e.g. Functional Medicine, Alternative Neurologist) that does not have established training requirements. As with most of these clues, this doesn’t automatically mean this person is a quack – some have taken a thoughtful approach to integrating alternative treatments, exercise, and diet with traditional Western medicine. However, there are many times when they cross the line from a balanced approach to feigning knowledge or expertise that simply does not exist, and that is a harmful deviation from standard practice.
8. The expert doesn’t take time to fully listen to you or examine you
This comes up in two contexts. In the first, someone with the goal of selling you a product lets you talk, but only up to the point where they feel they have the information they need to move forward with their sale. Sometimes this can be subtle. The expert pretends to listen to you, to “understand exactly what you are going through” and then, once they have your confidence, they begin to talk more than listen.
In the second, a practitioner, often a doctor or nurse, sees you in a hurried manner. Perhaps they are busy. Perhaps they have their own agenda. Perhaps, at some point your story they have made up their mind about what’s going on and are now simply seeking to confirm it. In any case, you get the distinct feeling that you’re not being seen or heard. Listen to this feeling. Recommending prescriptions or therapies without knowing your values or hearing your full story can lead to dangerous situations and regrets.
An unfortunate side effect of this issue is that busy and competent Western doctors sometimes push their patients to seek alternative options because their patients do not feel listened to. Listening by itself does not guarantee a good treatment, but it is a crucial ingredient.
9. The expert discourages you from getting a second opinion
Getting a second opinion is never a bad thing. If patients ask me about getting a second opinion, I encourage it. Maybe I’ll be proven correct, maybe I’ll have the opportunity to learn something, but most important is that the patient can move forward knowing they have the correct diagnosis and treatment. When someone warns you against getting a second opinion or dismisses second opinions without really listening, they are doing you and themselves a disservice. They are also providing a clue that what they are selling may be more about them than you. No matter how confident or important the doctor, treating their ego should never take precedence over the health of the person sitting in front of them.
10. The expert asks you to stop conventional treatments
People who don’t know you or your medical situation should not make recommendations about how you take care of yourself, and they certainly should not ask you to stop medications other doctors have prescribed. I am not talking about situations where a medication may be causing side effects or contributing to symptoms where stopping it may be perfectly reasonable. Rather, I am referring to situations where treatments that are working are stopped. As an example, I’ve known patients with Parkinson’s disease who were told to stop taking levodopa, the single most effective medication for this condition, in favor of acupuncture, herbal treatments, dietary changes, or cannabis.
Abruptly stopping this medication will not only worsen the symptoms of stiffness and tremor it was treating, but could have disastrous consequences ranging from falls to a life-threatening condition called parkinsonism hyperpyrexia, characterized by intense muscle spasms, fever, unstable blood pressure, and sometimes death. People who don’t know what they don’t know, and who believe they know what they don’t know, are dangerous when they start making recommendations about your health.
11. The expert calls themselves “a leading medical expert” or is endorsed by other “medical opinion leaders”
I have seen some of the world’s greatest researchers speak, including several Nobel Prize winners. Many of these individuals truly needed no introduction because their work was so well known. However, they still got introduced. And when they did, the introducer listed their impressive accomplishments, things like their major discoveries, illnesses they cured, people they trained, important new ideas… None of them were introduced as, or called themselves, a ‘health expert,’ nor did they list a bunch of bestselling diet books, Oprah appearances, or drop names of other medical (or nonmedical) celebrities who they are friends with. If you pay attention to how experts are selling themselves, ask yourself, “does this really matter?” Does writing a best-selling book really prove you know what you are talking about?
In some ways, this tip is like a product relying solely on anecdotes. There is a lot of positive fluff but no real substance. As in the last blog on products, I always get suspicious when an expert gets an endorsement from someone I consider an unreliable expert (e.g. Dr. Oz, Deepak Chopra), generally people who have made a living based on their celebrity status and advice rather than anything I would consider a true scientific advance.
If you have other tips to add to the list, suggestions, corrections or questions, please do not hesitate to reach out.
If you are considering a health care treatment and can’t figure out whether or not it’s bullshit, please consider sending me a question at Ask Dr. Benzi.
Medical Bullshit Detector II: Unreliable Experts CHECKLIST
References 1. Rusnock AA. Historical context and the roots of Jenner’s discovery. Hum Vaccin Immunother. 2016;12(8):2025-2028.
2. Ahmed N. 23 years of the discovery of Helicobacter pylori: is the debate over? Ann Clin Microbiol Antimicrob. 2005;4:17.