As the skeptical cardiologist surveys the heart health information available to his patients and the lay public, he sees two broad categories of misinformation.
First we have the quacks and snake oil salesman. These are primarily characterized by a goal of selling more of their useless stuff online.
I’ve described this as the #1 red flag of quackery. Usually I’m inspired to investigate these charlatans because a patient asks me about one of their useless supplements.
The second category is more insidious: the magazine or internet news site seems to have as its legitimate goal, promoting the health of its readers. There is no clear connection to a product.
Web MD, which I wrote about here, is an example of this second type. Hard copy versions of these types of media frequently make it into doctor’s waiting rooms: not because doctor’s have read and approved what is in them. These companies send their useless and misleading magazines for free to doctor’s offices, and the staff believe it to be legitimate.
How does glaringly inaccurate and often dangerous information get into media that ostensibly has as its goal promoting its readers health? Most likely, it is a result of media’s need to constantly produce new and interesting ways for readers to improve their health.
Clearly, readers will not continue subscribing, clicking and reading such sources of information if there isn’t something new and exciting that might prolong their lives: gimmicks, miracles cures, and “natural” remedies are more alluring than the well-known advice to exercise more, watch your weight, stop smoking and get a good night’s sleep.
Reader’s Digest and Stealth Quackery
A patient recently brought in a printout of Reader’s Digest’s “40 things cardiologists do to protect their heart” which is typical of the second category.
Reader’s Digest was a staple of my childhood. My parents subscribed to it consistently and I would read parts of it. It was small and enticing. Allegedly its articles were crafted so that they could be read in their entirety during a session in the bathroom.
To this day it has a wide circulation. Per Wikipedia”
The magazine was founded in 1920, by DeWitt Wallace and Lila Bell Wallace. For many years, Reader’s Digest was the best-selling consumer magazine in the United States; it lost the distinction in 2009 to Better Homes and Gardens. According to Mediamark Research (2006), Reader’s Digest reaches more readers with household incomes of $100,000+ than Fortune, The Wall Street Journal, Business Week, and Inc. combined.
Global editions of Reader’s Digest reach an additional 40 million people in more than 70 countries, via 49 editions in 21 languages. The periodical has a global circulation of 10.5 million, making it the largest paid circulation magazine in the world.
Reader’s Digest used to run a recurring educational feature on the various body parts and organs of Joe and Jane which intrigued me.
Here’s the first paragraph of “I am Joe’s heart:”
I am certainly no beauty. I weigh 340 grams, am red-brown in color and have an unimpressive shape. I am the dedicated slave of Joe. I am Joe’s heart.
The health information in this series was generally accurate but the presentation lacks the kind of sizzle that apparently attracts today’s readers.
The article my patient brought to my attention is typical of the mix of good and bad information and fluff that mainstream media can produce to attract followers:
Not So Bad But Not Clearly True Medical Advice
#1. I keep a gratitude journal. An internist “at NYU” is quoted as saying: “Studies have recently shown that expressing gratitude may have a significant positive impact on heart health.”
Fact Check: following the links provided provides no evidence to support this claim.
#2 I get 8 hours of sleep a night, every night. This cardiologist seems to have been misquoted, because her comment is actually “getting a good night sleep is essential. I make a point of getting seven to eight hours of sleep every night…Poor sleep is linked to higher blood pressure.”
Fact Check. One review noted that:
Too little or too much sleep are associated with adverse health outcomes, including total mortality, type 2 diabetes, hypertension, and respiratory disorders, obesity in both children and adults, and poor self-rated health.
Another broke down mortality according to number of hours of sleep.
A J-shaped association between sleep duration and all-cause mortality was present: compared with 7 h of sleep (reference for 24-h sleep duration), both shortened and prolonged sleep durations were associated with increased risk of all-cause mortality (4 h: relative risk [RR] = 1.05; 95% confidence interval [CI] = 1.02–1.07; 5 h: RR = 1.06; 95% CI = 1.03–1.09; 6 h: RR = 1.04; 95% CI = 1.03–1.06; 8 h: RR = 1.03; 95% CI = 1.02–1.05; 9 h: RR = 1.13; 95% CI = 1.10–1.16; 10 h: RR = 1.25; 95% CI = 1.22–1.28; 11 h: RR = 1.38; 95% CI = 1.33–1.44; n = 29; P < 0.01 for non-linear test)
Thus, in comparison to those who sleep 7 hours, those who sleep 5 hours have a 5% increase in mortality and those who sleep 11 hours have a 38% increase in mortality.
