When the letters are meaningless

Let’s just dispense with something right away, shall we?  Dr. Mehmet Oz is a far more accomplished physician than I will ever be.  From the recent profile of “America’s doctor” in The New Yorker:

Oprah Winfrey first referred to Mehmet Oz as “America’s doctor” in 2004, during one of his earliest appearances on her television show. The label stuck. Oz was a rare find: so eloquent and telegenic that people are often surprised to learn that he is a highly credentialled member of the medical establishment. Oz graduated from Harvard University in 1982. Four years later, he received joint medical and M.B.A. degrees from the University of Pennsylvania. He then moved to Columbia and New York-Presbyterian Hospital, where, as a surgeon specializing in heart transplants, he has served as vice-chairman and professor in the department of surgery for more than twenty years. (He still performs operations there each Thursday.) Oz also directs Columbia’s Cardiovascular Institute and Integrative Medicine Program, which he established in 1994, and has published scores of articles on technical issues, such as how to preserve muscle tissue during mitral-valve replacements. He holds a patent on a solution that can preserve organs and one on an aortic valve that can be implanted without highly invasive open-heart surgery.

Those are some impressive achievements, and it would be ludicrous to aver that Dr. Oz doesn’t deserve a great measure of respect for them.  Indeed, I almost feel sheepish, pissant little private practice pediatrician that I am, for daring to criticize him as a physician.


Because, as the above excerpt indicates, Dr. Oz is only really a doctor one day a week nowadays.  Nowadays Dr. Oz spends the rest of his time as a highly-successful television personality.  And underneath the patina of faux legitimacy his genuine medical triumphs confer is a distressingly large pool of snake oil.

“The Dr. Oz Show” frequently focusses on essential health issues: the proper ways to eat, relax, exercise, and sleep, and how to maintain a healthy heart. Much of the advice Oz offers is sensible, and is rooted solidly in scientific literature. That is why the rest of what he does is so hard to understand. Oz is an experienced surgeon, yet almost daily he employs words that serious scientists shun, like “startling,” “breakthrough,” “radical,” “revolutionary,” and “miracle.” There are miracle drinks and miracle meal plans and miracles to stop aging and miracles to fight fat. Last year, Oz broadcast a show on whether it was possible to “repair” gay people (“From Gay to Straight? The Controversial Therapy”), despite the fact that Robert L. Spitzer, the doctor who is best known for a study of gay-reparation therapy, had recanted. (Spitzer last year apologized to “any gay person who wasted time and energy” on what he conceded were “unproven claims.”) Oz introduced a show on the safety of genetically modified foods by saying, “A new report claims they can damage your health and even cause cancer.” He also broadcast an episode on whether the apple juice consumed daily by millions of American children contains dangerous levels of arsenic. “Some of the best-known brands in America have arsenic in their apple juice,” he said at the outset, “and today we are naming names.” In each of those instances, and in many others, Oz has been criticized by scientists for relying on flimsy or incomplete data, distorting the results, and wielding his vast influence in ways that threaten the health of anyone who watches the show. Last year, almost as soon as that G.M.O. report was published, in France, it was thoroughly discredited by scores of researchers on both sides of the Atlantic.

The article is lengthy, and goes into a great amount of detail about the kind of stuff and nonsense that comprises a sadly sizable amount of Dr. Oz’s airtime.  Furthermore, the estimable Orac at Respectful Insolence has covered the topic, and I hate to offer up a second-rate version of what someone else has already done well.  Interested parties are politely directed there.

But there’s something particular that I want to make clear.  As a physician, I do not view Dr. Oz’s attention to homeopathy or the latest whiz-bang supplement that will do nothing but separate customers from their money as a sign of admirable open-mindedness.  Touting fad diets and offering a platform for debunked junk science is not an indication that Dr. Oz is unconstrained by professional bias.  It is not a complement, expansion or blossoming of his medical practice.  It is a betrayal.

