Green juices, skincare, yoga. We all want to keep up with our health. But what happens when corporations, influencers, and snake oil salesmen prey on our insecurities to sell us something we don’t need, or worse soemthing, that could harm us? Abdul sits down with Rina Raphael, author of the newly released “The Gospel of Wellness,” to break down the people, the systems, and the failures that have allowed the “Wellness Industrial Complex” to thrive in the United States.

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TRANSCRIPT

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Dr. Abdul El-Sayed, narrating: After five weeks of decline, global COVID cases have leveled off. A new report found that 2021 marked the highest increase in sexually transmitted infections nationwide in decades. A panel recommends comprehensive anxiety screening for adults under 65. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. [music break] Today we’re talking about the wellness industry, the billions of dollars Americans spend on everything from yoga, green juice, to mindfulness and yoni eggs. This, as you probably well appreciate by now, is a pretty consistent theme of the show. A few weeks back, we brought you a reair of one of our very first episodes that explored the wellness industrial complex. Today, we’re talking to Rina Raphael, an investigative journalist who just released the new book, The Gospel of Wellness. But before we do, I want to meditate, [laugh] see what I did there? On the wellness industry. To delve more deeply, I want to think a bit about illness. And that’s because while defining wellness is hard, defining illness is a lot easier. Illness is something that causes us pain or discomfort, robs us of some kind of function, or shortens our potential lives. And when illness happens, it’s usually pretty clear that it’s happening. Those of us who are privileged enough will seek medical attention for it. We’re looking for some kind of relief. It’d be easy to say that wellness was the lack of illness. A bit too easy, perhaps. Illness is about the downside of having a body or a mind, about what happens to make them hurt, stop working or even die. But wellness is about the search for the upside. Think about it. You wake up and you feel just a bit off. You’re preoccupied by something you can’t get off your mind, or you lack interest in the things you have to do today. Are you ill? Well, chances are no. There’s no diagnosable illness that we can point to to explain your experience, you’re just not feeling, quote, unquote, “your best.” Wellness lurks somewhere in the space between illness and your best. But it’s also not just about today. It’s about tomorrow too. Humanity’s most pressing existential experience is the loss of life. It’s not even just the fact that all of us are going to die someday. It’s also the fact that the alternative, not dying but aging, means that even if we don’t become ill, the definition of wellness at 42 isn’t the same thing as it is at 22. Nor is it the same at 82. So much of our pursuit of wellness is also about trying to quell that existential dread of future illness, or even just aging itself. There are, of course, simple evidence driven approaches to promoting wellness. Take a walk, lift some weights, ride a bike, choose plants over meats, lean proteins over fats and carbohydrates. Take time off of work to engage in meaningful social activities with people you love. Meditate. All of these things will improve your wellness. All of them have great evidence behind them. All of them are great things to do. I appreciate a view on wellness that promotes these things, that encourages people to engage in healthy alternatives. But the part of wellness that I don’t appreciate, the part that I despise, in fact, is when corporations play on that existential dread and anxiety to tell us things that we don’t need or worse, things that could actually hurt us. Things like yoni eggs or unregulated supplements with no evidence behind them. These play on the space between our anxieties and our lack of knowledge to take our money at best and hurt us at worst. That wellness industrial complex, it preys on our vulnerabilities, manipulates our insecurities, and takes advantage of us. So much of what actually improves our wellness is outside our control. Do you live in a neighborhood with walkable communities? Do you have a grocery store that sells green, leafy vegetables? Was the air you breathe poisoned by industry? Is the water you drink clean and pure? In that respect, the wellness industrial complex sells us the notion that we can control our own outcomes, but also implies that wellness that health is a set of individual choices when so many people lack those choices at all. Those people, while they tend to be marginalized, Black and Brown, low income, poor. I wish I could say that the medical and public health communities were blameless here. We’re not. By selling the myth of personalized medicine. The health care community has led us down this path. And by failing to pay attention to those nagging issues that are far more likely to affect women, people of color or disabled people, we’ve left millions of people exposed to this kind of wellness profiteering. I sat down with Rina Raphael, investigative journalist and author of the new book The Gospel of Wellness, to learn about how the wellness industry preys upon our insecurities, how it operates, and how we can immunize people against it. Here’s my conversation with Rina Raphael: 

Dr. Abdul El-Sayed: It’s ready to go. 

Rina Raphael: Yeah. Let’s do it. 

Dr. Abdul El-Sayed: All right. Can you introduce yourself for the tape? 

Rina Raphael: Hi, I’m Rina Raphael. I’m a journalist and the author of the upcoming book, The Gospel of Wellness. 

