Has Dr. Oz Jumped the Shark?

It was bound to happen. It’s that moment in a television show when the deterioration is irreversible. For the popular 1970’s television sitcom Happy Days, it was when a water-skiing Fonzi literally jumped over a shark. And I think it may finally have happened with the Dr. Oz show. From a scientific credibility perspective, The Dr. Oz show is past the point of no return.

No, it wasn’t the silly green coffee bean “miracle” weight loss cure. Or his absurd clinical trial, that he conducted on his own audience audience without ethics board approval.

No, it wasn’t the “miracle” of longevity, red palm oil, which is anything but miraculous.

Nor was it past episodes featuring faith healing or even psychic John Edward.

The turning point was a few weeks ago, when the medical accuracy of Oz’s show hit a new low, with an episode on homeopathy. That same week, a detailed examination of Oz himself was published in the New Yorker. First, let’s look at the New Yorker piece, as it gives some context for the credibility erosion we’ve seen on the show. Written by Michael Specter, it’s entitled, The Operator: Is the most trusted doctor in America doing more harm than good? It’s the most detailed examination I’ve seen of Oz, with a narrative that goes from inside the operating room to the set of his enormously successful television show. I’ve been very critical of Oz in past posts – how he is an accomplished surgeon who should know better, like when when he has a homeopath as a guest who claims red palm oil prevents Alzheimer’s or reverses atherosclerosis. Yet he not only allows unfounded claims to go unchallenged, he regularly makes absurd, antiscientific comments himself. Spector’s column gives some relevant background:

It didn’t take long for Oz to become convinced that a patient’s state of mind could be important to a successful surgical outcome. With his father-in-law’s encouragement, he began to explore music therapy, energy fields, and therapeutic touch, and he began to offer them to his surgical patients. Here, too, Lisa [Oz’s wife] played a major role; she is a Reiki master, and Oz soon became famous at New York-Presbyterian, not to mention within the broader surgical community, for encouraging the practice of Reiki in the operating room.

It should not be a surprise to reader of this blog that therapeutic touch and reiki are pure quackery, just variants of faith healing.  And yet Oz’s wife is a Reiki master, effectively the alternative medicine equivalent of a holding a PhD in magic carpets. There’s no there there. It’s been proven not to exist by a 9-year-old. and yet Oz is credulous enough to promote these practices in the operating room. Spector’s article gives a few more clues about how Oz avoids the cognitive dissonance of practicing reductionist medicine (i.e., surgery) while simultaneously promoting therapies and treatments which at best, lack evidence, and at worst, may be harmful:

He describes modern medicine as a “civil war” waged between conventional physicians and those who are open to alternative cures for maladies ranging from anxiety to cancer; he considers it his mission to walk the line that divides them. But more often his show seems to erase that line completely, with results that may be less benign than Oz and his many viewers realize. “I want no more barriers between patient and medicine,” he explained to me not long ago, as we sat in one of the show’s production offices, just outside NBC’s Studio 6A, in Rockefeller Center. “I would take us all back a thousand years, when our ancestors lived in small villages and there was always a healer in that village—and his job wasn’t to give you heart surgery or medication but to help find a safe place for conversation.”

Which is perfectly consistent with his show, where Oz regularly ignores scientific evidence and promotes treatments which are the antithesis of good medicine. For the casual observer, this is is where the problems lies:  Oz can give good advice, but he regularly combines it with pseudoscience in a way that the typical viewer can’t easily distinguish between the science and the fiction:

Oz often says that he is just trying to present people with all their options, because they are sophisticated enough to make decisions for themselves. But some options are more beneficial than others, and medical experts are morally bound to explain the difference, as David Gorski told me recently. Gorski, an associate professor of surgery at the Wayne State University School of Medicine, is the managing editor of the influential blog Science-Based Medicine. “Oz has a huge bully pulpit, with the entire Oprah empire behind him,” he said. “He can’t simply dispense with facts he doesn’t find convenient.” Scientists often argue that, if alternative medicine proves effective through experimental research, it should no longer be considered alternative; at that point, it becomes medicine. By freely mixing alternatives with proven therapies, Oz makes it nearly impossible for the viewer of his show to assess the impact of either; the process just diminishes the value of science.

