Archive for the ‘health’ Category

Interview: Andrew Potter and The Authenticity Hoax

My pal Andrew Potter is a public affairs columnist with Maclean’s magazine (Canada’s premier newsweekly) and a features editor with Canadian Business magazine. He also has a Ph.D. in Philosophy.

Andrew’s new book, The Authenticity Hoax, is excellent. I interviewed Andrew recently, about the implications the issues discussed in his book have for a range of topics in Business Ethics.

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Chris MacDonald: Your new book, The Authenticity Hoax, is about the way our pursuit of authenticity is in many ways the pursuit of a mirage, and you argue that the pursuit of it is ultimately not just futile, but destructive. You say that one element of that — or is it a result? — is a lack of faith in the market. Presumably that plays out, in part, in a perception that business quite generally is unethical, on some level. Is that one of the deleterious effects of the pursuit of authenticity?

Andrew Potter: According to the theory I offer in the book, the quest for the authentic is largely a reaction to four aspects of the modern world: secularism, liberalism, technology, and the market economy. And I think you’re right, that hostility towards the market is probably the most significant of these. Why is that? That’s a whole other book! Though I think something like the following is at work:

First, markets are inherently alienating, to the extent to which they replace more gregarious and social forms of interaction and mutual benefit (e.g. sharing or gift economies, barter, and so on) with a very impersonal form of exchange. The second point is that the market economy is profit driven. This bothers people for a number of reasons, the most salient of which is that it seems to place greed at the forefront of human relations. Additionally, the quest for “profit” is seen as fundamentally amoral, which is why — as you point out — the mere fact of running a business or working in the private sector is considered unethical. Finally, you can add all the concerns about sustainability and the environment that the market is believed to exacerbate.

The upshot is that we have a deep cultural aversion to buying things on the open market. We think we live in a consumer society, but we don’t. We live in an anti-consumer society, which is why we feel the need to “launder” our consumption through a moral filter. That, I think, is why so much authenticity-seeking takes the form of green- or socially conscious consumerism.

CM: Claims to authenticity are a standard marketing gimmick at this point. In The Authenticity Hoax, you argue that authenticity isn’t the same as truth. Authenticity has more to do with being true to some essence, some deeper self. It strikes me that that makes for some very slippery advertising, including lots of claims that can’t be backed up, but can’t be disproven either. Is authenticity the ultimate marketing gimmick that way?

AP: Absolutely. What advertising and politics have in common is that they are both “bullshit” in the philosophical sense of term (made popular by Harry Frankfurt). What characterizes bullshit is that it isn’t “false”, it is that it isn’t even in the truth-telling game. That is why I think Stephen Colbert was dead on when he coined the term “truthiness” to refer to political discourse — he essentially means that it is bullshit.

What is interesting is that authenticity has the same structure as bullshit, in the following way: from Rousseau to Oprah, the mark of the authentic is not that it reflects from objective truth in the world or fact of the matter. Rather, the authentic is that which is true to how I feel at a given moment, or how things seem to me. As long as the story I tell rings true, that’s authentic.

And that fits in well with advertising, since advertising is all about telling a story. Everyone knows that most advertising is bullshit — for example, that drinking Gatorade won’t make you play like Jordan, or that buying a fancy car won’t make you suddenly appealing to hot women. But what a good brand does is deliver a consistent set of values, a promise or story of some sort, which fits with the idealized narrative of our lives, the story that seems true to us. That is why branding is the quintessential art form in the age of authenticity. Bullshit in, authenticity out!

CM: There’s an irony, of course, in the fact that so many companies are making claims to authenticity in their advertising and PR, since for most people the very term “PR” implies a kind of spin that is the exact opposite of authenticity. But that apparent irony echoes a theme from your previous book, The Rebel Sell (a.k.a. Nation of Rebels), doesn’t it? In that book, you (and co-author Joe Heath) argued that all supposedly counter-cultural movements and themes — things like skateboarding, hip-hop, environmentalism, and now add authenticity — are bound to be co-opted by marketers as soon as those ideas have gathered enough cultural salience. Is that part of what dooms the individual consumer’s pursuit of authenticity?

