Fake Cures, Witch Doctors, and “Evidence”
This is a horrific story. And maybe I’m about to make a horrific comparison. Feel free to let me know.
Here’s the horrific story, about thugs dismembering Albino children in Tanzania, because of the black-market value Albino body parts have for their supposed medicinal value and luck-bringing properties: Halting the slaughter of Albino innocents.
Under cover of darkness, a group of men charge into young Viviana’s room in the middle of the night, pin her pale form immobile, and hack off one of her little legs as her sister screams in horror.
Viviana, shockingly, is among the lucky ones. The commotion draws the attention of neighbours, and the attackers slip off into the night without finishing the job. She is left an amputee, but alive.
The single albino leg will fetch upwards of $1,000 in a gruesome market controlled by powerful Tanzanian witch doctors, who grind the bones into potions and repurpose them as good luck charms for struggling miners and fishermen.
What to say? Horrific. Unspeakable. I mean, the murder & dismemberment is awful. But it makes you want to pull your hair out when you realize that the reason for these deaths is so ridiculous: the attribution of “magic” powers to Albinos. I mean, those potions and charms won’t work, right? Right? Hmm, but the witch doctors say they work. And they’ve got plenty of satisfied customers, apparently. I mean, what could be better than first-hand experience to prove that a product works?
OK, you see the issue. Now, hop across the ocean with me, from Tanzania to Texas…
From the Wall Street Journal Law Blog: Man Oh Mannatech! Company, Founder, Settle False Marketing Claims
The multi-level marketing world – the same industry that gave forth Amway and other home selling networks – got a black eye this week.
Mannatech Inc., a maker of dietary supplements, agreed to pay $6 million to settle a lawsuit brought by the Texas attorney general. The state alleged that the Coppell, Texas company made false claims about its health benefits and marketed products as cures and treatments for diseases.
What evidence did Mannatech have for its claims? Why, first-hand experience, of course.
…the company’s annual employee-sponsored event, called MannaFest. Part bonding session, part Christian revival, Mannafest in 2007 in Dallas included numerous sales associates and consumers who stepped on the stage and testified how they had taken Mannatech products and recovered or had found relief from their paralysis, their tumors, and their lesions.
I don’t want to belabour the comparison. Mannatech didn’t murder anyone. They’re not witch doctors. But they still were making claims they couldn’t support, and taking people’s money. What such companies and their customers need to learn about is the limits of personal testimonials. There are good reasons why drug companies are forced to do randomized, double-blind, clinical trials. To understand better, you just need to take a peek at the enormous literature on cognitive bias, which details the enormous number of ways in which first-person testimony can go awry. People have a tendency to see correlations, and even causes, where none exist. They tend to mis-estimate relevant probabilities. They tend to mis-remember key events. Reputable companies test their products in ways that minimize those effects. When you’re selling things — especially when you’re taking money from people desperate for help — you owe them a higher standard of evidence.
The Business Ethics Blog 
One of the aims of Christian missionaries in Africa and elsewhere was to end or supplant superstitions and tribalism. Perhaps if they had not been discredited by colonialists and then ignored by socialistic nationalists, Rwanda’s madness, Darfur’s butchery and this pagan superstition would never have happened or just occurred on a smaller scale. Let’s not buy into the “myth of the noble savage” that every people and group encountered by missionizing Christians had great ethics and mores. I think the Aztecs had a few great recipes for “corazon (heart) con chipotle.”– Kevin McDonald, Halifax, NS
Historically it took quite some time to deal with scurvy but ascorbic (no scurvy) acid seems to have been useful.Limiting ourselves to a pharmaceutical paradigm with its aversion to natural products seems very one sided. No doubt people will make some errant conclusions about cause and effect but that doesn’t mean everyone of them is 100% wrong.
