A smorgasbord for the curious, a blur of theater and wellness, the Goop conference could just as easily have been called the Alternative Health Convention. Six hundred well-groomed women paid between $500 to $1,500 for a full day of healthy eating, toxin-free pampering, and guilt-free Gwyneth gawking. Inside a Century City warehouse that resembled a luxury jet hangar, guests learned the importance of gut bacteria, how our minds manifest sickness in the body, and the use of poisonous frog venom as a healing agent. They sipped “brain-boosting” Bulletproof coffee as IVs dripped vitamin B12 into their bloodstreams. The younger ones analyzed their futures with a crystal-wielding shaman. Others had their “auras read.”
Goop founder Gwyneth Paltrow brought along her celebrity pals. They were, as she attested, friends she “constantly” swapped healers’ phone numbers with: the actress Cameron Diaz, the designer Nicole Richie, and the supermodel Miranda Kerr. The latter was eager to share her most recent discovery: leech therapy, in which creepy crawlers suck on one’s face and the collected blood is then smeared back on the skin. “Health is wealth,” Kerr told the crowd.
To be fair, not all Goop fans take Paltrow seriously. To them, she and her lifestyle site are more entertainment than a solid news source. For them, knowing that some of the health information Goop promotes raises more than a few questions is part of the fun; part of “the journey,” as Gwyneth might say.1 They welcome the $135 coffee enema kit and vaginal steaming (reportedly to “cleanse” the uterus) with Pilates-toned open arms.
In some ways, Goop isn’t all that different from the traveling salesmen of the nineteenth century, who turned medical road shows into popular venues of entertainment. Brandishing magical elixirs and opium-laced concoctions, the salesmen knew the psychology of persuasion; they recognized a gap that could easily be filled with tonics, a bit of empathy, and mesmerizing onstage antics.2 And the audience had no issues with that. Plenty knew the Rattlesnake King straddled the line between health and sensationalism. To them, seeing the snake oil show was their version of dinner and movie. Santa Monica’s finest aren’t any different: they take their colonics with a dash of skepticism.
The conference alternated from informational and empowering to kooky and downright pseudoscientific—but above all, it was highly entertaining. Women reclined on chaise longues in the branded outdoor picnic area, making friends and swapping notes on meditation practices and sneaker styles. While I got an “organic manicure” (a manicure with “nontoxic” nail polish), I spoke to a woman in her late twenties who had spent the last hour taking in the parade of fashion.
“Aren’t they all just wearing yoga leggings?” I asked.
“Yes,” she responded, “but the best yoga leggings.”
Naturally, the longest lines led to the checkout counters in a scene that can best be described as self-improvement Black Friday. Goop fans might have been eager to learn about the latest health fad, but their consumerist tendencies drive the site’s ad and product revenue. Starting at 9:30 a.m., participants crowded numerous indoor shops, each one dedicated to a different sector, such as athleisure, beauty, and home. And of course, all the panelists hawked their own books and supplement lines. No wonder the company is believed to be valued at over $250 million.
But Paltrow remains the biggest attraction. Inside, as participants crowded into their auditorium seats, the founder took the stage, her designer paisley dress brushing the floor. “Why do we all not feel well?” she asked the audience. “And what can we do about it?” A good question, and one the actress turned leader purports to solve, one diet cleanse at a time.
Looking around the hall crammed with Louis Vuitton handbags, I did not doubt that the audience had access to doctors and specialists, if not some of the finest health care in the country. No one there looked sick. No one acted sick. A Black beauty stylist working at a touch-up station—one of only a handful of women of color in the room—remarked, “They look fine to me.”
And yet they were there, spending hundreds if not thousands of dollars on health advice from an actress who had no medical credentials. No schooling. And certainly no mainstream acceptance. The very same actress who, when confronted by the late-night TV host Jimmy Kimmel about Goop’s more bizarre suggestions, admitted, “I don’t know what the fuck we talk about!” As long as Paltrow provides hand holding, Goop fans don’t question an adult woman who once declared she was on an eight-day goat-milk cleanse—a diet that medical experts have concluded offers no benefits save for “more flatulence.”
So, if it isn’t mainstream acceptance or the backing of scientific studies, what has become so very seductive about Goop? How has Paltrow been able to so effectively crawl into her patrons’ ears?
Part of the answer lies in the fast-growing field of alternative health. Goop is part of a larger and flourishing ecosystem: 30 percent of Americans now use alternative medicine, with women more accepting of it.3 Some turn to alternative treatments as a complementary add-on, though many fully adopt them instead of Western medicine. Women, or more accurately, dissatisfied women lead this movement.
Women are stepping outside their doctor’s office, searching for something. And Gwyneth’s fattened golden goose is happy to lay vaginal jade eggs for them. But what precisely is inspiring this mass conversion?
The crisis of faith in modern medicine starts long before someone buys a ticket to the Goop show.
The inefficient and, at times, mind-bogglingly frustrating patient experience starts with sorting premiums, deductibles, hidden fees, and a maze of coverage limitations. (And that’s for those fortunate enough to even have medical insurance.) In the U.S., the consumer faces a cat-and-mouse chase of referrals and sign-offs to see specialists or get approval for a treatment. Long wait times and onerous paperwork can make a simple procedure seem like applying for a mortgage. Who has the time? Amidst work, parenting, household chores, and little to no time off, medical appointments only add to an already hectic schedule.
And it doesn’t end with just nabbing an appointment. So many times, I’ve gone in for a routine checkup, then weeks later received separate surprise bills for blood work, lab testing, etc. In my thirties, medical bills have been sent to collection agencies not because I didn’t have the money, but because I couldn’t keep track of all the various individual bills.
Then there are the experiences that leave women’s faith in the system badly shaken.
Jacquelyn Clemmons from Baltimore, Maryland, is one such woman. In 2003, the friendly and no-nonsense Queens, New York, native was two months into her first pregnancy when she visited a local doctor for help with a persistent yeast infection. Her mother was a physician, so she had full confidence in the doctor’s capabilities—what she called “a healthy respect” for the experts. But the appointment proved less than assuring. The doctor and personnel spent only a few minutes chatting with Clemmons, then quickly penned a prescription. “They didn’t touch me, they didn’t really look at me,” Clemmons told me. “They kind of sat at their desk and then wrote the script. I felt dismissed.”