Dr. Abdul El-Sayed: I really appreciate uh you writing this book because I think it’s just a really, really important um a really important intervention on a public conversation that uh we’ve been having without knowing that we’re having. So can we just jump right in? Tell us what is wellness? 

Rina Raphael: That’s such a good question. I’m asked that all the time. And I think it’s really telling that a lot of people are confused about what it actually is. Um. But at it’s most basic level, it’s the pursuit of well-being outside the realm of medicine. So essentially, basically everything medicine and insurance won’t touch. So it’s all the ways we want to physically, mentally or spiritually feel better. So that could include nutrition, fitness, sleep, stress management. Um. And so the argument I make in the book is that there are such things as real wellness, the ways we want to sleep better, to eat better, to feel better. And then there’s the ways it’s gotten muddied over the last decade where basically wellness can just as much mean meditation as it does. Oh, I don’t know, activated charcoal toothpaste. There’s been or sort of I would almost say like a dumbing down about what we actually need. And this industry has really been infused with consumerism, productivity pressures, a whole bunch of things that I would say are not necessarily always making us healthier, which is the actual mission. 

Dr. Abdul El-Sayed: You know, what’s interesting about the idea of even using the word wellness is that wellness is actually an outcome. Right. It’s the state of being of being well. But all of us have kind of sort of to understand come to understand wellness as an industry. All of these things that you talked about that are sort of extra medical uh in the set of interventions that we might engage with to get this outcome of being well. Is there any actual relationship between the state of wellness and the industry of wellness? 

Rina Raphael: Right. And those are the things that need to be separated. Right. Um. First of all, how do you define well? Everyone’s definition is different. And even, you know, based on sort of your culture, it could be different, you know? So that’s the other thing, too. It’s how do you define what’s well and what’s well enough and how do you know when you’ve reached it? It feels like the goalpost keeps changing. But because wellness is such a huge umbrella category and it’s such an ambiguous term that we can keep shoving new subsectors and products under its umbrella because it’s it’s kind of a vague term. And so that’s why I think there’s so much confusion about it. And that’s why you’ll see every industry now saying, oh, we’re part of the wellness industry. 

Dr. Abdul El-Sayed: Mmm. 

Rina Raphael: But are they really? And that’s where I think we need to take a more critical eye. 

Dr. Abdul El-Sayed: How big is this industry?

Rina Raphael: Globally I believe right now it’s valued at $4.4 trillion dollars. 

Dr. Abdul El-Sayed: Wow. 

Rina Raphael: Um. And again, that’s when you incorporate everything, when you’re incorporating everything from the fitness industry to organic food to crystals. I mean, that’s how it’s ballooned into something so big. And that’s how we’re actually, I would say, confusing the average consumer about what they actually need to feel and be better. They don’t need all this stuff. Right. But there’s no money to be made in telling someone to go for a walk, which is just as simple. 

Dr. Abdul El-Sayed: Yeah, I mean, this is this is the the fascinating piece here because, you know, the the consumer base for the wellness industry isn’t a broad swath of the general public. There are, you know, particular uh bands and demographics that the wellness industry tends to target. Who is the median wellness industry consumer, and what makes them so? 

Rina Raphael: Well, to some degree, you almost have to talk about which sectors. So obviously the fitness industry is different than, let’s say, the organic industry. But I would say overall, they’re targeting um more upper middle class, basically richer populations because they have the money to spend on all of these things. I mean, what you’re seeing in to some degree in the wireless industry is the same things we see in other swaths of the American population where it’s kind of, it’s going for the extremes, whereas the middle class is really kind of being left out. If you talk about things that get the most press or that people most associate with the wellness industry, like boutique fitness classes or peloton’s or green juices, those are not really available to the majority of Americans. Only a certain class of people can do that. And because so much of this industry is about optimization and betterment, it really is going after women who are more susceptible to this type of marketing. There’s a reason why certain groups like, let’s say young moms of young kids are the ones who are obsessed with organics and obsessed over processed food and all of these issues. Whereas oftentimes, even just anecdotally, it’s not as men who are as interested in it because they’re not as targeted. And this is why I make the argument that it’s a little misogynistic, how much they go after women. 

Dr. Abdul El-Sayed: Mmm. 

Rina Raphael: Women are being told they have to eat right. They have to meditate. They have to work on their body. They have to make sure they give their kids all these fresh, you know, produced meals. And you know, they don’t have the time for it necessarily. And this is where I think some of these what started as good trends, what started as trying to fight back against certain things that people are unhappy about in America, kind of got butchered. And it’s really stressing people out. It’s making them hyper paranoid. You know, I give an example where um if you go to a women’s uh media website and you type in the word toxic, you’ll get thousands of articles about how everything’s toxic, the food in your fridge– 

Dr. Abdul El-Sayed: Mmm. 

