Setting the record straight: Medical experts debunk the biggest myths in their field

Myth(s): You can’t trust science AND the latest “wellness woo” will help you live longer.

A big one is misinformation about misinformation. We’re hearing more and more rhetoric around the nature of misinformation and the strategies to fight it. I think it’s important to recognize that often the goal of “misinformation mongers” is to create distrust in institutions, which makes room for more misinformation. We’re seeing increasing distrust of science, scientists and health-care institutions, and that’s the direct result of the spreading of misinformation.

A big one is misinformation about misinformation.

The other more frivolous one that I’m following closely right now is misinformation about longevity. It’s kind of become the new high-tech wellness woo. People are getting full body MRIs, taking dozens of useless supplements and doing all these unproven therapies. This misinformation does real harm because it distracts us from simple measures like exercising, eating well, improving your sleep, not smoking and surrounding yourself with people you love. That’s what matters and all this high-tech wellness woo is really distracting.

Myth: You need to get sick to strengthen your immune system.

The idea that we need to get sick to develop a proper immune system is completely false. There’s absolutely no evidence to suggest this. Unfortunately, it’s one of those things that keeps getting perpetuated, often by health-care professionals themselves.

This concept stems from the “hygiene hypothesis” from many decades ago. But that specifically looked at early childhood exposure to specific microbes and subsequent protection against allergies. It has nothing to do with exposure to pathogens.

Think about it, when you get a cold during the winter, do you never get a cold again? Of course not. We see that with almost all viral infections. To some degree, when you are exposed to a pathogen, you mount an immune response against it, then your antibodies and T-cells have memory to fight off those infections. But the issue is, how long is your immune system going to remember?

But the issue is, how long is your immune system going to remember?

The length of time your body will remember how to fight off a particular pathogen varies significantly. For example, with measles, we have much longer-term immunity. Which is why after either an infection or just two vaccinations, you’ll have immunity for life in most cases.

But when it comes to building immunity through natural infection, the question also becomes at what cost? That’s a major reason why we have vaccines against certain pathogens – you really don’t want to put your body through the wringer just to mount an immune response so that you’ll have, in some cases, very short-term immunity against a particular virus.

If experts really felt that infections were good for your immune system, then we wouldn’t spend the time, money and resources to develop vaccines.

Myth: Drug regulation is nonsense! Drugs are dangerous and, therefore, should be illegal.

Regardless of their legal status, all drug use carries some potential risks. However, these risks are intensified when drugs are manufactured and distributed by criminal, profit-driven organizations. Drug prohibition policies exacerbate the social and health risks associated with drug use and push the market toward more potent and toxic substances (e.g., fentanyl) that have led to numerous preventable deaths across the globe. Additionally, criminalizing drugs promotes unsafe drug use practices, such as using alone, and exposes people who use drugs to high-risk environments. Furthermore, there is no robust evidence to show that under prohibition laws, drug use decreases.

There is no robust evidence to show that under prohibition laws, drug use decreases.

The fear of potential consequences and stigma discourages people who use drugs from seeking the necessary care and support they may very much need. Indeed, as noted elsewhere, prohibition policies have been tried and failed and drugs have won the “war on drugs.”

Conversely, legal regulation of drugs does not mean a drug “free-for-all” approach. Indeed, it ensures controlled, not increased, availability, with strict controls on what drugs can be sold, where drugs can be sold, and to whom they can be sold. Regulating the drug market allows for the implementation of taxation policies, quality control, drug dosage information and health warnings, as well as age restrictions to limit access to minors and young people. This approach also facilitates the re-allocation of resources from the enforcement and carceral systems toward education, prevention, and treatment programs, ultimately leading to a more comprehensive and effective approach to addressing drug-related issues.

Myth: Your individual freedom is more important than protecting the health of others.

As a public health ethicist, the most pervasive piece of health-related misinformation is the belief that decisions about your health are yours alone to make and that there is no valid basis for others (including the government) to interfere with your health decision-making. This simply isn’t true, and the law reflects this. This is most obvious when it comes to communicable diseases (e.g., COVID, measles, gonorrhea), where your health decisions (e.g., to go to work when sick, to not wear a mask, to not get vaccinated, to not wear a condom, etc.) can directly impact the health of other people.

“Freedom for the pike is death for the minnows.”

Unlike noncommunicable diseases like heart disease, where you have free rein to take risks to your health so long as you are personally willing to accept the consequences, decisions about communicable diseases cannot rest solely on your personal risk tolerance. In fact, beyond impacting other people’s health, the freedom to behave however you’d like can reduce other people’s freedom, too, for example, by making them ill or by creating risks that foreclose certain activities. As Isaiah Berlin put it: “Freedom for the pike is death for the minnows.”

Even if you privilege freedom above all else, there still are very good reasons to place limits on people’s ability to infect others, just like there are good reasons to limit people’s ability to assault others. After all, a primary role of government, if it is to have any role at all, is to intervene precisely in circumstances where one person’s freedom threatens the freedom or well-being of others.

Myth: You can – and should – “boost” your immune system with vitamins and supplements.

“Immunity boosting” has become a very sensational, attractive term, especially for people who are struggling with recurrent infections and autoimmune disease. But scientifically it doesn’t make a lot of sense. Mechanistically, when you say “boosting the immune system” to an immunologist, we think “Well, that’s not ideal.” Are we talking about boosting the number of cells? Or our immune response to different organisms? Because both things can be damaging. Overproduction of cells can be harmful and is the basis of some hematologic malignancies or autoimmune diseases.

