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The Cleveland Clinic: Promoting dubious diet advice on Twitter and beyond

I’ve mentioned on quite a few occasions that there’s a quote attributed to philosopher Arthur Schopenhauer that is much beloved of cranks:

All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.

I also like to point out that Schopenhauer probably never said this and just how silly the thought behind this quote is when you think about it. Unfortunately, as I was perusing Twitter yesterday, I couldn’t help but think of this quote, but not in the way quacks and cranks usually intend. Rather, I was thinking of a modified version of it to describe my feelings towards quackademic medicine.

Quackademic medicine, as you might recall, is a term first coined (as far as I can tell) by Dr. R. W. Donnell to describe the infiltration of outright quackery into academic medicine in the form of “complementary and alternative medicine” (a.k.a. CAM), which is now more commonly referred to by advocates as “integrative medicine,” the implication being that integrative medicine provides the “best of both worlds,” alternative medicine and real medicine. In actuality, it does nothing more than “integrate” pseudoscience and quackery into real, science-based medicine. In any case, in the world of quackademic medicine, one of the quackiest of the quackademics, a veritable bastion of quackademic medicine, is the Cleveland Clinic. It’s an academic medical center that has always had a lot of woo in its integrative medicine department, but in 2014 it surpassed itself by being the first academic medical center to host a traditional Chinese medicine (TCM) herb dispensary and clinic, run by a naturopath. Not satisfied with that, later that same year, it started a functional medicine clinic run by the founder and guru of all that is functional medicine, Mark Hyman, who also wrote an antivaccine book with Robert F. Kennedy, Jr. himself. Functional medicine, of course, is basically quackery gussied up to look like scientific medicine that is basically making it up as you go along. Unfortunately, that hasn’t stopped the Cleveland Clinic’s functional medicine clinic from being wildly successful.

So basically, my version of that fake Schopenhauer quote applied to quackademic medicine tends to boil down to: All quackery passes through three stages. First, it is ridiculed. Then it is violently opposed. Then it is “integrated” into medicine by credulous academic medical centers like the Cleveland Clinic.

What got me thinking about this was an incident yesterday where I happened to see in my Twitter feed responses by people I’m following to the Cleveland Clinic’s Twitter account. It wasn’t pretty. The reason it wasn’t pretty is because of what the Cleveland Clinic’s social media people were Tweeting. Mixed in among the usual self-promotional Tweets designed to promote the institution were some real howlers. For example:

My first reaction to this was that this sounds like something I would find being promoted by Dr. Oz’s or Oprah’s or—dare I say it?—Gwyneth Paltrow’s Twitter feed, not the Twitter feed of a respected academic medical center. What actually brought my attention to this particular Tweet were the reactions though, reactions like:



And perhaps my favorite:

Indeed. As was pointed out, spinach is great stuff from a nutritional standpoint, but it won’t give you a firmer bottom because of its vitamin C. It might help you get a firmer bottom if you eat more green leafy vegetables and exercise, but that’s less popular a message.

There’s more where that came from, unfortunately:

OK, the term “superfood” is a marketing term, not a term that has anything to do with medicine or science. It is a term that should never be seen on the Twitter account (or on other social media) of a reputable academic medical center. There is no such thing as “superfoods.” The term “superfood” implies, well, something “super” in the food, that the food is somehow far superior to most other foods or has some sort of nutrient that allows it to improve or bolster health or cure disease. Let’s listen to a real professor of nutrition:

“There’s no such thing as a superfood. It’s nonsense: just one of those marketing terms,” says University College Dublin professor of nutrition Mike Gibney, throwing on the garb of Ireland’s superfood Grinch. “There is no evidence that any of these foods are in any way unusually good.”