Rina Raphael: –All your beauty products, even your vibrator. Now go and type in that word to a men’s website. And toxic is used in relationship to your boss. Like, do you have a toxic relationship with your boss? They’re not–

Dr. Abdul El-Sayed: Mmm. 

Rina Raphael: –Targeted the same way that women are. And in speaking to even, you know, science food scientists who say work at organic food brands, they talk about how their marketing teams will always target women because they know women will respond to it and they can be made more fearful. 

Dr. Abdul El-Sayed: Hmm. 

Rina Raphael: You know, my husband isn’t terrified of his Mitchum deodorant, but all my friends are terrified that their face wash is going to kill them. There’s a reason for that. 

Dr. Abdul El-Sayed: Mmm. And as you think about that reason, that targeting, um how much of this is about trying to address broader societal forces through consumerism. Right. You think about the weight of implicit and explicit misogyny. You think about the weight of that uh that that sort of sense of of of being unable to control so many of the forces around you. And one of the things that I feel like you trace really well in the book is that so much of the wellness industry is about trying to sell you some modicum of control. But of course, in order to sell you control, they have to they have to play up all of the things that you seem to need to control. Right. Those things around you that are out to get you all the toxic things uh when really so much of what is toxic is um the broader forces of misogyny around us that that obviously target um women and to to other degrees um other folks who uh are vulnerable. Can you tell us a little bit about the psychology of of wellness and the role that um that that agency and control have in in the pull toward it? 

Rina Raphael: Yeah. Well, I will say that a lot of interest in wellness is because it touts solutions. Right? So if you’re not sleeping well or if you’re anxious or you feel sluggish, here comes the industry and says, we’ll solve it all for you. But they are dangling a mirage of control. If you do X, Y, Z, if you work out this certain amount, if you buy this product, if you eat clean, then you will be in control. Your body and mind will be in control. And the thing is, is that, as you said, what they’re ultimately selling is a dependency. Right? 

Dr. Abdul El-Sayed: Mmm. 

Rina Raphael: And to some degree, it does sometimes end up in paranoia. And so this is where I think that they’re not really solving anything. And I get very upset with, for example, the conversations around self care where they’re basically telling you you need to take all these bubble baths and do all these skin care masks and do all these things for self-care. And it’s not getting at the root causes of why you’re actually stressed and unhappy, right? 

Dr. Abdul El-Sayed: Mm hmm. 

Rina Raphael: Right. If you’re upset that you’re working 80 hour work weeks and your boss is emailing you after work, how the hell is a CBD cream gonna handle that? It’s not getting at the root issues. And amazingly, so many people who say they go to wellness because they’re unhappy with the medical industry will use tropes like, oh, well, the medical industry doesn’t care about root causes. But then they do the same exact thing with the wellness industry. They’re kind of masking it with consumerism and with these individual pressures, it’s the same exact thing. And I’m so tired of seeing headlines that say, stressed? You should do yoga. No, stressed? Maybe ask your husband to help out more with the kitchen. Maybe you should ask your boss that you need a little bit more time at home for work life balance. This is the problem. Like we’re almost sedating women with this consumerism instead of encouraging them to get loud and say, okay, what can we actually do to solve the real problems of why I’m stressed or why I’m not sleeping? 

Dr. Abdul El-Sayed: I feel like, you know, peak capitalism is when capitalism sells you a product to address the consequences of capitalism. [laugh] 

Rina Raphael: Right. 

Dr. Abdul El-Sayed: And I feel like so much of what we’re talking about here, right, tends to come with these huge price tags that, you know, if you cannot uh pay, then somehow you are going to be less well uh and therefore less able to cope. But so much of then the pressure to work 80 hour weeks to aspire to a bigger salary is so that you can then get the solution to all the stress that comes with with with those things. And I I I wonder, you know, what is the, what is the society sort of anti-wellness, right? Like what is the conversation we need to be having in our society that actually does get to the root causes, that’s juxtaposed to the wellness conversation that almost always has someone on the back end selling you something to make a lot of money off you. 