AP: Yes, that’s exactly right. Chapter four of my book (“Conspicuous Authenticity”) is a deliberate attempt to push the argument from the Rebel Sell ahead a bit, to treat “authenticity” as the successor value (and status good) to “cool”.

We have to be a bit careful though about using the term “co-optation”, because it isn’t clear who is co-opting whom. Both cool-hunting and authenticity-seeking are driven not by marketers but by consumer demand, in particular by the desire for status or distinction. And in both cases, the very act of marketing something as “cool” or as “authentic” undermines its credibility. Authenticity is like charisma — if you have to say you have it, you don’t.

That doesn’t mean marketers can’t exploit the public’s desire for the authentic, but it does mean they have to be careful about the pitch they employ; it can’t be too self-conscious. We all know that “authentic Chinese food” just means chicken balls and chow mein, which is why I actually think that things that are explicitly marketed as “authentic” are mostly harmless. It’s when you when you come across words like “sustainable”, or “organic,” or “local” or “artisanal”, you know you’re in the realm of the truly status-conscious authentic.

CM: I’ve got a special interest in ‘greenwashing.’ It occurs to me now that accusations of greenwashing have something to do with authenticity. When a company engages in greenwashing, they’re typically not lying — they’re not claiming to have done something they haven’t done. They’re telling the truth about something ‘green’ they’ve done, but they’re using that truth to hide some larger truth about dismal environmental performance. When companies greenwash, they’re using the truth to cover up their authentic selves, if you will. Do you think the public is particularly disposed to punish what we might think of as ‘crimes against authenticity?’

AP: I’m not sure. It is certainly true that in extreme cases of corporate bad faith the public reacts badly. The case of BP is a good example; as many people have pointed out, its “Beyond Petroleum” mantra is a very tarnished brand right now, and it is doubtful they’ll be able to renew its polish.

But at the same time, I don’t see any great evidence that the public as a whole is disposed to punish companies for greenwashing. Actually, I think the exact opposite is the case: I think the public is very much disposed towards buying into the weakest of greenwash campaigns. The reason, I think, goes back to the point I made earlier about most of us being fairly ashamed of living in a consumer society. Yet at the same time we like buying stuff, especially stuff that makes us feel good about ourselves and morally virtuous. Even the most half-witted greenwashing campaign is often enough for consumers to give themselves “permission” to buy something they really want.

CM: Let’s talk about a couple of product categories for which claims to authenticity are frequently made.

First, food. You argue that much of the current fascination with organic food, locally-grown food, etc., is best understood as the result of status-seeking. So the idea is basically that food elites start out looking down on everyone who doesn’t eat organic. But then as soon as organic becomes relatively wide-spread, suddenly eating organic doesn’t make you special, and so the food elite has to switch to eating local, or eating raw, or whatever else to separate themselves from the masses. And I find that analysis pretty compelling, myself. But a lot of devotees of organic and local foods are going to reject that analysis, and object that they, at least, are eating organic or local or whatever for the right reasons, not for the kind of status-seeking reasons you suggest. And surely some of them are sincere and are introspecting accurately. Does your analysis allow for that possibility?

AP: Sure. The key point is that these aren’t exclusive motivations. In fact, they can often work in lockstep: You feel virtuous eating organic, but you also want to feel more virtuous than your neighbour (moral one-upmanship is still one-upmanship, after all). And so you try to out-do her by switching to a local diet. And when she matches you and goes local too, you ratchet up the stakes by moving more of your consumption to artisanal goods (e.g. small-batch olive oil, handmade axes, self-butchered swine, and so-on).

And this would be a good thing if there were any evidence that these moves actually had the social and environmental benefits that their proponents claim for them. But unfortunately, the evidence is – at best – mixed; the more likely truth is that the one-upmanship angle has completely crowded out the moral calculations.

