Oprah and Chopra sittin’ in a tree…

I know I’ve been very hard on Oprah Winfrey the last couple of weeks, taking her to task for her promotion on her show of medicine that is at best dubious and at worst quackery, as promoted by frequent guests like Suzanne Somers, Dr. Christiane Northrup, and the queen of the anti-vaccine movement, Jenny “I’m not anti-vaccine but would never, ever vaccinate” McCarthy. Not that Oprah cares. After all, she’s Oprah, and I’m only a lowly blogger who, although having one of the top medical blogs out there, is as an ant to Oprah’s elephant of a media empire. Still, NEWSWEEK did a fantastic expose of the dangerously off-base medical advice being pushed on a weekly basis on Oprah’s show, and all that Oprah could come up with was this in response:

For 23 years, my show has presented thousands of topics that reflect the human experience, including doctors’ medical advice and personal health stories that have prompted conversations between our audience members and their health care providers. I trust the viewers, and I know that they are smart and discerning enough to seek out medical opinions to determine what may be best for them.

In other words, let the viewer beware! Oprah takes no responsibility for the quackery her show routinely dishes out. Never mind that she has the most popular talk show in history and she must know that her audience is greatly influenced by what she says. Never mind that she has said in the past that she doesn’t have guests on the show with whom she disagrees. Never mind that she had nothing but words of praise for Suzanne Somers and her book on bioidentical hormones, that she recommended bioidentical hormones herself, and that she not only praised Jenny McCarthy repeatedly but signed her up for a deal with Harpo Studios to develop her own talk show. None of it is her fault, and she’s not endorsing anything. Kevin Trudeau couldn’t have put it better.

There is, however, one person who may cause Oprah a bit of trouble. Ironically, it’s one of her staunchest supporters. Indeed, it’s someone we’ve met many times before on this blog, and he’s outraged that NEWSWEEK would be so mean to Oprah. Indeed, I’m referring to a man for whom I once coined a term to describe his mystical, magical, pseudoscientific New Age blather. Oprah, meet Chopra. Deepak Chopra, that is. Again.

And where do you think Chopra has written his defense of all things Oprah? Come on, take a guess! That’s right; it’s in that repository of all things woo, The Huffington Post, in an article entitled Mainstream Medicine and the Oprah Factor. He begins by planting his lips firmly on Oprah’s backside (he is, after all, sometimes a guest on Oprah’s show)

The story failed to gain traction for obvious reasons. Oprah has aired innumerable shows on health, of which the controversial ones are a tiny minority. Her intention to improve women’s lives on all fronts is so obvious as to be almost above criticism. The credibility for women’s well-being and welfare she has earned day after day over the past two decades will not be undone with a story that cherry-picks the guests who can be made easy targets of ridicule by the medical establishment. And the fact that she has celebrity guests who have causes and crusades in the area of health, such as Jenny McCarthy or Suzanne Somers, is not the same as Oprah herself endorsing what they say.

Bullshit. Oprah praised both Suzanne Somers and Jenny McCarthy on her show. She recommended Somers’ book on bioidentical hormones to her audience, raved about how great she felt after she started to take bioidentical hormones, and has made Jenny McCarthy into one of her proteges, poised to get her own TV show thanks to her, just like Dr. Phil and Dr. Mehmet Oz. There’s a reason I started this post with Oprah’s lame defense against the NEWSWEEK article, namely so that I could deal with it first and then dismissively point out that Chopra is merely parroting the same excuse. As for only a “tiny minority” of Oprah’s shows being controversial, well, how does Chopra know? In any case, even if it were true, the sheer pseudoscience and quackery dished up to millions by Suzanne Somers and Jenny McCarthy are so bad that it doesn’t matter if every other bit of Oprah’s health advice was as tame as tame can be. Of course, it’s more than just them; it’s also Oprah’s uncritical embrace of that woo-iest of New Age woos, The Secret, which led a woman named Kim Tinkham to reject conventional therapy for her stage III breast cancer, as documented in the NEWSWEEK article and as I’ve blogged about.

But let’s see what other Choprawoo the master wants to lay down in defense of Oprah:

The medical profession is burdened with a host of problems that Oprah addresses with more candor and force than the AMA. She promotes wellness and prevention, two areas that drastically need improvement. She brings up creative solutions to problems that medical science is baffled by, such as the healing response itself and the role of subjectivity in patient response. These are issues that few M.D.s are willing to explore, yet she has done so for decades.

Instead, we got a response from an oncologist in Canada repeating the establishment position: alternative treatments of cancer are bogus, subjectivity has no place in science, “soul talk” about illness is rubbish. This is exactly the kind of dismissive arrogance that drives millions of people away from conventional doctors.

Note how Chopra once again, like many CAM boosters, tries to equate “alternative” medicine with prevention and wellness. That’s utter poppycock. One might argue that conventional scientific medicine doesn’t emphasize lifestyle interventions, but the “wellness” interventions advocated by CAMsters like Chopra are either science-based interventions appropriated by the CAM movement and “rebranded” as “alternative” (exercise and diet, for instance) or consist of pumping loads of unproven and often impure supplements into the body as “nutrition.” Unfortunately, Oprah’s “creative solutions” to health problems consist of listening to woo like Christiane Northrup saying that “in many women, thyroid dysfunction develops because of an energy blockage in the throat region, the result of a lifetime of ‘swallowing’ words one is aching to say.”

