Disputation on the Power and Efficacy of Health Indulgences

The title of this post is an homage to the alternative title to Martin Luther’s Ninety-five Theses, his 1517 screed against indulgences. Indulgences were a neat fundraising technique, where Catholics were offered the opportunity to pay off their sins with money, rather than with time in purgatory. Luther’s campaign against this corrupt practice, among other things, instigated the Protestant Reformation and dramatically altered the course of the world. My takeaway from this reductive historical account is the combination of a grotesquely corrupt practice and a compelling screed can change the world. Without further ado, this is the compelling screed, and the grotesquely corrupt practice is the health and wellness industry.

Not all scams are equal according to our internal moral indignation calculators. For example, one is likely to feel more angry at the Catholic church selling indulgences than at a Nigerian prince phishing scheme. What makes the practice of selling indulgences especially distasteful to us? While all scams are somewhat repulsive and that repulsion roughly scales with the scale of the scam, I think there are two aspects of the indulgences scam that particularly offend our sensibilities. First, there is the misuse of power and the betrayal of trust. Clergymen, by virtue of their respected institution, have public authority and respect. They are and should be held to a higher standard than the average Joe. Those who are typically running scams often have lower societal expectations, so the shock is not as great. Second, the indulgence scam is distinguished because it relies on the charming but ultimately repulsive Pascal’s wager style argument. There is a risk of eternal damnation that encourages people to pay up, so even a skeptic may be convinced. You may think there’s a 99% chance that indulgences are a scam, but do you take the risk of it not being a scam and you’re stuck in purgatory for 100 years? If you pay, the worst case scenario is you lost some money or wasted some time. These sorts of manipulative arguments arise where the underlying probabilities (i.e. the Catholic church’s access to God) are impossible to discern and the outcomes (i.e. eternal damnation, salvation) are very important.

To recap, my definition of an “indulgence” is a profit-oriented scheme that a) comes from someone with authority where you b) are manipulated into participating by a probabilistic argument involving catastrophic risk.

In the rest of this essay, I aim to convince you that much of the health and wellness industry is engaged in a similar scheme. Instead of years off of purgatory, you are sold “improved health” and “increased longevity.” But, in this world as in 16th century Europe, one cannot buy salvation. And those who claim to sell it are scoundrels. So, whether it is the Catholic Church or Gwyneth Paltrow, just say no.

Health Indulgences

Keeping up with the various health and wellness trends is exhausting because they change so frequently, but they are hard to avoid. They range from the silly (cold plunges and beef tallow) to the nostalgic and bucolic (raw milk, water births) to the anarchistic (vaccine skepticism). Importantly, alternative health ideas are not fringe; RFK Jr’s ascendancy is evidence of their prominence. Hucksters abound pushing a variety of lifestyle indulgences often endorsed by reputable public figures. But what makes wellness products more like an indulgence than a regular scam?

First, many of these trends lead to a pay day for their promulgators through the classic advertising business model. For anything that can be bought, a person of influence can collect a fee for promoting the product. Similarly, the advertisers earn from selling the products. In the indulgence model, the influencers are the bishops while the businesses are the Catholic church. While there’s not always a profit motive (indeed, many trends like raw milk or vaccine skepticism seem driven more by vibes than acquisitiveness), there are plenty of marketable products that align with the wellness zeitgeist.

Second, these efforts are led by highly influential people with either formal or informal authority. Sometimes these influencers are credentialed elites (e.g. Andrew Huberman or Dr. Oz) and use their authority as learned doctors to convince their audience. Others, like Joe Rogan or Gwyneth Paltrow, lack institutional authority but they do command the respect and attention of millions of people. Further down the influencer food chain, there are micro–celebrities. These have a smaller reach, but this may help them create a closer, more trusted relationship with their audience. These smaller influencers are more akin to a local parish priest or pardoner who might have collected an indulgence in the 16th century. It’s easy to poke fun at influencers, their strange niches, and the triteness of it all, but it is best to think of them as mini–Oprahs. Whether they are deserving of authority or not, it is undeniable that many people look to them for advice and proceed to follow it.

