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Street Philosopher

Selling Snake Oil

Seán Moran hunts the hype around hypertension.

Isn’t this wonderful news? My photograph shows an inexpensive magnetic bracelet that relieves pain and cures so many ailments – including the ‘silent killer’, high blood pressure. Except it can’t cure anything. It’s not a panacea, it’s a scam.

I grant that the false claims may have a surface plausibility to them. After all, we remember from school that our blood contains iron, a shortage of which causes anaemia; and magnets attract iron, don’t they? Well, sort of. We might recollect magnets attracting iron filings in school science lessons. However, the iron in our blood is not in the form of iron filings, but is bonded to the oxyhaemoglobin molecule. And that structure is not magnetic, so nothing happens when magnets are brought near. I’m on iron tablets at the moment, so let me test this theory right now.

Here are the results: fridge magnet and steel paper clips: attraction; fridge magnet and iron pills: no attraction. That’s because the iron in the pills – and in the blood – is not in the form of metallic filings (Fe⁰), but is in the ionic incarnation of iron (Fe²⁺), which is not magnetic. (My apologies for including this bit of science in a philosophy article, but it is really the only effective epistemic defence against medical scams such as this, epistemology being the branch of philosophy that deals with knowledge claims. By the way, if you say the following word out loud, you can test how much attention you paid in science class. Here’s the word: ‘unionised’. If you said ‘un-ionised’, you paid more attention in science lessons. If you said ‘union-ised’, you paid more attention in history lessons.)

It’s only the metallic, unbonded, unionised form of iron that magnets attract. Which is just as well for me, since I recently had an MRI scan. With Magnetic Resonance Imaging you’re exposed to very strong magnetic fields as you slide in and out of a doughnut-shaped scanner. The fields are about fifteen times stronger than the bracelets’ fields: 3000mT, compared with 200mT (‘T’ is for Tesla, after the eccentric Serbian-American inventor Nikola Tesla). If haemoglobin were vigorously affected by magnets, I would have been in trouble; but I’m happy to report that I didn’t explode and become the jam in the doughnut. So the claim that magnetic bracelets can affect our blood has been conclusively undermined.

Magnetic bracelets can’t kill pain either. In their systematic review and meta-analysis of the literature in the Canadian Medical Association Journal (2007), Pittler et al concluded that there were “No significant effects of static magnets for pain relief relative to placebo.” And yet the BBC reported in 2006 that sales of ‘therapeutic’ magnetic devices topped $1 billion worldwide. What’s going on? How does this scam continue to deceive people?

Photo © Seán Moran 2022

Snake Oils & Their Salesmen

Arthur Conan Doyle’s diagnosis of human folly is a little harsh: “There seems to me to be no limit to the inanity and credulity of the human race. Homo sapiens! Homo idioticus !” (The Land of Mist, 1926). But he himself was famously fooled by hoax photographs purporting to depict fairies, taken by some young girls in Cottingley, England, and published by him in The Strand Magazine of Christmas 1920. Perhaps then we are all epistemically flawed and susceptible to being defrauded by cheats of all kinds.

I want to help Philosophy Now readers to protect themselves from medicinal fraudsters, sometimes called ‘snake oil salesmen’. A key intellectual quality for philosophers is critical thinking. So how do we critically differentiate between genuine cures and snake oil swindles?

Surprisingly, the original snake oil salesmen had some claim to legitimacy. They sold a product that did exactly what it said on the tin. Though they didn’t know the biochemical basis of their potion’s curative action, they had empirical evidence for its efficacy. In other words, they knew it worked. And it did have a legitimate biochemical mode of action. The Chinese indentured labourers who constructed the pan-American railroad system in the Nineteenth Century used oils from the Chinese water snake as a rub to alleviate sore muscles and arthritis. The oils were rich in omega-3 fatty acids, so the remedy was pharmacologically effective. It wasn’t just a placebo, it genuinely worked by reducing inflammation. Charlatans then tried to replicate this cure, but their nostrums used rattlesnake oils and they cited Hopi Indian tradition. However, these oils only contained a fraction of the active ingredient of the Chinese water snake oils, so their ‘cure’ was relatively ineffective, apart from potential placebo effects (more on which soon).

Clark Stanley went even further in this fraudulent enterprise. His foremost product, ‘Stanley’s Snake Oil’, contained no snake oil at all, neither Chinese nor American – only beef fat, red pepper, and turpentine. This product fell down over two key criteria for medical legitimacy: (1) Being more efficacious than a placebo (2) Having a plausible mode of biological action in the body. It fulfilled neither.