Rina Raphael: Yeah, completely. Listen, there are some things that we can’t you know, if you’re stuck in traffic, okay? There’s only so much you can control, right? So I’m not saying you can get at the root causes of everything, but I do feel like this industry is trying to quiet women and it’s almost, you know, putting everything on them. Oh, if you’re stressed, then maybe you should meditate more. Why should my employer direct me to some sort of wellness app instead of my asking my boss how I can make my life more livable? And, you know, again, I’m not saying that we can control everything in the news or what’s going on in this world. But I have seen workplaces band together and ask for better um work balance initiatives or ask for more maternity leave. There are things we can do, but instead we’re just asking everyone to quiet themselves. And yeah, there we’re ask. We’re basically shopping our way out of a problem and we’re also leaving out entire communities that are unable to do that. And I give one example of the conversations around, you know, toxic pesticide residue that is, you know, making women want to buy organic. And obviously there’s a huger conversation about whether or not organic is actually healthier, more nutritious. But what that ends up doing to some lower income groups is that they’re terrified of conventional produce, but they can’t actually afford organic. So they end up just skipping the produce aisle altogether, which is counterintuitive, especially since they’re one of the groups that do not consume enough vegetables and fruits. So this is the way that these trends that, you know, terrifying women over ingredients, which, again, just women I’ve yet to see a man really terrified of eating an apple isn’t really helping us. [music break] 

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Dr. Abdul El-Sayed: One of the aspects of a lot of these wellness products is that they also implicitly sell community. And there is something about being in the in-group, whether you’re you know a gym member at Equinox or you’re going to SoulCycle or you come to yoga or you shop at Goop. There’s something about selling you community. And in some respects, when you when you think about a practice and a community of practice, this tends to veer into the realm of religion and you almost talk about it as such. Why so? 

Rina Raphael: Well, I see certain pockets of the wellness industry offering things that we used to get from organized religion, um a sense of belonging, community, identity, purpose. I mean, these are all things that the pursuit of health can give you. And in some ways, I think that it’s great that people find community and friendship at gyms. I think that’s wonderful. But I take them with a grain of salt because without, you know, saying that everyone should join a church or a synagogue, there are problems with depending on your gym as your community. Because I’ve spoken to many women who lost their job. If you think you can go to a SoulCycle and say, hey, I can’t pay for this anymore, but hey, you’re my family, right? You’re my community. You’re my tribe. Remember you told me that. Can I still come? 

Dr. Abdul El-Sayed: Mmm. 

Rina Raphael: They won’t. Come on. That’s a joke. Whereas I would say, at least with, you know, organized religion, while definitely not perfect, has had centuries to perfect this where they have a little few more entry ways in and are a little bit more welcoming to people who have fallen on hard times. And I’ve spoken to the same you know, I’ve spoken to a group of women who also, when they were pregnant, were kicked out of their gym because the instructor was really terrified about teaching someone who is uh past a certain stage in her pregnancy. Well, they’re like, well, well, what about my community? 

Dr. Abdul El-Sayed: Hmm. 

Rina Raphael: What if someone gets injured? This is where I say. I think it’s it’s bizarre a little bit to depend on community when it’s dependent on your physical ability and your ability to play. To pay a class fee. 

Dr. Abdul El-Sayed: When you, when you think about the sort of funnel of of wellness, there’s this sort of entry approach, right? Basic things like yoga and gyms to a lot more eccentric things like Goop and the cult of Gwyneth Paltrow. You sort of trace them kind of like a funnel. Does that mean that gyms are a gateway drug and if not, why not? 

Rina Raphael: Uh. No, I wouldn’t say that. And I’m not against gyms, you know, I’m not against trying to live a healthier life. I think everyone should try to eat more fruits and vegetables. I think if you enjoy a gym, you should go. My issue is just more in placing our dependance on them and just being aware of the drawbacks sometimes. I wouldn’t call a gym a gateway drugs. I know a lot more people who’ve been affected by getting into clean beauty or getting into clean eating. Um. There’s not one sector, and I would think that those are actually far more problematic. I know plenty of women who got into clean beauty and they were made terrified of, quote unquote “chemicals” without even understanding that even water is made of chemicals and become obsessed with natural, although that is also sort of a meaningless marketing term. And then they become terrified of, are there chemicals in my medicines? Are there chemicals in vaccines? I mean, that to me is almost far more dangerous. Going to a gym. I think there’s nothing wrong with that. But depending on your gym to be your community, to be there for you during life events or when things go wrong, that’s the issue. 

Dr. Abdul El-Sayed: Hmm. But you can almost see how the community aspect of that does sort of tend toward a certain level of extremism. Right? Like you, you started a certain gym community and it’s going great. And then some folks are like, well, if you really want to get the most out of this, then you should try so-and-so supplement, right? And then you get into the sort of supplement community and from there you sort of watch a bunch of YouTube videos about this and you’re sort of getting pulled in and and you get to this point where, you know, perfectly capable, really smart people are spending a lot of money on things because you know, someone like Gwyneth Paltrow told you that it’s going to X, Y, Z for your wellness. And so you do have this sort of funneling effect. How can, right, the folks who are thinking about how to to engage with wellness in a sustainable way and want to be clear, you know, I didn’t ask the question about gyms being a gateway drug because I personally believe that, it’s just that you can kind of see how these communities tend to toward extremism. How can someone engage this while also making sure that they don’t get sucked into the sort of space where consumerism and community meet? Uh. And soon enough you’re making decisions or engaged with a set of folks who are pressuring you in ways that imply you’re spending your money on things that will not help you um and ultimately could actually hurt you. 