Clemmons says she looked up the medicine prescribed, Metronidazole, only to discover it was linked to an increased risk of miscarriage, which she was not made aware of.
The questionable treatment didn’t end there. While pregnant with her second child, she experienced severe abdominal pain and back-to-back contractions and sought hospital treatment. The staff assumed Clemmons was overreacting because she didn’t seem like she was “in enough pain.” They sent her home.
Clemmons returned, demanding attention. This time she came with a plan. Clemmons turned to her partner and said, “I’m going to have to fake it because they’re not believing me. So don’t look at me crazy.” She then proceeded to scream and wail at full volume. The Oscar-worthy performance did the trick. Staff discovered Clemmons was dehydrated and experiencing preterm labor, thereby endangering her unborn child. Afterward, Clemmons was placed on three months of bed rest.
As Clemmons recounts, pulling theatrics “is nutty to do on any day, but when you’re experiencing contractions and you just want to be comfortable, it’s even crazier.”
Then came the third pregnancy. Clemmons said she was subjected to a forceful cervix check and dealt with an anesthesiologist who attempted to administer an epidural while half the lights were out. Terrified and angry, her perception of medical care shifted. She explains, “I felt like I could no longer just safely walk into a doctor’s office, trust what they’re telling me, and walk out without harm being done to myself or my child.” Clemmons soon found herself asking “a million questions about everything, and not taking anyone else’s word about anything that I needed.” She decided to independently seek solutions, including natural remedies or changes in diet to alleviate ailments. “From then on, I was just going to do my own due diligence,” she says. “If it was something that I could do, I was going to do it before I decided to involve a doctor.”
These experiences inspired Clemmons to become a doula. She founded her practice, De La Luz Wellness, to be an advocate and pillar of support for women who also felt disregarded by medical personnel. Incorporating wellness modalities such as traditional herbal medicine, Reiki energy treatments, breath work, and relaxation techniques, Clemmons mostly serves Black and Indigenous women who come to her with the same goal: “I don’t want to die.”* These women distrust hospitals, and that alone is enough to make them opt for an at-home birth. “They get very tense and very afraid because they’ve had other hospital traumas and they don’t want that reaction to come up subconsciously while they’re giving birth,” explains Clemmons. “There’s this tension that builds, you automatically go on the fence. You walk in there already knowing you’re going to face a fight.”
Clemmons tallied multiple transgressions before throwing in the towel, but sometimes all it takes is one bad experience to taint one’s entire view. Whether it was a physician, therapist, or health expert, if someone hurt or dismissed you at your most vulnerable time—which is generally when we interact with medical providers—you will need to get over that experience. Some might need to break away for a while. But others, especially when it pertains to trauma, might vow never to return.
Clemmons is Black, part of a segment of the American population that has historically not experienced the same level of “care” as other patients. (More on this later.) Surely wealthy white women aren’t in the same boat. Affluent individuals presumably live a far different existence, for which the adage “see your doctor early and often” still holds considerable weight. Blessed with health insurance and access to top docs, they must have a better go at the whole medical appointment game. Right?
Unquestionably, wealth helps. A lot.
But wealth doesn’t necessarily protect you from everything. Having legitimate concerns dismissed by a physician is a problem that cuts across race and income.
In 2019, the actress Selma Blair appeared on Good Morning America to share what had been a silent struggle: an agony-inducing medical experience that spanned years. At just forty-six years old, thin and clutching a cane, the Legally Blonde star leaned on host Robin Roberts as they walked on the balcony of her Cape Cod–style L.A. home. Sitting down indoors, Roberts asked her a simple question: “How are you doing?”
Blair, sporting a chic blond bob, shocked viewers with her answer. It wasn’t what she said, but how she answered. Through broken and stuttering speech, Blair struggled to respond. Nobody had known that the Hollywood star had become so sick. She persevered through the interview, which covered years of attempting to convince doctors that something was wrong with her body. Blair said she was besieged with pain and bizarre symptoms like blurred vision, extreme exhaustion, and numbness in her leg. Sometimes she had trouble walking, experiencing a sense of vertigo. She started falling.
The single mother would become so fatigued that she’d need to pull over and take a nap while driving her son to school. She’d truly feared how she was going to get by from day to day while taking care of her child. “I was ashamed, and I was doing the best I could, and I was a great mother, but it was killing me,” she explained.4 Thinking she might have Parkinson’s disease, Blair reached out to actor Michael J. Fox, who was diagnosed with the neurodegenerative disorder in 1991. “I said, ‘I don’t know who to tell, but I am dropping things. I’m doing strange things.’”
Doctors didn’t take her seriously. “Single mother, you’re exhausted, financial burden, blah, blah, blah,” she recalled. They blamed it on postpartum depression or a hormonal imbalance. One said she was simply being “dramatic.”5 None of these doctors offered further significant testing, even as symptoms worsened. The unrelenting strain became so unbearable that Blair turned to self-medicating the old-fashioned way. “I was drinking. I was in pain,” she told Roberts. “I wasn’t always drinking, but there were times when I couldn’t take it.”6
Finally, after years of pleading with doctors, Blair’s condition was ultimately diagnosed as an aggressive form of multiple sclerosis—a chronic autoimmune disease that affects the nervous system. When Blair received the diagnosis, she cried. They weren’t tears of sadness, but of relief at finally being acknowledged. She thought, Oh, good, I’ll be able to do something.
The actress’s story struck a nerve with women across the country, many of whom showered the frail star with gratitude on social media and offered their own medical mishaps and battles with chronic conditions. “My symptoms were chalked up to stress,” wrote one woman in solidarity. “[My doctor] said I was having a panic attack!” shared another. Like Blair, they described doctors who denied their pain and brushed off medical inquiries. They felt they had to prove their case. Doubling over in agony, they were told to “suck it up” or simply accept that “this is part of being a woman.” Others were told to go see a psychotherapist, implying that their pain was purely psychological. Some were offered the most patronizing advice of all: “Just have a glass of wine.”
It would seem that average American women and Hollywood celebrities are united by their medical experiences. (Stars: they’re gaslit just like us!) It’s quite telling that Real Housewife Yolanda Hadid titled her memoir about Lyme Disease with a simple request: Believe Me.