Doctors aren’t scientists per se, at least not those of us whose practice is entirely centered on patient care.  But science informs (or at least is meant to) everything that we do.  Knowledge of the scientific evidence in support of any given clinical practice is necessary to be a competent physician, and competence is one of the two necessary qualities of any good medical provider.  (The other is compassion.)  Stoking your audience’s interest in remedies and rituals with no scientific evidence to support them is to turn your back on what makes medicine work.

What infuriates me about Dr. Oz is that his entire career as an entertainer is premised on his expertise as a surgeon.  His medical training lends the appearance of intellectual rigor where there is none.  It confers ersatz respect to products, viewpoints and people who deserve none.  At this point in his career (with the exception of one day per week), those letters behind his name aren’t a credential, they’re a sales gimmick.

Deepak Chopra is another ready example of this kind of misapplied legitimacy.  His gimcrack theories and blandly palatable pop psychology sell a lot of books, many with the gleam of his MD right there on the cover.  Make no mistake — what he peddles isn’t medical advice, no matter how sage his musings about Jesus or the afterlife or whatever.

These men and people like them dilute and pollute our understanding of what medicine really is.  Reiki and homeopathy and “applied kinesiology” and all the rest of it aren’t medicine, at least not until their boosters and practitioners can cough up some evidence that they actually do some good beyond the placebo effect.  (You’ll forgive me if I refrain from holding my breath.)  By promoting these forms of quackery, chicanery and shoddy or misrepresented science, Dr. Oz erodes his legacy as a physician.  The letters behind his name do not legitimize what he is doing.  Rather, he delegitimizes them.

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88 thoughts on “When the letters are meaningless

  1. It’s funny, before I got to the end of the post, I had found myself thinking, “this reminds me of Deepak Chopra.”

    Russell, is there any chance Oz covers these topics in a “it’s popular and controversial, but it’s also bunk” kind of way? I have never heard of the guy until now, so I don’t really know.

    If not, it’s a pretty good data point that the drive for better ratings does to TV medicine what it does to TV news.


    • Yet another quote from the article:

      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.”


      • And he explains everything right there.

        Which universe would you rather believe in:

        A) A cold, hard, mechanistic, universe with Newtonian rules for everything smaller than stuff that’s too big for us to comprehend and larger than stuff too small for us to comprehend?

        B) A universe that responds to your desires, your intentions, your beliefs, and your dreams and where, if something doesn’t work out, it indicates something about your own intensity rather than about the universe itself?

        B can be awfully tempting… and, indeed, there’s a handy explanation at the ready when something doesn’t work out.


  2. Some great points.

    A few comments:

    (1) I think it would have been interesting if Jerome Groopman had written the profile of Dr. Oz for the New Yorker.

    (2) Is it possible that Dr. Oz genuinely believes in the power of what he does? (I’m just playing devil’s advocate here, so please don’t take me to task too harshly.) There is a lot of evidence that convincing people that something will cure them – even if it is benign or neutral – is enough to cure them. The placebo effect is one such well-understood example. Maybe Dr. Oz really is selling snake oil, but snake oil is what’s helping people (as opposed to the cruel realities of existential skepticism). In order to criticize Dr. Oz then, you must value truth for its own sake, even if truth is not in the patient’s best interest.


    • Touting something because it will make people “feel better” while knowing that the effects it purports to have are nil isn’t medicine, no matter how happy to makes people. It’s fraud.

      And how much does he believe of what he sells? Another quote from the article:

      “Oz doesn’t follow any of the miracle cures or fad diets that he trots out so regularly for his audience.”


      • The issue is that I am not sure how much of an overlap there is between the Oprah audience and the New Yorker audience. People who read the New Yorker probably already thought of Dr. Oz as a snake oil salesman.

        Like you, I was surprised by his credentials. He is a serious doctor. Why can’t he go on TV and be a serious doctor? What is it about the American psyche that does not want this? I think the popularity of Dr. Oz and Oprah says more about Americans than it does about them.


