Hi,
You’ve probably heard these lines before:
- They want to keep you sick so they keep making money.
- Here’s what they don’t want you to know.
You might read these statements and think “Oh those wacky conspiracy theorists …”, or you might have written to us in support of these sentiments.
Today’s email is a divergence from our usual fare. I think the issues at the root of these kinds of statements are a bit more complicated than most people realize, and are actually quite important for understanding the big picture of health.
Where did these sentiments come from?
In 2002, my first job out of college was as a researcher in the strategy department of a massive U.S. health insurer.
Everybody loves health insurance companies, right? Paragons of virtue. NOT!
The job began as a regular 9 to 5. (What a way to make a livin’, am I right, Dolly Parton?) I didn’t know much about the healthcare system coming in, and right away was required to study for a healthcare management designation. I learned a lot.
Alas, I was a square peg in a round hole. I asked too many questions and was rarely satisfied with the answers. I became more and more disillusioned each month, for reasons that anyone familiar with the state of the U.S. healthcare system should understand, and eventually left to attend school for public health.
During my tenure at the insurer, part of my job was keeping up with major events going on in health, and summarizing them for insurance CEOs. One of those events was the rise and fall of Vioxx, the blockbuster arthritis drug made by pharmaceutical giant Merck that got pulled from the market for causing thousands of heart attacks and deaths.
The Vioxx fiasco was the first time I did a deep dive into who shapes these major events.
On the one hand, there was no evil corporate and/or government cabal pulling the strings with the express intention of hurting people.
On the other hand, Merck clearly wasn’t acting objectively. At several key junctures, they pushed back on safety concerns in ways that, retrospectively, obviously benefited the company and shareholders more than patients.
But Merck isn’t responsible for all health disasters
If only there was a single coordinated entity that was so, so evil and behind all the health problems in the world. We could do battle with it, end up victorious, and stop big corporate CEOs from hurting patients forever.
But ultimately, the source of these issues are various individual people. Individual people are rarely all good or all bad. So why don’t individual people speak up when they become aware of shenanigans?
Maintaining a well-paying job that supports you and your family is a big deal. Even if you pretty obviously work for “The Man”, your coworkers and boss will normalize (and sometimes reward) behavior that supports the company. A major debacle, such as Vioxx, is composed of dozens of much smaller screw-ups. The smaller screw-ups can be a mix of unintentional errors, intentional gaslighting or deflection, scientific uncertainty, and myriad other issues. The science is rarely as certain as it appears. Certainty comes from multiple long-term controlled trials looking at every important outcome in a huge sample of diverse people. Studies typically have at least one methodological shortcoming, and often there’s opposing data from another study. At best, well-meaning scientists can draw conclusions from the available data that look like they make sense, but are actually wrong. At worst, corporations can hide behind these discrepancies.
Are there intentional or unintentional bad actors in nutrition?
Of course there are! But not in the way you might think.
For example, 19 out of 20 members of the 2020 U.S. Dietary Guidelines Committee had potential conflicts of interest involving ties to food or pharmaceutical companies. The numbers appear to be a bit lower for the 2025 Committee.
But that doesn’t mean that these people are hopelessly corrupt, and the guidelines are a sham. Not so fast. There are gray areas.
For example, if you’re a nutrition professor, there’s a ton of pressure to churn out papers. Publish or perish. There’s a good chance that at least one of these papers was at least partially funded by a company or lobbying group. Funding can be very hard to come by, and sometimes scientists have to take what they can get, especially at a research university. Specific funding sources don’t automatically invalidate or affect the results of studies, but they do need to be disclosed so everyone can be aware of potential influences.
I’ve met or otherwise interacted with a very small number of Dietary Guidelines Committee members. They did appear to be earnest academics who think objectively and are very well-read. That doesn’t mean they or others aren’t biased, though. I did have some different viewpoints than one of the members I met, but that might come from being less well-read on certain topics. And that’s not too surprising: committee members don’t always agree even with each other on individual nutrition issues.
On the opposite side of the dietary guidelines are people who think the status quo is bunk and behind the times.
There are some vegans who think the guidelines are bought and paid for by the beef and dairy industries, and some carnivores who think the guidelines are shoving carbs down your throat. Everyone has specific (sometimes very specific) beliefs based on their life experience and education, from low-carb dieters to U.S. Dietary Guideline Committee members.
That doesn’t mean that everyone who disagrees with you (or me!) is a bad actor. I think it’s pretty clear that the committee member I disagreed with on a nutrition issue was still acting in good faith. Most people are doing their best to live healthy lives in the best way they know how, and help others do the same. And because health and nutrition are super, super complicated, sometimes we end up disagreeing.
It doesn’t help that people vary wildly in their responses to even the same dietary intervention. People are so different that it can be difficult to identify a singular “truth” of nutrition and draw generalized guidelines around it.
How do you figure out who’s objective and who might have an ulterior motive?
We prefer to focus on the science. By working exclusively with the research, we’re able to cut through a lot of the marketing and lobbying misinformation. Examine is a much smaller company than you’d imagine, and we’ve never accepted third-party ads, partnerships, corporate gifts, or any other source of outside funding. We can’t do any of that because we need to stay as objective as humanly possible, no matter what it’d do for our short-term bottom line.
Yet once in a while, even we get perplexing emails. If we summarize a study on plant-based diets, someone might accuse us of being funded by Big Agriculture. If we do the same for a keto study, we get accused of being funded by the beef industry. When we talk about the dangers of certain supplements, at least one person will accuse us of being funded by Big Pharma. When we talk about promising new supplements, we sometimes get accused of being supplement shills. (There’s a good reason we never recommend specific brands.) It’s so, so easy to accuse people of being bad when you feel strongly about something! And I get it! Nutrition is an emotional topic, especially when it hits too close to home.
That’s why I wanted to discuss health conspiracy theories today. It’s okay to be enthusiastic about what you think really works for you. But if you find yourself constantly accusing people based on what worked for you, consider taking a step back. Are you always accusing in good faith?
I’m curious about your thoughts. If you’ve developed a more nuanced view over the course of this email, or perhaps had a high up role in a food or drug company, I’d love to hear from you about your thoughts and experiences! I’m here not just to teach, but also to learn.
Sincerely,
Kamal Patel
Co-founder, Examine