When some women describe a medical condition, their doctors tell them they’re exaggerating or overreacting. If they dare express emotion (as opposed to the more stoic male stereotype), it is used against them as evidence of the “hysterical woman.” Although if they are too stoic, doctors will still not believe them; a lose-lose scenario if there ever was one. Worse, practitioners dismiss symptoms as a by-product of the patients’ own failings: Higher-weight individuals report being told it’s their own fault. Even younger patients face prejudice, as doctors just can’t believe a twentysomething-year-old could have a serious health condition. In one chronic pain treatment survey of twenty-four hundred women, 90 percent said they felt the healthcare system discriminated against female patients.7
The list of dismissed or misdiagnosed chronic conditions runs as long as a CVS receipt. Women suffering from fibromyalgia—a chronic condition that causes fatigue, pain, and tenderness in the body—usually see several doctors before they receive a proper diagnosis. Same for vulvodynia, a chronic burning and soreness in the vulva that affects roughly 16 percent of women at some point during their lifetime. Of those who seek treatment, 60 percent consult three or more doctors, many of whom can’t provide a diagnosis. The condition is often misdiagnosed.8 Some vulvodynia patients deal with constant pain across months and even years, at times so severe that they cannot sit, let alone have sex or use tampons.
Endometriosis is another chronic condition that often gets ignored. It occurs when tissue that generally lines the inside of the uterus develops outside it, and can be marked by intense pain in the lower back and pelvis, nausea, fatigue, cramping, and infertility. Those living with endometriosis have been shown to have a 52 percent greater risk of heart attack (in comparison to women without the condition).9 The painful disorder affects an estimated 190 million worldwide—one in ten reproductive-aged women. These women are often handed birth control (which manages some symptoms) and sent on their way.
Samantha Bee, host of the TBS talk show Full Frontal, best immortalized the issue in the public eye when she likened endometriosis flare-ups in the body to the horror slasher flick Saw. Bee asked the audience to imagine all their furniture thrown onto their front lawn, only for the police to say, “That’s life. Wanna take the pill?” She further declared, “One in ten women suffer from endometriosis and it’s just one of the many painful, debilitating lady diseases that get treated with birth control and a shrug.”10
And it’s not just male doctors—women experience subpar treatment from both genders. One study found that emergency room doctors were less likely to prescribe painkillers to women for acute abdominal pain.11 And statistically, women received far less aggressive treatment for heart disease than men, even though heart disease is the leading cause of death for women in the United States. This cardiology gender gap is called “Yentl syndrome,” a reference to Barbra Streisand’s iconic role as an aspiring Talmud student who disguises herself as a boy to enter a yeshiva. In medicine, this term connotes underdiagnosis and undertreatment, implying that women’s symptoms need to be more like men’s to receive adequate care.
Meanwhile, male patients undergoing coronary artery bypass graft surgery receive more opioids and pain medication than female patients. Women, however, are given more sedatives.12
Disillusioned and fed up with a system they feel doesn’t believe them, a growing number of women have taken it upon themselves to course correct their own medical care.
But the problem of not being heard starts with a medical structure that disinvests in meaningful physician-patient relationships even as it invests in bureaucracy and speed. For many women, traditional Western medicine seems built to make a buck, not to significantly care for their needs.
Fortunately, not every woman has a horror story or a traumatic history with medicine. But too many harbor a general dissatisfaction that opens the window for more alluring competitors to breeze in.† And this has a massive impact because they’re the stakeholders: women serve as the “chief medical officer” in their households, accounting for 80 percent of healthcare decisions for their families.
When I have gone in for a routine checkup, the experience has often been less than inspiring. Modern gynecology is best described as awkward. Convention forces me and so many women to strip down and don an embarrassing, paper-thin cloth gown, all while shivering like a hairless cat, and lie on a clinical examination table. The physician asks perhaps one question before crudely inserting tools, making patients feel more like a lab specimen than a human. Little is done to make us feel safe, comfortable, or welcomed. A quarter of women who skip their yearly OB-GYN appointments give this simple reason: they hate going.13
Let’s put it this way: I have seen at least six gynecologists over the last twenty years and cannot remember most of their names. But I know the names, hobbies, and favorite musical artists of nearly all of my hairstylists.
Maybe that’s a problem.
Surprisingly, the only time I found medical personnel willing to take the time to get to know me was at the NBC News onsite medical station, the inspiration for Chris Parnell’s Dr. Spaceman on the TV comedy 30 Rock. But that was likely because the staff were as lonely as the Maytag repairman—no one was ever there, since most NBC employees didn’t want their employer knowing their private medical issues. (As a Loehmann’s shopper, I valued a good deal and convenience over privacy.) I almost felt I was doing them a favor. Nurses would invite me to take a nap if I had a headache, listen to my fear of bedbugs, and ask how I was managing stress. I’d swing by to thank them following a recovery, and they’d offer me a hug along with free Tylenol packets for my purse.
But that’s not the norm. The current clinic model produces a hurried appointment, leaving little time for a well-intentioned doctor to meaningfully engage with the patient—a system that can be demoralizing for both parties. A 2018 study in conjunction with the Mayo Clinic monitored conversations in doctors’ offices, only to find that most patients were afforded eleven seconds to explain the reason for their visit before being interrupted.14 The average length of a primary care office visit runs 17.4 minutes.15 The system incentivizes productivity; some doctors are paid according to how many patients they see, not by the quality of health outcomes. Physicians see an average of twenty patients per day.16
With all too often lackluster impersonal care, diminishing allegiance to the medical system is understandable. A study by Harvard confirmed that although the United States spends nearly twice as much as other countries on health care, it has poorer health outcomes.
And that’s just the general population. Minorities are more likely to face discriminatory healthcare practices, which feeds into a general apprehension of medicine.
One study published in the American Journal of Public Health found that among Black patients, physicians were more likely to dominate conversations. Patients feel less involved in decision making and then less receptive to the doctors’ guidance.17 Results from a 2017 survey conducted by NPR, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health showed that a third of Black patients felt discriminated against at a doctor’s office or health clinic, while nearly a quarter avoided medical care all together lest they suffer the same treatment.18
In 2017, ProPublica and NPR jointly collected over 200 stories from Black mothers, and “the feeling of being devalued and disrespected by medical providers was a constant theme.”19 Likewise, some women I’ve spoken to insist they were pressured into hurried and unnecessary cesarean sections to limit a lengthy labor or to accommodate a doctor’s shift.
