There was a bit of a stir around Gotham a short while back when it emerged that a venomous Egyptian cobra had gone missing from the Bronx Zoo. We’ve grown accustomed to enduring risks great and small as part of life in this city, perhaps to the point of becoming too jaded by them. One highlight of the whole affair was an exceptional Twitter feed imagining how a modern snake on the town might entertain herself (my favorite: “Holding very still in the snake exhibit at the Museum of Natural History. This is gonna be hilarious!”). My younger self, who harbored a mortal fear of snakes (not usually the most obvious source of terror for a city kid), would probably not have been as amused. But all’s well that ends well, I suppose, and I hope the Bronx Zoo gets a nice uptick in tourist traffic for its trouble (and maybe a few leftover stimulus dollars for better security?).
With snakes on the brain and the subject of fear not far from my memory, I found myself thinking about “snake oil” and the multi-billion dollar industry of products and services that cater to our desires and vulnerabilities without the burden of unbiased empirical proof. If I were to lose some of my capacity for shame in a tragic personality-accident, I would immediately start a career developing and marketing nutritional supplements. Sites like Drugstore.com and Vitacost.com (both of which I frequent) read like catalogues of human insecurity. Too fat? Too thin? Too much hair? Too little hair? Are you worried that your feeling of fatigue at the end of the day might be a sign of heart disease, cancer, or Restless Leg Syndrome? There are dozens of pills, creams, and yoga regimens on DVD for each of those.
One of many valuable lessons I acquired from years of weekend trips to the racetrack is: be skeptical of offers that defy the logic economic self-interest. If a handicapper were unnaturally skilled at picking winners, why would he publish his recommendations and thereby dilute the returns he’d be able to get from making bets himself? (Or, even better: launching a hedge fund to bet other people’s money!) Why wouldn’t he have earned so much money from his wagering prowess that he could afford to stop running a business every day? Investment managers operate similarly, by the way. “Talking your book” – i.e., persuading people of your investment case for or against a security – can be a pretty good way to create the marginal buyer or seller that pushes a trade in the direction you want it to go. The issue isn’t that the handicapper or the investor can’t have good ideas — it’s that their greater economic incentive is to convince you that they are right rather than to just be right. So one should approach such ideas skeptically, and even more so if one is being asked to pay for them.
If it were really true that a supplement could reliably make you thinner, why would there still be so many overweight people? Well, one answer might be that the treatment is prohibitively expensive, but that is not the case for most supplements out in the market. (As a sidebar, I think there’s an interesting debate to be had about subsidizing gastric bypass surgery, for example, as a way to fight the health complications and public cost implications of morbid obesity; another story for another time.) Another answer might be that it only works on certain individuals, or in combination with other supplements, practices, environmental factors, etc. Perhaps – there is a lot we don’t know about health, medicine, and wellness. Yet another answer might be that the market just isn’t aware of the benefits of the supplement. This explanation has the added benefit of giving the consumer the sense that he is in on a special secret that will give him a leg up on the Joneses and Smiths.
None of these explanations is as simple as the racetrack-tout test. The economic imperative is to convince you that the supplement works, not to create a supplement that works. If the supplement works, that’s gravy for the distributor and the consumer. The placebo effect is a win-win. Why we have a heavily regulated prescription drug industry that places billions of dollars on the line over tiny observable statistical effects (that may not even correlate to health outcomes!) alongside a parallel universe of snake oil businesses wrapped in pseudoscience, nature-shamanism, and shameless exploitation of celebrity is beyond my comprehension. (Actually, it’s not: there are obviously entrenched economic interests on both sides.)
I will be the first to admit that I am a complete sucker for supplements of all kinds, in spite of everything I’ve just written. The dissonance reminds me of Pascal’s gambit: if I take this supplement, maybe it does nothing and I lose some money, but maybe it works and I avoid cancer!!! My rational consumer heuristics short-circuit a bit when inconceivably good or bad outcomes are thrown in the mix. I rarely consider whether the supplement could be actively harmful, even though that seems like the most reasonable prior assumption (after all, it’s something foreign to disrupt my highly evolved homeostasis) and should therefore bias me strongly against taking anything.
Perhaps this episode should teach me to be less worried about snakes on the town than about the snake oil in my medicine cabinet.