Rina Raphael: Yeah, I wouldn’t say it’s really gyms. I would say it’s actually more social media influencers and digital communities that have that effect on people. And. 

Dr. Abdul El-Sayed: Mmm. 

Rina Raphael: You know, I don’t know, they could find that out from being with a group of people at their local SoulCycle. But it’s really I would say the most influence I’ve seen is from uh influencers, digital communities that are really offering people a type of support. And if you even think of someone like an influencer, you know, most people don’t have a strong relationship with their doctor, whereas an influencer is there, you know, let’s say tweeting or posting one or two times a day. You can DM them, you can have a relationship with them. You know, it’s really sort of a community for people. And when you think about how lonely a lot of people are, it really does offer them something. And so that becomes, you know, they’ll use the words like tribe that becomes their, you know, online family and they start trusting them more. And that’s where it becomes kind of problematic because a lot of these influencers are not selling evidence based solutions. Oftentimes they’re trying to sell you some sort of detox guide, right? Whereas, you know, your doctor doesn’t have time to be online all the time and they’re not necessarily selling you something. And also, your doctor doesn’t sell assurance. It doesn’t sell he doesn’t sell certainty, which is why they’re not the leaders of this movement. When you have someone coming and saying, I can make your life beautiful or like Gwyneth Paltrow, take these supplements and, you know, is basically alluding that if you take supplements, you will be as fabulous as Gwyneth. You’ll look like Gwyneth, you’ll be as healthy as Gwyneth. That’s really alluring. It’s such sleek marketing. And I think that that was one of my missions with the book is to just really pull back the veil of what they’re actually selling you and to see sort of the tricks that they use with their marketing and advertising so that you can be more aware because as you said, really smart people fall for this. And it’s not because they’re stupid, it’s because it’s just the marketing is too good and they don’t understand for example, when they see something like, let’s say the term clinically tested. The average person sees scientific lingo like that and they think, oh, okay, this means it works. It doesn’t. It just means that someone tested it. It could have shown that it’s completely not effective whatsoever. But when you use scientific lingo, when you use all this beautiful, you know, millennial pink branding, it’s really seductive to the average consumer. 

Dr. Abdul El-Sayed: Toward that end. Right. You just outlined the way that social media has put this wellness movement on steroids, no pun intended. I wonder, does the wellness industrial complex take off if there is no social media to view it? 

Rina Raphael: Well, you know, throughout the book, I talk about how we’ve always had, you know, snake oil salesmen throughout American history. So that’s a strain of America that’s always going to be there. So it’s not just social media. However, I would say that social media has really amplified it. But we’ve we’ve always had people who’ve been selling us miracle cures and quick, easy fixes that aren’t really based on scientific evidence. And that’s partially just because we have certain trends in America that prime us for that. You know, I I do say that other countries are not dealing with the problems that we have here because America is very unique in certain aspects. 

Dr. Abdul El-Sayed: I want to ask right, because you alluded to this and I want to um get right to it. You know, we defined the wellness industry as the extra medical space of trying to improve your well-being. And one of the big places where the Anti-Vaxxer movement has seeded is in these wellness communities. And you get to this place now where in an effort to be healthier, you actually do things that are not just clinically tested but clinically proven demonstrated in study after study to help you. Right? So you forego things that really do help you and instead are invested in these things that that don’t. How should we be thinking about that place where wellness almost cannibalizes, you know, health care and medicine and how do we address it? 

Rina Raphael: Yeah, the wellness industry is to some degree aping the medical industry. And, you know, they use terms a lot like empowerment and liberation. And these are terms that Americans cannot refuse. And again, this is nothing new. The Anti-Vaxx movement goes back over a century, but people love these sort of themes. And when you couple that with a whole bunch of misconstrued studies and scientific lingo, it’s really alluring, especially to women. So yeah, they fall for things like alternative medicine, they fall for things like detoxes, um they start shunning vaccines because they’ve been given bad information. And once they get into these digital communities and because of the way the social media algorithms work, you know, you start following a couple of people who give you nonsense information and then you’re going to get started, you know, recommended other people who give nonsense information. And so they kind of get stuck in this loop, this echo chamber of misinformation. And that’s why and you know, and I’d also say this, a lot of this industry is based on belief. It’s not necessarily based on science. It’s based in the hope we we put into these products and these trends that if I take this green juice or if I take this supplement, then I will be better. I will feel better. And so what you’re dealing with sometimes with people who go down this rabbit hole, you can’t convince them out of it with logic necessarily, and with science, because it’s based on something bigger. It’s based on a feeling, it’s based on psychology. And this is where I make, you know, kind of the comparison to religion, which is also based on faith. It, logic doesn’t work anymore because you’re dealing with emotion. 