“I am not a person who believes Western medicine is totally unuseful, and I’m also not going to say that traditional medicine or alternative healing is unnecessary. There’s a balance,” clarifies Clemmons, who longs for the days when family doctors took the time to know individuals. “There is a level of connection, compassion, and tailor-fit care [missing from institutionalized medical care]. Someone has to take time to ask you questions, discuss your background and body composition … It’s so personal and so detailed. And I think that’s what is attracting women to wellness.”
Many doctors are equally unsatisfied with how care is currently managed. Do they want to rush clients out the door? Do they want to spend precious time dealing with multiple insurance companies? They didn’t break their backs throughout medical school and exhausting residencies to treat humans like factory inventory. Neither do they want to star in their own version of The Office, filling out piles of administrative paperwork. As the physician Dr. Danielle Ofri writes in What Doctors Feel, doctors spend over 60 percent of their time documenting ailments, reviewing records, and communicating with staff. “For physicians, this ‘indirect care’ is perceived as time they are spending on patients’ cases, but for patients, this indirect care is invisible. Patients are aware only of the time they actually see their doctor, and it feels like almost nothing … the patients, rightly, feel shortchanged.”20
It’s not necessarily the doctors. It’s the system. Too many physicians are overwhelmed—working long, stressful hours—and beholden to the current healthcare model. Some research suggests patients feel more satisfied and better adhere to treatment compliance when cared for by empathetic doctors, but for that to happen, we need a system that lets doctors flourish. Instead, 47 percent of physicians report burnout, which naturally affects their patience, empathy, and quality of care.21
Of course, doctors also have their own legitimate gripes about patients, including the frustration that comes with doling out guidance that’s ignored: stop smoking, exercise, eat your vegetables … When patients repeatedly refuse to take responsibility for their health, doctors—who are human too—can feel as if they’re living in their own Groundhog Day in which their empathy is constantly tested.
Still, some patients take issue with the outcome of such visits, which often end with a prescription. Although most symptoms—say, a cough or rash—will mend themselves in time, doctors and patients succumb to the “do something” psychology in which a specific remedy must be provided at the end of a consultation.22 Nearly half of the U.S. population took a prescription drug in the last month.
Once lost, it’s tricky to regain trust, especially in an age of ever-proliferating information. Constant access to the Internet pushes people to believe they can self-diagnose, while conflicting media reports erode faith in one consistently reliable source of medical information. Much of the general public is likely to encounter misleading information on social media because sensationalized headlines perform better. They’re juicier. False stories prey on emotions like fear, disgust, or shock, and people are more likely to share what moves them—for example, an emotional anecdote.
In 2019, a bipartisan network of scientists examined the one hundred most popular health articles of the previous year; specifically, those with the highest number of social media engagement. Of the top ten shared articles, they found that three-quarters were either misleading or included some false information. Only three were considered “highly credible.” Some lacked context on the issue, exaggerated the harms of a potential threat, or overstated research findings. Others, it seemed, had a skewed agenda.23
With doubt seeping in at multiple points, U.S. women are looking to try something different. Many women have had less than stellar doctor appointments. Or perhaps they’re convinced they alone can self-diagnose and treat an ailment, MacGyvering their way to better health. The question is: What is the alternative?
In 2018, the journalist Sarah Graham founded Hysterical Women, a blog documenting personal accounts of biases in women’s health care from the UK, the United States, and Canada. Female patients write in with complaints covering the spectrum: reproductive health, chronic illnesses, and disabilities. Graham found the consensus to be Hysterical until proven otherwise. According to testimonials, doctors accused patients of seeking attention, imagining symptoms, or attempting to acquire drugs. Often, women were reluctant to push back or challenge a doctor’s authority because they were raised to trust and obey them. Some reported they were taken more seriously only when a male partner accompanied them to an appointment, like some sort of medical chaperone.
Plenty didn’t get what they needed. So they pursued alternative self-care methods, including acupuncture, marijuana, and dietary changes—not necessarily as cures, but as complementary treatments to minimize symptoms. Many joined patient advocacy groups or online communities to share knowledge and to find peer support. “People are looking for alternatives outside of medicine, even if that’s just about sort of managing day-to-day life,” Graham told me, noting a prevailing sense of desperation. “There is definitely a sense of people being willing to try just about anything.”
I meet women all the time who want nothing to do with Western medicine, which they call “sick care” rather than health care. They believe the system isn’t all that invested in solving “root causes” (a trope used to slam doctors; mainstream medicine addresses both causes and symptoms, though there’s certainly room for improvement). The system doesn’t incentivize preventive medicine, they’ll say, so it’s no wonder people are unable to stave off chronic illness.
Alternative health is presented as a proactive approach—trying to prevent ailments in the first place, as opposed to traditional Western medicine’s reactive approach. Wellness advocates promise partnership over “patientship,” heralding ways to fine-tune the machine so it doesn’t break down as often, which is why seemingly fit and healthy women attend a Goop conference. That’s the point; they want to stay healthy. Or more like: what they believe is healthy. And they’ll work damn hard—or spend lavishly—pursuing it.
Western medicine’s approach is simply too myopic, these women say. Hospitals and physicians are ideal for acute problems like heart attacks or broken bones, while alternative medicine is preferable for chronic conditions. Eastern medicine or “natural” remedies appeal to those who say they want more personalized, less potentially harsh methods. They only need to turn on their TV to see how prescription painkillers like opioids have harmed millions of Americans.
More and more often, women are asking, What else is out there? Is there some other way besides pharmaceuticals? And how can I manage symptoms on my own?
Take Naomi, a marketing executive and mom of two preschoolers in Brooklyn, New York. She was diagnosed with rheumatoid arthritis and ulcerative colitis, an inflammatory bowel disease. Pharmaceuticals prescribed by her gastroenterologist failed to manage the symptoms; Naomi was besieged by fatigue, rectal bleeding, and abdominal cramps.
