The supplement industry isn't selling efficacy, it's selling relief from uncertainty
The world spends $6 billion a year on menopause supplements while the UK spent only £60 million on menopause research in the same year; collagen went from slaughterhouse waste at £15 a kilo to a £300 beauty product on the shelf.
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The argument · tap a timestamp to hear it
Collagen is slaughterhouse scraps
Zand van Tulleken gives the mechanism directly: collagen is the waste of meat and fishing processing — fish heads, fish bones, oxtail, cow ears, cow hooves, all of it otherwise destined for disposal. Ground up, boiled in hydrochloric acid, turned into a beauty product, the wholesale price goes from £15 a kilo to £300 a kilo on the high street, a markup he describes as the kind you'd get selling cocaine. So his conclusion is not ‘collagen doesn't work’ but: even if you believe it works, you're being fleeced — boiling chicken bones yourself gets you the same thing.
— Zand van TullekenRemove the industry-funded studies and the effect disappears
There are two ways to read whether collagen works. Put all the studies together and the conclusion is that it helps joint pain, skin appearance and elasticity; but strip out the industry-funded studies and the effect disappears. Zand says that in itself should be a very large clue. The methodology doesn't only apply to collagen — when he gets to multivitamins he also stresses that even if you believe the pill in the bottle works, ‘what's actually in the bottle’ is a separate question, and adulteration, contamination and damage to the scientific literature are harms independent of efficacy.
— Zand van TullekenThe billion-dollar failed vitamin D trials
When Zand was in medical school, every doctor believed vitamin D had those exciting effects on the heart and the brain, and a mass of research suggested as much. But when vitamin D was tested as a drug, roughly a billion dollars was spent over the past decade, by people who badly wanted to find those benefits, and nothing was found. The NHS now advises considering a low-dose supplement, especially in winter, which is good advice; but high doses may be harmful, and it won't give you the kind of ‘sparkle’ you were expecting. He adds that many people's approach back then was widely accepted, and they shouldn't feel like fools — the evidence has changed a great deal in just a few years.
— Zand van TullekenMenopause: $6 billion on supplements, $60 million on research
Zand says the menopause chapter was the hardest to write, because in the other chapters he is a victim alongside the reader, whereas in this one ‘nothing is coming for me’: the medical profession lets you down first, and then you're pushed into the arms of the wellness industry, in a very insidious way. The numbers he gives are $6 billion a year globally on menopause supplements, while the UK spent only about $60 million on menopause research last year — the UK doesn't even record how much is spent on menopause research, because the sum is too small. His judgment: the industry is selling doubt and hope, and the first emotion people want to resolve is ‘I don't want to have this problem’, and the second is hope.
— Zand van TullekenThe brain rewards the question, not the answer
The neuroscience Lani Watson cites is counterintuitive: when a question sparks curiosity, reward circuits connected to the hippocampus become active, the brain enters a state of ‘ready to learn’, and information acquired afterwards is easier to encode and easier to recall — and it doesn't have to be the answer to that particular question; in this state the brain doesn't distinguish. More crucially, the research shows we don't get the same reward when we find the answer. In other words, the brain rewards asking and staying in curiosity, not hunting the answer down.
— Lani WatsonSocrates would go after the wellness gurus
Lani holds Socrates up as the model for a 21st-century questioning mindset: he deliberately sought out people who claimed certainty and dragged them into a state called aporia — confusion, blankness, uncertainty. She says Socrates would have adored the wellness gurus, and would walk into the city square (today, the digital square) and ask them: how can you be certain what health is? What wellness is? What a vitamin is? She concedes Socrates had flaws, was famously annoying, and was ultimately put to death for being an annoying questioner and for challenging authority and the status quo.
— Lani Watson400 biomarkers are answers to questions you never asked
Zand contrasts two paths in medicine: he was trained in old-school medicine, which emphasises asking questions and letting the patient tell their story; now you can go to a private company and buy a panel of 400 biomarkers. His line is that it's a pile of ‘answers to questions you never asked’ — they put up a poster first asking ‘is something not quite right?’, then once they've asked the question they hand you the answer directly, and you play almost no role beyond handing over money and data. And among 400 blood chemistry answers, some will be wrong, and will take you somewhere very bad. This is also why the industry is hard to regulate: doctors use the same blood tests, but doctors are answering very specific questions.
— Zand van TullekenThe hollow earth belief is actually rather moving
Daniel Mason first put the hollow earth into the novel just because it was comic, felt a bit more ‘bad’ than flat earth, and wanted to push our beliefs about the world one step further. But after reading the material he changed his mind: the belief is in some way moving, because it shows that at a basic level we want to believe a better place exists — the hollow earth fantasy always contains an untouched kingdom, where people are treated more justly, and are more beautiful. Especially in New England: as wildlife and forests disappear, people want to believe that extinct animals are actually alive underground, that it's a place where vanished creatures can be found. He says he genuinely wishes the hollow earth existed.
— Daniel MasonIn their own words · checked verbatim
the profit margins go from 15 quid a kilo wholesale to on the high street, 300 pounds a kilo, which is the kind of markup that you would be doing if you were selling cocaine
Zand van Tulleken7:22
But if you remove the industry funded studies, then it stops working.
Zand van Tulleken7:22
And that probably cost about a billion dollars over the last 10 years done by very enthusiastic people who really want. to find these benefits they did not find these benefits
Zand van Tulleken9:32
we spend um six billion dollars a year around the world on menopause supplements and last year we spent about 60 million dollars on menopause research in the uk
Zand van Tulleken11:37
our brain rewards us for asking the question and for sitting in the curiosity not for figuring out the answer
Lani Watson18:49
And that is a set of answers to questions that you haven't asked.
Zand van Tulleken28:05
what it suggests is that on some basic level, we want to believe that there is a better place
Daniel Mason37:18
Figures
| Collagen wholesale and retail price | £15 a kilo wholesale, £300 a kilo on the high street | 7:22 |
| Global annual spending on menopause supplements | $6 billion | 11:37 |
| UK annual spending on menopause research | about $60 million | 11:37 |
| Number of biomarkers offered by private health checks | 400 | 28:05 |
Glossary
- need for cognitive closure
- A psychological concept: the urge to shut a question down quickly and get a definite answer; the stronger the pressure, the stronger the urge.
- aporia
- The state of uncertainty, blankness and having no way to answer into which Socratic dialogue leads a person.
- why chaining
- The practice of a small child asking ‘why’ over and over, treating the answer as a midpoint on the journey rather than the destination.
How to listen
Anyone who has bought collagen, a multivitamin, or a private health check, plus founders and investors in health consumer and supplement brands — the first half has hard material on cost structure and evidence quality.
From 30:05, the discussion of the characters in the novel Country People and the hollow earth, unrelated to the health consumer theme.