Third, selling wellness products relies on a manipulative existential risk argument I will call Paltrow’s wager. Pascal’s wager says that you should believe in God regardless of whether He exists because the penalty for not believing (eternal damnation) is really bad and the cost for believing if He doesn’t exist is relatively low. Although no influencers are saying “buy this or you will go to hell,” they do imply that inaction may lead to compromised health. In our more secular world, hell is not a compelling threat to many; indeed, without belief in an afterlife, death is the final punishment. So, suggesting that not doing something is bad for your health (i.e. may contribute to premature death) shares a fundamental quality with a clergymen warning of eternal damnation. Paltrow’s wager goes like this: the $66 Goop jade egg increases your health in some ambiguous way. Sure it is expensive, but are you willing to risk not inserting this into your REDACTED. If you refuse to use a product that has a claimed health benefit, you receive a harm in the form of the foregone benefit. This harm is catastrophic because you may be less healthy and die prematurely.

I don’t mean to suggest that there is a conspiracy from Big Wellness that brainwashes people into buying more expensive food and obscure supplements. This culture precedes any capitalist conspiracy. For many, there is an innate distrust of new technology and a preference for that which is putatively “natural,” as opposed to human-made. For example, people might prefer a vitamin to an antibiotic, an herbal tea to a cough drop, or a water birth to a hospital birth. This cultural tide, rather than Big Wellness, primes people to be sold various wellness products.¹ Beyond their “natural” bias, many have health issues and are desperate to feel better but medical science has nothing to offer them. Thus they turn to “alternative health practitioners” (chiropractors, acupuncturists, naturopaths) and/or experiment with things they can control like their diet or over-the-counter supplement routine. However, I do not think people’s inborn bias towards wellness schemes absolves the influencers. It’s not right to take advantage of people’s vulnerability even when they are gleeful participants. Many people feel permanently guilty without reason (ask me how I know), but that doesn’t make it ok to sell them indulgences. Again, even if it’s what they want! Even if it makes them feel better.

Low-Friction SAAS is the new usury or: My $500 Tortilla Subscription

Peoples’ decisions to buy a wellness product lack a simple causal explanation. The cause is some combination of the aforementioned public fixation on non-medical health interventions, the vast network of attractive wellness influencers, along with many other factors. However, the most impactful factor (at least in my case) is often an Insta–shaman who recommends a particular product. And so it was that one day my wife set her crosshairs on gluten, which is inflammatory or something. While this had various effects on our day-to-day routine, the largest impact was on our tortilla supply. She went from the normal grocery store tortillas ($0.25 each) to gluten-free Siete cassava flour tortillas ($1.25 each) for a $1 increase per tortilla. With her average consumption of two tortillas every weekday, that’s roughly 500 tortillas/dollars a year! Through some Siete influencer legerdemain, we are now paying a $500 annual tortilla premium.

As a frugal household that has spirited debates over whether a Netflix subscription ($72 a year) is worth it, we would never want to spend that much on a premium tortilla subscription. But, there is a genius to low friction subscriptions: $10 a week mostly just blends in with monthly expenses.² In this way, you can absent-mindedly pay for it forever. If we don’t change our ways, by the time we retire we’ll have paid roughly $20k in tortilla premiums to Siete. And the tortillas are just the tip of the iceberg.³

These wellness premiums quickly stack up. You may get it in your head that you should be eating organic. Why wouldn’t you invest in your health? It’s priceless. So you’re now buying organic groceries at a ~20% premium. An influencer you really admire claims if you want to feel your best, you need a new multi-vitamin because cheap CVS multi-vitamins are now bad. Fortunately, she has partnered with a vitamin startup. You can subscribe monthly for a $50 vitamin that is calibrated to your vital vitamin needs, and if you use her code, you even get the first month free! It’s convenient and it has cool packaging. Another influencer alerts you to potential issues in your gut microbiome. You need a pre-biotic, post-biotic, pro-biotic, and pendant-biotic. Fortunately, Biotic-mart offered to sponsor this post. They can send these all to you in a cool package for $100 a month. She acknowledges it’s a little pricy but gut health is very important and poor gut health is probably causing most of the problems in your life. One successful click-through at a time, you slowly transfer more of your money to various health and wellness businesses until you are destitute and in an almshouse.⁴

Does Anyone Care?