Naomi decided to visit a holistic doctor, who told her three things acted like “shards of glass” in her digestive system: gluten, dairy, and sugar. He told Naomi she must never consume them again. “That diet was the first thing that ever really helped my symptoms,” she recalls. When Naomi went back to her gastroenterologist for a routine colonoscopy, she mentioned her newfound strategy only to receive a heavy dose of skepticism. The doctor stated it wouldn’t work, even though it seemingly was working. “I said, ‘I have stomach issues all the time. How can you look me in the face and actually tell me that the things I’m [eating] are not affecting the pain that I’m feeling?’”
In the following years, Naomi began researching alternative methods of self-care, becoming more and more entrenched in the wellness world. Now she pretty much avoids traditional Western medicine, save for surgical needs. Her health regimen incorporates whole, gluten-free foods and fresh juices, which she says helped heal her gut. When she last got sick, she went straight to an energy healer. “You have to just take [your health] into your own hands,” declares Naomi.
In self-preservation, the sick and vulnerable might avoid what let them down in the past, then invest their faith in promising cures. If they find the system isn’t addressing their concerns, they’ll find new sources to meet their needs.
Flashback: When Americans Succumbed to “Puke Doctors”
Samuel Thomson faced the court, a sea of serious faces stretched along the wooden pews. It was winter 1809 in Massachusetts. The mood was solemn, the cold air filled with tension. Among those in attendance were Thomson’s lawyers and an array of witnesses who at one point had been his patients. Thomson knew the press would turn the court case into a media circus, as this was no slight accusation. Thomson was on trial for murder.24
Thomson was famous for his botanical treatments and purging techniques, which he sold to licensed administrators across the country. He believed that sickness stemmed from an internal temperature imbalance, that all an ailing body needed was a restoration of heat and a release of toxins in the stomach and bowels. To that end, he employed steam baths, oral purgatives, and enemas laced with cayenne pepper. His licensed operators were soon dubbed the “puke doctors.”
Thomson had prescribed one patient the emetic herb Lobelia inflata, also known as Indian tobacco. The patient was forced to puke daily, to the point that he lay in perpetual sweat. He died within one week. At one point, Thomson’s lawyer dangled Indian tobacco in front of the courtroom. The lawyer then abruptly swallowed it whole, drawing gasps from the audience. He claimed he felt just fine and in fact could easily consume three times the amount without ill effects. The press ate it up like a page-turning thriller.25
Thomson was ultimately acquitted, but that didn’t satisfy him. He saw the trial as the product of a power-hungry, corrupt medical establishment attempting to quash alternative medicine. At that time, who had access to information—and how it was wielded—was shifting. The “anti-establishment” President Andrew Jackson, who campaigned on a populist platform, celebrated the average citizen who relied on nothing more than grit and intuitive wisdom. The idea of rugged self-reliance permeated more than just D.C. politics; it became a siren song for the Everyman to revolt against what was seen as a two-tiered system of health care, making do with herbal remedies while access to doctors was reserved for the privileged few. Playing up a common perceived enemy, as always, bolstered support and galvanized communities. Medicine—both access and quality—became fuel for class conflict.
For Thomson, it was also personal. As a young man, he bore witness to the rudimentary medical care administered to his mother, who suffered from the measles. By prescribing mercury and opium, the doctors “galloped her out of the world in about nine weeks,” he reported.26
By the 1830s, the Thomsonians had grown into a sizable movement, and botanic physicians came to be seen as on par with medical doctors. The ordinary people applying this new democratic approach sometimes obtained better results than those who were bled by doctors. Reportedly, 2 million Americans—more than a tenth of the population—adopted the Thomsonian system, which stressed a key motto: “To make every man his own physician.”
Thomson wasn’t alone in taking on the medical establishment. Americans soon embraced a hodgepodge of alternative healthcare methods, everything from magnetic healing to homeopathy. For better or worse, medical care was no longer concentrated in the hands of a select few.
Those who flock to Paltrow’s altar take comfort in believing that the Oscar winner (or more likely, her team of employees) is playing lab rat for them, although it’s unclear whether any of these rituals in any way make her, per the mission, healthier. But that doesn’t matter, for Goop provides a seductive fantasy of health and beauty. There’s a strain in American culture that leads us to believe we can have or do anything as long as we put in enough effort. We live by the prevailing creed of personal control over one’s environment—the very same creed that propelled man to the moon. Our go-getter mentality, bred by a Puritan work ethic and a belief in American exceptionalism, made us hard workers but also big dreamers. This unique mix finds its way into our leaders, our markets, and our health landscape. High expectations coupled with rugged individualism push health seekers to greener, more holistic pastures.
Goop also lends women a much-needed ear. It caters to a population longing to hear three simple but powerful words: I believe you. After years of feeling minimized and discredited, women gravitate toward those who validate their pain, who take them seriously.
Gwyneth Paltrow embraces this disillusioned group, filling a vacuum in which no empathetic or aspirational brand captured the market. Goop publishes pieces on Lyme disease, fibromyalgia, and other chronic conditions. Paltrow and her publication share alternative treatments, such as biomagnetic therapy (to balance the body’s pH levels) or bee venom (which involves live bee stings to supposedly treat inflammation). For patients whose doctors offer nothing more than a shrug, these kinds of alternatives feel like manna from heaven. Just buying her pricey wares makes them feel cared for and comforted.
That’s because navigating a chronic condition isn’t just extremely aggravating and painful. It’s lonesome too. Many women describe how friends and family are quick to offer a helping hand at the start: casseroles, babysitting, pharmacy runs. But when they fail to improve—over weeks, months, even years—the attention wears thin. Meal delivery tapers off, the visits more seldom. It’s not that people don’t care, rather they just don’t quite know how to react to someone who isn’t getting better. We’re not accustomed nor equipped to manage medical failure, even on a social level. (We Americans are far more comfortable with success stories; we want to hear of triumph, of overcoming the hurdles!) The long-suffering know there are only so many times they can reach out for help before they’re considered a “burden” or labeled that person who is “still” sick. In this regard, digital patient communities and websites provide crucial emotional support.