The more general point is that we need to stop assuming that something that gives us pleasure, or feeds our spiritual needs, will also be morally praiseworthy and environmentally beneficial. That assumption is one of the most tenacious aspects of the authenticity hoax, and it is one that we have no reason to make. There are good and bad practices at the local level, and artisanal consumption has its costs and benefits. Same thing for conventional food production — there are good things and bad things about it. It would be nice if the categories of good versus bad mapped cleanly on to the categories of local versus industrial, but they simply don’t. The belief that they do is nothing more than wishful thinking.

CM: What about alternative therapies? Much of the draw of those products — and at least some of their marketing — seems to revolve around authenticity. People who are attracted to alternative products seem to want to reject modern medicine, which they find alienating, in favour of what they perceive as something more authentic. Now most critics of alternative therapies such as homeopathy primarily object that there just isn’t good evidence that those therapies actually work. But your own analysis provides a further kind of criticism, rooted in the way that those who seek ‘authenticity’ via alternative medicine are engaged in what is more generally an unhealthy rejection of modernity. Is that right?

AP: There is a lot to dislike about modernity, and my argument is not that we should just suck it all up and live with it. My point is rather that modernity is about tradeoffs, and that we need to accept that for the most part, the tradeoffs have been worth making. Yes, some things of value have been lost, but on the whole I think it’s been worth it.

But if there is one part of the pre-modern world that is well lost, it’s the absence of evidence-based medicine. Yet for some bizarre reason, the longer we live and the healthier we get, the more people become convinced that we are poisoning ourselves, and that modern medicine is not the solution to our woes, but part of the cause.

The turn away from the benefits of modern medicine is one of the most disturbing and pernicious aspects of the authenticity hoax. My book has been interpreted by many as an attack on “the left”, but it perplexes me that things like naturopathy, anti-vaccination campaigns, and belief in the health benefits of raw milk are considered “left wing” or “progressive” ideals. As far as I’m concerned, this is part of a highly reactionary political agenda that rejects many of the most unimpeachable benefits of the modern world. We know that naturopathy and homeopathy is a fraud; we know that vaccines don’t cause autism and that public vaccination is the one of the greatest public health initiatives ever; we know that pasteurization has saved countless lives over the years.

But for reasons I cannot fathom, these and many other related benefits are ignored or shunned in favour of an “authentic” lifestyle that is an absolute and utter hoax.

Chiropractic Referral Fees & Conflict of Interest

Sometimes, when consumers need two different, but related, goods or services, they rely on the advice of the provider of one product to select a provider of the second. That often makes sense, because providers in related businesses often have specialized knowledge that lets them give good advice (e.g., the guy who sells you your carpet likely knows who would be good at cleaning that carpet.) In such a case, people in related businesses can be a good source of expert, independent advice.

That is, if the advice is truly independent. And the most obvious way to eliminate independence is to inject a financial interest into the scenario. If the person you’re relying on for advice is financially beholden to the person he or she is recommending, you have every reason to doubt that advice.

And if that advice you’re after isn’t about something mundane, like carpets (something about which a great many non-experts know quite a lot) but is instead about your health, you have every reason to worry — especially when one of the service providers involved is taking active steps to put the person you’re relying on for advice into a Conflict of Interest.

Here’s an article (in which I’m quoted) about just such a situation. It’s by Yoni Freedhoff, MD, writing for the Canadian Medical Association Journal, Chiropractic clinic offered referral kickbacks

A chiropractic clinic with locations in Ontario, Nova Scotia and Manitoba offered lucrative kickbacks to physicians for referring clients to its five outlets until the College of Physicians and Surgeons of Ontario (CPSO) apparently stepped in to scuttle the payments as a result of CMAJ inquiries.

The offer of kickbacks, which were in the form of financial compensation, arising out of referrals from doctors, came to light as a result of a CMAJ request for a “doctor’s information kit” in accordance with instructions from an advertisement placed in the journal by the Low Back Clinic.