Such nonsense is not science-based. It’s mystical, prescientific superstition.

As for that Canadian oncologist, let’s just say that I have a sneaking suspicion that I know who that person is and that he’s rather close (he’s also not Canadian). In any case, let’s just say that Chopra can lay down the Choprawoo so well that he channels Mike Adams “the Health Ranger” in going off the deep end with conspiracy theories:

Scientific medicine by and large ignores wellness, prevention, and alternative medicine in general. On a daily basis doctors don’t deal in these things; few take courses in medical school centered on them. That’s why a massive movement has arisen driven by patients themselves. Oprah serves as a public outlet for a conversation that needs to be ongoing. As long as official medicine, backed by huge pharmaceutical companies, denies the existence of the problem, much less alternative solutions, the movement will remain patient-centered and the attitude toward alternative medicine will be one of unfounded disdain, suspicion, and ignorance on the part of physicians.

Chopra, of course, doesn’t know what he’s talking about. (But, then, what else is new?) Physicians are taught nutrition in medical school; they are taught prevention. As for alternative medicine, unfortunately, increasingly they are being taught the same sorts of unscientific alternative medicine beloved of Deepak Chopra, as I’ve railed about time and time again right here on this very blog. As for the attitude of physicians towards alternative medicine, there’s a reason why it’s looked upon with disdain. It’s because the vast majority of it outside of herbal medicine is based on prescientific notions of disease that are highly implausible from a scientific viewpoint. But you know what? Their attitudes would change pretty fast if the woo-meisters could provide scientific evidence that their woo works as well or better than what science-based medicine can offer. They’d not only appropriate them as conventional medicine; they’d take credit for them!

Of course, neither Chopra nor his fellow merry CAMsters can produce such data. Indeed, NCCAM has spent $2.5 billion and hasn’t found such data.

Not that that stops Chopra from cherry picking and misrepresenting the data, as he has done so many times before:

This lopsided emphasis has created dilemmas that official medicine hasn’t remotely solved:

* In Seattle a recent study of 638 patients with chronic lower back pain were given either some sort of acupuncture or standard treatment with anti-inflammatory drugs and massage. On average, the acupuncture patients received twice as much benefit as those on standard treatment. The kicker is that some of the patients received fake acupuncture — they were pricked superficially with toothpicks — and received the same relief.

Wrong, I say. Wrong, says Steve Novella. The study shows nothing of the sort. It is hilarious, though, that Chopra takes the fact that sham acupuncture with toothpicks worked as well as “real” acupuncture as evidence that acupuncture “works.” In fact, the study cited by Chopra shows just the opposite of what he says it does. In fact, that study shows very definitively that acupuncture does not work any better than a placebo.

No rant against conventional medicine would be complete without the “iatrogenic holocaust” gambit:

* Iatrogenic disease, roughly defined as illness that results as a complication from a doctor’s care, leads to between 230,000 to 284,000 deaths every year, making it the third leading cause of fatality in the country.

Oddly enough, Chopra doesn’t cite primary literature but rather letters to the editor of JAMA. Interestingly, some of the letters point out how inflated these estimates are, for instance this letter by Dr. Jonathan D. Reich:

Dr Starfield relates the poor quality of US public health to often-quoted statistics about medication errors and other iatrogenic causes of death. The statistics on iatrogenic deaths are extrapolations based on limited reviews of adverse drug reaction forms, and their accuracy is questionable.2 More important, these statistics are used without any reference to the type of patients experiencing these adverse events.

It is misleading to state that “. . .(medication errors and nosocomial infections) constitute the third leading cause of death . . . after heart disease and cancer.” People who die of iatrogenic causes are, by definition, already sick. Since heart disease and cancer are the most common causes of death, many of the patients who died of iatrogenic causes actually died of heart disease and cancer and are thus listed twice…

The conjecture that public health statistics are better in other countries because we have too many iatrogenic deaths is to assume that other counties have systems of preventing medication errors and regulating procedures that do not exist in the United States. I have practiced medicine in and spoken to many practitioners from other countries, and I am not aware of such systems. If there are no additional safeguards in other countries, then US physicians are either incompetent or taking care of sicker patients. While there is no evidence to support the first contention, there certainly is evidence to support the latter. The United States spends more resources on critical care and terminal care than any nation on earth.

Suffice it to say that the oft-cited figures for iatrogenic deaths are dubious at best. Personally, I consider one iatrogenic death to be one too many, but I also know that no effective medicine is without risks. There will always be iatrogenic deaths, and our job is to try to keep that number as low as possible, but the risk-benefit ratio of scientific medicine still remains favorable. Of course, Chopra has no idea how many deaths are caused by “alternative” medicine or how many patients die because they rely on the sort of quackery that Chopra promotes. The reason? No one keeps track–unlike the case of scientific medicine.

