A dear friend is tryign to help an addict. He sent me the link for Emerald neuro-recover and asked if it was BS or not. It’s BS. It took me only thirty seconds to turn up an NPR news story not only about fake addiction treatments, but about this specific clinic.

One of the most pervasive problems in healthcare is “snake oil”. Exotic sounding fixes for healthcare problems that don’t actually do anything. False cures, quack doctors, and ineffective or even dangerous treatments are so common that the US created a whole body of laws and a federal agency to try to deal with the problem. The interesting thing about the FDA is that it was created in respose to consumer demand. People don’t like it when their loved ones die, and they like it even less when loved ones die to quackery.

Unfortunately there are a lot of factors when people are ill that tend to produce untested and untried solutions.

  • People hate being sick.
  • We generally suck at curing chronic diseases.
  • People who are sick and have exhausted the available options are eager to try new things.
  • The placebo effect is POWERFUL.
  • “Skin in the game” like tolerating an injection, paying a lot of money, traveling to a distant clinic, or taking something exotic-sounding makes the placebo effect work even better.
  • Placebos work for a broad range of conditions, albeit temporarily.
  • Placebos work best for exactly the set of chronic conditions that are so difficult to treat.
  • Healthcare practitioners want to believe they made their patients better.
  • Many people spontaneously recover from chronic conditions.

This creates a situation where a patient is chronically ill, pays an exorbitant price for a bottle of snake oil, gets a strong placebo effect and feels better, and recovers either irrespective of or despite the treatment. The patient believes the snake oil cured him because of natural cognitive biases. Framing and overconfidence tend to make people not even consider that they would have recovered spontaneously or even worse that the snake oil was actually harmful and they recovered despite it. If a healtcare practitioner is involved, the healtcare practitioner is usually also biased by overconfidence.

Knowng all that, consider Emerald. Now, one of my hobbies is reading about functional medicine so I happen to know that NAD therapy has not been shown to work, but the web page is covered in other clues you’re dealing with a quack. The most obvious is the big web presence. Does the best doctor you know even have a website? Of course not. S/he is too damn busy and probably not even accepting new patients. The price is exorbitant. The list of conditions on the homepage is overly broad and includes non-illnesses like Candida, Metals, and the grand catch-all, Fatigue. Everyone wants to recover from fatigue. Instead of peer reviewed literature, there is a page of testimonials. The web page carefully frames the treatment as natural, innovative, and holistic to set up a good placebo effect. If I made up an alternative health Buzzword Bingo card, I’d win halfway down the NAD page. Finally, a quick search of Pubmed for NAD and alcohol withdrawal turns up only one paper from 1971 so there is essentially no evidence that the treatment works.

If the clinic is run by a quack, why are they allowed to stay open? Well I used to work at FDA and the answer is too complicated for this post. Basically they exist in a legal grey zone. When it comes to supplements like amino acids or NAD+, it’s basically caveat emptor. The clinic is probably doing plenty of normal drug withdrawal protocols, and they probably do succesfully cure the small subset of addicts who genuinely want to be rid of their addition competely irrespective of whether NAD was involved. Neither doctor nor patient can ever know whether the alternative therapy helped, but they’re both cognitively biased to believe it did.

So watch for signs of quackery. Lots of buzzwords, testimonials, high cure rate, treats everything, and above all no real evidence of effectiveness.