Yet here’s the Cleveland Clinic claiming that kiwi, pineapple, guava, and papaya are “superfoods” that’ll give you smoother skin. It’s antiaging woo combined with nutrition woo, and it’s all over the recent Twitter feed of the Cleveland Clinic. For example:

Of course, the benefits of antioxidants aren’t nearly as clear as the Cleveland Clinic would lead you to believe, and there’s a paucity of evidence that antioxidants do anything like that. Worse, one almost gets the feeling that Oprah now owns the Cleveland Clinic:


Either that, or a fashion magazine has taken over. As a friend of the blog put it:

In any case, is there anything more inane, from a medical standpoint, than these Tweets from the Cleveland Clinic? A significant fraction of recent Tweets seem to be pushing vegetables more as a source of substances that’ll rejuvenate a woman’s skin, giving her a tight bottom and smooth lips and:

Seriously, who has snakeskin hands? Is that anything like snakeskin cowboys?

I suppose I shouldn’t be surprised. If you had taken a look at the webpages for the Cleveland Clinic Center for Integrative & Lifestyle Medicine, you wouldn’t be surprised either. Take a look at the services offered:

  • Acupuncture
  • Chinese Herbal Therapy
  • Chiropractic Services
  • Guided Imagery
  • Holistic Psychotherapy
  • Lifestyle U
  • Massage Therapy
  • Reiki Therapy
  • Yoga

Take a look at what it says about reiki:

Reiki is a form of hands-on, natural healing that uses universal life force energy. The term comes from the Japanese words “rei,” which translates into universal, and “ki,” which means vital life force energy that flows through all living things. This gentle energy is limitless in abundance and is believed to be a spiritual form of energy. It is not tied to any specific religion or nationality.

The Reiki practitioner is the conduit between you and the source of the universal life force energy. The energy flows through the practitioner’s energy field and through his or her hands to you. The energy does not come from the practitioner; it comes through the practitioner from the universal source. There is no energy drain on the person giving the treatment. You may experience the energy as sensations such as heat, tingling, or pulsing where the practitioner places her hands on your body, or you may feel these sensations move through your body to other locations. This is the energy flowing into you. Some people may not perceive any change at all. Most people feel very relaxed and peaceful. Many clients even fall asleep while receiving Reiki treatment.

Elsewhere, the Cleveland Clinic asserts that it offers reiki for:

  • Cancer
  • Infertility
  • Parkinson’s disease
  • Psychological illnesses
  • Chronic pain
  • Digestive problems
  • Stress-related diseases

Every time I go back to the section about reiki on Cleveland Clinic’s website I keep hoping that I won’t find that passage. I’ve been hoping in vain for several years. This is the same text I found on a pamphlet from the Cleveland Clinic at least seven years ago. Of course, as I’ve explained time and time again (more times than I can remember, but it’s worth explaining briefly again), reiki is nothing more than mystical magical wishful thinking. Think of it this way. Its adherents claim reiki “works” by allowing the reiki master to channel “energy” from what reiki believers call the “universal source” through him and into the patient in order to heal. Now substitute the word “Jesus” or “God” for “Universal Source.” Now what are you dealing with? That’s right. You’re dealing with faith healing. The only difference is that reiki bases its faith healing on Eastern mystical beliefs instead of the Judeo-Christian god.

And the Cleveland Clinic has been featuring a credulous description of this superstitious belief on its website for several years now, at least.

That’s not all, of course. the Cleveland Clinic also offers the Esselstyn Program, which is a plant-based diet program to “reverse heart disease” developed by Caldwell B. Esselstyn Jr., MD. He’s a former surgeon who’s become a vegan evangelist. According to his book, Preventing and Reversing Heart Disease, to reverse hear disease you must follow the following rules:

  • you may not eat anything with a mother or a face (no meat, poultry, or fish)
  • you cannot eat dairy products
  • you must not consume oil of any kind
  • generally you cannot eat nuts or avocados

As the Skeptical Cardiologist has pointed out, Esselstyn’s program is based on incredibly bad science. For example, he points out that the best randomized controlled clinical trials that we have for diet to prevent heart disease “have shown that supplementing diet with olive oil and nuts substantially lowers CAD.”