The public conscious maintains a certain animosity towards Big Pharma and health insurance companies. Considering the medieval response to the United Healthcare CEO’s murder, the Protestant Reformation of the Middle Ages doesn’t seem too far off as a comparison. People don’t like feeling ripped off and one’s health is an especially touchy subject. But Biotic-mart and Gwyneth Paltrow and the wellness lifestyle influencers are doing something worse than the proposed crimes of the healthcare industry. Not only are you ripped off in the form of $500 gluten-free tortilla fees so the influencer can collect advertiser money, but you are also sold a lie. Medicine is an imprecise instrument. Much of it has questionable efficacy, but at least the FDA demands considerable effort to prove (or fake) that an intervention matters. You may feel ripped off by your $5,000 prescription, but there is at least there is a plausible pathophysiological mechanism for it to help. But where medicine falls short of a cure (e.g. irritable bowel syndrome, Lyme’s disease, skin issues), health and wellness fills the void with expensive and useless supplements. Even if you don’t have any problems, they caution you that your lifestyle could be healthier if you only bought more expensive alternatives to the things you’ve been using for years. Why doesn’t that seem to bother anyone? But what do I know? After all, you really can’t put a price on your health. And that tincture may actually solve your digestive issues. And switching to organic lettuce may extend your life by a year. And the right vitamin mix may restore your confidence and self-esteem.

We all want a pill that will make our problems go away. Whether they are biological, psychogenic, or interpersonal, whether it is possible or not, we just want a surgeon to cut it out of us. And if it isn’t possible, we especially want someone to reassure us and tell us they will fix it with vitamins rather than live with the discomforting reality of an unfixable problem. Perhaps this essay is just a longwinded way of lamenting this very human instinct to escape pain even if it means denying reality.

Out with Pascal, in with Precaution or: The Probiotic Reformation

I often end my grumpy essays with a proposed solution or incremental improvement, but I am more or less at a loss here. Wellness influencers are prohibited from making claims of medical efficacy, and Goop was sued for such claims. But the purveyors of wellness usually don’t make medical claims; they gesture at ambiguous potential health improvements. I’m not interesting in banning supplements or restricting influencers’ speech. It’s also not that big of a problem because it mostly impacts a portion of the population that can afford to throw their money away on magic pills and fancy produce. Didn’t Marx once say: “health and wellness is the opiate of the rich?”

My modest proposal to combat the health and wellness shakedown is to introduce a countervailing manipulative approach: the precautionary principle. Right now, the thinking is “I need to do this because there is a chance it may help.” But, the precautionary principle says “I shouldn’t do that because it may make things worse.” One obstacle to getting people to internalize this when it comes to health and wellness is there is an implicit fetishization of natural things. People don’t think vitamins or probiotics can hurt them, and they might be hesitant to accept that claim, whereas they are easily convinced that antibiotics or vaccines may be harmful. With that said, a sufficiently influential crazy could probably start some campaign against them. So, I need to create a public relations firm that mobilizes campaigns against dubious wellness products. If you see headlines about probiotics causing autism, my master plan has worked.

Counterarguments

As I was writing this, I began thinking of many reasons I would disagree with the many exaggerations in this satirical article, so here’s a list with my responses.

• What you’re describing is a first-world problem. The wellness industry exists for rich people to feel better than those who can’t afford it. So, who cares? Yup, basically.
• If medical science is unable to help with something, do we prevent anyone from trying to fix it? For example, gut health appears to be important. Why can’t companies experiment with selling probiotics? They may help. That’s a good point and they shouldn’t be banned, but I think a more responsible approach would be to articulate the uncertainty in the process. They shouldn’t pretend to know more than they do.
• Indulgences are fine. If people want to pay to have peace of mind, let them. Two consenting parties can generally do whatever they want. I understand this argument but moral indignation preempts reason.
• What about the mind-body connection? There are a lot of mysteries and even medical doctors are mostly in the dark about how health works. Yea, I mostly just want people to be more honest in their advertising.
• What if influencers push useless products because they genuinely believe they work? That is, they aren’t intentionally misleading their audiences. I agree that many of these people are doing important advocacy for health. It makes it more annoying to me because it can be so sanctimonious. If it isn’t obvious, there are many underlying pathologies that help explain the wellness phenomenon. Chief among them might be apathy towards scientific rigor.
• Is upselling generally bad? What’s wrong with selling more expensive eggs? Isn’t it like selling a fancier TV, or the pro model of an iPhone? Upselling is fine, and please try to sell me the fancier tv, but I would argue upselling people by stoking paranoia about their health is unethical.