The AMA acts to try to rein in doctors spreading misinformation

Even if you’re a relative newbie to this blog, you probably wouldn’t be particularly surprised to learn that I don’t much like Dr. Mehmet Oz, a.k.a. “America’s Doctor.” Of course, I refer to him as something slightly different, namely “America’s Quack,” for a whole host of reasons, including his featuring psychic mediums like John Edward and Theresa Caputo, faith healers, Ayurveda, homeopaths, dubious dietary supplements, and even antivaccine loons like Robert F. Kennedy, Jr. Indeed, when about a year ago Senator Claire McCaskill (D-MO) hauled him in front of her Senate committee over his unethical promotion of diet supplements as miracle weight loss aids and humiliated him, skeptics rejoiced. Unfortunately, that setback was only temporary, and Dr. Oz was soon back to his usual antics, just a little more circumspect about the “flowery” language.

Ever since Dr. Oz went over completely to the dark side and became “America’s quack,” skeptics have asked what can be done about him. After all, he was once a highly promising young academic surgeon and is still a prominent member of the faculty of Columbia University. A couple of months ago, a group of physicians and scientists, some of whom, unfortunately, were associated with industry and known for how the views they promote almost always align with industry, wrote a letter to Lee Goldman, MD, the Dean of the Faculties of Health Sciences and Medicine at Columbia University to complain about Dr. Oz’s extracurricular activities. It was a tactic that backfired spectacularly, as the dean predictably invoked academic freedom in response, and Dr. Oz did a whole show attacking them all as industry shills. The result was the status quo. Dr. Oz is still doing his show, even though leaked e-mails from the Sony hack revealed that he was looking for some sweet, sweet shilling opportunities of his own.

Perhaps if medical boards, universities, and other regulatory bodies won’t do anything, then maybe medical societies can address the problem of quack celebrity doctors like Dr. Oz. He’s not alone, after all. Just looking at the pediatricians, for instance, who spread antivaccine misinformation, such as Dr. Bob Sears and Jay Gordon, shows that it’s not just Dr. Oz. He’s just the biggest offender because he has a syndicated daily television show seen by millions every day to spread his views, compared to the much smaller audience to which Sears and Gordon and their ilk can tap into. Not that they don’t have influence. We’ve seen that they do, rallying opposition to SB 277 in California. Fortunately, in this case they failed.

In trying to address this problem, the American Medical Association (AMA) is taking the lead. Benjamin Mazer, the same medical student who has spearheaded Doctors in Oz, a blog and project whose purpose is to highlight and publicize the harm caused by bogus medical advise given by Dr. Oz, has co-authored a resolution with Joy Lee, another medical student and member of the AMA-MSS Committee on Legislation and Advocacy. This resolution asks the AMA to issue a public statement reiterating the importance of transparency to the profession and to craft guidelines on how doctors can ethically use media to help the public. In addition, it asks the AMA to issue a report on what disciplinary pathways might exist for doctors who continue to abuse their access to the media to spread medical misinformation:

WHEREAS, Patients receive medical information from a variety of sources other than their physician, including media outlets such as news programs and talk shows which feature physicians as experts; and

WHEREAS, The medical information disseminated in the media reaches millions of Americans, affects public health, and changes health behaviors; and

WHEREAS, The talk shows The Dr Oz Show and The Doctors draw 2.9 million and 2.3 million viewers per day, respectively; and

WHEREAS, a study published in the BMJ found that for 80 randomly selected recommendations made in The Dr Oz Show in 2013, only 46% were supported by evidence, 15% were contradicted by evidence, and evidence was not found for 39%; similarly, 80 randomly selected recommendations made in The Doctors in 2013, evidence supported 63%, contradicted 14%, and was not found for 24%; and

WHEREAS, it has been shown that only 0.4% of recommendations on The Dr Oz Show and The Doctors were accompanied by disclosure of potential conflicts of interest; and

WHEREAS, A physician is bound by the profession’s code of ethics to “participate in activities contributing to the improvement of the community and the betterment of public health”, a responsibility which encompasses the provision of accurate and relevant information; and

WHEREAS, A board-certified physician releasing inaccurate medical information is in violation of professional ethics, including but not limited to the oath to do no harm; and

WHEREAS, The AMA finds incompetence, corruption, or dishonest or unethical conduct by medical professionals “reprehensible” and has created a system by which individuals can report misconduct to the AMA and other medical societies for disciplinary measures; and

WHEREAS, In the case of Andrew Wakefield’s inaccurate and unscientific study linking vaccines with autism, the medical community responded by publicly retracting the relevant published article and banned Wakefield from further practice, setting a public precedent for self-policing within the medical community; and

WHEREAS, The AMA has policy which supports the provision of accurate medical information and authentication of medical credentials (E-5.04, H-445.997), active physician participation in the prevention of medical misinformation (H-225.994), proactive responses to misleading media releases (H-445.995), standards of conduct for social media, general public health, and the protection of public confidence in the medical profession; therefore be it

RESOLVED, That the AMA Council on Ethical and Judicial Affairs report on the professional and ethical obligations for physicians in the media, including guidelines for the endorsement and dissemination of general medical information and advice via television, radio, internet, print media, or other forms of mass audio or video communication; and be it further

RESOLVED, That our AMA release a statement affirming the professional and ethical obligation of physicians in the media to provide quality medical advice supported by evidence-based principles and transparent to any conflicts of interest, while denouncing the dissemination of dubious or inappropriate medical information through the public media including television, radio, internet, and print media; and be it further

RESOLVED, That our AMA study existing and potential disciplinary pathways for physicians who violate ethical responsibilities through their communication on a media platform.

