Today we (Eve and Bob) watched Dr. Oz to see Steve Novella’s appearance. This is pretty much a journey into the Heart of Darkness for a science-based physician. All week, the episode was marketed under the title, “Why is your doctor scared of alternative medicine?”
Ung. So we were worried that Oz would edit the hell out of the interview, but as far as we could tell, the editing seemed to be fair. Sure, Novella was outnumbered 3-to-one, but he’s like Neo in a Matrix of goof:
Steve Novella (middle, flying) takes on the forces of fail.
We’ve never watched Dr. Oz all the way through before. We’ve seen clips where he is being especially irresponsible, but not an entire episode.
Apparently, Oz has been reading the blogs (or ego surfing), and he seemed surprised that bloggers were attacking his rotten use of non-science in the treatment of actual sick people. Indeed, they flashed Orac’s Respectful Insolence during the opening.
Oz begins by saying that he is taking on a controversial issue that “has everything to do with you taking control of your health. There are many doctors–including me–who are putting their reputations on the line because they are using alternative therapies in their traditional practices.” This is true. Your reputation is at stake, Oz. Unfortunately, the only thing that he says that is uncontroversial is that lots of doctors think that alt med is “junk science and potentially dangerous.” And these are two questions that he does not address in any meaningful way in the rest of the segment.
The segment was 15 minutes long, and he opened with the statement that over 40% of ‘you’ (Oprah fans, presumably) are using alt med, like chiropractic, acupuncture and herbs, to treat everything from stress and insomnia to chronic pain to “cancer symptoms.” This seems like a bandwagon appeal to us: although he does not say it’s efficacious because so many people use it, but that’s clearly the implication.
He goes on to say that he has “showcased” a number of these treatments, which cost his viewers some $35 billion dollars a year (out of YOUR pocket–the appeal to YOU is very strong here). It strikes us that someone like Novella could easily cite that number to emphasize the magnitude of the problem. So, the stat sounded out of place. He brags about giving opportunistic quacks like Deepak Chopra (depressingly the most respectable of the bunch), Andrew Weil, and Joe Mercola free advertising time and unearned respectability.
He says that some the most stubborn holdouts against alt med are doctors (hm…) who ask whether these treatments are effective and safe. He addresses the doctors’ concerns in a rather accusatory manner. Presumptuous doctors, being concerned about the safety and efficacy of treatments!
“YOU’VE shown you are not afraid of testing the time honored traditions of alternative medicine,” he says as a woman lying on a teetertotter gets flipped upside down, presumably for health reasons. Doctors, however, are afraid.
Have you noticed how, so far, Dr. Oz has been describing the patient doctor relationship as adversarial? This is not fair, generally true or productive. Of course, it does establish him, by process of elimination, as an authority who is “on your side,” even if the premise is completely bogus. At the same time, it shifts the burden of expertise from the doctor to the patient. This is dangerous.
Oz starts the interview with Novella by asking “Why are there so many doctors out there, doctors of our viewers,” he emphasizes, “who don’t like alternative therapies? Why don’t you want me to talk about these?” Since Steven Novella has made an avocation out of addressing just these issues, this is essentially a straw man. Now if Oz had said “promoting this ” it would have been a fair question, but Oz makes it seem as if Novella and others like him want to stifle the quacks’ freedom of speech. Steve adresses what he has against alternative medicine, saying that alternative medicine is an “artificial category” used to sell treatments that are not subject to the same standards of evidence as medicine.
Novella is arguing to ensure standards of efficacy and safety of treatment, a concern to which Oz referred slightingly in his introduction. Oz ensures that these standards will not apply to certain treatments merely by placing them in the “alternative” category.
Oz then turns to his other guest, Dr. Mimi Guarneri (3:40), a cardiologist who uses alt med in her practice, who equates prayer and meditation with exercise and nutrition for heart patients, and smugly says that it is wrong to suggest that nutrition and exercise are alternative medicines. Of course Novella is too classy to yell “STRAWMAN!” or “Can I see your medical license?” but there are so many holes in this argument that I’m afraid no number of little Dutch Boys could ever plug them. She makes it sound as if Novella is against nutrition and exercise. Novella agrees that these are not alternative treatments. They are part of standard medicine and have been for some time. They are real medicine, the kind that works, the kind that has been shown to be safe and effective. But, as she just demonstrated, nutrition and exercise are being lumped in with…wishing you were better (prayer) as a form of “alt med.” This is unfair to the known practice of preventative medicine, or at least it lends unearned respectability to prayer.