          • “Nothing we can give you will prevent old age and death,” “The research is still very preliminary on this question,” “You’re going to get sick sometimes, sorry” etc are all probably not the kind of audience draw that gets your contract renewed.


            • But by providing the audience with a little bit of the unseriousness it wants to hear, they’ll continue to stay tuned in for the important stuff and at least become more aware of how they should be monitoring their bodies.

              I imagine if there were some way of quantifying the effect Dr. Oz has on public health, it would show a net benefit despite all the cringing.


              • Well, first of all I think figuring out how to set the measures on that study would be nigh unto impossible.

                And then one has to ask, even if there is some unquantifiable net benefit in the nation’s health from whatever Dr. Oz is pitching, at what cost in essentially worthless juices and pills and purges and diets and all the rest? How much worthless garbage will people buy/ingest/imbibe/undergo and at what expense for some essentially ineffable boost to their sense of wellness?


                • I think you could do it empirically. Find some group of people who watched Oz up to some point but were quickly disgusted by it and stopped watching and observe them longitudinally against a group that continues to tune in faithfully. (I don’t think you’ll be winning any NIH grants any time soon for such a study, but it’d be interesting.)

                  I value truth for its own sake, but what say you of AA for instance? Doesn’t Alcoholics Anonymous essentially operate on a similar business model as Dr. Oz? What’s the difference between believing that Jesus or Vishnu or Cthulhu or Sauron died for our sins and believing that acupuncture will cure what ails us if such beliefs result in desired health outcomes? How many clinicians would refuse to endorse AA for a patient because the organization compels irrational belief in a higher power (whether for empirical reasons or out of genuinely-held conviction)? There are legitimate physicians who will recommend all sorts of woo if they think it will benefit a patient.

                  I’m with you on Dr. Oz: I think he’s largely a quack and a nutcase, and that his credentials are a detriment to truth. But truth and patient outcomes are not always in sync. I think there are some macropsychological phenomena going on here that at least compel a closer examination and probably a slightly softer rebuke.


                  • Good luck tuning out all the noise from that study, my friend.

                    I think you’re reducing AA to only one of its elements, which does not alone comprise all of its means of helping people. My thoughts on AA are mixed, but mostly positive. Belief in a high power is, indeed, one of its Steps, but there are other concrete elements that give it more power to help people than mere belief alone.

                    And that still leaves open the question of how much benefit to Patient/Viewer X. How much better must he feel to justify the money he shelled out for those supplements made from green coffee beans? Or red palm oil? Etc etc etc


                    • Points taken about AA and the fact that my perspective assumes watching Oz confers net health benefits. But I still think the comparison is apt. Admittedly I’ve only seen Oz in bits and pieces here or there, so I cannot be certain, but, certainly there is at least some real health education going on?


                    • AA can be done with little or no spiritual beliefs. You can call the door knob your higher power if you wish. Its the incredible network of social support, guidance and friendship that is the really transformative thing.


                    • Oh, I’m not denying the truth of your last sentence at all. I think a great deal of legitimate medical education occurs during his program, for which I think credit is due. And, y’know, dude deserves respect for what he’s managed to do as a real doctor.

                      But then he goes and sullies those legitimate achievements by tagging the resulting faith they instill to things that deserve no faith. I can understand needing to fudge a little around the edges to hold people’s interest, but (as is described at length in the link to Respectful Insolence ) when he shills for homeopathy? Nope. That’s a clear indication that he’s decided to abandon some cardinal principles.


              • Carl Sagan never had to fluff up his Astronomy & Physics with Astrology. He did get a little New Agey now & again, but only when talking about the limits of human understanding.

                People still loved to learn from him.


          • They might watch him, if he were acting like a serious doctor. If I were producing his show, I’d have an A&R guy out there in the weeds of the medical profession, finding issues which troubled ordinary people and filled their hearts with fear. Fear sells.

