America’s quack, dissected yet again

If there’s one doctor who irritates me possibly more than any other, it’s got to be “America’s Doctor,” a.k.a. Dr. Mehmet Oz, thanks to The Dr. Oz Show. He’s been an all too frequent topic on this blog and at my not-so-super-secret other blog. Of course, I refer to him as “America’s quack,” because, well, that’s what he is. Ever since Oprah Winfrey found him and elevated him from a promising young academic cardiothoracic surgeon with a penchant for woo to America’s quack, I’ve been pointing out how much dubious medicine and outright quackery he’s been pushing, including homeopathy, faith healing, dubious unproven (and almost certainly nonexistent) links between cell phones and breast cancer, GMO fear mongering, promotion of the antivaccine views of Robert F. Kennedy, Jr., and even psychic scammers like John Edward and Theresa Caputo. It’s gotten so bad that Dr. Oz has increasingly faced less than adoring press and even been hauled before Senator Claire McCaskill’s (D-MO) committee for his unscrupulous boosterism for unproven weight loss supplements to be humbled. It got so bad that not long ago Dr. Oz’s social media people tried to do a an “Ask Dr. Oz” segment on Twitter under the hashtag #OzsInbox. Let’s just say that it backfired spectacularly and hilariously.

If there’s one thing that’s also puzzled me about Dr. Oz, it’s how someone who was such a promising young surgeon-scientist back in the early 1990s could have fallen so far—from a scientific standpoint, obviously. He is, after all, making a ton of money and enjoying incredible fame, thanks to his embrace of woo. Even more frustrating, even though Dr. Oz has disgraced himself more times than I can remember, he remains faculty in good standing at Columbia University. Heck, he’s more than faculty in good standing. He’s a full professor in the department of surgery there. Heck, he’s vice-chair! He’s also the director of Columbia’s Cardiovascular Institute and Integrative Medicine Program. In other words, he does hold high ranking positions in Columbia University’s department of surgery and integrative medicine program.

It’s this latter fact that’s irritated me, and I’ve wondered why no one has ever made a stink to his university about this. Then, upon arriving home from New York from NECSS, what to my wondering eyes should appear but one answer to my question in the form of a post on Skepchick by Kavin Senapathy revealing that Dr. Henry Miller had written a letter to Lee Goldman, MD, the Dean of the Faculties of Health Sciences and Medicine at Columbia University complaining that Dr. Oz is faculty at Columbia:

I am writing to you on behalf of myself and the undersigned colleagues below, all of whom are distinguished physicians.

We are surprised and dismayed that Columbia University’s College of Physicians and Surgeons would permit Dr. Mehmet Oz to occupy a faculty appointment, let alone a senior administrative position in the Department of Surgery.

As described here and here, as well as in other publications, Dr. Oz has repeatedly shown disdain for science and for evidence-based medicine, as well as baseless and relentless opposition to the genetic engineering of food crops. Worst of all, he has manifested an egregious lack of integrity by promoting quack treatments and cures in the interest of personal financial gain.

Thus, Dr. Oz is guilty of either outrageous conflicts of interest or flawed judgements about what constitutes appropriate medical treatments, or both. Whatever the nature of his pathology, members of the public are being misled and endangered, which makes Dr. Oz’s presence on the faculty of a prestigious medical institution unacceptable.

The letter is signed by:

Henry I. Miller, M.D.
Robert Wesson Fellow in Scientific Philosophy
& Public Policy
Hoover Institution
Stanford University
Stanford, CA

Scott W. Atlas, M.D.
David and Joan Traitel Senior Fellow
Hoover Institution
Stanford University
Stanford, CA

Jack Fisher, M.D.
Professor of Surgery (emeritus)
University of California, San Diego
La Jolla, CA

Shelley Fleet, M.D.
Anesthesiologist
Longwood, FL

Gordon N. Gill, M.D.
Dean (emeritus) of Translational Medicine
University of California, San Diego
La Jolla, CA

Michael H. Mellon, M.D.
Pediatric Allergist
San Diego, CA

Gilbert Ross, M.D.
President (Acting) and Executive Director
American Council on Science and Health
New York, NY