Longtime readers know that I did my general surgery residency at University Hospitals of Cleveland back in the late 1980s and early 1990s and that I got my PhD at Case Western Reserve University in the early 1990s. I know Cleveland. Even though, back in those days, the Cleveland Clinic was the bitter rival of University Hospitals, there was always respect. When I moonlighted as a flight physician for Metro LifeFlight for two and a half years, the Cleveland Clinic was a frequent destination for the transport of cardiac patients. Its cardiology and cardiac surgery programs were world class then, and they’re still world class. That’s why it’s so depressing to me to see what the Cleveland Clinic has become.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

53 replies on “The Cleveland Clinic: Promoting dubious diet advice on Twitter and beyond”

Schopenhauer’s quote is : “To truth only a brief celebration of victory is allowed between the two long periods during which it is condemned as paradoxical, or disparaged as trivial”. Which is not very different from the other quote, and not silly at all. And has very few to do with the Cleveland Clinic.

Actually, that quote is quite different from the quote attributed to him that I discussed because there is nothing about these “truths” as inevitably being accepted as “self-evident.” That’s the part of the quote that makes it very silly. Actually, go back and read my discussion of the quote. The whole quote is silly because many truths aren’t violently opposed or condemned.

I’ve just read the JAMA article “Unintended consequences of expensive cancer therapeutics—the pursuit of marginal indications and a me-too mentality that stifles innovation and creativity: the John Conley Lecture.”
It’s a lot to digest, but first thing I thought was ‘altmed loons are gonna love it’… Water to their mill.
What do you think about this analysis? I’m slightly confused, tbh.

I won’t mention where I practice. The acute pain service has received and I am already resisting the offer of assistance from some local reiki practitioners. Also on a recent OB anesthesia call lets just say- epidural 1, essential oils 0 !

Oral # 2
Truths and untruths are violently opposed or condemned if they threaten some interests. Otherwise, they are simply ignored.

@ Amaria
There is no innovation and creativity in alternative medicine, just a different kind of conformism.

I won’t mention where I practice. The acute pain service has received and I am already resisting the offer of assistance from some local reiki practitioners. Also on a recent OB anesthesia call lets just say- epidural 1, essential oils 0 !

Yeah, it’s everywhere. There’s a common progression. First reiki practitioners offer their services for free. Some hospitals fall for this and reiki masters get a foothold in those hospitals. Then, if the program is popular, the hospital considers hiring a reiki master or two. Then the program gets entrenched.

The Cleveland Clinic is just among the worst.

I guess fermented food is out on the Esselstyn Program. (For non-cooks and bakers, “Mother” is a common term for an already fermented portion added to a new batch to start it fermenting),

The discussion thread on the previous post about the fake Schopenhauer quote mentioned the quote from Carl Sagan:

They laughed at Columbus, they laughed at Fulton, they laughed at the Wright brothers. But they also laughed at Bozo the Clown.

That last item neatly encapsulates the fallacy to which people offering the fake Schopenhauer quote succumb. Just because a proposition goes through the first two stages doesn’t mean it’s actually true. Often a proposition will go from being ridiculed to being violently opposed because somebody did the experiment and found that the proposition was not only wrong but dangerously so. Orac has discussed several such cases in previous posts.

I do have a couple of nits to pick with the Sagan quote. One, it’s not entirely fair to Bozo, who was one of the best in the world at his chosen profession (i.e., he wanted people to laugh at him). Two, Columbus’s critics actually did have a point. They didn’t doubt that the earth was round (that myth seems to have been invented in the 19th century); they correctly objected to his claim that the Earth’s circumference was about 30,000 km, rather than the 40,000 km that Eratosthenes measured in ancient Greek times. Columbus was lucky that there turned out to be a previously unknown continent about as far west of Spain as he claimed Japan would be.

. . . There’s a common progression. . . . services for free. . . . Then the program gets entrenched.

Ack. That sounds like how drug dealers work. Well, at least they offer something that has an effect.

It’s times like these that I’m tempted to open a Twitter account…fortunately, the temptation passes.

Dear Cleveland Clinic,

If I eat pineapple, I will have smoother skin. The mortician’s staff will see to that. I eat broccoli 4 or 5 times a week because I love it. I still have old lady skin and lips – possibly because I’m an old lady. I don’t even know where to go with spinach = firm bottom. But, it certainly gave me a much needed laugh!

I think this is the marketing department at work.

What twenty-five year old is going to eat more vegetables and fruits to prevent long term chronic disease, but if it improves one’s appearance today…. now there is a great argument.

