Goop: What a Mess

I wanted to share this with our readers.

I’m sure by now you have heard of Goop, Gwyneth Paltrow’s multimillion-dollar modern wellness and lifestyle venture launched in 2008. And I’m sure you are not surprised at how successful the company is. After all, who doesn’t want to look like Gwyneth? She’s nearing 50 and looks better in a bikini than most 20-year-olds. But we as physicians need to recognize that Paltrow is not on our side. In fact, Goop is passionately converting everyone it can to complementary and alternative therapies with little or no evidence of benefit—and, in some cases, potential risks to health.

Patients are frustrated. A 2018 Harris Poll survey of 2,000 adults found that Americans want a deeper relationship with their doctor, one that goes beyond treating illness. In fact, nine out of 10 patients agreed that health means more than treating sickness; it involves being happy, calm, relaxed and living independently. But doctors don’t address these needs. Only about 50% of doctors discuss exercise; fewer than half discuss diet (42%), sleep (40%) or mental health (36%); and only 10% mention spiritual health. The majority of patients want to discuss nonmedical therapies such as nutrition, acupuncture or meditation with their physicians. Patients are unsatisfied with their allopathic medicine experience, which focuses on sickness and pharmacotherapy, and they understandably are going elsewhere.

Goop recognizes that patients are searching for CAM approaches, especially online. The internet is a convenient bastion for accessible and free health care information. Seventy-two percent of U.S. adults say they have used the internet to search for health information.² Most began their digging using general search engines instead of specialized health websites. It’s pretty easy to get from Google to Goop.

Goop is an attractive, well-designed website with emotional headlines and photographs of beautiful food and people. What can you expect to find in the health section? Mostly articles written about diets and diseases “in partnership” with a brand or company selling a product or promoting a book. For example, a top contributor to Goop’s health articles is Dr. Will Cole. His credentials include the Institute for Functional Medicine Certification Program (IFMCP) in Functional Medicine and a doctor of chiropractic degree. Dr. Cole is not a fan of conventional medicine, which he refers to as “superficial, disease-centered, autocratic, limited, palliative, reactive and profit-driven.” He does not note that Goop has been valued at $250 million, part of which comes from the sale of supplements. In contrast, functional medicine is described as “investigative, holistic, safe, patient-centered, participatory, restorative, preventative, and evidence-based.” Who would ever want to see an allopathic physician after reading this?

Most of Goop’s health articles focus on conditions outside the scope of training for the typical allopathic physician. Topics include leaky gut, histamine intolerance, heavy metal toxicity, fungal overgrowth and others. Most of these conditions have not been scientifically proven to exist. For example, UpToDate describes histamine intolerance as having “no pathophysiologic mechanism that has been demonstrated in prospective, controlled studies.” Also alarming is that cancer is nowhere to be found, leaving it out of the differential diagnosis as patients look for a reason for their symptoms.

This mass exodus from traditional medicine and instead focusing on alternative treatments for disease management often does not end well for patients. CAM is the second most common cause of drug-induced liver injury (DILI).³ In fact, CAM accounts for nearly one in five DILI cases, perhaps because these products are not subject to the same vigorous clinical trials and regulations as prescription medications. Manufacturers of CAM agents are not required to prove efficacy and do not answer to a governing body about product safety, purity or labeling. New York state investigated over-the-counter supplements in 2015, and found that four out of five products did not contain any of the ingredients on their label, and contaminants were often present.

Thankfully, some governments are taking a stand. For example, Spain is planning to ban alternative medicine in health centers, a move that was prompted by several high-profile deaths, including a 21-year-old who died after stopping chemotherapy for leukemia because a naturopath said he could cure cancer with vitamins.

Goop can’t ignore science for long. In fact, it recently settled a $145,000 lawsuit over the advertising of a $66 vaginal detox egg that claimed to balance hormones, regulate menstrual cycles, prevent uterine prolapse and increase bladder control. Prosecutors stated the claims were not backed by “competent and reliable science.” The court judgment also included new rules stopping Goop from making claims without supporting evidence. Paltrow has been quoted previously saying that controversy, such as with the jade eggs, drives traffic—and therefore dollars—to her site. Many alternative practitioners claim pharmaceutical industry money is corrupting medicine, but is CAM not driven by business interests as well?

So are we with Gwyneth or against her? I advocate to heal this divide in health care and work toward helping patients understand the traditional as well as CAM approaches to medicine. Medical schools and residencies have failed to include any formal education on CAM, and as physicians, we generally don’t feel equipped to discuss it. Many patients fear that bringing up CAM will lead to their physician reacting with confusion, disdain or even ridicule. It makes sense that patients are afraid their doctor will have a negative response and are more comfortable discussing their care with a nonphysician. If we want to protect and maintain our patients, we need to provide the best evidence-based health care approach while understanding what their health care needs are, from wellness to illness. Otherwise, we risk sending them into the swamp that is Goop.

References

1. Dossett ML, Davis RB, Lembo AJ, et al. Complementary and alternative medicine use by US adults with gastrointestinal conditions. Am J Gastroenterol. 2014;109(11):1705-1711.
2. Fox S, Duggan M. Health online 2013. Washington, DC: Pew Research Center; January 15, 2013.
3. Hillman L, Gottfried M, Whitsett M, et al. Clinical features and outcomes of complementary and alternative medicine induced acute liver failure and injury. Am J Gastroenterol. 2016;111(7):958-965.
4. Greenlee H, Ernst E. What can we learn from Steve Jobs about complementary and alternative therapies? Prev Med.2012;54(1):3-4.