Then Oz deploys what for him is a major rhetorical gambit, that alt med is “customized.” I’m not sure how medical decisions reached by a patient and doctor together, taking into consideration the needs and desires of a patient, are anything but already customized health care. All medical responses should be tailored to the needs and symptoms of the patient, and no action is taken without their consent. Right? This is what untested treatments avoid. When herbs aren’t held to quality control, for instance, can a patient be assured that they are making a wise, informed decision about what they are putting in their body? No. Cure-alls are non-specific and generic and not necessarily relevant to the individual patient’s needs.
Of course, Oz does not actually ever respond to the points that Novella makes. He merely changes the topic.
Oz then makes up 3 categories of alt med, things you put in your mouth, things that are done to your body, and the mind-body connection.
Novella is like, “yeah, whatever. Sure” (paraphrase). He is probably busy wondering why Oz is not commenting on his substantive points.
Regarding the first type (supplements and vitamins, etc.): Oz says there is a study showing that 50% percent of people use some sort of dietary supplement, as if that fact were in itself evidence of … anything: “Here is what “YOUR” doctor [as portrayed on film by Dr. Clifford Bassett, allergist and asthma specialist] has to say. What Bassett says is that, while herbs can be powerful and effective, he has some MAJOR reservations, especially about dosage, quality control, toxicity and drug interactions, when the products are outside of the purview and requirements of the FDA. He also mentions the problem of the appeal to nature. Yay!
At this point you can predict that Oz is going to ignore these real problems…again…Novella will say something reasonable, and Oz will reply, “I hear what you are saying, but what your are really saying is…” and then not let Novella answer. Let’s see how good we are, eh?
Novella reinforces Bassett’s point, saying that in 1994 Congress let down consumers by suspending evidentiary requirements concerning efficacy and safety for producers of supplements. Oz, “totally disagrees” about whether or not these products have been studied (of course, Novella has just said that echinacea has been studied and found not to work. Hell, Oz used the “they don’t work” part of that statement in his promos for the show!). Oz, also disagrees with the idea that no evidence has been found to support these treatments.
But he goes on to concede a point that Novella didn’t ask him to concede, a point, indeed, that he didn’t even make. In any way. He says that Novella’s (and others’) underlying concern is that patients are not telling their doctors what alt med they are trying. He is reinforcing the adversarial relationship (Hmmm, I wonder who is going to get the blame here). Novella could be (and likely is) concerned that this discussion is not happening, but Oz happily dismisses the real problems of efficacy and safety backed by evidence, the overlying–one could almost call it the “overarching”–concern. And he does not let Novella answer. Instead, he asks a pharmacist who works on PubMed…I’m sorry, I meant the “Natural Standard,” which reassuringly declares itself as “The Authority of Integrative Medicine” and has that twit Weil on the editorial staff. We are rather annoyed that in this context, Oz referred to her as “Doctor.” Hell, both of us (Eve and Bob still) could legitimately be referred to as “doctor,” but we think that it is important in a medical context that “doctor” refers an MD. Maybe this is niggling, but we think it is slightly deceptive.
They show Novella nodding, perhaps expecting to be asked to reply to what the pharmacist claims is a large amount of high-quality data. But we don’t hear a peep. They move on without allowing him to answer, again. Damn it.
Speaking of manipulation, Oz moves on to “body manipulations.” Specifically acupuncture. Now, YOUR doctor is played by Audrey Halpern, MD, a neurologist. She says that body manipulation can be effective, but that such treatments are often time consuming and expensive and have not been studied well enough. (Have you noticed how YOUR doctor is being generous to these therapies while still pointing out their weaknesses? Have you noticed that YOUR doctor’s concerns are being ignored?)
Dr. Guarneri, professor of Non Sequitor Therapy, then discusses how she began to use acupuncture after putting a stent in one of her patients. She does not say that she is using acupuncture to put in stents, but when her heart patients start to exercise again, they often ache. She hesitates to give them drugs, and so she uses a mixture of acupuncture, physical therapy and stretching, which reduces her anecdote to complete and utter irrelevance. How do you isolate the effects, if any, of acupuncture from those of the proven therapies of PT and stretching? It’s like claiming a miraculous healing on someone who has had the best possible medical care because someone prayed for the patient while they were in the hospital. (Pay attention Catholic Church!)