There might even be something to this (with a lot of YMMV), Eating healthy food can make one feel better, and if you feel better (or lose weight) you can look better.

Between the perplexing ingredient selection and the poor knife technique in that image, I can only imagine that the outcome is not going to be good.

@ Eric
Maybe the worst fallacy is in the idea that truth eventually wins. What about religions, astrology, homeopathy, acupuncture and so on ?

I can’t swear that eating lots of spinach will give anyone a “firm bottom” but it’s well established that eating lots of spinach will give some folk an increased risk of kidney stones.
If you want a firm bottom, get off of it and move it around.

they correctly objected to his claim that the Earth’s circumference was about 30,000 km, rather than the 40,000 km that Eratosthenes measured in ancient Greek times. Columbus was lucky that there turned out to be a previously unknown continent about as far west of Spain as he claimed Japan would be.

I had never heard that, Eric Lund #9. Public education sux; We were taught the myth. Though, ‘Japan’?? I was taught India thus the native americans became called ‘Indians’.

@Eric #9, @Gilbert #15

It was known in Colombus’ time that the Earth was round, but that knowledge was mostly kept away in ancient Antiquitiy knowledge. Copernicus and Galileo were persecuted by the Church, which had much more power and message control than they. The problem was not the flat/round Earth per se, but more of the Earth/Sun/Center of Universe relationship, and what orbits what. The fear of sailors of falling off the edge of the world, and sea monsters, was real, because the lay man did not get to know the scientist’s view very often, but went to Church every Sunday.

Colombus didn’t start on his journey with only just his hunch that the Earth was round, and he got financed because the theoretical knowledge existed too. The Americas were not really known and recognized then in Europe (only the Norse had been there, but the Basque had visited the coastal waters too, and both knowledge source were mostly oral and disregarded/unknown), and Colombus’ big mistake was that he hadn’t reached the Indies but thought he had. Europeans who had known the Indies from the other way around knew immediately they were not at the same place. Magellan’s trip was more precise, and even then, he misjudged the size of the Pacific Ocean which was way larger than anyone thought. His slave, Enrique, who could speak to the tribes in the Philippines but was bought in Malaysia, is probably the first man to circumnavigate the globe in history. But that expedition did reach its intended destination.

Sorry for that long OT posts…

Often, much of woo-fraught ( so-called) health/ diet advice amounts to appearance-centred hacks for women who have feelings of inferiority.

All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.

Even if Schopenhauer had said it, and even if it was broadly true of “great truths” …

It still wouldn’t say that only truths are ridiculed and opposed – stupidity and lies can be and often are ridiculed and opposed, but never accepted.

(“They laughed at Einstein!” … “They also laughed at Bozo.”)

The foods that come closest to having the set of nutrients needed for healthy skin are the skins of other animals.  Which skin to eat depends on your own skin problems.  If you have oily or scaly skin, for example, you should not eat fish skin.  If you have bumpy skin, you should not eat chicken or goose skin.  For most people, pig skin comes closest to the ideal of a healthy smooth skin.  This is widely available as fried pork rinds, sold in the snack section of supermarkets everywhere.

But Mark!
Many of the woo-enticed would never eat anything which had a face or a mother!
And pigs and chicken do!

My usual response to the quote at the top of the post is, “Sure they laughed a Galileo. They also laughed at The Three Stooges.”

I was taught India thus the native americans became called ‘Indians’.

Usage of geographic terms, like other aspects of language, evolve over time. In Columbus’s day the Indies were the islands to the east and southeast of the Asian mainland–e.g., what we now call Indonesia. The modern country of India was then known as Hindustan; its current name is derived from the Indus River, which ironically is in Pakistan, not India (the British Raj included those two countries plus Bangladesh).

My memory is hazy, but I have a recollection of Columbus circling an island he thought was Japan. It was actually Cuba.

This is a related quote: “A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.”

-Max Planck (Nobel Prize winner)

“The Reiki practitioner is the conduit ……. There is no energy drain on the person giving the treatment.”

Just a drain on the finances of the Reiki con’s victims (“patients).