            Let’s put people’s fear of cancer. Huge issue. Well, what is cancer anyway? How do you “get” cancer? Damn, I could write up a whole season’s worth of material on cancer alone, beginning with questions from the Oprah Crowd, the ordinary well-meaning folks who live in fear of this ‘n that giving them cancer. Explaining things is an art. There is a certain amount of magic to a good explainer. Bring in cancer survivors, have them tell their stories. Cancer is ten thousand stories. People are literally dying for lack of accessible information.

            Sure, nothing will prevent old age and death but there’s plenty we do know about both, things people want to know. The research might be preliminary but it’s all based on some interesting hunches made by some interesting people. How do they go about acting on those hunches and turn them into cures, especially when we know a given drug won’t “cure” everyone? We’ve got a bunch of rednecks digging for gold in the Amazon, doing land office business on History Channel and they’re not digging out a big nugget every day — and we can’t make digging for a cure as interesting? I don’t buy it.

            This stuff could and should be made interesting. Eventually, someone’s going to pitch that idea and it will take off like gangbusters.


              • Ecch, would that Randall was half as smart as he thinks he is. Snark is no substitute for clever. The saga behind AIDS is more interesting than you might suppose. If I was writing that cartoon, I’d show about ten thousand centrifuges spinning away with one or two of them holding a useful protein fragment which might save millions of lives.


                • And the non-scientist would look at that and say “wow, look at all the science you’re doing! Surely a cure is gonna happen today, if not sooner!”

                  And the scientist replies “well, no, actually we don’t even expect these ten thousand centrifuges to get anywhere. Half of them won’t even give us a *failure*, because something will go wrong with the test and the results will be gibberish. And the rest are mostly just running down the end of a cell line that we already know is a loser. But we won’t even know *that* for another ten hours or so, and then we can start to–hey, where are you going? I *am* making this interesting! This is as interesting as it gets!”


                  • Oh please. Nobody spins up ten thousand centrifuges without a reason. And it’s high time Joe and Jane Public came to terms with the reality of what a medical “cure” means. Presented correctly, it’s no different than the Bamazon Show, all those fat knuckleheads out there in the jungle getting their asses eaten by fire ants and dreaming and scheming and the tracks coming off their machinery.

                    Research is interesting. Lot of big egos in those labs. More drama than friggin’ Tennessee Williams. One good molecule under patent and there’s more money in that hole than a gold mine.


            • +1

              A smart show where a doctor like Oz meets with patients and talks about the relevant science as he tries to cure or treat them and discusses their emotions and background could be incredible and gripping. Maybe he occasionally discusses the latest possible advances in a serious way, sort of like a Nova episode or something. A cross between House, Ricki Lake, and Nova.

              The problem is that smart shows that are well researched take a lot of work. (Try to create an episode of Nova or Frontline that airs new episodes daily for many months at a time.)

              By contrast it is easy for the producers to have Oz say, “maybe this miracle cure works. Let’s show a 30 second clip of people saying it worked for them and conclude with a ‘maybe’ that keeps people excited.”

              I’d bet Oz started with the best of intentions to a do a serious show, then his producers took over and fed him a bunch of stupid shows and segments and he couldn’t figure out how to do a better show that got ratings. Granted, he should’ve walked away in disgust or asked for a different format of show, but given the format and the time and resources (and stupidity level) of his producers, I bet the option was quit or do the junk he’s doing.


      • That’s definitely right.

        I was using the example of placebo as an analogy above for how lifestyle decisions – whether or not they are directly, physiologically beneficial for a patient – can affect a patient’s health for the better if the patient believes that what he is doing is affecting his health for the better by, for example, reducing stress or causing a patient to be more in tune to a certain aspect of his physiology.


  3. The few times I have seen him delve into the woo along with several articles about him that I have read, all indicate his presentation of alternative nonsense with only the mildest bit of criticism even when there is overwhelming contracdictory evidence. It’s is the credulous “I am open to the idea” and “science can’t explain everything” canard. He is an enablere of fraud and snake oil salesman, whose presentation and credentuals serve as an endorsement.