That fallacy was so painful, I need to put some acupuncture on that.
She’s very pleased with herself that she is doing no harm. Then Novella says, reasonably, that if it doesn’t work and there is risk involved, no matter how slight, yes, you are potentially doing harm.
Then, regarding acupuncture, Oz sticks it to Novella: “THERE ARE BILLIONS OF PEOPLE AROUND THE WORLD WHO USE ACUPUNCTURE AS THE BASIS OF THEIR HEALTH CARE, AND IT’S THE BASIS OF ANCIENT CHINESE MEDICINE.” Yeah, says Novella, for centuries people used leeches as the basis of their healthcare.
Oz builds his argument on embarrassingly shaky ground, a double appeal to tradition and popularity. He also suggests that science may not know how it works. (Begging the question and just ignoring the fact that science has failed to find compelling evidence of these treatments’ efficacy.) Mega sad. He also seems not to notice that the people who are stuck with acupuncture as their sole treatment (pun only slightly intended) would love to have a dose of chemotherapy.
It’s seems to us that both Dr. Guarneri and Dr. Oz are advocating complementary medicine as opposed to “alternative” medicine, essentially charging patients for useless therapies in addition to the stuff that is actually helping. That’s really cheeky and dishonest.
Regarding mind-body connections, YOUR doctor is played by Mark Melrose, DO, emergency medicine. (I wonder how often he tells his his mangled glider accident victims that they will be better if they just meditate.) Mark says that maybe, maybe it is effective, but there is stuff we know works, why not use that?
So, Oz asks if Novella disagrees with mind-body treatment because it is “soft and fuzzy, or do you think that it is just unproven and worthless?” It’s the false dichotomy fallacy, and Novella calls him out on it. “Neither,” he says. Relaxing and meditation are fine, he says. Just don’t tart it up in mystical language or claim that it can cure cancer.
At this point, Oz…freaking loses it. He complains that Novella is dismissing the patient’s knowledge of his or her own body by calling it mysticism, thereby standing two arguments away from what Novella is saying. And, you know, dismissing it. The subsequent rant is not loud, but it sure as hell is not rational or organized. We reproduce it here, verbatim:
“But here is where the big disconnect that we have is on this point. Because I think I that when people begin to study their bodies, and you call it mysticism, which again I think is a bit dismissive of the process, it’s people inuitively understanding what’s happening in their body beginning to examine it, and you know what? maybe we can harvest our immune cells so that they can kill cancers, neither you nor I know that, that’s darn hard to study, so my advice to everybody is, customize therapy for yourself. Figure out what makes sense for you. Do drugs and surgery work? Yeah, they often work pretty well, and they have side effects as you [Novella] acknowledge and we all talk about them all the time. But the difference for me is a bow and arrow, a stealth [he probably means "targeted"---do you want your health care to sneak up on and pounce you?] approach to getting exactly what you want to get that works in you versus the ballistic missile approach that we have so often become comfortable with [this is specifically a chemotherapy argument, which he does not explain]. Now, there have been lots of other findings from the National Institutes of Health that have been very positive, I think, in regard to alternative medicine. And the majority of schools in this nation now are offering programs that teach students so that we are more understanding ’cause you know what I think the big problem is? You know why people aren’t talking to their doctors? Because they don’t think that their doctors know anything about it. [To audience] Is that close to on target, folks? [mumbling yeah]. So if I can give you my take, alternative medicine, I think, is at the grassroots level, and because of that nobody owns it. Now, that stated, I think that we have our homework to do, but alternative medicine empowers us. And that’s the big message for all of ya, but only if you know more about it, all right and if it does work for you, trust me,don’t let anyone take it away from you. Dr. Novella, thank you very much….”
Steve does not get to reply, of course. And, really, how could you? It’s Oprah-flavored incoherent. There is empowerment, and people trying to take away your bows and arrows and shoot you with missiles. It’s a long, rambling, populist non-thought. He throws in immune cells for some reason. It sounds like he is saying, “Perhaps the mind does have some effect on cancer [Novella had just mentioned that meditation can relax you, but it cannot cure cancer], and you can’t know that it doesn’t. Neener neener.” This is a classic appeal to ignorance. He goes so far as to mention how hard it is to study things. Uh, yeah, we know. So let’s redirect some of that $35 billion dollars being flushed down the alt med toilet to do some actual research on cancers.
Good job, Steve! You have the stomach of a concrete elephant.