Even those with minor chronic ailments seek solutions and support. With that mindset, Goop launched its most ambitious product—a collection of supplements to address women’s everyday health issues. The cleverly named Why Am I So Effing Tired? pill to “help re-balance an overtaxed system” was created because Paltrow found herself feeling sleepy all the time. She joins a big club: fatigue is the most common complaint for 10 to 20 percent of primary care visits.27
The pills, $90 for a monthly pack, were also designed for people suffering from “adrenal fatigue,” a theory suggesting that overworked adrenal glands might not produce enough cortisol. Western medicine doesn’t officially recognize this malady (which is not to be confused with myalgic encephalomyelitis, also known as ME/CFS or chronic fatigue syndrome). The Mayo Clinic describes adrenal fatigue as a lay term given to a collection of nonspecific symptoms, like body aches, fatigue, and nervousness, but one without an accepted medical diagnosis. Goop’s Dr. Alejandro Junger, in comparison, likens it to an “epidemic.”28
Adrenal fatigue is a new, invented term for feeling tired or stressed. It’s possible that one’s adrenal function is shot, but it’s generally not a primary problem with one’s adrenal gland, doctors I interviewed tell me. But as soon as it was suggested, consumers were convinced they had it. Before hearing the term, they might have assumed feeling sleepy sometimes was just a marker of modern life. Now they were self-diagnosing and buying Goop vitamins in bulk. It then becomes socially contagious, with friends suddenly discussing the “condition.” And this is where Goop and unproven remedies can become potentially harmful. Some buyers might be ignoring actual symptoms with actual solutions. Their sleepiness could be the result of real medical conditions, including immune disorders, a thyroid condition, or depression.
Goop’s supplement line sold $100,000 worth of product on its first day. (Even though you can buy the supplements’ equivalents for half the price at your local GNC.) If women feel more understood by Gwyneth Paltrow than their own doctor, there’s a problem with medicine.
Many of Goop’s quasimedical suggestions lack solid scientific evidence. Moreover, their health advice always seems to converge to one end point: Buy more stuff. And not just any stuff, expensive stuff. At their conference, I noticed a $42 “transformational” flower essence oil—also called “vibrational” medicine—to combat a wide assortment of ailments: social anxiety, self-consciousness, self-criticism, and the “tendency to isolate.” (What, it doesn’t also cure my Netflix addiction? Align my bowel movements to my horoscope?) Is this science? Probably not. Is it great salesmanship? Definitely.
This hasn’t gone unnoticed. In 2018, Goop agreed to pay $145,000 in civil penalties after an investigation by a task force of prosecutors from ten California counties claimed its product advertisements lacked reliable scientific evidence. Consumers who bought their jade vaginal egg, marketed for “hormonal balance,” were entitled to a full refund. A year earlier, the advertising watchdog group Truth in Advertising filed a complaint with two California district attorneys against Goop after it found more than fifty instances in which Goop claimed it could treat, cure, prevent, or reduce the risk of developing a number of ailments.29
Goop was on a roll at that time. Their signature perfume claimed its collection of ingredients “improves memory,” “treats colds,” and “works as an antibiotic.” Then there were Goop’s $120 wearable energy healing stickers, which generated as much media scrutiny as Ben Affleck’s back tattoo. These stickers reportedly “rebalance the energy frequency in our bodies” and were said to be made of the same conductive carbon material NASA used in space suits to monitor an astronaut’s vitals. Not only did NASA deny the existence of the material, but a former NASA chief scientist went so far as to respond, “Wow. What a load of BS this is.”30
Goop products and content now often include a convenient disclaimer: “This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.”
Goop as a company does not shy away from controversy and has defended its practices. The brand said it anticipates questions surrounding its content but takes issue with attacks on its methods, reframing them as an attack on women’s empowerment (and thereby appealing to consumers’ feminist leanings). “We always welcome conversation. That’s at the core of what we’re trying to do,” read an open letter Goop published in 2017. “Being dismissive—of discourse, of questions from patients, of practices that women might find empowering or healing, of daring to poke at a long-held belief—seems like the most dangerous practice of all.”
Goop’s strategy is to put edgy wellness ideas out into the world and let readers make up their minds about them. In a way, the company absolves itself of any responsibility because their role is to simply introduce new ideas—not to ensure their efficacy. It’s a brilliant business model—the possibilities are endless.
While there is a glimmer of logic to Goop’s openness to new treatments, the issue is that many of their products are not put through any kind of rigorous medical evaluation process. And without an approval process that involves rigorous testing and standards, their claims of benefits are just that: claims, not medical advice.
But Goop is not the whole of alternative medicine, and it would be unjust to presume as much. There are plenty of other players in town who don’t resort to steam-cleaning their private parts. So, one might ask, what about all the other alternative healers and clinics exploring new treatments? What if they know something mainstream medicine doesn’t?
When it comes to poorly understood or chronic conditions, a gray area does exist between evidence-based medicine and unorthodox treatments. I tread lightly here—appreciating mainstream medicine while fully accepting its current limitations—because physicians have yet to truly figure out some of these debilitating conditions that leave women in agony.
Many conditions go undiagnosed or misdiagnosed, especially ailments that don’t show up on blood tests.31 That does not invalidate mainstream medicine, rather it reminds us that medical mysteries still exist. Also, it doesn’t necessarily follow that alternative practitioners do have the answers. Some alternative medicine practices have little, mixed, or no scientific backing. Homeopathy, for example, is based on the philosophy of “like cures like”—that a condition can be treated with an ultra-diluted ingredient that has similar symptom effects. So an allergy remedy, by this logic, might contain onion because it too causes irritated eyes and a runny nose. This “similar” symptom concept goes against basic scientific principles. Besides, ingredients are generally so diluted that it’d be hard to label them an active ingredient. Homeopaths argue that dilution increases potency, while scientists counter that they’re diluted to the point of being negligible.
Homeopathy (which is often conflated with herbal remedies) hasn’t been proven to significantly affect specific diseases or symptoms even after thousands of papers.32 In this regard, we need to separate interventions that have been disproven from interventions that are unproven.33
As for patients, their suffering should be taken seriously. While people can certainly convince themselves of symptoms or illnesses, we should not be quick to assume “it’s all your head.”
