The Washington Post publishes an advertorial on IV drips

Last week, I wrote about a poorly framed article in the New York Times by Apoorva Mandavilli about people who thought they were vaccine-injured, pointing out how it seemed to downplay vaccine benefits versus tiny risks while putting front-and-center an unfortunate woman who seems to believe that her health problems were caused by a “contaminated batch” of the Johnson & Johnson COVID-19 vaccine and has been drifting into quackery while making rookie mistakes discussing the vaccine safety monitoring system in the US. At the time, there was another, even worse, article about health published in The Washington Post on the same weekend, but I left it aside because discussing COVID-19 vaccines seemed more important than discussing IV drips of minerals and vitamins.

I doubted that I’d ever get back to the WaPo article or figured that, if I did, I would do it at my not-so-secret other blog, which, for whatever reason, I didn’t do. As I was considering what to write this week, even though there were other issues deserving of attention, I kept finding myself coming back to this WaPo article on IV drips again and again because it was just so incredibly egregious, starting with the title, The new cure-all for vacation excess: the IV drip. Written by a travel reporter, Andrea Sachs, and boasting one of the most blatant examples of false balance and the use of the token skeptic, it reminded me very much of the sorts of news reports that I (and others here at SBM) used to write about routinely before the pandemic, while nothing else going on this week really popped for me enough to motivate me to write about it. I have no idea why, but I long ago discovered that once my brain fixates on a topic, for whatever reason, I have a hard time moving on to other topics until I’ve scratched the itch in my brain and covered that topic. Moreover, it just kept occurring to me: One big reason that we have had so many dubious takes on COVID-19 in the mainstream press is because the mainstream press has never entirely disavowed articles like the WaPo article on IV drips.

Even as I started writing this, I remembered that we have indeed written about IV drips containing vitamins and minerals before, dating back at least to 2018., when the FTC cracked down on “IV bars,” where people would receive “intravenous micronutrient therapy” (IVMT), and including an article on an infant who nearly died of sepsis after IV drips with vitamin therapy and how there is no evidence that IV drips of vitamins and minerals can treat infertility. As I’ve noted before, although there are many forms of pseudoscientific, prescientific, and unscientific treatments offered by naturopaths and physicians promoting “integrative” medicine, one common form of “treatment,” often marketed as preventative medicine or antiaging medicine but sometimes marketed as a real treatment (or part of a real treatment) for real diseases, is intravenous vitamin therapy. One of the most common forms of this treatment is the use of high dose intravenous vitamin C to treat cancer, an idea popularized by Nobel Laureate Linus Pauling and continuing to fuel pointless research and attempts at clinical trials even today. In fairness, there is preliminary evidence that high dose vitamin C might—I repeat, might—have some use in sepsis, but in cancer it has been and remains what I like to refer to as a very long run for a very short slide. However, it’s much more common these days that IV drips of vitamins, minerals, and other supplements are marketed to the “worried well” as a preventative or “pick-me-up,” and it’s the latter angle that this Wa Po article hits, namely as a cure for overindulgence during vacations, which is why such “therapy” is being offered in luxury hotels and at Airbnb’s.

Like the NYT article on vaccine injury (more correctly, the perception of vaccine injury), the WaPo article starts out with an anecdote. Unlike the NYT’s anecdote, which was tragic, this one is just stupid:

On a sunny Saturday afternoon, Noreen Tofel sat cross-legged on her couch in Alexandria, Va., with her left arm stretched out on a pillow. A vein rose like a riverlet on a relief map. As nutrients trickled into her bloodstream, she talked about how IV drips fit into her travel regimen.

Before a work trip, Tofel, who works in human resources risk management, will schedule a drip to boost her energy and immunity levels. If she is planning an indulgent vacation, she will reverse the order. The healthy intravenous cocktail, she said, will make amends for the boozy imbibed ones.

