The Great and Powerful (Dr.) Oz, dissected in The New Yorker

In the beginning, medicine was religion. Indeed, if you look at the history of medicine, you’ll see that the very first physicians were virtually always religious figures in addition to their roles as healers. Indeed, in ancient Egypt, for example, the professions of priest and healer were one, and most medicine involved incantations, invocations of magic, and, of course, prayers to the gods, who were believed to be both the cause and the cure of human disease. Amulets were particularly popular, and consisted of three types: homeopoetic, phylactic and theophoric. Homeopoetic amulets, for example, portrayed an animal or part of an animal, and the wearer hoped to gain the attributes of the animal, while phylactic amuletes were believed to protect against evil gods and demons who sought to cause harm and theophoric amulets portrayed gods.

Of course, 4,000 years ago all of this made sense. People believed in gods who intervened directly in human affairs and believed that priests could intercede. They also had no scientific understanding how the human body functioned or broke down. Not surprisingly, the main areas in which ancient Egyptians developed treatments that didn’t depend primarily on prayer or magic were traumatic injuries, as I discussed a very, very long time ago after having seen the Edwin Smith Papyrus at the Metropolitan Museum of Art. They also realized that blood was important and that the heart pumped it. They also knew about breast cancer and tried treating it with cautery. Not surprisingly, it didn’t work too well.

It took many hundreds of years, which stretched into thousands of years, before it was fully accepted that medicine should be based on science. Indeed, arguably, it wasn’t until 103 years ago, with the advent of the Flexner Report, that medicine, in the U.S. at least, was placed on a firmly scientific basis, and what we now know as randomized controlled clinical trials did not see their debut, much less become the basis of determining which treatments worked and which did not, until the 1940s. Although physicians have been trying to base their craft on science for hundreds of years, it’s really only been in the last century or so that they’ve succeeded. Yet still some would like to go back to the way it was. They yearn for the days when doctors were “healers” and shamans, the way medicine was for hundreds and hundreds of years before science intruded.

Unfortunately, one of those physicians happens to be “America’s doctor,” as quoted in an excellent article by Michael Specter entitled THE OPERATOR: Is the most trusted doctor in America doing more harm than good? In it we learn this about Dr. Mehmet Oz:

“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.”

Oz went on, “Western medicine has a firm belief that studying human beings is like studying bacteria in petri dishes. Doctors do not want questions from their patients; it’s easier to tell them what to do than to listen to what they say. But people are on a serpentine path through life, and that is the way it is supposed to be. All I am trying to do is put a couple of road signs out there. I sit on that set every day, and that is what I am focussing on. The road signs.”

Of course, back when our ancestors lived in small villages, medicine consisted of shamans, priests, and magicians who couldn’t actually do much for anything other than physical injuries, for which they could bind up wounds, sew up lacerations, and splint fractures. However, they could do little or nothing to treat infections or other diseases. If people got better, it was usually because the disease was self-limited or the victims were fortunate. Oz also appears to buy into the false dichotomy that drives me crazy whenever I hear it: Namely that in order to be a good “holistic” doctor, you have to embrace the quackery that is much of what is now referred to as “complementary and alternative medicine” (CAM) or, more recently, “integrative medicine.” My retort is always that you don’t have to become a quack to be “holistic.” I also question Oz’s romantic view of these “healers.” It sounds all too much like the “noble savage” myth, a case of Oz falling for romantic primitivism, which he seems to want to fuse with modern medicine.

Worst of all, if you want to know why Dr. Oz falls for so much quackery, Specter explains it by letting Dr. Oz speak for himself and asking Oz how he can feature on his show people like, for example, Joe Mercola, who are anathema to science and promote pure quackery. (OK, he didn’t use those words, but that’s in essence what he asked, and he did mention Mercola’s rabid antivaccine views and his having promoted cancer quack Tullio Simoncini, who claims that cancer is a fungus and that baking soda cures it, on his show.) This passage is what I view as the central exchange in Specter’s entire article, as to me it reveals exactly why Dr. Oz is the way he is and why he promotes the quackery he promotes:

“I’m usually earnestly honest and modest about what I think we’ve accomplished,” Oz told me when we discussed his choice of guests. “If I don’t have Mercola on my show, I have thrown away the biggest opportunity that I have been given.”

I had no idea what he meant. How was it Oz’s “biggest opportunity” to introduce a guest who explicitly rejects the tenets of science? “The fact that I am a professor—one of the youngest professors ever—at Columbia, and that I earned my stripes writing hundreds of papers in peer-reviewed journals,” Oz began. “I know the system. I’ve been on those panels. I’m one of those guys who could talk about Mercola and not lose everybody. And so if I don’t talk to him I have abdicated my responsibility, because the currency that I deal in is trust, and it is trust that has been given to me by Oprah and by Columbia University, and by an audience that has watched over six hundred shows.”

I was still puzzled. “Either data works or it doesn’t,” I said. “Science is supposed to answer, or at least address, those questions. Surely you don’t think that all information is created equal?”

