"Take this, it's good for you!" Or maybe it isn't.

“Take this, it’s good for you!”

 You probably heard this growing up from your parents, or grandparents, or others, about lots of things. Medicines, foods, supplements, and even activities (“Do this, it’s good for you!”). You probably have continued to hear this from other people even if you are now grown: friends, family, people you have just met, and that most reliable of all sources, random posts (I was going to say “random people” until I realized that many or most of them could be bots) on the internet! So, should you take it? I mean, is it good for you?

I know my answer is going to be shocking: “It depends.”

On what? On a whole lot of things.

The whole idea that there is a general concept of things that are “good for you”, whoever you are and what you are hoping to achieve, is nonsense. What is good for one person – say an infant or a toddler – may well not be good for a middle-aged or older adult, and vice versa. And, of course, the most important question is “good for what?” What do you seek to have happen to you that this nostrum is “good for?” Do you even share the interest in achieving the end goal that the recommender presumably does? Lower cholesterol, lower weight, more muscle mass, stronger bones, having better balance or more stamina, improved sexual function, looking younger, better bowel movements, avoiding a deficiency disease like rickets, scurvy, or pellagra? Sometimes even cheap and easily available things from which big corporations or influencers do not make a lot of money, and that in fact do work well, are also unnecessary. Parents and grandparents may push things that their parents and grandparents told them were good for them, and they might have been, back once, but are not now. Back then, when our diets were often lacking in essential vitamins, scurvy, pellagra, and rickets were real issues in the US (and may still be in some parts of the world), but are not, generally, here now. In the not-too-distant past parents gave their kids castor oil, either as a treatment for a condition that the child might or might not have, like constipation or worms, but there are much better, safer, less unpleasant, and more effective treatments for both now. (That is not considering those who gave it as punishment!)

After you have answered the question of “good for what?” and decided that that “what“ is something you want to achieve or more toward, the next set of questions are “will it do that, does it actually work?”, “does it work for everyone the same or are there some groups of people (based on age, gender, health status, etc.) for whom it works better or not as well, and “what are the untoward effects that may, or even are likely to, happen, which may be far worse than the benefit?” Anabolic steroids, for example, do work to increase muscle mass, endurance, and power (see: sports stars) but also cause serious bad things (liver disease, testicular shrinkage, and a host of others). If it is legal and you are not competing in a sport where it is banned, it is up to you to decide whether the risk:benefit ratio is one you are willing to take (provided you are an adult, since in this area as many others, teens are poor judges of risk:benefit and do not have a good long view). Psyllium seed powders can be good for your bowels, lowering cholesterol, and helping to control your appetite, but some people have problems with the side effects. Testosterone, now being pushed by the Secretary of War who is competing with the Secretary of HHS and the President for being the administrations most macho ignoramus, can be good for some people who are deficient who should not be, but is far from a panacea that turns regular people into mindless Orcs (many medical professionals disagree, Doctors question evidence behind Pentagon testosterone plan). By the way, this is a good time to note the intrinsic contradictions in the “men’s health” movement. Its two big issues are prostate disease (especially cancer) and “low T”. Testosterone will not only make prostate cancer (or even benign prostatic hypertrophy) worse, blocking endogenous testosterone is the mainstay of treatment for prostate cancer. Oh, well, let’s see what it does for Pete Hegseth.

Some things generally are good for you. For example, age-appropriate vaccines are good for almost everyone (except those with known allergies to its components or previous severe reactions, by which I mean things like Guillain-Barre Syndrome, not a sore arm or short-term fever). Virtually all vaccines for children and adults (MMR, DTP, meningococcus, chicken pox, H. flu, influenza, Covid, shingles, polio, etc.) are really wonderful miracles that save thousands (sometimes millions, see: “Covid” and influenza) of lives, even more thousands or millions saved from serious morbidity, and with a very low rate of any significant negative effect. This is true. If you hear different information from your favorite TikTok star or Facebook friend, or Secretary of HHS, they are wrong.