The kit included a document detailing appropriate patient referral criteria, which was followed by the proclamation: “In compliance with the C.P.S.O. standards, a $300 documentations fee will be provided once the patient completes care….”

Summary of problems:

  • The payments put referring physicians into a conflict of interest;
  • The payments, which are based on completion of a course of care, induce physicians to encourage patients to complete a course of care independent of whether that’s in the patient’s best interests;
  • The payments risk jeopardizing patients’ trust in their physicians;
  • The payments risk the professional reputation of the medical profession quite generally;
  • Referring to the payments as being “In compliance with the C.P.S.O. standards” falsely implies that the payments are required by the C.P.S.O.

All in all, this scheme was a pretty bad idea. Perhaps the clinic offering the fee could be excused for not knowing that doing so was contrary to regulation. But health professionals certainly ought to know enough about conflict of interest to recognize that such a scheme is seriously ethically problematic.

Business Ethics & Alternative Medicine

This is a “meta” blog posting, bringing together the various blog entries of mine over the last couple of years on the single topic of business ethics and alternative medicine.

Alternative medicine (includes things like homeopathy, herbal supplements, Traditional Chinese Medicine, acupuncture, therapeutic touch, and so on) raises some interesting ethical issues. On one hand, most of it doesn’t work (or to be more accurate, most of it is unproven, and much of it is disproven), and we tend to think people should only sell products that work as advertised. But on the other hand, alternative medicine has many fans, and we generally think consumers ought to be able to choose for themselves what products are good for them.

Two other factors make alternative medicine interesting, from a business-ethics point of view.

One factor is that both the safety and efficacy of alternative therapies varies. Some therapies (e.g., homeopathy) are entirely implausible, whereas others such as some herbal therapies probably are effective. Not surprisingly, the pattern is reversed for safety: homeopathy is entirely safe (unless the consumer does something foolish like forgoing real medicine in favour of homeopathic remedies for the treatment of a serious illness), while on the other hand some herbal remedies pose significant dangers.

The second important factor is that alternative medicine is generally under-regulated. In Canada, for example, herbal supplements are categorized as “natural health products” and subject to only minimal oversight. The result is that neither consumers nor companies can assume that the law is providing significant oversight. In the absence of strong consumer-protection legislation, there’s a particularly strong obligation for companies to act ethically.

Here are my blog postings on this topic, in reverse-chronological order:

By the way, to the best of my knowledge, there is not a single scholarly paper that looks at the selling of alternative medicines from a business-ethics point of view. If you know of one, please let me know!

Unethical Herbal Supplements

Hey, what’s in that bottle of all-natural herbal supplements on your kitchen counter? Are you sure? What will those supplements do for you? Cure all that ails you? Something? Nothing? One way or the other, how do you know? The truth is, you probably shouldn’t feel so certain.

Here’s the story, from Katherine Harmon, in Scientific American: Herbal Supplement Sellers Dispense Dangerous Advice, False Claims

[The lack of evidence for their effectiveness] …hasn’t stopped many supplement sellers from making the false claims and even recommending potentially dangerous uses of the products to customers, according to a recent investigation conducted by the Government Accountability Office (GAO). To obtain a sample of sales practices, the agency got staff members to call online retailers and to pose undercover as elderly customers at stores selling supplements.

Customers were not only told that supplements were capable of results for which there is no scientific evidence (such as preventing or curing Alzheimer’s disease); the advice and information also was potentially harmful (including a recommendation to replace prescription medicine with garlic)….

Some fans of herbal remedies are liable to complain that the relevant government agencies ought to be directing their efforts at the real culprits, namely Big Pharma. Why pick on people who package and sell “natural” herbal products when major pharmaceutical companies are, on a regular basis, found to have engaged in a whole range of dubious and sometimes deadly behaviours? But that’s roughly like a bank robber, upon his arrest, complaining that the cops ought to be out chasing white-collar criminals instead. The fact that embezzlement is a bad thing does nothing to diminish the badness of robbery. Both are wrong, and both are worthy of punishment.

