Snake Oil, Influencers, & Booming Business

I'm an interventional cardiologist & entrepreneur (cofounder of Lylah). There's no entrepreneurial equivalent to the Hippocratic Oath, but that's how I choose to conduct business. I'll walk the walk when it comes to that, so let's look at the unethical way to conduct business.

Any opportunity to 💩 on snake oil salespeople gives me tremendous joy and satisfaction.

Tl;dr many prominent supplement companies conduct trials that are BS & not linked to any real outcomes. They pay to publish. They pay influencers insane amounts to sing their praises. In another time, they'd make a killing as the mafia.

Read the explicit details and share in my schadenfreude 😇

Company X: “Evidence Based” Solutions

Imagine a few hypothetical companies sell supplements to large commercial success. Let’s start with Company X. They have a website and tout “evidence based” solutions.

Here's a fun game: Go to their website and read the description of the84 gold standard trials. Try your best to find any link or name of the study on the website. Try your best on Google. All the results, interestingly, link to Company X's website rather than the original study.

It's obnoxiously hard to find any evidence of these "gold standard" trials on their website. That's interesting. They wax poetic about each one, but when you search pubmed & clinicaltrials.gov like anyone with 2 neurons and a set of thumbs, the "gold standard" outcome is apparently "X changes occur, completely unrelated to any actual disease process, and it won't kill your liver or kidneys."

The Studies

Don't believe me?

I'll spare you the pain & show you the studies:

• NCT06564285
• NCT06332898
• NCT06181214
• NCT06521424

Pay-to-Play Publishing

Now, look at the exclusion criteria (who they leave out of these very very basic and clinically meaningless trials). Then, look at the types of journals they're publishing.

Spoiler: it's pay to play. Pay $2630 to submit your research.

That's not how good science works. You pay if no one else wants your study. You pay out of desperation. Any trainee physician trying for a research career or checking a box to get into a subspecialty can tell you the ins and outs of this game.

The Exclusion Criteria

The exclusion criteria?

• Can't be vegan or vegetarian
• Can't follow keto diets
• Can't be on any "IBS treatment," which interestingly includes virtually all heartburn
  Medication
  
• Can't have taken a multivitamin in the last 3 months
• No antibiotic, antifungal, or antiviral within the last 3 months
  
• Can't eat grapefruit 5 or more times a week
• Can't be on any medication that can
  "potentially" affect the GI tract (at their discretion, of course)
  
• Can't have diabetes, asthma, fibromyalgia, etc

A Grain of Rationality

Some of these make sense. Keto diets are extreme if you're looking for signal in nutrient supplementation. The excluded comorbidities they're looking at make sense for a proof of concept in a healthy population.

Despite the schadenfreude, there's a tiny grain of rationality in the millhouse of insanity.

P.S. If you can't tell, there's an immense degree of schadenfreude here.

The Larger Pay-to-Play Problem

Let's take a step back here.

While that was gratifying, the larger pile of 💩 underneath is the concept of pay to play in the marketplace. Company X pays influencers $60 per new subscription then continues to reward them at a clip of $30 a month in recurring fashion PLUS equity. They're easy to pick on.

What about Company Y? Valued at over $1 Billion, they position themselves as a respectable and science-backed leader in the industry.

The “28 Day Reset”

First, let's examine their "28 Day [Insert Symptom] Reset." The study "validating" the product uses a variety of self-reported parameters with variable clinical relevance.

For example, the PROMIS GI Symptom Scale, one of their outcomes, notes "The Gastrointestinal Belly Pain Scale is not disease specific and is multifaceted." Next, for the nerds out there, their statistical analysis involves Fisher's Exact Test for symptom differences. They only report p-values without a confidence interval. This means a finding touted as statistically significant by p-value contains no mention of uncertainty.

Here's an example: a p-value of < 0.05 means nothing if the confidence interval crosses 1.0. In simple terms, that p-value is made moot if the uncertainty is such that it spills into the realm of no benefit.

What the Validation Study Admits

Straight from the validation study, under the discussion section, they note a few key things:

• "Importantly, a subsequent large clinical trial by Ringel-Kulka and colleagues with the same probiotic strain in generally healthy participants showed no benefit for bloating or abdominal discomfort."

• "Furthermore, the trial relied upon validated self-reported instruments rather than objective physician-administered measurements (e.g., direct measurement of abdominal girth).”

• "As such, participants did not have a physician evaluation at baseline (e.g., clinically validated medical history and physical examination). We acknowledge this limits the formal identification of physician-verified severe bloating conditions (e.g., objective visible distension) and may result in the inclusion of underdiagnosed functional bowel conditions.”

The Influencer Strategy

Now, the influencer strategy:

Influencer's get 100% commission on new
customers. That means if a customer pays $49.99, the influencer gets $49.99

Before an influencer can get paid, they have to be "educated' via "Company Y University"

This one is more nefarious. Let's keep going.

Company Y University

After claiming anyone can be an "expert" in the internet age, they require the following after completing the courses through Company Y University:

"We require a 100% score on the final exam, but rest assured, you can take it as many times as you need (and we can also provide a study buddy if you're really stuck-just let us know)"

Why, though? Legality, baby. They're shielding against blowback from violating FTC guidelines. Influencers learn what they can and cannot say. They don't become experts in anything but peddling nonsense

Let's examine their (required) "Hippocratic Oath"

"#Accountability is a big deal, so here's a really big application:

I, [Full Name] [Email] from [Country], want to co-create a future of accountable influence. I acknowledge that as a Company Y partner, I have a responsibility to the [Audience Size] members of my community that I publish to on [Instagram URL], [Facebook URL], [TikTok URL], [Youtube URL], [Web URL], [Other].

I pledge to live more scientifically, to inform myself before misinforming others, and to commit to a practice of learning and questioning."

Hmm 👀

Company Y isn't the only offender of course.

Company Z: The “Medical Advisory Board”

Company Z has a "medical advisory board." Look closely at the credentials. My brain autocorrected "ND" to "MD."

Did yours?

NDs, or Naturopathic Doctors, are not recognized by any medical society of note, cannot prescribe medications, cannot perform procedures, and, get this, are banned in Florida, Tennessee, & South Carolina. Kansas, Minnesota, & North Dakota (among others) severely limit their scope and claims they can make.

Oh yeah, and NDs don't do any required clinical training (except in Utah, where 1 year is required). Less than 10% of NDs complete any clinical training.

Company G: Observational Studies and Bystander Markers

Company G makes claims based on observational studies (the lowest level of scientific data) and focuses on "bystander" markers like TMAO and imprecise measures such as "biological age" via RNA analysis (far from ready from prime time & uhh, not FDA approved, which is a low, low bar).

I could go on.

The General Pay-to-Play Playbook

Here's the general "pay to play" playbook:

Influencer
Tier Follower
Count Est. Payment Per
Post Skeptic's Note

Nano 1k - 10k Free Product ($50
value) "Seeding" product creates a sense of obligation to post for free.

Micro 10k - 50k $200 - $1,000 +
Commission The "sweet spot" for brands. High engagement, low cost.

Macro 100k - 1M $5,000 - $20,000 Often a flat fee. At this level, they care less about commission.

Mega 1M+ $50,000+ Pure branding play. Often includes equity or long-term contracts.

Stop by more often if you learned something.

Until next time.