Some things are generally bad for almost everyone, like taking dangerous drugs for unapproved indications (e.g., ivermectin for Covid), not to mention drinking or injecting bleach! The internet is full of recommendations for magic bullets that will cure whatever ails you or doesn’t even ail you but tells you it will or might if you don’t buy their solution. These claims are no more reliable than the clothes, makeup, hardware, and amazing items that will solve all your household worries. That is, some may be of value, for some people, in some circumstances, but often are not and even are dangerous, but all make money for those selling them (or in the modern world, selling their ability to influence others to the companies that make the products).

A big issue, it seems, is whether to take drugs, especially prescription drugs, manufactured by big, evil, pharmaceutical companies and heavily advertised by them, or to take “natural” over-the-counter drugs made by any-old-person or company and pushed by – any-old-person (or bot). Pharmaceutical companies are evil, as are most huge for-profit corporations (and they are usually the most for-profitable!) because their profits, not your health, is their main function. This does not mean that their products (or at least all of them) are not effective or safe when “used as directed”. They have two important characteristics non-prescription, even “natural” remedies, do not. First, they are tested, and approved after an extensive process, by the FDA (or were, before the FDA was decimated by the administration), which other remedies are not. Second, the doses are standardized, so you know what you’re getting. Even when plants (natural) are the basis for the drugs – say willow bark for aspirin – dosing is an issue. How much willow bark? From how old a tree? Growing in what setting? An aspirin tablet is standardized. Taking unregulated medication is akin to taking street opiates – you cannot be sure what, and how much you are getting. Plus, remember “natural” is not intrinsically good, safe, or protective. There are at least as many natural poisons as beneficial substances. If something you ingest, “natural” or manufactured, has a biologic effect that you desire, it also can (and likely does) have biologic effects that you do not desire (“side effects”, a term meaning biologic effects you don’t want). Testing and standardization are keys. Not that this in any way excuses the rapacious profit-taking of Pharma, but neither does it of those selling unregulated nostrums.

Finally, and I have said this before and will say it again, when thinking about whether something is “good for you” and whether you should take it, anything that sounds too good to be true probably is.

Pregnancy, contraception, and misinformation on social media

A recent article in the Washington Post, “Women are getting off birth control amid misinformation explosion” (March 21, 2024), by Lauren Weber and Sabrina Malhi, discusses a recent explosion of misinformation about contraception on the Internet. More important, it notes the more serious result – women getting pregnant when they didn’t want to be because they believed this misinformation and acted on it by not using effective contraception. In many cases, according to anecdotal reports, women have sought abortions but found themselves living in states that made this difficult or impossible.

The article is not paywalled but does require (free) registration to read, so I will include some of the other important points in it.        

•  Much of the misinformation is especially found on sites like TikTok and Instagram that are followed by young people.
• Many of these sites and posts are by people with no medical training or credentials, but who cite their personal experiences, and such ideas as “natural” (whatever that is or isn’t).
• Many of the latter are folks trying (or succeeding) in developing careers as social media “influencers"; in addition to the usual ways of making money (advertising or payment from companies for promoting their products) they also can actually sell their services (one “charges hundreds of dollars for a three-month virtual program that includes analyses of blood panels for what she calls hormonal imbalances.”).
• An OB/Gyn physician in DC says that many of the women he sees “have traveled from states that have completely or partly banned abortions, he said, including Texas, Idaho, Georgia, North Carolina and South Carolina.”
• A variety of experts have cited the particular vulnerability of “Women of color whose communities have historically been exploited by the medical establishment may be particularly vulnerable to misinformation, given the long history of mistrust around birth control in this country… [including] forced sterilizations of tens of thousands of primarily Black, Latina and Indigenous women happened under U.S. government programs in the 20th century”.
• Much of the misinformation is propagated by those with political, social, and religious agendas.