These data are based entirely on observational studies so it is impossible to know if the shortened sleep is responsible for the increased mortality or if some other (confounding) factor is causing both.
My advice: Some people do fine with 6 hours and 45 minutes of sleep. Some require 8 hours 15 minutes for optimal function. Rather than obsessing about getting a specific amount of sleep time, it makes more sense to find our through your own careful observations what sleep time works best for you and adjust your schedule and night time patterns accordingly.
#3. I do CrossFit.
Fact Check. There is nothing to support CrossFit as more heart healthy than regular aerobic exercise (which the vast majority of cardiologists recommend and perform).
#4. I meditate. “Negative thoughts and feelings of sadness can be detrimental to the heart. Stress can cause catecholamine release that can lead to heart failure and heart attacks.”
Fact Check. There is a general consensus that stress has adverse consequences for the cardiovascular system. Evidence of meditation improving cardiovascular outcomes is very weak.
A recent review
Participation in meditation practices has been shown to reduce depression, anxiety, and negative mood and thus may have an indirect positive effect on CV health and well-being. This possibility has led the American Heart Association to classify TM as a class IIb, level of evidence B alternative approach to lowering BP.32
Non randomized, non blinded studies with small numbers of participants have suggested a reduction in CV death in those performing regular TM.
However, we need better and larger studies before concluding there is a definite benefit compared to optimal medical therapy.
Thus far, the recommendations have been pretty mundane: exercise, stress reduction and a good night’s sleep is good advice for all, thus boring.
Seriously Bad Advice From Quacks Mixed In With Reasonable Advice
In order to keep reader’s interest (and reach 45 things) Reader’s Digest is going to need to add seriously bad advice.
My patient had circled #34. “I mix magnesium powder into my water. If sufficient magnesium is present in the body, cholesterol will not be produced in excess.”
This bizarre and totally unsubstantiated practice was recommended by Carolyn Dean MD, ND.
What do we know about Dr. Dean?
-She was declared unfit to practice medicine and her registration revoked by the College of Physicians and Surgeons of Ontario in 1995. From quackwatch.org :
- After being notified in 1993 that a disciplinary hearing would be held, Dean relocated to New York and did not contest the charges against her.
- Dean had used unscientific methods of testing such as hair analysis, Vega and Interro testing, iridology and reflexology as well as treatment not medically indicated and of unproven value, such as homeopathy, colonic irrigations, coffee enemas, and rotation diets.
-The initials after her name (ND, doctor of naturopathy) should be considered the second red flag of quackery. See quackwatch.org (here) and rational wiki (here) and the confessions of a former naturopath (here ) for discussions of naturopathy. As noted at science-based medicine:
Naturopathy is a cornucopia of almost every quackery you can think of. Be it homeopathy, traditional Chinese medicine, Ayurvedic medicine, applied kinesiology, anthroposophical medicine, reflexology, craniosacral therapy, Bowen Technique, and pretty much any other form of unscientific or prescientific medicine that you can imagine, it’s hard to think of a single form of pseudoscientific medicine and quackery that naturopathy doesn’t embrace or at least tolerate.
-She has a website (Dr. Carolyn Dean, MD,ND, The Doctor of The Future) where she incessantly promotes magnesium as the cure for all ills.
-She has written a book called “The Magnesium Miracle” (hmm. wonder what that’s about).
-She sells her own (really special!) type of magnesium (see red flag #1 of quackery).
-She writes for the Huffington Post (I’m considering making this a red flag of quackery).
-She is on the medical advisory board of the Nutritional Magnesium Association (an organization devoted to hyping magnesium as the cure for all ills and featuring all manner of magnesium quacks).
Reader’s Digest is not alone in allowing the advice of pseudoscience practitioners to stand side by side with legitimate sources.
For example, Prevention Magazine in its August 2017 issue highlights “35 All-Time Favorite Natural Remedies” with the subheading
“Go ahead, try them at home: Experts swear by these nondrug cures for back pain, nausea, hot flashes, and other common ailments.”
Who are these “experts”? Let the reader beware because the first quote comes from “Amy Rothenberg, past president of the Massachusetts Society of Naturopathic Doctors.”
Finding The Truth
It’s getting harder and harder for the lay public to sort out real from fake health stories and advice.
When seemingly legitimate news media and widely followed sources like Reader’s Digest and Prevention Magazine either consciously or inadvertently promote quackery, the truth becomes even more illusive.
Readers should avoid any source of information which
- Profits from selling vitamins and supplements.
- Utilizes or promotes naturopaths or other obvious quacks as experts in health advice.