Analyzing Snake Oil

Over at Slate is a good antidote to the chemophobia that is endemic in popular culture. The author, chemist Michelle Francl, is a self-described "equal-opportunity" and "professionally annoying skeptic", who encountered a popular New York Times article advocating an innocuous-sounding folk remedy for a child's case of juvenile idiopathic arthritis. The article makes several excellent points, but three stand out in particular.

First, the article explains in layman's terms that chemophobia is not just an absurd position, but also a dangerous one:

The reality is this. Meadows has been tricked by the language, maliciously or not, into considering switching her child from a carefully measured weekly dose of this molecule [chemical structure omited] [t]o four doses a day of an unknown amount of this chemical [structure omitted].

Really?

...

Meadows admits to obsessing at night over the potential side effects of methotrexate, which are clearly--and frighteningly--detailed on the prescribing information. Nausea, dizziness, liver damage. What was she doing to her little boy?

But what does Meadows know about the risks of what she calls Walker's regimen? Four-marvels powder has no ... rigorously reviewed package insert. Berberine, one of the drugs found in four-marvels powder, has been documented to cause brain damage in infants. Hello? Exactly how much of this have you been giving your son? And that may be the most important question. Meadows has no idea that she is giving her son this drug, and she certainly has no idea how much he is taking. ...

Everything is made of chemicals, including the various magic powders and elixirs being peddled to chemophobes.

This point leads directly to the second, which might help more scientifically literate people become better able to reach out to loved ones they fear might be making or contemplating a bad decision. Namely, how on earth does this kind of stuff have any traction in the first place?

Let me point out that the active chemicals--yes, chemicals, the stuff everything is made from--in four-marvels powder include quercetin, berberine, and achyranthine, names that don't smell quite as sweet as Montmorency cherry juice. Meadows is not unique in being seduced into complacency by language. Psychologists call this "processing fluency" -- we cope better and trust information more when the words it's couched in are easy to pronounce and familiar. Terms that don't roll easily off our tongues make us nervous. Given the choice, more people would rather take smooth-sounding Aleve than naproxen, though they are the precisely the same chemical. [bold added]

In other words, proper chemical names remind people through their unfamiliarity that there is lots they don't know, whereas an innocuous-sounding name (that sounds time-tested to boot) doesn't raise the same red flags so easily. Conversely, and as seen in the story, when people seduce themselves into thinking they are on top of something through this shortcut, they end up dismissing people who are actually more knowledgeable (even if only about what they still need to know) as unthinking (e.g., "trusting"). Both aspects of this point are worth understanding.

The third and most important point the article raises I have already alluded to. The author's self-description describes the proper attitude to take regarding all medical advice, whatever its source. Do whatever it takes to satisfy your own mind that the advice is good, bad, or mixed. Be an equal-opportunity skeptic. When considering medical advice from others, put yourself in their shoes for a moment and consider the following questions: Are you omniscient? Would you even want someone you cared about to just follow your advice without checking it or consulting others? Would you not want that person to ignore your advice if it were, in fact, bad? Would you not be grateful if that person helped you discover the truth if your advice were bad? If that person seems in any way not to appreciate why you might want to think about his advice first, you should be doubly suspicious.

Although this is an outstanding article, I do have to raise one point of disagreement. The author speaks too well of the FDA, which should be abolished and whose function of scientific review should be performed by private watchdog groups that can't prevent people from making their own medical decisions. The phenomenon of chemophobia is mostly a byproduct of poor education (in both thinking methods and information). However, a major contributor to the entrenchment of such primitivist attitudes is the whole idea that anyone in general or the government in particular can somehow save individuals from having to think for themselves by serving as some kind of guarantor of objectivity.

There is no shortcut to knowledge. The sooner we all understand this, the better.

-- CAV

Updates

2-12-13: Corrected a spelling error.