Essentially, what we’re seeing here is history catching up with the makers of herbal supplements. Over the last decades, we’ve imposed increasingly tough rules on the pharmaceutical industry (though those rules still need to be tightened up in various ways). But herbal products are part of the “natural” products industry, and that industry is woefully under-regulated. Indeed, that industry is probably about as well-regulated today as the pharmaceutical industry was, say, 50 years ago.

(p.s. for information about which herbal supplements are and are not backed by good science, see Scott Gavura’s Science-Based Pharmacy blog.)

Pharmacists and Candour About Homeopathy

If someone selling something believes that it doesn’t work, should they tell you so? Does it matter if the person doing the selling is a licensed professional, someone with advanced training and a sworn duty to promote the public good?

From the BBC: New guidance for homeopathy use

The regulatory body for pharmacists in NI [Northern Ireland] has proposed that patients be told that homeopathic products do not work, other than having a placebo effect.

The draft guidance comes following a report on homeopathy published earlier this year by the House of Commons Science committee.

It reviewed the evidence base for homeopathy and concluded that it was “not an efficacious form of treatment”….

Of course, some people believe — despite the best available evidence — that homeopathy really works. But pharmacists (being educated in the scientific evaluation of evidence) generally do not. And as professionals, they have an obligation not just to be honest with customers about that, but indeed to be candid about it.

Here is the Code of Ethics for the Pharmaceutical Society of Northern Ireland. The Code calls upon Pharmacists to “Maintain public trust and confidence in [their] profession by acting with honesty, integrity and professionalism”. That’s pretty vague, so applying it requires interpretation. And in the literature on professional ethics, the argument is usually that what we need from professionals like Pharmacists is not just old-fashioned honesty, but candour. Why? Because mere honesty really just boils down to telling the truth when someone asks you a question. And that’s a very good start, of course. But in many situations — the kinds of situations where we turn to professionals for help — we often don’t know the right question to ask. So we rely on the professionals to be candid; in other words, we rely on them to be open and forthright, and to volunteer information that they think we would want and/or need. And health products are among the most difficult for consumers to understand. So, it’s not at all surprising that the professional body in this case advised its members to be candid with the consuming public about the lack of evidence in support of homeopathy. In fact, it’s barely even commendable, given that candour about such things is a basic professional responsibility.

Ethical to Teach a Bogus Therapy?

Needless to say, the industry I myself work in — higher education — is in no way immune from sub-par business ethics. (Those of us involved in the teaching end of higher education don’t like to think of it as a business, but at some level that’s what it is, as long as a fee is being charged.) And what else can I call it but bad ethics, when a university offers courses teaching students to manipulate forces that don’t exist in order to generate effects that don’t happen?

Check out this article, from Common Ground magazine: Integrative energy healing

The Integrative Energy Healing (IEH) Certificate Program at Langara College in Vancouver is actively involved in weaving together the science and research of energy-based healing with its practice. For eight years, this program has worked to offer a three-year certificate program in IEH, which offers an in-depth study of the various Eastern and Western scientific theories underlying energy-based healing. It is also an exploration of the human condition and the practice of different types of energy-based treatments….

Here’s Langara’s page about its Integrative Energy Healing. (And for good measure, here’s the page about its Holistic Healing & Skills program.)

Sounds groovy. The problem: they’re teaching something that doesn’t work. “Energy Healing” is part of a cluster of practices that claims to diagnose and treat illness by examining and modifying energy fields that flow around and through the human body. These practices have been pretty well investigated, and they’re simply baseless. The physical starting points of these practices conflict with fundamental physics, and experiments have proven that they just don’t work. One of the main sources supposedly supporting the value of energy medicine, cited in the article above, is Energy Medicine (Oschman, 2000).
Here’s an article reviewing Oschman’s book: Energy Medicine, reprinted from Skeptic Magazine. The review is pretty devastating.