David:I’m not sure what the “pharmaceutical paradigm”. Do you mean the paradigm that seeks to ensure things work before selling them?I certainly having nothing against natural things. I like natural things. When they work. The problem is that many of them don’t. I mean, if they do, that’s great. But selling unproven “remedies” is akin to fraud (whether it’s Big Pharma doing it, or your local herbalist).Chris.
David:This might not have been your intent, but here’s what your argument basically seems to add up to:1) You don’t like big pharma.2) Big pharma uses scientific evidence to try to prove things work.Therefore:3) Using science to prove things work is bad.That’s akin to the old, “Hitler was a vegetarian, and Hitler was bad, so vegetarianism is bad.”Chris.
Personally, I would rather go with someone’s personal story than have a pharmaceutical company lie to me about it’s trials – when Lilly ‘settles’ for 1.4 BILLION because of misrepresenting trial results – they probably killed hundreds with one of their drugs – we know we really have to be on the lookout!Mannatech products are food that don’t have an LD50 – that’s a letahal dose 50 – when half the test animals (or in this case people) die!Let’s get some honesty, instead of greed, back into Big Pharma!Judy Deane, Katonah, NY
Judy:I share much of your anger with Big Pharma.But your argument is fallacious.The fact that Big Pharma has done some bad things does not imply that everything non-Big-Pharma companies do is good.Mannatech products may not be toxic, but then neither is tap water. The question is whether they do any <>good<> for someone with a serious illness.Chris.
It should also be noted that in Canada I can talk about one of Mannatech’s products, Bounceback, and it’s value in helping with Osteoarthritis. Health Canada which tends to not to make Mannatech’s life all that easy, gives it’s approval for making this claim.But in the U.S. and specifically to be in compliance with the wishes of the Texas State Attorney, they cannot make that claim. A useful product, according to Health Canada, for dealing with osteoarthritis and it can’t be talked about in the U.S., seems rather unfair. Who is this supposed to protect?
David:What can I say? Law is local. That includes drug approval laws. To get to make a health claim, locally, you have to convince local authorities. 2 different bureaucracies doing their best, let’s assume, to protect <>their<> citizens from quackery.Note also that Health Canada has (I’m taking your word, here) approved <>one<> product, for one purpose. That’s not a general endorsement of Mannatech.Chris.
I am saddened by what appears to be your limited research of this company and your quickness in which you lump it in with other companies that “make claims without sufficient support”.If you had done your homework, you would realize that this company has spent over $20 million in research and development in the last 5 years and partners with various universites and research institutions on various projects, including clinical and longitudinal studies. It also has dozens of patents all over the world and a number of world renowned doctors and scientists connected with it. Furthermore, the company has never made claims that their products “will cure, treat, or mitigate any disease”. They do state that if you give the body the nutritional tools it needs, it is amazing how the body can function in terms of wellness and optimal health. However, some folks have had such amazing health improvement experiences that they have crossed the line in what can be legally stated. The company also sponsored an education website called Glycoscience.org that had thousands of scientific research articles/papers and had an independent editorial review board of doctors/scientists. This website actually had won awards for its educational and scientific excellence on the web a few years ago. But, unfortunately that website had to be taken down. Oh by the way, for almost two years, the company in question offers a 6 month money back guarantee if a consumer is not fully satisfied with their product experience. I understand your skepticism Chris. None of us want to be ripped off and taken advantage of. I researched this company, their products and the science, called people I know and trust who had been on the products, and after 2 months I reluctantly started to take them. I am stunned at the quality of life improvements that I am privileged to have now. I will continue to encourage folks to do due diligence and consider trying these nutritional products. With the money back guarantee, you have nothing to lose and possibly lots to gain. Thankyou, Jerry S.
Jerry:Limited research? Well, sure. I’m just relying on the Wall Street Journal, reporting on the conclusion reached by the Texas attorney general.And your claim about “clinical and longitudinal studies” conflicts badly with your claim that Mannatech has never made health claims. Which is it?If you understand my sketpicism, as you claim, and if you read the final paragraph of my blog posting, you’ll know that relying on the first-hand experience of “people you know & trust” isn’t the best way to find evidence for what things will improve your health.After all, that’s the standard used by people who buy bone dust from witch doctors.Chris.