Samuel Schneider, M.D.
Psychiatrist
Princeton, NJ

Glenn Swogger Jr. M.D.
Director of the Will Menninger Center for Applied Behavioral Sciences (retired)
The Menninger Foundation
Topeka, KS

Joel E. Tepper, M.D.
Hector MacLean Distinguished Professor of Cancer Research
Dept of Radiation Oncology
University of North Carolina School of Medicine
Chapel Hill, NC

As much as I appreciate the sentiment, I can’t help but see this as a wasted opportunity, something that is unlikely to accomplish anything but brief publicity, with Columbia already having responded with the predictable bromides about “academic freedom.” I hate to be too negative about an effort like this, so I’ll tell you why I am. Think about it. There are only ten signatories. Two are from the Hoover Institution, a conservative think tank based at Stanford University whose fellows tend to be climate change denialists. In other words, it’s an institution whose commitment to science is highly questionable to nonexistent in one area, and it’s attacking Oz for pseudoscience? Two others are affiliated with the American Council on Science and Health (ACSH), a group that is pro-science when that science aligns with industry interests, particularly the pesticide industry. ACSH’s late president Elizabeth Whelan was known for dismissing any concerns about various chemicals as potential health hazards as “chemophobia” and even referring to “chemophobia” as an “emotional, psychiatric problem,” which is not very skeptical at all. Indeed, as I’ve mentioned before, a few years ago, when ACSH invited me to be on its board of advisors, I turned it down because I perceive ACSH as going too far in the other direction (not to mention the problem of its behaving largely like an industry shill) to the point that it takes the germ of a reasonable idea (that there’s too much fear mongering about “chemicals”) and takes a despicable turn with it by implicitly likening concerns about chemical pollutants and other chemicals that might cause health problems to mental illness by labeling them “chemophobia.” Lately, ACSH has been pushing e-cigs as the greatest thing since sliced bread, the answer to tobacco addiction, and attacking anyone who has the temerity to suggest that e-cigs are unproven and should perhaps be regulated.

That’s why ACSH is such a frustrating organization. It’s often right scientifically about issues like vaccines, deconstructing The Food Babe’s nonsense, and attacking quackery, but on issues like the question of health problems related to various chemicals, e-cigs, and taking the food industry to task it’s maddeningly—to me, at least—in the thrall of commercial interests. Or, at least, that’s the way it appears. It also makes some incredibly bad arguments sometimes. In this case, ACSH is right to criticize Dr. Oz, and Dr. Miller is appropriate to question why Columbia retains him in high ranking positions in its department of surgery, cardiac institute, and integrative medicine program. Indeed, I have no problem with what Dr. Miller did, but I really wish he hadn’t done such a half-assed job of it. There are lots of skeptical doctors (like myself) who would have signed the letter if it had been presented to us before sending it to Columbia. I probably would have signed it, even given my reservations about some of the signatories and my doubts that it will do anything other than produce some transient bad publicity for Dr. Oz and Columbia. In actuality, if anyone is going to “bring down Oz,” I think it will be the slow, careful sort of campaign being waged by a medical student named Ben Mazer rather than just a letter to the dean. Mazer has been documenting examples of patient harm that have resulted from Dr. Oz’s bad medical advice, and, I suspect, it is the slow drip-drip-drip of such stories that will ultimately irrevocably tarnish the Oz brand.

There’s also the issue of appropriateness of trying to get someone fired for their views outside of their job, something I’ve been on the receiving end of more than once and been grateful that the two universities where I’ve been faculty have basically ignored such complaints. In any case, whether or not Dr. Miller’s letter was a good idea, did or didn’t go far enough, or will do any good, just yesterday, Julia Belluz of Vox.com published a nice overview of how Dr. Oz the promising academic surgeon of 20 years ago became Dr. Oz, America’s quack, entitled The making of Dr. Oz: How an award-winning doctor turned away from science and embraced fame. What I liked about it was that it was a good overview and filled in some blanks in my knowledge about Dr. Oz’s history. For instance:

I spoke to dozens of Oz’s colleagues, mentors, and other health professionals who have been touched by the surgeon or his work, some who’ve known the man since his early days fresh out of the University of Pennsylvania and Harvard. I read his early books. I talked to his fans — including my own mother. I found out that the roots of Oz’s experimentation with alternative techniques go all the way back to his childhood, and that his departures from evidence-based medicine have gotten more extreme as he’s become more famous. I also learned that the making of Dr. Oz says more about America’s approach to health than it does about its most famous doctor.