Doctors I interviewed say we aren’t always equipped to deal with complex chronic conditions, particularly those that lack clear causes and treatments. Part of this has to do with how we think about medicine. We generally think of acute infectious diseases, in which there’s this one thing that causes a disease, and if you take an antibiotic it all goes away. That’s the gold standard: a simple cause-effect-treatment paradigm. “That is actually the exception, not the rule,” explains Dr. Adam Gaffney, a critical care physician and assistant professor at Harvard Medical School. “A lot of our symptoms have not one cause, but a multitude of causes.”
Many chronic conditions need more than one intervention, and conditions can manifest very differently in each individual. This is especially true for some contested chronic illnesses—those that some doctors debate are even real. ME/CFS, for example, is marked by extreme fatigue and severe body aches over a long period of time. It’s a brutal condition that can leave some patients with dizziness and intense brain fog and others unable to get out of bed. Uniform cookie-cutter treatments just won’t cut it.
What you hear from women with chronic conditions, many of them living with agonizing pain and fed up with what little medicine has to offer, is defeat: Doctors aren’t going to save me. It’s up to me.
It might be up to them because doctors generally abide by the philosophy “First, do no harm.” That mentality can translate to “do nothing” if they don’t have treatments they believe are guaranteed to work when it comes to patients with a certain constellation of symptoms. There are always trade-offs with any intervention, so doctors balance risk versus benefit. But if someone is desperate, they might be willing to take more risk—provided there’s some scientific plausibility to the treatment in question. Given what we know about the human body, chemistry, and biology, does this intervention make sense?34 Their best bet is to find a doctor who fits their threshold of risk-taking if they are open to experimenting with treatments that have less evidence behind them. Ideally, that doctor could interpret the available data and safely see what works for them.35
Those doctors exist but are rare. Inevitably, this puts desperate patients in a sleuth-like position where they search for under-the-radar therapies within patient support communities. Throughout my research, I have spoken to women who experiment with (and swear by) unconventional treatments few Western doctors would endorse: water cures, laser therapy, mold avoidance, mixing of pharmaceuticals, and the like. Some will be money-sucking bunk, some will nary move the needle, and some might actually help. A portion might be dangerous (certain interventions carry real risk of harm). But patients will say the best they can hope for is to lean on that which has the most data—or, more likely, anecdotal success stories—to manage symptoms.
Anecdotes are a fine place to begin the process, but personal tales of recovery are subject to all kinds of biases and misleading contributing factors. Anecdotal “data” is not reliable. Thousands of people who attest to something can very well be wrong. (Exhibit A: flat-earthers.) At first glance, it may look like a strong grouping of evidence, but because the data was collected in a nonscientific way, it can leave out pivotal information.
Anecdotes are powerful and potentially misleading. Too often, especially in alternative medicine, we only hear the success stories. We rarely hear about the person who depended on energy healing, then got sicker, and ultimately died. They’re not here to warn us. Dead men tell no tales.36
It’s also at times difficult to measure the efficacy of any one treatment. This goes for both mainstream and alternative medicine. Generally, common medical conditions improve on their own, whether or not a patient took something, so intervention is hard to judge. It’s very easy to assume causation when it’s in fact correlation or placebo. If you take an herbal supplement at the height of a flu and then you start feeling better the next day, you might think it was the pill’s doing. In reality, it was just the passage of time; in the normal course of things you were going to improve regardless.
Likewise, when patients go for an energy healing appointment, it might be the calming spa environment that relieves pain and stress or reduces tension headaches. It could be the act of something touching you or even the practitioner’s personal attention and reassurance. In one study, participants who received a sham acupuncture (placebo) treatment said they experienced a 43 percent reduction of headache frequency.37 Some might also believe a treatment works because they’ve invested time and money, in the same way I’m “certain” my pricey Estée Lauder serum dissolves wrinkles.
For these reasons, alternative medicine flourishes: people believe whatever they’re taking or doing is what’s aiding their recovery.
But alternative medicine isn’t completely harmless, much in the same way mainstream medicine isn’t. One element in mainstream medicine’s favor is that—when practiced correctly—doctors evaluate the best body of evidence and weigh it against risks before recommending a particular intervention. Not always so with its competitors: “Sometimes alternative medicine gets a bit of a pass in the risk assessment department because it’s seen as being ‘natural,’” explains Jonathan Jarry, a biological scientist and science communicator with the McGill Office for Science and Society. “So it’s seen as having only potential benefits and no real risks.”
But there are risks: of side effects, physical harm, and just wasted time or money. There are cases of people who got liver damage from Chinese herbal medicine. On rare occasions, acupuncture has resulted in a punctured lung.38
Of course, most alternative remedies are not actively dangerous. But here’s another issue: they potentially replace actual science-backed interventions and rob consumers of real therapeutic opportunities. It’s sort of like how believing in flying carpets is harmless, but if you’re stranded on a desert island and you wave off a rescue boat to wait for Aladdin’s mode of transport, you’ve got a problem.
Alternative medicine can induce a rejection of traditional medicine, potentially leading down a slippery slope of conspiracy thinking or overconfidence in alternative methods. A 2018 observational study published in the medical journal JAMA Oncology found that cancer patients who depended on complementary medicine (herbs, vitamins, homeopathy, and other alternative therapies) were more likely to refuse conventional cancer treatment such as chemotherapy or surgery and therefore had a twofold higher risk of dying than those who never sought complementary care.39
Once you start questioning medicine, researchers warn, you might just take it too far. Steve Jobs shunned what might have been timely and lifesaving cancer surgery in lieu of alternative therapies and a strict vegetable diet. (Jobs had a rare form of pancreatic cancer, a neuroendocrine tumor, which is less lethal than the more common forms of pancreatic cancer.) He died at age fifty-six. His biographer, Walter Isaacson, reported that he later regretted his rejection of orthodox medical treatment.40
There are those opting for a more hybrid approach when it comes to medical innovation. Dr. Lucinda Bateman is the founder and medical director of the Bateman Horne Center, a medical center devoted to ME/CFS and fibromyalgia. She was inspired to dedicate her career to these conditions after her older sister became sick with ME/CFS. Dr. Bateman has gathered other doctors and specialists to come up with expert recommendations that could be used in the absence of a large evidence base.