  Oz’s own words and actions make it clear that he’s rejecting (if he ever held) a science-based worldview:

Oz sighed. “Medicine is a very religious experience,” he said. “I have my religion and you have yours. It becomes difficult for us to agree on what we think works, since so much of it is in the eye of the beholder. Data is rarely clean.” All facts come with a point of view. But his spin on it—that one can simply choose those which make sense, rather than data that happen to be true—was chilling. “You find the arguments that support your data,” he said, “and it’s my fact versus your fact.”

This really is the crux of the entire feature. If you’re committed to a taking scientific perspective, you cannot pick and choose the data that fits your confirmation bias. Yet Oz believes medicine to be a religion – a faith system, and not an objective, scientific endeavor. Which tells you all about his commitment to his description to scientific accuracy on the Dr. Oz show. It’s a remarkable piece – go read it.

The Dr. Oz Homeopathic Starter Kit

How Spector’s piece came to be released on the same day as Dr. Oz announced his “Homeopathic Starter Kit” is either smart timing from the New Yorker or a a nice coincidence. The fact Dr. Oz was going to feature a show on homeopathy is no surprise – homeopaths have been lobbying for some time, they admit:

Your NCH team has been hard at work seeking ways to promote homeopathy to the nation – with success!!!  Last week we worked diligently with the producers of the Dr. Oz Show to create a show with a special focus on homeopathy. As a result, Dr. Oz is hosting a special show talking about this grand system of medicine on Monday, January 28th at 4pm on CBS stations across America!!! (Check your local TV listings.)  Watch as he interviews Naturopathic Doctor and NCH member, Dr. Lisa Samet, as well as Dr. Albert Levy, MD, FAAFP. Dr. Oz is a University of Pennsylvania trained MD, a well-known television personality, and is a strong supporter of Homeopathy.

I’ve blogged about homeopathy more times than I care to admit, because it’s the perfect case study for how easily both patients and health professionals can fool themselves when it comes to our health. Homeopathy is an elaborate placebo system where the “remedies” are so dilute that they contain no active ingredients of any kind. Homeopathy wasn’t discovered, rather it was invented out of thin air, by a German physician, Samuel Hahnemann. Hahnemann decided (there is no other way to describe it) that “like cures like” meaning that a substance that causes symptoms can also treat those symptoms if diluted sufficiently. This is, of course, false. For homeopathy to actually work, many of the core facts of physics, biochemistry and medicine would have to be wrong. None of this is the case – homeopathic remedies are the alternative medicine equivalent of Jack and the Beanstalk’s magic beans, and homeopaths go to great efforts to decide just which magic beans are best for a patient given their symptoms. (Interestingly, for all homeopaths claim about homeopathy treating the “root cause” of disease, the selection of “remedies” is solely based on patient’s symptoms. No investigations in to “root causes” at all are necessary.) Despite the known facts of homeopathy, its proponents position the practice as grounded in science, despite the fact that the remedies have been studied extensively, and perform no better than an equivalent placebo. Yes, you can find positive studies. But given the poor quality of most studies, it would be abnormal for there not to be the occasional positive study – it’s a simple consequence of the statistical analysis. After 200 years of study, there is no credible scientific or medical debate about the validity of homeopathy. None. Given the serious scientific credibility problems with homeopathy, what better proponent for the practice than Dr. Oz, who seems more than willing to reject the scientific evidence when it fits his confirmation bias?

The segment (preceded by another segment on detox, which is simply another alternative medicine marketing tactic) is online for your viewing pleasure. There’s an accompanying post on the Dr. Oz website:

The basic concept of homeopathy is “like cures like.” Hence, homeopathic practitioners use potentially toxic substances to provoke defense and self-regulatory responses. Hence, something that causes an illness (like vomiting) could cure the illness if it’s served in smaller, less-concentrated quantities.  Homeopathic products can come from plants, minerals, venom of poisonous snakes, or, sometimes, prescription drugs.

Which is actually incorrect, as most homeopathic remedies are so dilute that that there is effectively zero possibility that they contain even a single molecule of the original product. The 30C “potency” is common – it’s a ratio of 10^-60.  You would have to give two billion doses per second to six billion people for 4 billion years to find one molecule of the original material. So while Dr. Oz profiles several products, they are, for all measurable purposes, indistinguishable. They are sugar pills – pure placebo.

