The wellness industry thrives on preying on anxieties about health and aging, offering products with dubious scientific backing that often promise more than they can deliver, according to a doctor and broadcaster.
Doctor Xand van Tulleken, in an exploration of the wellness industry for his new book, highlights how concepts like eternal youth and longevity are easily marketed but difficult to substantiate with rigorous scientific evidence. He points to supplements like nicotinamide adenine dinucleotide (NAD) and its precursor, nicotinamide mononucleotide (NMN), which have gained popularity among celebrities and the public for their purported anti-aging effects.
While NAD is essential for cellular energy and DNA repair, the molecule is too large to be absorbed when ingested directly. Precursors like NMN are marketed as a solution. David Sinclair, a Harvard researcher, promoted resveratrol, found in grape skins, for its potential to delay cellular aging, which led to a surge in supplement sales and red wine consumption. However, initial promising results in small animal studies did not translate to human trials, and the molecule is no longer considered 'miraculous.'
Sinclair also experimented with NMN, reporting positive effects on his own aging markers, which significantly boosted the supplement's profile. However, van Tulleken notes that longevity research has yet to produce robust studies demonstrating that any drug or supplement extends life in healthy humans.
Wei Zhu, CEO of SyncoZymes, a company that manufactures NAD, described how interest in the molecule for longevity surged after Sinclair's research. While NMN shows promising results in animal studies, human trials have yielded less convincing outcomes. A 2021 randomized controlled trial involving postmenopausal women with pre-diabetes showed a modest improvement in insulin sensitivity with NMN supplementation, but it did not significantly affect other metabolic markers. Other small studies have reported subjective improvements in fatigue and sleep quality, but none have demonstrated a reduction in mortality or extension of lifespan.
Concerns also exist about potential risks. While NAD fuels DNA repair, it may also accelerate cell division, potentially increasing cancer risk. The lack of data for specific populations, such as pregnant women or individuals with cancer, highlights the precautionary approach taken by some regulatory bodies.
The success of the wellness industry is significantly driven by consumer anxiety, fueled by shifts in medical consensus and the inherent fear of aging and bodily decline. This anxiety often leads to the embrace of extensive screening tests, both public and private, which blur the lines with actual healthcare.
For example, the Prostate-Specific Antigen (PSA) test, used to screen for prostate cancer, can generate false positives, leading to unnecessary anxiety and potentially harmful treatments for men without cancer. Conversely, it can miss slow-growing cancers that may never pose a threat. A Finnish trial found that less than 30% of men with a positive PSA result actually had cancer confirmed by biopsy. Furthermore, the Prostate Cancer Prevention Trial revealed that about one in seven men with a 'normal' PSA result had prostate cancer.
The private blood-testing industry has expanded rapidly, partly due to difficulties in accessing healthcare through public systems and aggressive social media marketing. Healthy individuals are encouraged to test numerous biomarkers, making it virtually guaranteed to find an 'abnormality' in the body's constant fluctuations. Margaret McCartney, who founded the Royal College of General Practitioners’ overdiagnosis group, argues for greater transparency from both public and private providers regarding the risks and limited benefits of many health screening tests. Unsubstantiated claims by private screening companies can lead to consequences like false positives, patient anxiety, and unnecessary treatments, often burdening public healthcare systems.
Van Tulleken shared his experience of being paid a six-figure sum for brief promotional work with a private blood-testing company, highlighting the substantial financial incentives for medical professionals to endorse such products. He urges caution and suggests prioritizing existing, evidence-based national screening programs like those for bowel, cervical, and breast cancer, as well as routine dental and eye checks, which are available free of charge.
Marketing of testosterone has also surged, with prescriptions increasing significantly between 2021 and 2024, despite no change in the proportion of men with low testosterone. While testosterone therapy can genuinely help men with diagnosed deficiencies and sexual dysfunction, claims of improving overall well-being or extending life are often unsubstantiated. Experts warn that high doses can increase the risk of heart disease and other side effects, and may lead to dependence and suppressed fertility.
Wearable technology, such as the Apple Watch, is increasingly presented as a medical tool. While capable of detecting conditions like atrial fibrillation (AF), the evidence that this early detection ultimately prevents strokes or saves lives is weak. Randomized studies have not yet shown that consumer wearables screening for AF reduce the risk of stroke or other complications. The benefits of early detection are accompanied by trade-offs, including the risk of bleeding from anticoagulant medications, and the over-detection of problems can lead to unnecessary interventions. Van Tulleken advises caution with using wearable tech for health improvement, emphasizing that until robust trial data supports its efficacy, it might do more harm than good.