I knew Dr. Oz embraced reiki, even inviting reiki masters into his operating room, as far back as the 1990s. I hadn’t known that his flirtation with alternative medicine had gone back to his childhood. I did know this, but it’s worth emphasizing again:

Oz has achieved some of the greatest scientific accomplishments of his career at Columbia. While a resident there, he was the four-time winner of the prestigious Blakemore research prize, which goes to the most outstanding surgery resident. He now holds 11 patents for inventing methods and devices involved in heart surgeries and transplants. This includes helping to research and develop the left ventricular assist device, or LVAD, which helps keep people alive while they’re awaiting a heart transplant. Oz had a hand in turning the hospital’s LVAD program into one of the biggest and most active in the world.

This is, as they say, a BFD, an incredibly impressive accomplishment. I have no problem admitting that I never won any prize this prestigious as a resident or in my career. Even as an attending the one award I did earn doesn’t measure up. Oz’s accomplishments as a young surgeon were truly impressive. Given Dr. Oz’s current submersion in quackery for his TV show, it’s easy to forget that back in the late 1980s he was the real deal, a true surgeon-scientist in development. By the early 1990s he was a rising star in academic surgery and continued on that path for many years afterward. Dr. Oz is only a couple of years older than I am; so we are of the same generation and came up through the academic surgical ranks around the same time; so I have an idea of how difficult it was to have earned such awards back then.

Part of Belluz’s article involves an interview with Dr. Richard Green, the associate chief of cardiac, thoracic, and vascular surgery, Dr. Oz’s division. It is in this interview that to me confirmed my belief that complaints to the bigwigs at Columbia about Oz are unlikely to go anywhere. Dr. Green has his proboscis so far up Dr. Oz’s posterior that he could clean the back of Oz’s teeth with his own tongue. It’s nauseating and depressing, with Green saying that he’d vote for Oz if he ran for president and attributes the leveling off of the increase in obesity rates in the US to Dr. Oz’s show and how it raises awareness of the importance of eating right.

Here’s what’s maddening, though. Belluz asked Green a question about a recent article in the BMJ that that examined the health claims on The Dr. Oz Show and The Doctors and found that about half the recommendations had no evidence to support them or even contradicted what the best science tells us now. I’ve blogged about this very study (of course). His response was telling:

Green admitted that he had never seen The Dr. Oz Show. “I don’t know what he would promote or not promote,” he said.

Then he asked: “Why would anyone mistake that for anything but entertainment?”

Green said he thought people in Oz’s audience would be able to distinguish between the man’s work on TV and his work in the operating room. Plus, he said, even if Oz did deviate from science sometimes, this didn’t make him any different from every other doctor. After all, physicians don’t always practice in an evidence-based manner. Critics were being unfair to Oz by holding him to an evidence-based standard, Green felt. Oz wasn’t pushing narcotics and antibiotics through his show, Green reasoned — just harmless supplements and health tips.

“What can a TV doctor do except for give advice about how to live your life?” he asked.

I thought my head was going to explode as I read that passage. It has it all: False equivalence, a shruggie attitude that doesn’t care about whether Oz is peddling quackery or not and even excuses Oz if he is, lame justifications for what Oz does every day. Clearly, Dr. Green is as much a part of the problem of Dr. Oz as Dr. Oz is himself!

Equally telling is how Dr. Green seemed to dance around the topic of whether Dr. Oz is still a good cardiothoracic surgeon:

I asked Green whether he’d want to be Oz’s patient, and he said, “If you did a poll of the staff at Columbia and asked them, ‘If you needed a heart operation and Mehmet was there, would you want him?’ they’d say yes.”