  4. Well, you know the old joke about what surgeons use for birth control: their personalities.

    An excellent surgeon exists in the context of an excellent surgical team, excellent post-op, excellent follow-up. The surgeons might be the fighter pilots of medicine but those fighter pilots know who owns their aircraft and keeps them in the air: the crew chiefs.

    Seems to me Dr. Oz has lost his way. So, for that matter, has Sanjay Gupta over at CNN, though less-so than Dr. Oz. Sutor, ne ultra crepidam, let the cobbler stick to his last. When it comes to cardiac surgery, I’d gladly tune in to see what Dr. Oz has to say about these clever new anastomotic devices and advances in robotic surgeries and suchlike. But on any other subject, why not bring in Subject Matter Experts? That way you won’t have debunkers like James Randi saying things like this about you, calling you a Promoter of Nonsense:

    The Media Pigasus Award goes to Dr. Mehmet Oz, who has done such a disservice to his TV viewers by promoting quack medical practices that he is now the first person to win a Pigasus two years in a row. Dr. Oz is a Harvard-educated cardiac physician who, through his syndicated TV show, has promoted faith healing, “energy medicine,” and other quack theories that have no scientific basis. Oz has appeared on ABC News to give legitimacy to the claims of Brazilian faith healer “John of God,” who uses old carnival tricks to take money from the seriously ill. He’s hosted Ayurvedic guru Yogi Cameron on his show to promote nonsense “tongue examination” as a way of diagnosing health problems. This year, he really went off the deep end. In March 2011, Dr. Oz endorsed “psychic” huckster and past Pigasus winner John Edward, who pretends to talk to dead people. Oz even suggested that bereaved families should visit psychic mediums to receive (faked) messages from their dead relatives as a form of grief counseling.


  5. A great piece, with great sources. Thanks, Russ. I long suspected that Dr. Oz was a quack from what little I saw/read of him. Then I saw on Wiki he is quite accomplished and didn’t know what to think. This is of great use. Though it just further confirms my philosophy of avoiding doctors like the plague. :-D


  6. I thought an interesting part of the article was about how his dad disapproves of his celebrity status and constantly asks about when he is going to go back and practice “real medicine”. It is also interesting that his wife’s vaccine skepticism rules the house even though he disagrees with it (is it ever possible for a dad to win this kind of argument?) He also seems to be under the influence of the step-father.

    However what he is pitching is exactly what the Oprah audience wants. These are the same people who think Dr. Phil is a respectable psychologist instead of the mockery he is of the subject. Oprah sells fairytales and inspiration, not the tough work of actual medicine and actual psychology. These people want the miracle cures that are oh so easy.


  7. Why should i believe Oz about anything when he ” never did give nothing to the Tin Man
    That he didn’t, didn’t already have “


  8. Over the years, I’ve run across a large number of MDs who peddle Woo of some variety or another & use their credentials as a way of bolstering their opinion. Some I’ve just run across, others I actually visited as a patient (& the moment the Woo came out, I started looking for a new Doctor).

    When my mom had cancer, the sheer amount of Woo she was peddled by MDs blew my mind.

    I long ago decided that MD != Scientist. Maybe science informed, or science minded, but not necessarily a practitioner of, or believer in, the scientific method.


  9. I caught one episode of the show and it happened to be the apple juice / arsenic one. His data and findings seemed a little suspect and after a small amount of Googling, I found that he was full of sh!t. The lab refuted his findings, there’re was no “panic”, it was all BS.

    And don’t get me started on Dr Phol.

    Oprah has done a LOT of good with her shows, but unleashing these two charlitons undoes a lot of goodwill.