“I want to drink my margaritas and have my piña coladas and kind of take my body for granted,” said Tofel, 39. “If I did the IV drip before, then I would feel bad drinking over it.”

Once just in hospitals, IV drips have become a crossover sensation in the health, wellness and travel sphere. Travelers previously had to rely on pain killers and sunglasses (hangover), melatonin (jet lag) or copious amounts of caffeine or sleep (exhaustion) to recover from travel-related afflictions. Now, they are hooking up to IVs to erase the excesses that could derail their vacation. And you don’t have to venture far to find them. IV drips are popping up in hotel spas, resorts, casinos and shopping districts. You can even order one from the cushiness of your rental property or hotel room.

“Once just in hospitals”? The science-based indications for intravenous vitamin and mineral therapy are really quite limited. One indication, of course, is in patients whose gastrointestinal tract is not functioning properly or not absorbing nutrients; such patients might require total parenteral nutrition (TPN), in which all the nutrients needed by the body, along with minerals and vitamins, are administered intravenously until the GI tract is able to function properly again. Of course, surgeons have long known that feeding using the GI tract is always better, when possible, than TPN; so we try to feed patients by that route as soon as possible, in order to get them off the TPN. Other specific indications would include abnormally low levels of certain minerals, like potassium, calcium, magnesium, or others, or critically low levels of certain vitamins, levels so low that they cant’ be replenished fast enough by oral supplementation. That’s it. I also can’t help but wonder if by “hospital environment,” what they really mean here is “clinic.” Again, intravenous drips containing minerals are commonly used in the hospital in sick patients, intravenous vitamin drips much less so.

Let’s just put it this way. Preparing to go on an alcoholic binge on vacation is not an indication for IV drips of…whatever. As much as I detest insurance companies, there is a reason why health insurance won’t pay for them. So, just as “IV bars” were a business opportunity, expanding the business to be a “wellness amenity” in hotels and Airbnbs was an even bigger business opportunity, which one quack is even quoted as saying, ““Taking it out of the hospital environment was his brilliant move… Everyone jumped on the bandwagon.”

The rest of the article serves mainly as an advertorial for dodgy quack clinics providing IV drips as an amenity to hotel and Airbnb travelers. It’s really quite blatant, so much so that WaPo hired a model for the photoshoot associated with the story. She is portrayed in soft light, wearing a white bathrobe, receiving IV drip “therapy” and then chilling at poolside afterwards. Again, these are the sorts of photos I would expect to see in an advertisement, not a news story, not even a fluffy travel story.

Let’s meet some of the quacks.

A panoply of dodgy sources

Andrea Sachs wastes no time in listing some of her sources:

“People get really dehydrated when they travel. They get hangovers and sun exposure. They’re at high altitudes when they’re flying,” said Sarah Muniz, director of clinical operations at PureDropIV, which serves the Washington, D.C., area and counts Tofel as a client. “Having the ability to get the hydration and B-12 vitamins and vitamin C really helps people bounce back.”

Ron Kapp, a Santa Barbara-based physician and anti-aging research clinician, said the therapy’s evolution from medical procedure to self-care treatment started in the 1960ѕ, when Jоhn Myers, аn іntеrnіѕt at Jоhnѕ Hорkіnѕ Hospital in Baltimore, discovered that injecting nutrients is more efficient than ingesting them. He created a rejuvenating concoction called the Myers’ cocktail. It’s now a staple on IV drip menus today.

In 2010, Jason Burke, a board-certified anesthesiologist and pioneer in the field, created an IV hydration remedy for folks who partied a little too hard. He cruised the Las Vegas Strip in a 45-foot-long Hangover Heaven bus, administering IV drips. The clinic-on-wheels is undergoing repairs and a refurbishment, but visitors can book an office appointment or schedule a rental house — or hotel — call.