“My family has been using homeopathy for three generations” – Dr. Oz

So just what gets profiled on the Oz show? Oz starts off with his own starter kit. A naturopath describes five different remedies:

• Belladonna for fever – “The perfect remedy” says the naturopath. She recommends a 200C “potency”, which means you would have to consume a pile of tablets larger than the entire universe to get a single molecule of belladonna. Not surprisingly, the degree of the dilution isn’t disclosed – the naturopath only calls it a “tiny” dose, which is quite an understatement.
• Phosphorus for cough – “The person who does well on phosphorus usually craves cold drinks” says the naturopath.
• Gelsemium for influenza – “The person who is so weak they can’t get out of bed”
• Pulsatilla for upper respiratory infections – “For lots of yellow mucus.. tends to be sad and needs and wants affection.”
• Nux vomica for indigestion, bloating and heartburn – “They tend to be chilly, irritable, inpatient”

It’s worth repeating that these “remedies” are chemically indistinguishable. That is, if the labels were removed, there would be no way to differentiate the remedies through testing, as none contain any active ingredients. (James Randi has offered $1 million dollars to anyone that can identify a homeopathic “remedy” versus a comparable “placebo”. No homeopath has yet accepted the challenge.) Oz is effectively endorsing the idea you buy five identical packs of sugar pills to treat medical conditions ranging from indigestion to fever.

Next up? The True Believers – physicians who have “integrated” homeopathy into their medical practices.

“Most doctors schooled in conventional medicine don’t have a lot of faith in homeopathy, because we are still trying to understand why it works” – Dr. Oz

Oz works hard to attach a veneer of scientific legitimacy to homeopathy – if only the Big-Pharma-worshipping-health-professional-sheeple would understand, it’s not “if” it works, but “why” it works! But you don’t need to answer “why” until you answer the “if”. And the “if” has been definitively answered. Oz profiles three physicians, all of whom provide glowing testimonials for homeopathy:

• Dr. Scott Stoll, who claims success with a product called Guna-Sleep, which according to the manufacturer is “a homeopathic blend of choice herbals and metabolic factors such as melatonin”. The label reveals a dilute mix of herb, animal gland extracts, interleukin and drugs like melatonin, all in a 30% alcohol solution. Evidence it works? Nothing but Dr. Stoll’s anecdotal evidence.
• Dr. Albert Levy recommends arnica cream and pillules. He claims it helps speed injuries. This remedy has actually been tested, and some versions are not dilute enough to be truly homeopathic. Dilute or not, arnica is no more effective than placebo.
• Dr. Karlene ChinQuee takes homeopathy to a whole new level, by combining it with another pseudoscience, acupuncture. Voila, “biopuncture” which is essentially injecting “remedies” (read: water) into acupuncture points which she claims will reduce pain and improve mobility. There’s no reason to think that water injections offer anything more than placebo effects to patients.

In the final segment, the naturopath returns to describe Bach Flower Remedies, and highlight “Rescue Remedy” which is, like the other remedies, free of active ingredients. Harriet Hall at Science-Based Medicine summarized the evidence based for Bach Flower remedies quite succinctly:

People Actually Believe This Rubbish

Rescue Remedy has been critically reviewed, and Edzard Ernst published a paper in 2010. His conclusion was also succinct and unambiguous:

 All placebo-controlled trials failed to demonstrate efficacy. It is concluded that the most reliable clinical trials do not show any differences between flower remedies and placebos.

None of this evidence makes its way into Dr. Oz’s glowing profile. And is it any surprise? Oz is a true believer. Thankfully, and to the show’s credits, the printed show notes actually acknowledge that scientific reviews show fail to demonstrate homeopathy has any meaningful effects, though they cite a Swiss health technology assessment as positive evidence when in fact that report has already been thoroughly discredited.

Conclusion

It’s no longer accurate to describe The Dr. Oz show as a health program. This is infotainment, with segments that now look like parodies of sensible health information. How can anyone take the information he offers seriously? He has no hesitation endorsing the use of  sugar pills for fever, anxiety, pain, cough, respiratory tract infections, sleep disorders, and musculoskeletal injuries. By discarding the facts when they don’t fit his confirmation bias, Oz does his viewers a disservice. His show needs a disclaimer. Like horoscopes and psychics, the Dr. Oz show is “For entertainment purposes only.”