Let’s see what else Chopra has to say:

* Two of the most frequently performed surgeries, heart bypass grafts and balloon angioplasty, became fashionable without serious testing (the government approves drugs but not surgical procedures). They continue to be used in the face of perennial findings that neither procedure increases life expectancy. Besides relieving symptoms, which of course can be very troubling to the patient, both procedures carry serious risks. (The most recent finding showed that diabetics with stable heart disease do not survive longer if given heart surgery.)

The study that Chopra cites is this one, which only looked at type II diabetics with heart disease. it’s long been known that type II diabetics have higher rates of coronary artery disease than those without diabetes and that they don’t do as well when they do develop heart disease. Moreover, both bypass and angioplasty are more effective in nondiabetics at relieving symptoms.

Here’s the one that needs the biggest slapdown:

* In the past, such common procedures as hysterectomies and radical mastectomies were widely performed without testing their efficacy. Not until European results revealed that lumpectomies were often just as effective did American surgeons question the staunch support of mastectomies. One might also consider that surgeons were very slow to perform cosmetic breast replacement for women who faced devastating psychological fallout from their mastectomies — a typical neglect of any patient’s subjective response to illness.

Wrong, wrong, wrong. First off, radical mastectomy was a procedure developed over 125 years ago by William Halsted. The reason it persisted for so long is because there was no effective adjuvant chemotherapy or radiation for breast cancer for many decades. Surgery was it; if surgery didn’t cure the cancer, there was nothing else to use. Consequently, radical surgery was what became tried and true, surgery that today makes us cringe to think about it. But there was no radiation to reduce recurrence rates and no chemotherapy to reduce metastasis. Be that as it may, do you want to know what study definitively showed that a modified radical mastectomy is just as effective as a radical mastectomy? NSABP B-04. But there’s more. Guess what study showed that lumpectomy and radiation therapy produced the same long term survival in breast cancer? NSABP B-06, which was reported in 1976. Here’s a hint, Deepak: NSABP is an American group. Here’s another tidbit. Want to know who the person most responsible for the idea that breast cancer is a systemic disease and that less surgery, if it is accompanied by adjuvant radiation and chemotherapy, can produce equivalent survival? Bernie Fisher. An American. No, I’m not at all disparaging European physicians and scientists; they have made many contributions to the treatment of breast cancer. I’m merely pointing out that Chopra is talking out of his ass when he tries to paint American physicians and surgeons as somehow so much more close-minded and dogmatic than their European counterparts.

As for the reluctance to perform cosmetic breast replacement, again, Chopra doesn’t know what he’s talking about. Perhaps that was true a couple of decades ago. Back then the concern was whether reconstruction would make it too difficult to detect a recurrence. Once studies made it plain that that wasn’t the case, reconstructive surgery took off. Indeed, it is not uncommon for women to undergo immediate reconstruction done as part of the same procedure with their mastectomies.

Chopra is also eager to take credit for…nothing that alt-med should be taking credit for:

It’s one thing for official medicine to decry alternative medicine and hurl accusations of quackery, not just at the non-M.D.s who work as health practitioners but at licensed, highly educated and qualified physicians who are creative enough to explore new avenues of treatment. Their own lack of curiosity and creative thinking is disturbing. Does the most brilliant researcher in the world know why cancer sometimes spontaneously disappears? Why a patient with obsessive-compulsive disorder or depression can respond equally well to talk therapy and drugs — that is, why talk is as effective as chemicals in altering the brain? Or how the body’s healing system is influenced by outside forces?

The. Stupid. It. Burns.

Let me turn the question around: Does Deepak Chopra know why cancer sometimes spontaneously disappears? Why a patient with obsessive-compulsive disorder or depression can respond equally well to talk therapy and drugs — that is, why talk is as effective as chemicals in altering the brain? Or how the body’s healing system is influenced by outside forces?

He does not. He only wants you to think that he does.

No, it is not woo-meisters like Deepak Chopra who will answer such questions, as much as he would like to snooker readers into thinking that he has some sort of insight into these questions that scientific medicine lacks. He most definitely does not. No, it’s science that will someday lead to an understanding the biology behind these processes. I suspect that, deep down, Chopra knows that, which is why he is so disingenuous the time:

Scientific medicine is leery of so-called anecdotal evidence, that is, individual stories of disease and cure. Their skepticism is rational and well-founded. We all agree that without impartial studies, the advance of knowledge becomes chaotic and untrustworthy. But Oprah is letting individuals tell their stories for other, positive reasons: to share their pain, to reach out to others in the same circumstance, to provide hope.

No, the reason Oprah provides those stories is because they make compelling television. It doesn’t matter to her if they distort of misrepresent science. All that matters is: Do they make good TV? Will they bring ratings? Will their stories of woo interest Oprah’s audience?

The problem with medicine today is not that it is too scientific and dismissive of “alternative” medicine. In actuality, the problem is that medicine today is too anxious to embrace the sort of pseudoscientific “quantum” nonsense that Deepak Chopra lays down on a regular basis. A couple of years ago, Richard Dawkins featured Chopra on his two-part TV special The Enemies of Reason. In his defense of Oprah, Chopra demonstrates just how well Dawkins had him pegged.