It is certainly true that people can get dehydrated when they travel. Recycled air on airplanes is often insufficiently humidified, and travel can mean not drinking as much as usual. While intravenous therapy can certainly reverse dehydration, there is no compelling reason to go to such lengths when water is available. Worst case scenario, sports drinks, which contain minerals, will do just fine. As for the Myers’ cocktail, I’ve discussed this before. It’s basically an intravenous cocktail of various vitamins B vitamins, vitamin C, and minerals created by Dr. John Myers, who died in 1984. Myers never actually published his recipe for the cocktail, but the doctor who took over his practice, Dr. John Gaby, published a recipe that is the current one used for Myers cocktail, even though he admitted that he didn’t know exactly what was in Myers’ original concoction. Since then, quacks have developed, as you might imagine, many variants of Myers’ cocktail that continue to be referred to by the same eponym. There is no evidence that any of these Myers’ cocktail variants is efficacious for any of the conditions for which they are commonly used, although of course they likely can treat dehydration because any IV drips containing appropriate amounts of the correct minerals in amounts nontoxic at the concentrations used can treat dehydration.

Let’s take a look at some of the quack clinic cited. I’ll start with PureDropIV, which is described as an “on-demand concierge intravenous (IV) therapy service that delivers infusion therapy treatments to replenish essential fluids, vitamins, minerals and amino acids directly to the body for maximum absorption” and boasts that its “registered nurses provide IV vitamin and hydration treatments directly to you in your home, hotel, office, or event at your leisure” and how each nurse “undergoes an exhaustive selection process that meticulously validates licenses, certifications, work history, and educational qualifications, all of which must meet our uncompromising standards.”

Naturally, the PureDropIV features a quack Miranda warning at the bottom of its website:

The services provided have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat or cure or prevent any disease. The material on this website is provided for informational purposes only and is not medical advice. Always consult your healthcare provider before beginning any therapy program. All therapies are specific formulations prepared by PureDropIV.

Never mind that, though. According to the website, IV drips of vitamins and minerals claim the following benefits:

• “Supports whole body wellness.” (Whatever that means—see the Quack Miranda warning above).
• “IV therapy promotes healthy weight loss.” There is, of course, no evidence presented, even though the website claims that, while “not a substitute for exercise, a nutritional diet, or fixing a metabolic disorder – but it can help speed along the process to a new and improved you.” The company also claims their products can “organically flush the body of toxins and removes heavy metals that cause damage to your cells” and “boost your metabolism at a cellular level.”
• Quick hangover relief. Any sort of hydration is good for this. Just sayin’. You don’t need to spend hundreds of dollars on IV drips.
• “Peak athletic performance.” PureDropIV claims that its athletic formula can “flush free radicals, promote fast recovery, support muscle and tissue health, and deliver quick hydration and 100% vitamin absorption to the body,” (which is all nonsense, other than the hydration, which can be accomplished without IVs), while its muscle recovery formula “contains amino acids that create proteins to help the body break down food, grow, build and repair muscles during the recovery process.” Or you could just drink much cheaper protein shakes and take creatine supplementation. (Creatine is the only supplement of which I’m aware that has a decent evidence base behind it, at least for resistance training, something that has been known for decades, although its effects on performance are variable. Also, oral creatine is just fine.)
• Beauty therapy for long-lasting youth. Do I really need to say more about this claim?

The quack Miranda warning is necessary, of course, because none of what PureDropIV offers is an actual science-based treatment, although it offers various formulas ranging from $249 to $369 per bag, including for hydration (the least expensive), “energy boost,” recovery (apparently for muscles if you exercise more than you’re used to), and, of course, “immune boost” (the most expensive). You can also choose add-ons, like glutathione, for “detox.” PureDropIV also heavily markets NAD+ Therapy. NAD stands for nicotinamide adenine dinucleotide, and the biochemists out there will realize that NAD+ (along with its reduced form, NADH) is essential pyridine nucleotide that serves as an essential cofactor and substrate for a number of critical cellular processes involved in oxidative phosphorylation and ATP production, DNA repair, epigenetically modulated gene expression, intracellular calcium signaling, and immunological functions. It is also true that NAD+ is being studied as a therapeutic target for a variety of degenerative diseases. What is not true (or at least is unknown) is that intravenous NAD+ supplementation is a seemingly magical cure-all for cognitive function, strengthened immunity, anti-aging, “energy boost,” and decreased stress. It is, however, $699 a pop.