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 there you go. Oz has bought into the “science is just another religion” canard. How he can manage to do that, given his history, is mind-boggling. After all, he really was a decent surgical researcher, and he really did publish a lot of papers in the peer-reviewed surgical literature. I’ve expressed wonder at this transformation before: How could such an undeniably brilliant surgeon and surgical investigator fall so far, at least from a scientific standpoint? Personally, I think I see a bit of rationalization in the passage above for his transformation. Actually, it’s more denial. Dr. Oz thinks he is still a surgeon-scientist and doesn’t seem to understand that his promotion of the vilest sorts of pseudoscience and quackery have removed from him the right to be considered as a serious scientist—or even as a serious science-based doctor. Notice how he takes on an attitude that says, in essence, “How dare you question me, you puny journalist? I am the Great and Powerful Oz. I’m co-author on hundreds of peer-reviewed articles. I cannot be corrupted, and I know what science is.”

To which I reply: “Not so much. Not any more. You sold your soul for ratings.” Even worse, he has thrown ethics to the wind, doing what is in essence a clinical trial without IRB approval or any ethical oversight, all for his television show. This is arguably against the rules of his university and violates the Common Rule, which is designed to protect patients who participate as subjects in human studies. None of this appears to bother Oz.

As for the part about religion, sadly, it’s all of a piece with Oz’s other stated desires, namely to have healers the way we used to hundreds or thousands of years ago. Many of those healers were shamans or priests, and much of what they did was little more than faith healing. So For Dr. Oz to pine for a return to that time makes perfect sense. Of course, I’m sure that Dr. Oz imagines that he will “integrate” those ancient healing practices with modern medicine. That’s what “integrative medicine” is, after all. Personally, I love it that Specter basically got Oz to admit that he doesn’t believe in science-based medicine. Homeopathy (which he just featured yesterday on his show, which I am thinking of blogging about as soon as the video is online at his website), reiki, acupuncture, supplements, it’s all the same and to him it’s all just as valid as science-based medicine. Indeed, it’s hard not to conclude from this that Oz views science and science-based medicine as just “another way of knowing.” It’s also good to see Oz basically admit that he doesn’t review the literature to see what does and doesn’t work; instead he cherry picks the literature to support his conclusions, or, as he puts it,”it’s my fact versus your fact.”

No, it’s not. While everyone has preexisting biases and it is true that the literature can legitimately be interpreted different ways by different scientists, that does not mean that it’s “your fact versus my fact.” That’s far more a legalistic point of view than a scientific one, and or maybe more of a debate team point of view. It’s like two lawyers, each picking his own facts and putting them into battle against his opponent’s facts, without acknowledging their weaknesses or inconvenient facts that don’t support the narrative each is trying to promote. It’s not science. Specter is right. Oz’s view of applying science to medicine is indeed pure spin—and chilling spin at that. Oz has clearly lost it when it comes to science. Even given how far Oz has fallen with respect to science, even I never imagined that he now has such contempt for science that he views it as no more than a “religious experience.”

Then there’s his claim that “so much of it is in the eye of the beholder.” That’s only true if you rely on personal experience and anecdotal evidence. The very reason we need science, the reason we need controlled clinical trials, is to compensate for the human tendency for observations to be “in the eye of the beholder.” That Oz appears no longer to understand that (if indeed he ever did) is disturbing in the extreme given his enormous audience and influence. Instead of educating the public about science and what is and isn’t good medicine, all too often, he sells quackery mixed with sensible, science-based advice, “integrating” to the point where even physicians sometimes have trouble separating the nonsense from the science. Indeed, Eric Topol is asks an incredibly apt question, “But how are consumers to know what is real and what is magic? Because Mehmet offers both as if they were one.”

That is, of course, exactly the problem with “integrating” quackery and magic with science and medicine, which is what Oz increasingly does these days. It’s a problem that has become so widespread with the infiltration of “integrative medicine” into academia, that one has to wonder whether Oz is a cause or a symptom of the problem. Perhaps he is both. Worse, I’m not even sure that Oz is able to separate the nonsense from the science anymore. Perhaps he doesn’t care anymore. His most pressing purpose now is not science or medicine. It is to pander to his audience so that he can remain The Great and Powerful Oz, adored by millions. His brand must remain supreme:

One day, I asked Oz whether he minded that many of his medical peers criticized him for following the dictates of daytime television more than the demands of scientific truth. “I have always played offense,” he responded. “So I don’t care what people call me. I used to. I felt that to say I was an entertainer was dismissive. But it is part of what I have to do. I want to get my message across to people who are not going to get it in other ways. And I can’t do that if I am not palatable to the people who watch the show.”

In other words, “Suck it, geeks!” It is now, sadly, very clear that Dr. Oz now values his celebrity over science and science-based medicine to the point that he will do and say whatever it takes to remain the most famous doctor in the country, if not the world, and if it takes fusing bronze age concepts of disease with the latest science until no one can tell which is which anymore, he’s apparently fine with that.

It’s rather amusing and ironic that in the course of this article, Oz is quoted as referring to surgeons as “assholes” and referring to surgery as “controlled arrogance.” On the one hand, he has a point. On the other hand, the lack of self-awareness demonstrated by Oz in saying this is truly staggering. Indeed, I sense in Oz something I’ve seen in other doctors before, namely arrogance that rises to such a level that they think that their judgment should overrule science when they see fit. Unfortunately, these days, Dr. Oz sees fit a lot.