Interesting ethics Chris. Why did you not put in all of my responses to you?
David:Excuse me?I believe I approved everything you submitted. If I missed anything, it was an oversight. I’ll double-check my moderation files.Chris.
David:I’ve double-checked, and I see no other replies from you. I posted what you submitted. If something didn’t get through, it’s not because of me.Chris.
It seems to me that the greater issue here is what is generally accepted as the best philosophy of health and wellness … and who controls what is considered valid. The drug companies have done a great job of getting the laws written in their favour. i.e. only a drug can treat a disease by law. Is that necessarily good for the general public … not! The vast majority of drug approval expense goes into safety testing. Is that generally necessary with natural products … certainly not to the same degree. Not anywhere close to the same degree. But if a natural product is put through the double blind randomized placebo controlled studies to meet the “gold” standard … then they get classified as drugs, can only be prescribed by doctors (even though their is zero toxicity), and will cost 10 times as much. Is that in the interest of the public … again I doubt it. The issue is the way the laws are written and the way Big Pharma has government in it’s back pocket because of the huge tax dollars and political funding dollars involved … and the lobbyists at the federal level in every major nation of the world. There is no way to categorize the probable cost of this monopoly to the general public … in both health and finances. When an industry that kills people every day is allowed to exist and exhonorated as the “gold” standard of excellence and scientific validation, the basic philosophy is completely screwed!. For my part, I’d risk some of my cash for the reward of finding out if what worked for someone that I know, could work for me. That, in my opinion, is an acceptable risk-reward relationship and should be capitalized on and even encouraged for research purposes.
David:1. Not all “natural” products are safe. There are plenty of “natural” poisons. It’s a complete fallacy to argue that natural products have zero toxicity.2. It’s simply not true that being classified as a “medicine” means a prescription is required. There are plenty of OTC drugs.3. There’s no doubt the pharmaceutical industry has too much influence. But that doesn’t mean they’re the ones behind the requirement that health-claims be backed by evidence. Pharma would love to have looser rules in that regard. Ask yourself this: how would YOU like us to tell apart the honest purveyor of “natural” remedies, on one hand, and the true snakeoil salesman on the other? Surely, we should be able to ask both for evidence to back up their claims, and tell them apart by how well they can show some evidence?4. You’re still not dealing with the overwhelming evidence that first-hand observation is subject to a huge range of cognitive biases. “Hey, it worked for my dad!” is a lousy substitute for actual clinical evidence. Good clinical trials are <>randomized<> and <>double blind<> precisely because scientists (not drug companies) know that that’s the only way to produce reliable evidence.Chris.
Mannatech is not a fly by night company. It has been around for 15 years. They had no desire to break the law, nor did they think they had done anything wrong. Their legal team went over the DSHEA Act of 1994 and concluded that they were able to have people give testimonies of positive changes from the use of the products. They did not say this was a cure but rather gave the body what it needed in order for it to cure itself. The Texas State Attorney General disagreed with that interpretation. Essentially, denying people freedom of speech. They never intended to rile up the powers that be, it is simply not good business, and they have felt the full effects of the one sided reporting that has happened to them. Since they could no longer use these testimonies they implemented a 6 month money back guarantee as part of their new business model. As a testimony to the quality and efficacy of the products only 1% of them get returned. Not bad for snake oil.When you use words, implying bone dust from witch doctors, you do a great disservice to the countless number of people of integrity including people like Dr. Ben Carson M.D. who has taken and found these products personally beneficial. Numerous doctors are involved in Mannatech and recommend these products to their patients. It is far too easy to make snap judgments based on limited research. I’m sure you have taught your students that they have to look beyond the catchy headlines when they truly want to understand something.The problem that Mannatech has experienced wasn’t that the products weren’t beneficial but that they worked too well and its very difficult for people who have experienced life changing improvements to not talk about them. But for them, the gag order is in place, and freedom of speech has been lost.If you studied the history of scurvy you would discover that it was personal testimony that proved that vitamin c was effective in dealing with it. The medical community didn’t like that and refused to accept those findings for many years. Eventually science caught up with what sailors already knew and was able to agree with them.