This is a lot of things. Some of them need to be addressed on an individual basis by doctors and other health professionals when beginning women on contraceptive treatment. Especially important is identifying, which requires asking about, any concerns women may have, what the source of that concern is, and honestly discussing potential side effects. The discussion should address what those side effects do, and do not, indicate, ways of treating them, and effective alternatives if they get too serious. The most important point about both hormonal (oral contraceptive pills, implants, and some IUDs) and long-acting reversible contraception (LARC, mainly IUDs and implants) is that they effectively prevent pregnancy and are generally are what women who are having sex and do not wish to become pregnant should use. But if there is not (or is insufficient) discussion about worries that women have about the other effects of contraception, and as a result they are not used, or not used appropriately (e.g., oral contraceptives must be taken daily), unplanned and undesired pregnancy may be the result.

It is true that there is a horrific history of medical experimentation (and exploitation) of Black people in the US. The most famous is the Tuskegee Study, which followed a group of Black men with syphilis to study its “natural history” for years after treatment was available – but not given to them. Black women were victims of forced sterilizations, long after slavery, carried out by leading American physicians such as J. Marion Sims, whose statue in New York City was recently taken down (photo in this excellent review in The Intercept) and continued until relatively recently. A New York Times article from 2022 focuses on two sisters who were only in their early 60s at the  time, and were sterilized in 1973 at 14 and 12. It is unsurprising that, given this history, that Black and other minority women may legitimately be suspicious of treatments that affect their reproductive capacity.

It is also important to remember that all pregnancies, even when desired, carry health risks greater than that from any contraception. A recent piece in The Hill reports that nearly 40% of Black women of reproductive age are very concerned about the risks to their health should they become pregnant, especially with the repeal of Roe v. Wade and the restrictions on or abolition of abortion in many states. There is a great disparity in maternal mortality. As the Hill article notes

Studies show Black people who give birth are three to four times more likely to die from pregnancy-related causes than their white counterparts, while Black infants are two times more likely to die within their first year than white infants. Reasons for the disparities are nuanced, but many point to systemic racism in the health care system that dismisses Black women’s symptoms.  

That these fears are not unwarranted is horrifying, but to the extent that people are aware of them suggests that the misinformation on social media is not the only message getting out, and that accurate information is being provided by knowledgeable and trusted groups such as In Our Own Voice.

There is no question that right-wing, anti-abortion forces are behind much of the misinformation about contraception that is rampant on social media. But why? After all, if their concern is limiting abortions, the most effective way is to limit the number of unintended pregnancies, and this is what contraceptives do. While I have heard this argument made by a number of organizations and individuals who work for funding of contraception but not (necessarily) abortion, it doesn’t seem to get much traction with the bulk of the right-wing “anti-abortion” movement, which is also frequently are anti-contraception. What is this about?

There are a number of possible reasons. Perhaps it is related to the fact that often those providing contraception, such as Planned Parenthood, also provide abortions so that, in the thinking of these groups, contraception becomes tainted by association. It may also be a revulsion to sex, especially if undertaken for any purpose other than conception – in marriage.

But if sex is only ok if it is for conception and within marriage, why would they want to deny contraception to women who are having sex when they are not married and are not desiring to be pregnant? One answer is that they have an overall intent to control, restrict, and punish women, who they believe should have no agency. Men, of course, are just men and can be forgiven their “lack of control”, and even rape (like some presidents) but women are guilty and sinful even when they are the victims of that rape.

It is likely that the misinformation on social media is a result of all these factors, from “influencers” who are seeking fame and fortune to those promoting right-wing political and social agenda. Or maybe it is just all about providing misinformation so people can not effectively do what they want to. Whatever the reason, however, women should not be forced to risk pregnancy when effective and safe contraception is available, and certainly not be forced to find themselves requiring, and unable to get, an abortion.

Whatever the intent of the “misinformers” is, the result is the same, and bad.