  10. My uncle was a flight surgeon and for a time the youngest captain in the Navy. He would have been the youngest admiral but turned down promotion 3 times because he couldn’t continue to practice medicine. After the Navy he went on to teach at a prestigious medical school holding an endowed chair. He was scrubbed up and in the operating room for the world’s first heart transplant (along with about 40 others IIRC). For all that, he kept his preconceived notions about medicine. If I heard him say it once I heard it one hundred times, “Only surgeons are /real/ doctors, the rest are just pill pushers”. Interestingly, he made that comment at a party at my parent’s when I was young and my best friend’s dad, coincidentally a pediatrician was right there. Without missing a beat he replied, “Surgeons are just the mechanics of the medical profession”. Having thus attacked and parried, the two became life long friends.

    Once I was out golfing with my uncle, an old navy chief and me. We were on the CNIC Oceana course at that time one of the courses was reserved for officers the other for enlisted. The chief and I were guests of my uncle. We had caught up to the group ahead of us and sat on the benches while they teed off. The very macho very muscular fighter pilots were hammering their drives and one of them drove the green, a good 345 yards according to the marker. I turned to my uncle and said, “Wouldn’t you like to drive it 345 yards?” He said, “I’d bet that guy can’t reach inside someone’s chest and massage their heart and bring them back to life”. I said, “Have you done that often?” and the chief said, “He did it for me”.

    Given what Gawande says about medicine: “We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.” I’m not surprised that there will be confusion in the ranks at least. On the mechanic versus pill pusher front, I’m reminded of my years going to Napa and buying the latest and greatest synthetic oils and fuel additives to forestall the eventual demise of my vehicles. Were those “pills” worth the money or was I just fooling myself? Would I have had to go to the “mechanic” more or less had I skipped all that? Did my car “live” longer because of the pills or the mechanics, or both?


  11. Great post, Russell. (I was thinking of Dr. Drew, who is also pretty bad at times, though maybe better than Phil or Oz or Chopra.)

    I think it is hard for us to accept both of the following:

    1. Oz is a brilliant, hard working, focused guy who has had great success as a surgeon and a professional, working hard to save and improve lives.

    2. Oz is a charlatan peddling BS that ruin lives and hurt people.

    Indeed, we want to place #1 in the past tense: “Oz was a brilliant…” But really, both 1 and 2 could be true at the same time. In fact, there is no conflict at all there, despite some kind of deep seated need we have to think of 1 and 2 as logically or psychologically incompatible.

    I think being on television (on a show like his, or in a different way, a reality show) probably brings out weird awful stuff in a person that no one would’ve ever guessed is there. The context of where a person is or what they are doing can change them, almost instantly, in radical ways.


    • Dr. Drew really went off the rails, didn’t he? He used to be fairly reasonable/respectable, if a bit over-fixated on the idea that any female who ever called into “Lovelines” with any problem, must have been abused at some point in her childhood. But now he does this celebrity rehab trash and it’s just sad.


  12. On a completely separate note: Good luck and be careful to all those in the Northeast. That nor’easter sounds nasty.

    It’s been warm here in AK and we’ve been hurting for snow and you guys are getting all of it.


  13. The one time I saw his show he had on Glynnis McCants (sp?), a fishin’ numerologist of all things! She takes your name or birthday and converts it into a single digit and from that she was claiming to be able to glean… something relevant to your health, God only knows what. And the good doctor was just nodding and going along with it all.

    I shall not watch again.


  14. Dr. Oz and Dr. Sears are two physicians who have stopped being science minded and reasonable, and instead have bought into their own ‘hype’.



    Alternative vaccine schedule pulled out of thin air?


    I have no respect for either of them.


  15. It somewhat reminds me of how the press and public think a “xenobiologist” is somehow heads and shoulders above a regular biologist, even though xenobiology is a science without a real subject at this point (a single alien cell, or even a fossil of a single alien cell, would be infinitely more subject matter than they currently have).

    Somehow the “xeno” prefix got accepted as a legitimate mark of scientific authority, at least as long as people don’t push it by minting themselves xenoeconomists or xenosociologists so the press will interview them as “experts” – in wholly imaginary fields.


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