Dr. Abdul El-Sayed: Mm. 

Rina Raphael: You know, when someone takes, let’s say, a CBD cream. And they’re trying it at home and they’re like, well, gosh, I don’t I don’t know if I feel anything, but my friend said it does something and my magazine says it does something and they almost have to convince themselves into it. So at a certain point, when you try to show them, hey, I found some information about this CBD cream, I don’t think it really works. You’re no longer dealing with science. You’re dealing with the fact that they had to convince themselves into it, because so much of this industry is based on hope. 

Dr. Abdul El-Sayed: Hmm. And it’s almost like admitting that it doesn’t work would be turning their back on their community. 

Rina Raphael: That too. 

Dr. Abdul El-Sayed: And that’s that place where. Yeah, community and consumerism, you know, once you build a community around consumerism, it tends to really be really difficult to dislodge. 

Rina Raphael: Yeah. And I would just add one more thing, which is that and this is where I have a lot of empathy and I have a whole chapter on this, which is that a lot of women have been hurt by their doctors or they’ve been gaslit by the medical industry. So they will trust a wellness influencer over their doctor because they weren’t shown that same kindness or empathy by the initial industry. And this is where I think that medicine does need to improve. Otherwise we’re going to keep bleeding patients to this alternative industry. So, you know, it’s not that they’re just being sold gimmicks and that they’re being marketed to and preyed upon. Some of them are really, really dissatisfied and it’s legitimate. So you almost to some degree, can’t blame them when they’ve been, let’s say, hurt by their doctor or they had a bad childbirth experience. And then they completely vow, I’m never going to a hospital again, and they find someone else to basically fill that vacuum. 

Dr. Abdul El-Sayed: That this is a really important point. I was actually just about to ask uh that question. You know, I come from the traditional medical community and we in so many ways are are blameworthy. Right. The the role of of capitalism and consumerism in destroying the doctor patient relationship and fundamentally overselling and under-delivering when it comes to the human side of medicine, uh the empathy, the care, the respect, that those are all circumstances that undermine trust in evidence driven medicine, in scientific based medicine, and leave people vulnerable to this this kind of thing. If you had two or three tips to the average um clinician, uh what would they be around being able to engage with folks uh around this space? 

Rina Raphael: That’s a really tough question to answer because I don’t necessarily know that doctors are completely to blame. It seems like the entire industry set up doesn’t let–

Dr. Abdul El-Sayed: The system. Yeah. 

Rina Raphael: The system doesn’t let doctors flourish. Like, of course, doctors would love to spend an hour with their patient, get to know them and really help them and and figure out what’s going on in their life. But the system doesn’t incentivize that, right? You have doctors who need to see sometimes 20 patients a day. They’re forced to to keep their clinic open or they’re they’re forced to in order to have a living and to work with uh, you know, let’s say insurance companies. So it’s not it’s I I spoke to a lot of doctors as well who are equally dissatisfied with the system, who understand what women are going through. So, you know, I don’t I don’t know that I would give them advice um because they’re almost victims as well. 

Dr. Abdul El-Sayed: Hmm. So if we wanted to rethink the health care system around these experiences that keep making people, and particularly women, vulnerable to this, what would we do? 

Rina Raphael: Well, I’ll say this. Um. The women who have the money and time to work on their wellness, to buy all these supplements, to go to functional medicine clinics, they have a bit of money. But the number one thing I hear from them is that they just want someone to talk to them for an hour or so. And I mean, this is what a lot of people get out of um the alternative medicine scene. So, you know, I wish we had a system where people could spend more time with their doctors and build a personal relationship to them. I mean, this is what a lot of women are getting out of following a wellness influencer who post three times a day, they feel a personal connection to them and doctors just don’t have the time for that at all. So I wish we could develop a system like that. I don’t see that happening any time soon, it’d be very, very costly, but I think that’s a big chunk of it is just time. 