Finally, I can’t help but note that nowhere on the PureDropIV website do I see a mention of any physicians overseeing things. I do note that its founder, Jordyn Brown, doesn’t mention any medical credentials whatsoever, noting only, “Growing up surrounded by caring nurses who were not only strong and empathetic but also nurturing, I learned at a young age the transformative power of compassionate care.” Clearly, Brown is overqualified.

I’m picking (mostly) on PureDropIV, but all the companies and quacks who run them are very similar, both in the claims that they make and the services that they offer; for example, the WaPo story mentions:

According to the Global Wellness Institute, there were 7,000 medical-spas worldwide and thousands of IV drip centers and facilities last year, including hotel spas, wellness retreats and mobile clinics. Restore Hyper Wellness, for instance, has more than 225 locations. Reviv boasts clinics in nearly 50 countries.

Adam Nadelson founded the I.V. Doc in New York City in 2013 after he suffered a bout of food poisoning during his medical residency and rebounded with the help of an IV drip. His company has expanded to 33 U.S. cities, plus London and Ibiza, Spain. He said his team serves guests at many luxury hotel brands, such as the Ritz, Aman and Four Seasons.

“You name the hotel,” he said, “we’ve certainly been there.”

Shortly after Nadelson spoke those words, the I.V. Doc received a text from the Plaza New York. The concierge requested an appointment for a guest that day — emphasis on “soon.”

IV Doc, like PureDropIV, offers memberships for a monthly fee that includes a discount on many services, priority booking, and other perks. As I said, these services are all very similar, although IV Doc does offer something it calls “Neuro Boost” for $399 to “empower your mind and body.” As for these other retreats, Restore offers quackery ranging from all the IV drips to an “oxygen facial” to infrared saunas to red light therapy, while Reviv claims that IV drips can treat menopausal symptoms.

I could go on, but you get the idea.

Enter the “skepticism”

Over on X, the hellscape of a social media site formerly known as Twitter, it was noticed by some that:

Also, props for the sarcasm:

So let’s see this “skepticism.” Enter Beth McGroarty, vice president of research at the Global Wellness Institute. I wasn’t familiar with this institute; so I started poking around its website and was immediately drawn to its section on evidence, thinking that I could evaluate how science-based the organization is by looking at what it says about various treatments. As you can imagine, its page on acupuncture is…not good. It’s quite credulous, to the point of claiming that acupuncture can treat tension headache (it can’t) and that there is “limited evidence” that it can increase in vitro fertilization success rates (nope). I found similarly credulous takes on evidence for traditional Chinese medicine, halotherapy (salt therapy), forest bathing, and more. So, right off the bat, I wonder how “skeptical” McGroarty would be—as turns out, not too bad, but too little and too late:

Despite their popularity outside of hospitals, many experts in the medical and wellness fields are wary of IV drips. Beth McGroarty, vice president of research at the Global Wellness Institute, said the injection can lead to serious infections caused by improperly sterilized equipment or unclean skin. A reaction might occur during the treatment or hours to a day later.

Notice that her first warning is that the solution or needles might not be sterile, which is true but also a risk taken with legitimate, science-based uses of IV drips. The point should be first that these IV drips do not do what is claimed for them, other than perhaps reverse dehydration, depending upon the amount and composition of the IV fluids used, which means that even a tiny risk of these complications is not worth it for zero benefit.

Next up:

In addition, flooding your body with unnecessary vitamins, minerals and other substances can cause toxicity and overwhelm your kidneys. To underscore her point, she cited a Texas woman who died of cardiac arrest last year after an electrolyte injection.