Between Knowledge & Ignorance

Our epistemic station in life is an intermediate position: unlike God as traditionally defined, we humans are not all-knowing; but neither are we completely ignorant. Our power to take action is limited, too: we are not all-powerful. But it’s just as well that we have such limitations, for they can work beneficially together: as Thomas Aquinas once wrote, “it is better for a blind horse if it is slow” (Summa, 1a2ae, Q.58, a.4). If we were omniscient, we would know exactly what was coming down the tracks for us – but without the Godlike power of omnipotence we’d be in the awful position of not being able to do anything about it. Being epistemically flawed can be an advantage. Sometimes it is better not to know precisely what lies ahead.

All of us are fooled some of the time, too. For example, many jokes rely on ambiguities which the punchline then disambiguates. Consider a joke by Bob Monkhouse (again, it’s best said out loud): “I hate Italians… with their little slanty eyes… Oh wait, I mean italics.” We firstly infer that he is a despicable racist; then we deduce that he’s confused; finally, the punchline restores our epistemic equilibrium, making us laugh when we realise that he’s actually talking about typography. It’s also fine to be outwitted by a conjurer’s sleight of hand, in fact, our enjoyment depends on it. The trick is to avoid being bamboozled when there’s a lot more at stake than mere entertainment. It is extremely unfortunate to fall for a quack’s ‘cure’ if our illness is potentially life-threatening and the ‘cure’ doesn’t work. We could be robbed of years of life by putting our trust in an untrustworthy source of medical advice. If your blood pressure is high, making heart disease more likely, a magnetic bracelet will not reduce it, unless the placebo effect helpfully intervenes.

However, there are reliable ways of reducing blood pressure: by adjusting diet and exercise, or by taking doctor-prescribed medication. There are facts of the matter, and good medical practice is backed up by empirical data. ACE inhibitors and beta blockers work: magnetic bracelets are ineffective. And yet we can convince ourselves that the fake cure is doing good, courtesy of that well-established psychological phenomenon the placebo effect (from the Latin placebo meaning ‘I shall please’), which sometimes makes a fake cure work, to a degree. It does this by triggering the brain’s ‘feel-good’ chemicals, endorphins, and by unleashing the neurotransmitter dopamine. The placebo effect is a psychological phenomenon which relies on our ability to harness our powers of thought to improve our health – albeit the effect is subjective: if you think that the placebo is doing good, then it will do good, or at least, appear to do good. The opposite phenomenon is the ‘nocebo’ effect. If you think that something is harmful, then it becomes harmful, whatever the objective realities otherwise. These are epistemic effects, for in both cases our beliefs are fooling us and keeping us from the truth.

The Australian comedian Tim Minchin quips that “You know what they call alternative medicine that’s been proved to work? – Medicine.” I would quibble with his use of the word ‘proved’ here – ‘demonstrated’ would be better, for medical knowledge is provisional, not provable like maths. However, he makes an excellent point. In the unlikely event of the ‘alternative’ magnetic bracelet approach to high blood pressure being shown by empirical evidence to be effective, it becomes part of medical knowledge. Otherwise, it is pseudoscientific woo-woo, and to be shunned.

Magnetic Attraction

Such is the seriousness of medical swindling that the state should arguably have a role in combating it. There is no need to monitor the trickery of the comedian or the stage conjurer, but crooks touting fake cures deserve close official attention. To protect the public from its own folly, they need to be watched and prosecuted. (The word ‘folly’ is a little harsh perhaps, for the claims of magnetic bracelet vendors, though spurious, have a superficial plausibility.)

I contacted the authorities here in Ireland who deal with this sort of thing. But to protect my own blood pressure I almost gave up on the lengthy back-and-forth of emails. Eventually the Health Products Regulatory Authority conceded that the bracelets didn’t work: “where such bracelet products have been reviewed, the HPRA has not seen evidence to date to support medical claims of this nature” (email, 31/08/2022). They offered to take on the case, if I provided “further details including the name of the legal manufacturer or any product packaging/labelling or images if available.”

Snake oil has never been a thing here in Ireland, since Saint Patrick drove all the snakes into the sea. Ironically we still seem to be attracted to bogus magnetic bracelets. Caveat emptor. Cave fraudator.

Seán Moran teaches postgraduate students in Ireland, and is professor of philosophy at one of the oldest universities in the Punjab. His doctorate is in philosophy, not medicine, so please consult a proper medical practitioner if you are affected by this article.