[AD BREAK]

Dr. Abdul El-Sayed: You end your book on a really important note, which is on um the the way that the wellness industry tends to exacerbate inequities because, you know, we’ve been talking about wellness as a stand in for a very particular kind of pernicious industry, but taking a walk regularly and exercising regularly, those are perfectly healthy, really important things to do. And so it’s not that, you know, optimizing towards your wellness is itself uh a bad thing. It’s that, you know, the way that capitalism has wrapped its tentacles around this thing to sell you more and more extreme, uh less and less effective antecedents to that really is the bad part. But there are so many people in our country who lack basic access to the means of good health, whether that is a walkable sidewalk in a safe community, or that is a grocery store that sells healthy fruits and vegetables uh in their community within uh driving, walking, or public transit distance. And this has left so many people without the basic means of of decent wellness. Uh. How do, how should we be thinking about those huge disparities and what can we do to right size the situation?

Rina Raphael: Those are really complicated issues. And I actually personally get a little irritated sometimes with how I feel like these issues are discussed within media. A really great example is lower income communities not having access to fresh food. And you’ll hear a lot of people say, oh, they live in food deserts just uh make sure they have a supermarket nearby with uh vegetables. 

Dr. Abdul El-Sayed: Mm hmm. 

Rina Raphael: Okay. When someone’s working two jobs a day, how are they going to have time to cook that? 

Dr. Abdul El-Sayed: Mm hmm. 

Rina Raphael: How will they have time to prepare it? One of the reasons that people opt for processed food is because it’s easy. It’s simple. You just throw it in the microwave. This is where, you know, I think we don’t think about that, you know, or they say, oh, we just need to build uh gyms and parks in lower income communities, okay but they don’t have the time for it. Or maybe we’re serving them. We’re giving them access to foods that are not part of their culture. These are far more complicated issues. And I think that, you know, I don’t know the answers necessarily to that. I know that they require a group of people from those communities who can really speak to those issues. 

Dr. Abdul El-Sayed: I really appreciate that point. I um I served the city of Detroit as health director, and one of the fundamental failures that we have in our public policy around these issues is that we fail to put ourselves fully in the circumstances of folks who are living in certain conditions. And so we assume that the same things that would work for us, right, uh would work for everyone else. And the problem is, is that, of course, most of the people making these public policies, as you talked about, tend to be people with means. And so much more of the experience of poverty is one that is comprehensive. It’s not just the space you live in or access to certain resources. Uh. It’s actually also access to your own time, access to the means of being able to engage those resources should they be available, uh a whole political capital uh around being able to demand basic things like breathable air um and that the, you know, the corporation that’s burning fossil fuels doesn’t sit right next door to your home or your kids school. And those things are things that a lot of the folks, um even people who are well-meaning, take for granted. So I really appreciate you making that point. And I think that’s absolutely correct, is that we have to rethink the way that we actually engage, and so much more of that approach is really about um the circumstances of poverty. It’s the the attitude that says that people should just work their way up or work their way out of poverty, despite the fact um that you know that means that by definition, you’re working two or three jobs because they pay, you know, you know, God forbid, $15 an hour. And uh that means that you know even if you can afford those fruits and vegetables and you can access those fruits and vegetables, you may not have time to prepare them. And the calorie efficiency questions that go into buying two bags of broccoli versus buying a Big Mac um are fundamentally different. And uh so those are things that we have to we have to be thinking about. 

Rina Raphael: I’d love to add one um I have two points. Another point is that, you know, fitness is another great example of this, where I often don’t see enough conversations about how to help people in rural communities or lower income communities access fitness. And there’s such a naivete that I hear from people of, oh, well, they live in rural communities, they have access to the outdoors, they don’t need it. It’s cold half the year. Maybe they don’t enjoy walking and running. Maybe it’s not safe for them after they finish their work duties to go out and run by themselves. Or then they’ll say, well, can’t they just watch a streaming video? Maybe they don’t have broadband access, you know, Internet access. So there’s a lot of just misunderstanding about what other communities need. And I don’t feel like there’s enough sophisticated conversations about how to help them. I also, if I can, I’d love to add one thing. You asked a question, and I just remembered one thing that you mentioned in terms of what clinicians could do better. I think it goes beyond clinicians. It’s also the medical and research community. A lot of times you have women, especially those suffering from chronic conditions, come to the wellness industry because there are not solutions within medicine. And that’s just because medicine is really behind when it comes to researching women’s issues and women’s health issues. Um. They weren’t included in clinical trials until 1993. 

Dr. Abdul El-Sayed: Mm hmm. 

Rina Raphael: We’re very, very behind. So when women feel like there aren’t solutions with them within medicine, they’re going to veer over to another community that does offer them solutions. Whether they’re real or not. That’s another issue. But there’s a big frustration of basically doctors, you know, throwing up their arms and saying, I don’t know what to tell you. I don’t know what this is. I can’t help you. 