This was better, but, again, notice how she doesn’t say that these IV drips don’t do what their sellers claim, which means that the risk of toxicity from too much mineral is not worth it for zero benefit.

Finally:

McGroarty also takes issue with the lack of federal oversight. The states regulate the practitioners, though governmental agencies occasionally step in with warnings.

In 2021, the Food and Drug Administration alerted consumers about unsanitary conditions at medical offices and clinics that administer treatments involving compounded drug products such as IV drips. “Contaminated, or otherwise poor quality, compounded drug products can lead to serious patient illnesses, including death,” the agency stated.

While this is true, but notice how in her concern about federal oversight she didn’t mention the 2018 FTC consent agreement (which I discussed then) with a company selling IV drips. Here’s a snippet from the press release about it:

The proposed settlement order, which is subject to public comment, prohibits iV Bars from making the false or unsubstantiated claims that its iV Cocktails: 1) are an effective treatment for any of the diseases included in the complaint; 2) produce fast, lasting results; or 3) cure, mitigate, or treat any diseases, unless the claim is supported by competent and reliable scientific evidence. The order also prohibits iV Bars from making any express or implied health, safety, or efficacy claims unless they are not misleading and are supported by scientific evidence.

In connection with the advertising, marketing, promotion, or sale of any covered product, the order prohibits iV Bars from misrepresenting that it has had medical professionals test or approve the product, or that it has a research facility. The order also prohibits iV Bars from misrepresenting the existence or conclusions of any scientific evidence, or that a product, including iV Cocktails, is scientifically or clinically proven to produce any benefit.

The agreement also required that the company admit to its customers that, contrary “to the company’s marketing materials, studies have not shown that the Myers Cocktail is an effective treatment for any disease, including nine specific diseases, ranging from cancer to multiple sclerosis and diabetes.”

There’s little doubt in my mind that the FTC could easily come to the same findings about any of the companies mentioned rather positively in the WaPo article if it bothered to.

Even as minimal as the token skepticism in this article is, Sachs immediately undermines it by, in essence, saying that these companies don’t do that sort of thing:

For Tofel’s drip, Madison Gnan, a registered nurse, removed the sterile items from their packaging, pulled nine vials of her travel case and made the cocktail to order.

“I would not go to a place that doesn’t open it in front of you,” Tofel said.

That’s right, Sachs seems to be saying, unlike those places that don’t compound their IV drips under sufficiently sterile conditions or administer them aseptically, you can trust PureDropIV’s concoctions to be made under sterile conditions that are sterile and not contaminated and to be administered by a nurses who know what they’re doing when it comes to administering IV solutions.

What’s the harm?

After all that we’ve written about the deadly COVID-19 pandemic and the tsunami of medical misinformation, disinformation, and outright lies that it provoked, why bother with what seems like an almost quaint example of false balance and token skepticism in the service of outright quackery of the variety that we would periodically discuss for years before the pandemic. Indeed, it’s not even about an obviously harmful form of quackery, like Stanislaw Burzynski’s antineoplastons, for which I used to write article after article about how the press portrayed Burzynski as a brave maverick who might have been onto something, or the antivaccine movement, for which we would castigate the press for including something about parents who believe that vaccines cause autism in every story about vaccines. It’s seemingly just a little flighty travel article about a dubious (and expensive) intervention that (probably) doesn’t hurt too many people, complete with shots of a model getting the treatment being discussed.

You can argue that of course you shouldn’t send a travel reporter to do a story about a medical intervention, and you’d be right. However, it’s articles like this (and, for example, a more “serious” but equally credulous WaPo article on acupuncture) that show the problem with how all too many news outlets and reporters view evidence. Worse, this one shows that newspapers and media outlets appear to have learned nothing over the last four years.

There. Itch scratched, I can now move on.