Overactive immune response to organisms can also be too much of a good thing. For a lot of the symptoms that we see from infections like colds and flu, the damage done is not actually by the viruses or the bacteria, but from the immune response. In COVID-19 infections, when that immune response is overwhelming, it manifests as the now widely known cytokine storms and multi-inflammatory syndromes.

Overactive immune response to organisms can also be too much of a good thing.

If you want to maintain a healthy, balanced immune system, effective ways of doing that are not going to be as attractive as just taking a pill: maintaining a healthy diet, exercising, limiting sugars and refraining from alcohol.

It is true that globally, nutritional deficiencies can contribute to immune deficiency. But in developed nations, our diets are reasonably complete. If anything, our immune systems are taking a hit because we need more fresh air and exercise. Immune cells also are unable to function properly when faced with chronic inflammation caused by too much sugar in our diets that lead to metabolic syndromes.

It’s also worth noting that supplements are largely unregulated. Not everything is disclosed in ingredients lists and can often provoke allergic reactions. We’ve even seen lawsuits where so-called “immune boosting” supplements have too much Vitamin A and even Belladonna, which can be toxic in excess.

The only real, and desirable way to boost your immune system is through adding antibodies and immunoglobulins if you live with a tested immunodeficiency. Otherwise, any “immune boosting” you do will either be ineffective, or likely result in physical – and financial – harm.

Myth: We can solve homelessness and addiction by getting people into treatment.

Serious mental illness is over-represented in people who are unhoused. And the public perception, and a key misunderstanding of the issue, is that the majority of people who are unhoused are suffering from severe mental illness or addiction.

The public and policymakers – because they don’t understand the problem – propose that the solution is more hospital-level mental health care, primary care and building more of what they call “treatment and recovery” programs. They think the problem is that the people on the street are sick. The real problem is that the people on the street don’t have enough money to access non-existent housing.

The real problem is that the people on the street don’t have enough money to access non-existent housing.

If we resourced highly supportive housing and transitional housing the way we currently fund mental health treatment, we would actually see much of the mental health and addiction issues we’re seeing on the street evaporate.

Myth: “Non-emergent” patients should avoid the emergency department.

A sore ankle turns out to be an infected joint. A viral illness turns out to be an infected heart valve. A calf “sprain” turns out to be a blood clot.

It is a dangerous myth that seemingly non-urgent patients should avoid the emergency department (ED) when hospitals are over capacity. This is perpetuated by numerous hospitals advising to avoid the ED with “non-urgent” problems. The problem with this advice is the average person may underestimate a serious problem and medically decompensate. The vast majority of ambulatory patients don’t contribute to the ED gridlock crisis we face.

The vast majority of ambulatory patients don’t contribute to the ED gridlock crisis we face.

A person with chest pain told to avoid the ED may write it off as heartburn when in fact they are having a myocardial infarction. Nagging abdominal pain dismissed as constipation can be pancreatic or colorectal cancer. A person increasing doses of their regular medications feeling faint can be having drug-toxicity seizures. Another patient feeling faint needed an urgent pacemaker. These situations really happen.

Benign illness in someone seeking ED care is a determination after a trained, experienced and measured clinician takes an adequate history, conducts a proper physical exam, conducts required tests, generates a differential diagnosis, involves specialists where needed and plans aftercare. Non-urgent patients with Canadian Triage Acuity Scale scores of 4 or 5 do not heavily utilize limited hospital resources like beds, do not come to the department in high numbers and, consequently, are not a cause of overcrowding.

Myth: “COVID is mild,” especially for children.

The “mild” narrative has produced a false sense of security. COVID is not a cold. Every COVID infection can harm us even if acute symptoms are mild or absent. For example, COVID can damage blood vessels and affect everywhere blood flows in the body. After COVID, it can be harder for our bodies to fight off infections. COVID infections also increase the risk of many serious problems like heart attacks, brain damage and even Type 1 diabetes and long COVID in kids.

A tricky thing about COVID is the high number of pre/asymptomatic cases – more than half of us may not notice when we’re infected. Many of us have no idea how many times we – or our children – have been infected. This is unsettling because roughly one in 10 infections lead to long COVID, risk may increase with each infection, and no treatments for long COVID have been identified yet.

The only way to prevent long COVID is to prevent infection.

The only way to prevent long COVID is to prevent infection. To do that, we need public health education campaigns that teach people both that COVID is not mild and that it spreads through the air. Given that most of us spend 90 per cent of our time indoors, indoor air needs to be safer to breathe – by filtering it, for example.

We all may be just one COVID infection away from myriad health troubles, lifelong disability or death. COVID is not mild.

Myth: In-patient recovery beds are the best way to treat substance use disorders.

There’s a misconception that addiction treatment requires admission to a bed somewhere – like a detox or recovery bed. The vast majority of treatment, in fact, happens (and quite successfully) in a community setting. Therefore, the number of new beds built to address substance use care, which is generally the area of focus when trying to ascertain if the government or others are doing enough, is not a meaningful representation.

The vast majority of treatment, in fact, happens in a community setting.

Community treatment can look different depending on the type of treatment needed. For example, some people who are housed and have a supportive network are appropriate for home detox (mostly for alcohol) with visits from medical professionals or others. For others, visiting an addiction medicine clinic daily for a few days to be medically assessed and have withdrawal symptoms managed with medications is another way to receive withdrawal management without having to wait for access to a detox bed.

Admission to detox beds should be reserved for those individuals who are at high risk for severe, complicated withdrawal and need to be medically observed. Other types of community treatment can include psychosocial interventions like group meetings, counselling and day programs like daytox.

Rather than having a system that works in silos, we need to break down those silos and develop a more coordinated regional approach to offering substance use care. In an ideal setting, success would be measured by the time it takes to access substance use services (both inpatient and community-based) and not by the number of new beds created.