Of course, it’s not hard to find others who have found Energy “Medicine” at least worth looking at. The Common Ground article cites the US National Institutes of Health (NIH) “formally recognizes and encourages the study of energy therapies.” What the article leaves out is that funding has so far turned up zero in the way of useful therapies, and there have recently been significant calls by scientists for the NIH to stop funding this pseudoscience.

So, what is there to say about a university teaching this stuff? Well, to the extent that students believe they’re learning real health science, they’re being ripped off. And since the practices being taught are part of the enormous alternative medicine industry, students are being taught a set of practices intended to be sold to customers: they’re being taught to sell a bogus product. Oh, and in the process, Langara is cheapening the entire notion of higher education.

A final thought, for those of you not yet convinced that it’s problematic for an institution of higher learning to be teaching a highly-questionable practice like “Energy Healing.” What would our reaction be if a parallel university-based programme were started up with the intention not of teaching students to “heal” patients, but to build bridges? What if, instead of using math and physics to build bridges safely, we taught engineers to simply lay their hands on iron beams to “feel” whether they were strong enough?
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Addendum:
Just a bit of clarification: the story above is about Langara College. But I refer to it throughout as “a university.” Technically, colleges & universities are different kinds of institutions in Canada (they’re provincially regulated & mostly provincially funded, so the details vary). But everything I say above applies to higher education institutions of all kinds.

Ethics of Organic Farming

My blog entry saying nice things about Wal-Mart last week didn’t draw too much fire, so maybe this is a good time to say some things about organic food. (Not coincidentally, I also blogged last week about Wal-Mart’s foray into the world of organics.)

Organic farming is a business. Indeed, it’s a big one. And for many, it is the epitome of an ethical business.

Organic foods enjoy a reputation among consumers that may not be substantiated by anything like real evidence. Consumers tend to think organic foods are healthier (either because they believe non-organic foods have dangerous levels of agrochemicals, or because they believe organic foods have superior nutritional value). Those beliefs are not fully justified, based on my reading of the available evidence. (Note that to say that a belief is “not justified” is different from saying it is “false.”)

And producers of organic foods undeniably benefit from the public perception that organic foods are healthier. Farmers and retailers benefit from that perception, because it means that a certain percentage of consumers are willing to pay a significant premium for organic foods. But are organic foods really any better? Organizations representing the organic agriculture industry are careful not to make health claims for organic foods (and indeed, in some juristictions such claims are forbidden by law.) But it’s hard to find a pro-organic website that doesn’t have some sort of claim — however vague — about the health benefits of organic food. Look, for example, at the 10 Top Reasons to Go Organic, from the organic lifestyles magazine OrganicFood.co.uk. (Note that the article does not cite sources; and many of its implied causal claims are highly suspect.)

So, here’s the qestion: what ethical concerns should we have about those selling organic food — a boutique product with only uncertain benefits? Is there more to be said for organic foods than there is for such dubious (and expensive) products as Qray bracelets and other pseudo-scientific products? And is organic food more than the bourgeois status symbol that some people say it is? Why don’t advocates for organic foods welcome the idea of Wal-Mart bringing organic foods to the masses? Is it because that would reduce the symbolic value of organics, the way the caché of Starbucks coffee would be diminished if they sold that at Wal-Mart? Do the claimed environmental benefits of organic farming stand up to the argument that intensive agriculture is more productive, and hence more sustainable?

As always, this blog is not the place to wrestle an issue to the ground. Whatever else this blog is for, it ought to get people to question their assumptions about what business practices are ethical, and why. Here are just a few links.

Footnote: From the category of debunked criticisms — there have in the past been claims that organic foods carry higher levels of E. Coli (a deadly bacteria) than other foods, because of the greater use of manure as a fertilizer on organic farms. This has pretty much been debunked (or is at least unsubstantiated, for now.) Also debunked have been claims about higher levels of mycotoxins (toxins produced by fungi) in organic foods. The scientists may still be wrangling over these issues, but for now it looks like these are not serious concerns (i.e., there is no reason to think that organic foods are, in general, less safe than other foods.)

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