This resolution was accepted a week ago at the AMA’s annual meeting in Chicago. Interestingly, it was approved at the same meeting that produced a public position statement from the AMA in favor of eliminating personal belief exemptions to school vaccine mandates, a fantastic bit of news that I took notice of last week. As Mazer puts it:

“This is a turning point where the AMA is willing to go out in public and actively defend the profession,” Benjamin Mazer, a medical student at the University of Rochester who was involved in crafting the resolution, said. “This is one of the most proactive steps that the AMA has taken [on mass media issues].”

The AMA will look at creating ethical guidelines for physicians in the media, write a report on how doctors may be disciplined for violating medical ethics through their press involvement, and release a public statement denouncing the dissemination of dubious medical information through the radio, TV, newspapers, or websites.

Of course, the AMA can’t really enforce anything. It’s not a regulatory or governmental body. Enforcing standards or laws is beyond its purview, as it’s a trade association for physicians that has generally represented the interests of doctors in a variety of areas. However, despite its membership having fallen from approximately 75% of American physicians in the 1950s to less than 20% of physicians today, it is still the single largest medical association in the US; so its position statements do carry weight. As well, it is still important that the AMA take a position on this issue because it still represents the single largest megaphone that physicians have to the public. As such, it could pioneer new ethical guidelines for how physicians should disseminate information in the media, and it’s never a bad thing for such a prominent doctors’ group to reiterate formally that a physician has an obligation to be evidence-based in all medical information that he promotes in public.

Certainly, it’s clear to me that the AMA is taking a move in the right direction from the reaction of quacks to the announcement. For example, the Alliance for Natural Health USA (ANH-USA), other wise known as one of the foremost promoters of “health freedom” (a.k.a. the freedom of quacks from being impeded by pesky government laws and regulations) is not pleased with this news. No, it is not pleased at all, so much so that earlier this week it published a screed lambasting the AMA and this resolution, describing it as a “gag order for medical dissenters.” What’s ANH-USA afraid of? Take a guess:

Dr. Oz is a high-profile example, but countless integrative doctors in states across the country routinely face harassment and the threat of having their licenses revoked by state medical boards for the most specious reasons—you may recall our past coverage of the Washington state board’s appalling crusade against Dr. Jonathan Wright as only one example among many. But when conventional doctors engage in behavior that is similar to that of integrative physicians—or when conventional docs flout the laws in the most egregious ways—state boards are far more lenient, if any action is taken at all.

The bias, then, is already overwhelmingly against integrative practitioners, and now the AMA is looking to take further steps to silence them. What will happen to doctors who don’t unflinchingly support the CDC vaccine regime, or who inform their patients of any alternative treatment that clashes with conventional orthodoxy? In Europe, it is already illegal for doctors to use the terms “probiotic,” “superfood,” and “antioxidant” when used in relation to commercial food products or supplements—and European doctors who even mention the benefits or health claims of any food, supplement, or non-drug product to patients face jail time. Will we allow free professional speech to be similarly suppressed here? Has the US come to this?

Gee, ANH-USA says this as though it were a bad thing.

Of course, it’s the same old whine and distortion that we hear all the time, as the regulations in Europe being complained about don’t even say what ANH-USA claims they say. No, it is not illegal to use terms like the ones described above. Certainly it isn’t in the US. It’s illegal to use such terms in advertising to make health claims that are clearly not supported by the evidence, particularly claims to diagnose or treat diseases. As for conventional doctors being treated more leniently when they engage in behavior similar to that of “integrative” quacks, I’d go the other way. I’d say that conventional doctors engaging in such practices should be treated every bit as harshly as any “integrative physician.” The real problem, though, is that neither are really treated all that harshly. It’s amazingly difficult to discipline and delicense physicians practicing alternative medicine because of the double standard promulgated by pulling various forms of quackery under the “integrative medicine” umbrella by so many doctors. It’s what we call “quackademic medicine” when it’s in academic medical centers, but it’s also finding its way out into the community.

In case you doubt me, just wander over to Dr. Wright’s website. You’ll find what I consider to be a veritable cornucopia of quackery, including thermography, blood viscosity, naturopathy, treatments (including IV) with minerals, amino acids, and vitamins, and prolotherapy. He should be shut down. The ANH-USA’s whine about being “muzzled” or “gagged” is utter nonsense. Medical professional societies have the right—no, the duty—to uphold professional standards, and this is all that the AMA is trying to do.

In the overall scheme of things, the AMA’s action probably won’t do much by itself. But if it serves as a start, an action that inspires other professional societies and—dare I dream it?—even state medical boards to follow suit, it could have a real impact. Imagine, for instance, not just Dr. Oz facing professional ostracization by the AMA. Imagine that, for instance, the American Academy of Pediatrics actually ostracizing antivaccine doctors like Dr. Bob Sears and Dr. Jay Gordon, the latter of whom prominently features “FAAP” after his name as an indication that he’s a fellow of the AAP. Now that would be something.