Dr. Abdul El-Sayed: I really appreciate that point. And, you know, so much of the way that we define, quote unquote, “questions worth answering” uh is about whether or not they’re worth answering for people in places of power and because of misogyny, because of racism, that that tends to be a very particular group of people. And our failure to answer those questions means that folks are going to go to places with answers. And we really appreciate you um educating us about the wellness industrial complex. Our guest today was Rina Raphael. She is the author of the new book, The Gospel of Wellness. I hope that folks will check it out. It’s really uh well-researched, well thought through, well-written, uh and chock full of a number of stories that really illustrate a lot of the themes that we’ve been talking about. Rina, thank you so much for writing the book and for taking the time to chat with us about it. 

Rina Raphael: Thanks for having me. 

Dr. Abdul El-Sayed, narrating: As usual. Here’s what I’m watching right now. Last week, we talked about the contrast between what President Biden said about the pandemic and what W.H.O., Secretary General Tedros Ghebreyesus had to say about it. President Biden said that the pandemic is over. While Tedros was careful to compare the pandemic to a marathon, stressing that we need to run through the finish line rather than coast through the end. Indeed, global cases have been falling substantially over the past month, but cases stopped falling this week. It’s unclear if this is a momentary pause or if this is a lull before cases start to increase again. All of this highlights the risk of declaring a pandemic over before well, the pandemic actually is over. As you’ve heard me tell you now, over and over and over again, the autumn, while beautiful, has been a critical surge point for the virus for the past two years. And while cases have yet to surge, it’s still early. Why does what we say about this even matter? After all, whether we say it’s over or it’s nearly over. Does it really affect what the virus is going to do? Well, yes. Look, I’m not so naive as to believe that people are really going to change their behaviors without seeing a massive jump in cases just based on what we say. But institutions, workplaces and schools just might. And more importantly, it’s all about resources. And right now, we simply are running out of them. The U.S. is running out of COVID funding for everything from testing to treatment to vaccines. And President Biden just undercut his administration’s ask for more. And if cases do turn upward, we’ll be yet again behind the curve. Has everyone just forgotten, last fall, when Omicron surged and you couldn’t find a test anywhere? Yeah. How about we just don’t do that again? On that note, we’re starting to understand the full consequence of the pandemic on the rest of our public health infrastructure. Remember, because we hadn’t fully funded our public health infrastructure for decades, even before the pandemic, public health departments were operating on a shoestring. And when the pandemic did hit, every department around the country had to reshuffle, moving resources from elsewhere to handle the pandemic. Monkey Pox has provided yet another shock to the system. One of the important things that health departments do is testing, treatment, and prevention for sexually transmitted infections. And you probably can see where this is going. SDI rates were way up in 2021, and that’s the second annual increase since the pandemic started. Syphilis is up a whopping 26% in 2021, as high as it was in the Truman administration. The late forties, y’all. Literally, just a few decades after penicillin, which is used to treat syphilis, was discovered. It should be a reminder for us that progress isn’t guaranteed. Just because we have the knowledge of how to prevent and treat a disease doesn’t mean we can do it. There are real people and institutions that have to do the work of pressing forward to achieve that progress. And when we stop doing that work, well, people get sick. Meanwhile, another major consequence of the pandemic has been a surge in mental illness. Rates of depression and anxiety among young people in particular are way up as well. Nearly 42%, that’s two in five Americans have symptoms consistent with anxiety or depression. That too, well, that’s up because of the pandemic. And that’s why the United States Public Health Services Task Force recommended last week that every single American under 65 be screened for anxiety. They’re making a major change in clinical policy here. And it’s one of the first times that a nearly universal mental health screening has been recommended. All of this reminds us that even if COVID cases don’t climb again in a major way, if the pandemic really is over, though, I don’t think that’s possible to claim right now. The consequences of the pandemic certainly are not. We’ll be wading through this for years to come. That’s it for today. It’s our third birthday here at America Dissected. So on your way out, please do give us a birthday present in the form of a nice rating and review. Also, if you love the show and want to rep us, I hope you’ll drop by the Crooked store for some America Dissected merch. We’ve got our logo, mugs and T-shirts. Our science always wins sweatshirts and dad caps are available on sale. America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Our associate producer is Tara Terpstra. Veronica Simonetti mixes and masters the show. Production support from Ari Schwartz and Ines Maza. The theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Sarah Geismer, Sandy Girard, Michael Martinez, and me, Dr. Abdul El-Sayed. Your host. Thanks for listening. [music break] This show is for general information and entertainment purposes only. It is not intended to provide specific health care or medical advice and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health.