Business is booming for only a few industries—video conferencing, hand sanitizer, and…elderberry syrup manufacturers. In Washington, hit early and hard, a pair of siblings now work 70-hour weeks filling orders for their immune-boosting formulation, up four times from February. In Texas, a kombucha shop is selling out of elderberry concentrate and elderberry gummies. Across the United States, panicked consumers have cleaned out major retailers, who also report shortages of other “immune-boosting supplements,” among them Vitamin C, zinc, and Vitamin D.
It makes sense to see these purchases as irrational and possibly dangerous: a waste of money when money is scarce, and unscientific when respect for scientific authorities is at a premium. The National Center for Complementary and Integrative Health, the division of the National Institutes of Health tasked with evaluating “alternative” medicine, put out a warning with a key takeaway in bold print:
“There is no scientific evidence that any of these alternative remedies can prevent or cure the illness caused by this virus. In fact, some of them may not be safe to consume.”
When Dr. Oz tells a national TV audience that supplements “may be beneficial in shortening the duration” of infection—elderberry among those he recommends—he’s in the same camp as televangelist Jim Bakker hawking “Silver Sol Liquid.”
Shut it all down, just like the FTC shut down Bakker. As health policy expert Timothy Caulfield argues in a blistering opinion piece, there should be no tolerance for pseudoscientific cures that drain resources and might kill you. We should condemn those engaged in “leveraging the fear and uncertainty surrounding the outbreak to sell products and ill-conceived health theories,” whether they’re faith healers, Dr. Oz, or supplement sellers—and we should strive to educate those who fall for their sales pitches so they are no longer vulnerable.
I once held this position. Dr. Oz’s openminded posture, I suggested, is actually risky; tolerating “alternative facts” about alternative medicine diminishes our ability to sort truth from falsehood more generally.
But now I am less certain—not about the pseudoscience, or even the dangers it poses, but about the place these “irrational” beliefs and practices occupy in people’s lives. Illness and death exceed scientific explanations. The threat they pose is existential, not physiological. When confronted with cancer or COVID-19, we are forced to acknowledge the fragility of our bodies, our systems, our world. Cancer patients frequently describe the experience in terms of being “betrayed” by their bodies. This pandemic is a rupture of trust in everything that once seemed stable. It’s all out of control, including ourselves.
Faced with an existential crisis, people turn to existential solutions—rituals to beat back the chaos and affirm empowered participation in a coherent system. Traditionally these rituals come from religion: touching relics, pilgrimages to healing sites, prayer. Such practices are, of course, unsupported by scientific evidence, but that’s not the point. The most important function of prayer isn’t to heal the body, but to heal the soul that can no longer count on the body.
Whether traditional Chinese medicine, Indian Ayurveda, or “natural” supplements, alternative medicines draw their authority from holistic explanatory systems that look a great deal like religion. They were developed at a time when religion, medicine, and science were not separate categories. You fall ill because you have strayed from Nature, with a capital N, which is at once a physical and spiritual system. Likewise, they offer the direct empowerment of religious rituals, without the intermediary of medical experts. You can heal yourself by harmonizing with that system. You do have control.
The demand for alternative forms of healing is not a function of unscientific thinking. In a study of people who take supplements, two professors at Harvard’s School of Public Health can only describe the regimens using language drawn from religion—“daily activities of affirmation and assurance . . . liturgical acts of recognition with deeper implications for social, moral, and spiritual redemption.”
As the sphere of traditional religion’s authority shrinks, religious practices such as prayer are less likely to offer adequate reassurance in a medical crisis. The growing popularity of alternative medicine and supplements shows that people want a different kind of liturgical act—one that participates simultaneously in spiritual language (“natural,” “ancient wisdom”) and scientific language (“vitamin,” “help your immune system”).
During a pandemic, the need for protective liturgical acts becomes acute. This is why Caulfield and others are rightfully concerned about grifters and charlatans who see in this moment a unique opportunity to victimize the vulnerable. But if you tell people that their priests are preaching falsehoods, that their practices offer no protection—then what will fill the void? Hand-washing and social distancing do not offer the existential comfort of prayer, or of natural healing products like elderberry syrup.
Dealing with misinformation, in itself, is fairly straightforward. President Trump will kill people—has already killed someone—by trumpeting the benefits of untested medicine. He and other public personalities who pretend to have discovered cures or effective forms of prevention should be called out, as they have been, by responsible experts.
But we must also put effort into solving a more difficult problem: how to meet the need for the liturgical acts that keep many of us whole. As it is right now, our medical system does not do enough. Precisely at the moment your body betrays you, medical rituals take it further from your control.
When physicians used to handwrite prescriptions, their writing was famously inscrutable, a mystical formula meant only for the eyes of the pharmacist. The transition away from handwriting has done little to improve the underlying problem. Medicines function according to biological principles that the majority of patients do not understand.
Even the names of medicines seem designed to be alien. If you are a breast cancer patient, suddenly you’re thrust into a world where regaining control of your body depends on Abraxane, Mitomycin, Taxotere, Xeloda, Thioplex, and Gemzar. Which of these is the best choice? Only your doctor can tell you, which means that choice really isn’t involved at all. And why did your doctor choose Taxotere over Gemzar? Was it the right call? Now you must learn the arcane language of clinical trials, p-scores, and NNT vs. NNH, and once you do, the randomized phase II clinical trial that justifies your doctor’s choice might be hidden behind a paywall.
If medicine continues to feel like this, if “clinical” continues to be a synonym for “cold” and “harsh,” then the battle against pseudoscientific healing will be a losing one. The problem is not only with insufficiently educated people choosing unproven treatments—it’s also with a medical system that conceives of illness primarily as biological, not existential; of the human body as a machine, not a human.
We need to reform that system. Medical school, and medical practitioners, must center the less technical aspects of their craft more than they currently do. We need to give doctors more time, so the humanity of healing isn’t lost in a rush to get through all the patients. We need to dial back the coldness and harshness of medical contexts, the blinding white and stainless steel that dominates hospitals—except for pediatric wards, the only place regularly designed as if humans will be occupying it.
Until that system is reformed, the elderberry will continue to fly off the shelves—and pseudoscientific charlatans will only be partially to blame.