Mist Fantasy

Fanciful Reasoning About Health in an Age of Low Trust

Americans this year will spend about $35 billion on dietary supplements. All over the world, spending will add up to more than $150 billion. What will it do for us? Not much, says the U.S. Preventive Service Task Force in a new report released yesterday about the value of these supplements for preventing heart disease and cancer. So why do we do it? Because, says Peter Ubel in an editorial for JAMA Internal Medicine, “Too many vitamins feels just about right.” Simply stated, fanciful reasoning about health has become the norm.

Meanwhile, many people are ready to dismiss people with real expertise on health if it doesn’t fit with their fanciful reasoning. In case you haven’t noticed, we are living in an age of low trust.

Barely Half Trust CDC

In a new report issued by the Harvard School of Public Health and the Robert Wood Johnson Foundation, we learned that barely half (52 percent) of U.S. adults put a lot of trust in recommendations of the CDC. Nearly a third flatly don’t believe them. And here’s the kicker. CDC commands the most trust of seven health agencies in the survey. NIH and FDA scored high trust from only 37 percent of respondents.

The U.S. is not alone in this age of low trust. For example in China, a bungled lockdown of Shanghai and opaque health systems leave much of the Chinese public with little trust in health authorities.

Fanciful Thinking

In the absence of trust in health expertise, fanciful reasoning takes over. We plunk down good money for supplements that most people do not need. Don’t get us wrong. Some folks – bariatric surgery patients are an obvious example – have good medical reasons for taking a supplement. But the rest of us are just feeding the bank accounts of greedy supplement marketers peddling puffery.

Another bit of fanciful thinking stemming from mistrust is the undercurrent of thinking that obesity is not a real health concern. It’s a fabrication, “made up,” says fat activist Tigress Osborn. This kind of fanciful reasoning even draws in people who should know better. It surfaced recently at the University of Chicago School of Public Health. A policy brief there called for banning use of the word obesity.

Earning Trust

Trust is earned. Slowly. Hype and ill-conceived recommendations serve to tear it down quickly. The rise of fanciful thinking that obesity is not a health concern comes as an equal and opposite reaction to years of hype, misinformation, and flat-out fat shaming from public health on the subject.

Trust indeed can be earned. On the subject of obesity, it will accrue as we do a better job of caring for and about the lives of people who are living with it. It will come from sticking to the facts, admitting the limits of what we know, and working hard to fill in the gaps with actual evidence. Not fanciful reasoning.

Click here, here, and here for the new reports on the limited value of dietary supplements in the absence of a clear indication. For more on mistrust in public health agencies, click here.

Mist Fantasy, painting by J. E. H. MacDonald / WikiArt

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June 22, 2022

3 Responses to “Fanciful Reasoning About Health in an Age of Low Trust”

  1. June 22, 2022 at 7:35 am, Joe Gitchell said:

    Thanks, Ted–such important stuff.

    If you want to go next-level on the issues of trust and trustworthiness in health and public health, I highly commend this Peter Sandman post:


    Uncomfortable reading, for sure, but I think he makes a compelling argument.


    • June 22, 2022 at 8:42 am, Ted said:

      Thanks, Joe! Another excellent recommendation.

  2. June 24, 2022 at 7:53 am, Ken Kaszak said:

    In the darkest days of my life, I had to take a contract w/ a bodybuilding supplement company to keep the doors open. I was great at pushing the products. What helped me was knowing it was all BS. I’ve written about my experiences in the supplement industry, including a piece on fellow Baldwin High School alum Orrin Hatch (father of the DSHEA). A few years ago I had the chance to meet Dr. Paul Offit. Offit is a well-known pediatrician and immunologist. We had a discussion about the supplement industry and he signed his book on the industry, “Do You Believe in Magic?” for me. Well worth your time to read.