David:When regulators stop companies from making false claims, they’re not “denying people free speech.” They’re protecting the public. It’s their job.As for Dr. Carson: I’m not impugning the integrity of anyone who claims to have found a product useful. But a personal anecdote is still just a personal anecdote, even if you’ve got the letters “MD” (or “Ph.D!”) after your name. It’s not. Good. Evidence.So, Mannatech’s products “work too well,” do they? Then it should be easy to demonstrate that, in a randomized, double-blind trial. The company has 24 or so products on the market? Have any ever passed that test?As for scurvy: OK, great. Nifty discoveries sometimes begin with anecdotes. So, you hear some interesting anecdotes. Then what? <>Test<> them, to see which ones are the next “Vitamin C for scurvy” and which are the next snake oil.Chris.
This is a third try at posts that don’t get to you. According to the Texas AG if someone says that Vitamin C cures scurvy you would be breaking the law unless of course you are a doctor.Mannatech is in a catch22 scenario. If they prove they have a cure they can’t tell anyone because they’re not doctors. You keep talking about double blind placebo without understanding that the first step for proof is finding LD50 of a product. Since Mannatech products are not toxic they can’t establish the baseline of killing 50% of the animals. Without this baseline the double blind placebo carries no weight in the medical community. Mannatech used testimonials because according to their lawyers they were well with within the boundaries of the DSHEA Act of 1994. The Texas AG disagreed. It was never in Mannatech’s long term interest to break the law. It would be ludicrous to assume they were secretly doing this, hoping not to get caught.Consequently, since it has been determined by the AG that people can’t talk about how the products have personally affected them, they have stepped away from testimonials and now offer a 6 month money back guarantee. Remarkably only 1% of products get returned. With over 400 million in sales last year, people seem quite happy with something they can’t say works for them.Mannatech does concentrate on cutting edge science in how they get their ingredients naturally. The products work on a 90% absorption rate so that the body actually recognizes them as food and is able to use them the way nature intended. They also use Good Manufacturing Practices to ensure that was is on the label is in the products.If you compared Big Pharma vitamins, you would find they have a history of selling bedpan pills. In other words their products simply pass through the digestive tract without actually getting into the body. Their products tend to be made with cheap synthetics. But the body actually prefers food as the delivery system for nutrition. By using synthetics Big Pharma is able to make cheaper vitamins which end up in our sewage systems. Now that does sound like snake oil.
David:That’s simply false.An LD50 is absolutely <>not<> required. In fact, the LD50 is an old test, being phased out in most places.<>Besides:<> It’s <>never<> been true that an LD50 was required in order to “carry weight” in the medical community as you claim. Lots and lots of clinical trials are done on nutritional interventions, exercise regimes, etc. They’ve even been done on that ridiculous Q-ray bracelet. All are perfectly good kinds of studies, widely accepted as valid, and <>none<> required an LD50. And you do <>not<> have to be a physician to say that something cures a disease, if it’s really true.And a 1% return rate for a product means little. It could mean customers either a) feel like they got a bit better (placebo effect?) or b) feel foolish for having wasted money, and are too sheepish to ask for it back. You are simply refusing to deal with the fact that first-hand observations of that sort have been proven, time and time again, to be unreliable.I’m ending this discussion. You’re simply mis-informing my readers (perhaps unintentionally), and not backing your claims with reputable sources. I’m afraid your zeal for the product you sell is limiting your reliability as a source of information.Chris.