Those tweets remind me a lot of the ridiculous things I see in the tabloids and magazines at the checkout line at the grocery store (lose 20 pounds in 2 weeks!). And based on those statements, I am disinclined to believe anything else I read in those publications.

And it’s the same way for the Cleveland Clinic. Sure, it used to be super respected, but all those tweets make me concerned that the quality of *all* of their care has gone down, not just that they’ve adopted nonsense. How is the average patient supposed to know if they will still be offered good, evidence-based, science-based medical treatment?

Eat spinach for a firm bottom. This leafy green contains the #collagen boosting nutrient vitamin C, which keeps your skin tight and firm.

So out of the thousands of plant foods that contain Vitamin C, only spinach is mentioned?

If spinach gives you a firm @ss, then I wonder what the Pauling Therapy can do? (Ever watch Death Becomes Her?)

@JustaTech #27:

ridiculous things I see in the tabloids and magazines at the checkout line at the grocery store (lose 20 pounds in 2 weeks!).

The only way they can get someone to lose twenty pounds in two weeks is if that person spends £1.43 a day on those stupid magazines!

@ Rich Woods
You can lose more than 20 pounds in less than two weeks, but it costs an arm and a leg.

The Cleveland Clinic’s tweets are fairly innocuous and easily ignored. But almost everything from @MarkHymanMD makes me want to gouge my eyes out. Mostly because I don’t consider him a crank, but a woo-peddling opportunist. I try, but it’s pretty ineffective to troll on Twitter 🙁

#22 justawriter

usual response to the quote at the top of the post is, “Sure they laughed a Galileo. They also laughed at The Three Stooges.”

Well yes, Galileo was being an idiot but no one laughed at him.

If he had a theory that held water then he was probably fine; a theory that is palpably false, well he is in trouble. Cold fusion anyone?

This is my usual response to the Galileo crap. Galileo was taken seriously until it became obvious that his “theory” was nonsense. Any theory that predicts one tide a day is not likely to be endorsed by clerics who grew up on the western coast of Europe.

And let’s see, clerics from western France, Spain, Portugal maybe present day Netherlands? Probably laughing like mad.

And remember the Jesuits in Rome ( at the Pontifical College) were among the most leaned astronomers in Europe at the time. And they had problems with his theory.

There is no doubt that he was a brilliant experimental but some of his later theories were a bit dicey.

Still, for a man in his 60’sm with arthritis and failing eyesight, house arrest in his own home does not seen a real persecution.

And reportedly he published another three books ( in Amsterdam to be sure) before he died.

My god, he really was persecuted.

Eat spinach for a firm bottom. This leafy green contains the #collagen boosting nutrient vitamin C, which keeps your skin tight and firm

Hey it works for me. I love spinach.
Err, combined with the 4–12 KM cycling every day but I did get a complement the other day.

Vaccine Truther, no vegetables, but the cheapest milk you can find. That’s made by dairy cattle that are given hormones which increase udder size and capacity. That’s what you want.

@ jkrideau
“If he had a theory that held water then he was probably fine”
How can you know? Galileo was persecuted not because he was wrong , but because he was a threat to Aristotelian order.

Well, if it works for Popeye’s forearms, I’d say spinach might firm your gluteals. If you’re a cartoon character.

#37 Daniel Corcos

Galileo was persecuted not because he was wrong , but because he was a threat to Aristotelian order.

Oh definitely, sorry I did not mean to imply otherwise. That was why he was summoned before the Inquisition but if his theory had worked he almost certainly been okay. Aristotelian order was not fundamental Church doctrine. The Church could, fairly easily, adjust to it.

He had already been censured for suggesting that a heliocentric solar system theory was “true”. The Church didn’t seem to mind if he wanted to present the idea as a “thought experiment” but they wanted “very” solid proof before they would question Aristotle.

He claimed that his new theory was true. The theory did not work properly and he presented it in a way that seemed to imply that the Pope was an idiot or, at least, that’s how the Pope interpreted it. Apparently Galileo was not always the most tactful or politically astute person.

“Aristotelian order was not fundamental Church doctrine”
Actually it was very important

It may very well have been very important, I’m not at all conversant with its impact on Church thought but, again, I’d argue not fundamental. Aristotle was a pagan philosopher not a church father or something out of the bible.