As a physician, Dr. Bateman readily admits it’s “heresy” to criticize the high standards of evidence-based medicine, but “the concept that everything has to be evidence-based before it can be taught is a problem because when you have something new that you’re discovering, it takes a while to build an evidence base.” COVID-19, for example, helped us understand we can’t wait to initiate care. Yes, double-blind, randomized, controlled trials are ideal, but when a crisis hits, we don’t always have that luxury. “In order to have more rapid progress, we’ve had to let down our standards in the United States about what constitutes good evidence.”
While Dr. Bateman recommends working with a physician, she fully understands that that isn’t always a possibility. To that end, she advises: Buyer beware. “There’s lots of good education online, but don’t go hook, line and sinker, especially after someone is making a lot of money from selling products,” she says, singling out supplements, for one. “As soon as people are earning their living by selling these [pills and products], then all credibility goes out the window as far as I’m concerned.”
Mainstream doctors don’t have all the answers, but it doesn’t follow that then anything goes. All science is evolving, though there are stark differences between pseudoscience and that which is supported by evidence.
The commercialized wellness space can lend itself to predatory practices by those who seek to profit from the needs of the struggling. Uncredentialed influencers assert themselves as legitimate substitutes. They push pricey placebos masquerading as supplements, sham “detox” diets, and unsubstantiated IV vitamin injections. If you were to believe the marketing hype on cannabidiol (also known as CBD), you’d think the cannabis extract could cure cancer and solve the Middle East conflict; while CBD shows promise, cure-all claims are supported by little conclusive evidence and lack sufficient clinical trials. The Federal Trade Commission has pursued companies like HempMe CBD—which sells oils, creams, and gummies—for what they say were misleading claims regarding AIDS, autism, bipolar disease, cancer, depression, epilepsy, and seizures.41
It can be hard to judge “other” treatments when the marketing, branding, and presentation are just so good. A great example is the hot new trend of an alternative medicine MD or a functional medicine practitioner.
These are primary care doctors trained in a variety of alternative medicine modalities. Functional medicine says it treats the patient “as a whole” using herbal remedies, acupuncture, and other unorthodox methods along with lifestyle changes, but it doesn’t necessarily shun pharmaceuticals if necessary. “The best of both worlds” is how it’s described: bridging wellness and medicine. These practitioners are available for lengthy, in-depth appointments at sleek new clinics that feel more like fancy spas. Patients are welcomed into a beautiful space boasting lots of natural light, potted plants, stocked kombucha, and a comfy hotelesque lounge.
Upper-middle-class women in their thirties and forties, many dealing with chronic conditions, flock to these coastal clinics. Some clients likely saw functional medicine billboards sprouting up around L.A., preaching “You deserve a better doctor.” These are women, as one clinic founder told me, who just can’t get a doctor to “investigate” their medical issues. Here they will not be rushed out in seventeen minutes. They get more like a full hour.
These alternative clinics are attractive because they advocate preventive lifestyle habits that no one would argue with: eat more vegetables, exercise, get proper sleep. In many cases, they do help people by holding them accountable to these modifications. But they sometimes add on treatments with little or any rigorous evidence, such as detoxes and hefty supplement regimens. It’s a mixed bag: a bunch of great recommendations combined with what sometimes amounts to pricey pseudoscience and unnecessary lab tests.
What’s wrong with endless rounds of fancy-sounding tests? Well, it insinuates that conventional doctors are keeping essential information from you (“Why doesn’t my doctor check XYZ?”) while encouraging a preoccupation with details that might not lead to anything worthwhile, especially since some functional medicine tests are considered bogus by mainstream medicine.
Science communicators liken overtesting to conspiracy thinkers who fixate on teensy details as if they’re holy grails. Too often, these details prove to be nothing more than red herrings. Unnecessary lab tests without a specific reason aren’t recommended because the more tests you order, the more likely you are to get a false positive result because tests aren’t perfect42 (as anyone who has taken a COVID-19 test knows). The likelihood of an “abnormality” is high. This results in heightened anxiety, then more pricey tests, and then more supplements.
Many functional medicine clinics lambaste conventional doctors’ relationship with pharmaceuticals even though they often follow the same format with supplements.
Part of this fixation with testing lies at the intersection of the quantified-self movement and the “do something” medical mentality. Dr. David Scales, a sociologist, physician, and assistant professor of medicine at Weill Cornell Medical College, also observes a psychological component: “[Wellness seekers] tend to be uncertainty avoidant people. There is the thought that more data is better, more data is going to provide more certainty.” Usually these are people who believe the worst thing possible would be to “miss” something, without realizing that overdiagnosis (and overmedicating) pose their own risks.
Regardless, functional medicine’s messaging is effective because it positions alternative care as empowering and anti-authoritarian even if it too can be plagued by exploitative practices. Or, more simply, this messaging and marketing is a heck of a lot better than that of mainstream medicine. Functional medicine clinics look like spas, and they understand women’s pain points. They know exactly what we want to hear: that we are unique and therefore require tailor-made treatment, that Western doctors aren’t listening to us, and that medical care can be enjoyable.43
It’s hard to understate how much women want a better relationship with their physician—the primary reason they go to these clinics. Patients want more time to talk. They want doctors to help them retool their lifestyle and better emphasize preventive medicine. Many women are not getting this from traditional medicine. If we only look at treatments strictly from a medical perspective and not a psychological one, medicine will continue to lose patients. The experience does matter.
The hard left turn to alternative health has been galvanized by the dissatisfaction women have experienced in their doctor’s offices. None of this, however, should undermine an appreciation for medicine and great strides in scientific discoveries. Antibiotics, vaccines, and proven medical methods ensure that most of us reach an age well beyond what any of our ancestors ever dreamed possible. No one should throw the baby out with the rose quartz–filtered bathwater.
And yet a gender bias continues to plague a portion of female patients dealing with a laundry list of mistreatments at the hands of an imperfect system that can ignore, trivialize, or misdiagnose ailments—and then follow with inadequate treatment.
But this phenomenon almost doesn’t make sense. Why would those who take the Hippocratic oath purposely ignore women’s calls for help? Surely they don’t intend to hurt their patients who come to them in tears and desperation.
Undeniably, some harbor discriminatory tendencies, but in light of such a large volume of complaints, a bigger story must be behind it. There’s an explanation for why physicians shrug their shoulders and rattle off perfunctory prescriptions. And it goes way back: back to when women were purposely excluded from the halls of medicine solely because of their sex.