He then added, “He’s probably a little rusty right now.” He said Oz seemed to be operating less and less — from several hundred surgeries per year at his peak to a maximum of about 100 now — as he entertains more and more.

Notice how Dr. Green didn’t directly answer the question. Instead, he cited a hypothetical poll of the staff at Columbia without actually saying whether he himself would go to Dr. Oz if he needed heart surgery. Then he even conceded that Dr. Oz is probably a bit rusty because he doesn’t operate nearly as much as he used to. Let me tell you something. I’ve been a surgeon over 25 years. I know that surgeons don’t like to speak ill of other surgeons and will almost never directly say that a surgeon is no good, particularly to the media. Dr. Green’s reluctance to answer a direct question about Dr. Oz’s surgical competence, his invocation of Oz’s being “rusty,” and his excuses for Dr. Oz all combine to scream at me that Dr. Green doesn’t think particularly highly of Dr. Oz’s current surgical skills but can’t openly say so. If that weren’t the case, he would have said something along the lines of, “Hell, yes! If I needed a heart operation I’d pick Dr. Oz to do it!” You can’t fool a fellow surgeon that way, Dr. Green.

Of course, Dr. Oz brings fame and fortune to Columbia, and that’s what really matters. If Dr. Green were to go on record publicly criticizing Dr. Oz, I doubt he’d retain his division chief job long after that. Who can blame him for using code and playing dumb, saying that he’s never watched Dr. Oz’s show, which he did in his interview? I can, that’s for sure. Even so, I feel a bit sorry for him. He probably would have been better off declining to be interviewed.

It’s also interesting how Dr. Oz is not particularly fond of criticism. No one is, but when you’re a major media figure, it doesn’t look good if you do things like this:

Oz’s staff, unsurprisingly, doesn’t like the criticism either. When I tried to attend that March taping of Oz’s show in New York after getting a ticket through a lottery, Tim Sullivan, the show’s media representative, told me, “We cannot accommodate you attending Friday’s taping or other future tapings” — despite the fact that several other journalists have gone to Oz show tapings in the past. Sullivan then stopped returning any of my emails, including several requests for interviews and information for this piece.

Now that’s not the way someone committed to science, good medicine, and openness deals with the press. It never looks good to shut out critics like that, even if she writes:

I talked to many other doctors from across America with patients who have been touched by the Oz effect. Again and again, they used phrases like “snake-oil salesman” and “quack” to refer to him. They worried about their patients. Rather than heaping him with praise as Oz’s New York colleagues or fans did, they said he is a menace to public health, that he takes advantage of people and confuses medical issues.

Yup. that’s exactly right. Also, rather predictably (albeit still depressingly), this story reveals that it’s been all about Dr. Oz, rather than patients, for a long time. In other words, Dr. Oz is always acting and has turned into a publicity hound:

Monique Class, a family nurse practitioner and another former employee of the center, said the media attention negatively affected their work. “It became about Oz. Not about the project. Not about the patients. Not about the work. That all became secondary to his rise to the top.”

It wasn’t uncommon, Class said, for Oz to say some version of the following to her or to the other employees: “Give me a patient because the cameras are coming in, and tell me what I need to know.”

Class said, “He was always acting. He didn’t know this patient. He was not connected to this patient. We’d give him a two- or three-minute sound bite and he’d sit there in front of the cameras like he’d done this work and had this deep connection.”

Which is exactly what he does on his show.

While I was at NECSS, I spoke to a couple of primary care physicians (whom it’s great to see at NECSS), and their perception is that they’re getting fewer “but Dr. Oz says” sort of comments and questions from patients. However, that’s strictly anecdotal. I have no idea if it is representative of a larger trend, but I can hope because, if true, it suggests that maybe America’s finally getting wise to the snake oil hucksterism that is the Dr. Oz brand. If not, I hope America wakes up soon. We deserve “America’s doctor,” not “America’s quack.” Unfortunately, with Dr. Oz, America’s quack is what we’re getting.