Actually the Bible’s statement that the Sun stopped was probably a more serious issue but the Catholic Church never insisted on a literal interpretation of the Bible if solid conflicting evidence showed that a certain bible passage should be interpreted as allegorical. See recent Popes stand on evolution.

It might have taken a lot of hair-splitting and theological footwork to switch to a heliocentric theory but that’s one of the reasons for keeping theologians on the payroll.

The Church was not anti-science but having a very important, if not really fundamental, piece of doctrine challenged meant that one needed really strong evidence. One, probably, need to be a good salesman too. Galileo seems to have failed in both and he was very lucky not to have been convicted of heresy.

Try denying the Virgin Birth or the Trinity and then you are in real trouble. Those were/are very fundamental to Catholic doctrine. I believe these were some of the many things that got Giordano Bruno burned at the stake. These were real heresies.

One of the many charges against Bruno seems to have concerned his astrological (?) theories but here again it seems it was not his heliocentric theory so much as his denial that the world would never end. That was/is heresy.

There are many less politicized examples of scientific heresy. Take Gilber Ling’s theory on the Association-Induction Hypothesis.

This seems like a better theory than the Membrane-Pump Hypothesis, yet it is dismissed by the orthodoxy. I have this seminal book in the mail (first edition) and will be able to talk more authoritatively on the matter in the future.

Look at the history of scurvy and Vitamin C if you want to see how the obvious can be ignored for decades by scientists intent on finding a bacterial cause.

@ Ted Striker
The association-induction hypothesis has been cited 104 times from 1973 to 1991, which seems to indicate that it was not so heretical. After this date, it was cited only 5 times. Maybe this has to do with the identification and cloning of the membrane pumps….

# 43 Daniel Corcos

At this time, heresy consisted in saying that the host could not contain the body of the Christ, and the Catholic Church found support in Aristotle writings to declare it possible. Everybody who was against Aristotle was heretical.

As far as I am aware saying that the host could not contain the body of the Christ, still is heresy.

I think you are underestimating the mental agility of the Church theologians. I am pretty sure that they would be able to make an exemption for a heliocentric model if the evidence was good enough.

If I am reading that Transusbstantian wiki correctly it looks to me while Aristotelian philosophy was important in supporting the concept of host as the body and blood of Christ it was not essential.
Certainly the belief seems to have been held long before the Western Church adopted Aristotelianism and the wiki points out that one did not need it formally.
In Roman Catholic theology

The distinction between “substance” and “accidents” – the latter term is not used in the Catholic Church’s official definition of the doctrine but has been used in the writings of theologians – arose from Aristotelian philosophy, but in Roman Catholic eucharistic theology is independent of that philosophy, since the distinction is a real one, as shown by the distinction between a person and that person’s accidental appearances

Still, I probably should grab that new bio of Galileo by David Wooton and see if he has any new information on the issue.

Take a look at what it says about reiki:

Reiki is a form of hands-on…

Not even ten words in and they’re already getting it wrong.

Membrane pumps. You keep using this word Daniel, but I don’t think it means what you think it means.

Identifying a protein and calling it a pump does not necessarily make it so.

@ Ted Striker
I acknowledge that the “pump” is a protein that transports molecules across the membrane, and not a real pump, but does it change anything?

Pedantic point… The original quote far upthread has now been revived by the Great Pumpkinhead in a recent speech and was incorrectly attributed to Gandhi: “First they ignore you, then they laugh at you, then they fight you, then you win.” There is apparently no evidence that Gandhi actually said it.

@ Sara
There is some truth in this quote, which may seems quite general but is biased. Another statement “First they ignore you, then they laugh at you, then they fight you, then you lose.” is also true.

You can’t “fight” wrinkles, you prevent them by using sunscreen and wearing a hat in the sun. This also helps protect against skin cancer. You’d think a clinic would want people to know this.

The only certain way to prevent wrinkles is to die young. Not many clinics seem to recommend that.

@rs — or you can get fat. As ZsaZsa Gabor supposedly once said, ” As a woman, you have to choose between your fanny or your face.”

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