The Dr. Oz Show: The Price is Right of Medical Woo

Previously, on Skeptical Humanities:

We wrote about Dr. Steven Novella’s appearance on the Dr. Oz show (Dr. Novella describes his experience here; the first part of the show is available here). Of course, Dr. Novella appeared only in the first segment of the show, roughly the first ten minutes. So what happened on the rest of the show?

First a brief recap: Dr. Novella and the three physicians featured in the “Here’s what your doctor says” clips repeatedly pointed out that “alternative” therapies are not subject to the same kind of rigorous testing that conventional therapies are. By law, non-alternative medications have to be tested for efficacy and safety. Alternative therapies are not under the oversight of the FDA and do not have to meet the same standards. These concerns were never properly addressed.

In segment 2, after Dr. Novella has been whisked from the stage, Dr. Oz discusses online companies that use his name and image to sell their products without his consent. Dr. Oz could have used this fact to emphasize the risks of buying medical products online: many of the claims are deceptive. How can a consumer be sure the products are effective and safe and that the claims are valid? Instead, Dr. Oz just expresses irritation that they are using his name. He mentions one advertisement specifically that has a disclaimer at the bottom, which makes it technically legal. This company sells products “featured on the Dr. Oz show.” Oz notes, “There are times when you can be factually on target but be untruthful.” This statement is, of course, true, but I find it highly ironic for a number of reasons. In the first place, I wonder what Oz actually found untruthful about the statements in the ad. Is he annoyed that the ad suggests that he has endorsed this specific company and its products? Or is he suggesting that he has never endorsed the supplement in general? I’m assuming the former because they show a screenshot of an ad for Omega-3 krill oil pills, and later in the same show, Dr. Oz does enthusiastically promote fish oil supplements for heart health. So it seems the ad is correct when it says that a product similar to the one it sells has been both featured and endorsed on the Dr. Oz show.

In the second part of this segment, Dr. Oz promises to help viewers decide “what alternative products are safe for you.” Hurrah! He’s addressing one of the major concerns of science-based medical practitioners. Surely he’ll bring back Dr. Novella to help his viewers evaluate the claims of safety and efficacy made by producers of alternative therapies. Well, no. Instead he brings back Catherine Ulbricht, chief editor and co-founder of the National Standard Research Collaboration (their website), which Oz describes as the “gold standard of databases that study alternative medicine. We use it on the show all the time.”

Ulbricht begins by explaining how Natural Standard evaluates supplements. They “collect traditional information [and] historical data….” Hey, that sounds good to me! Of course, I’m a medievalist. I’m not sure folklore and anecdotes are the most reliable way to evaluate the safety and efficacy of medicine. To be fair, though, she says that they collect this information “as well as hardcore scientific evidence [and] clinical trials.” Their grading scale is based on that of the US Preventative Services Task Force. So, okay, that all sounds a bit better. So how do you know whether a supplement or therapy is safe?

1. How long has it been around? “You’re safer using therapies that have been around a long time, traditionally used in foods, grown in your own garden.” You know, the therapy of bleeding people to balance their humors was around for a long time. That doesn’t make it a safe or effective therapy. She notes that aspirin “is a good example because willow bark is a natural product that’s been around, you know, since forever, and it’s one of the mainstay therapies in conventional and alternative medicine.”

I’m not a medical expert, but it seems to me that she’s got this backwards. We know aspirin is safe and effective not because willow bark is natural (hemlock’s natural too) but because the chemical acetylsalicylic acid has been studied out the wazoo and found to be safe (with some risks) and effective. Aspirin is a drug and therefore regulated by the FDA.

Dr. Oz notes that a supplement that is available in food form and has been around for centuries is “probably not going to be catastrophically risky for you.” Now, perhaps I’m being unfair by parsing an off-the-cuff remark too closely, but certain words in that sentence bother me, specifically “probably,” “catastrophically” and “risky.” And while it may be true that these herbs are safe in food form, are they safe in supplement form? How much of the active ingredient do they contain? What other ingredients do they contain? Can we trust the companies that sell them? We don’t really know because they are not regulated by the FDA.

2. Evaluate the claims. This seems really important. They spend roughly 30 seconds on it. Ulbricht says that the more specific the claim, the more likely it is to be accurate. If it claims to be a panacea, don’t trust it: “There is no such thing as a magic pill.” That seems reasonable as far as it goes, but it doesn’t go nearly far enough. Yes, general, overarching claims are probably false, but many specific claims are false as well, or at least not backed by good, scientific evidence.

3. Determine safety. Ooh, really important. They don’t spend much time on this either. Ulbricht advises viewers to speak with their healthcare providers “even if they don’t know, they can use resources like Natural Standard and educate themselves and work with you to customize your care.” She also suggests looking at clinical data. This is good advice, although the plug for her own organization is perhaps a bit off-putting. But,again, the advice doesn’t go nearly far enough. How do people evaluate clinical data? Or find it?

Nowhere in this segment does either Oz or Ulbricht discuss potential toxicity or drug interactions. They don’t mention quality control.

At the end of the segment, Dr. Oz says “the only thing I endorse is information.” This is right after he and Ulbricht have endorsed fish oil, glucosamine and echinacea. He then endorses Natural Standard, telling his viewers to go to his site to find a link so they can get one free login at Natural Standard. Like many professional databases, Natural Standard is asubscription only resource. It seems possible, even likely, that some viewers, after using their free login, will choose to subscribe. Surely, Dr. Oz is endorsing not just information, but also a fee-based service. In short, what Dr. Oz says about endorsements seems to be “factually on target,” but misleading.

In the next segment Dr. Oz continues to endorse alternative supplements. The show calls this segment “Assistant of the Day.” I call it “The Price is Right of Medical Woo.” An audience member is invited to “come on down!” (okay, they don’t really say that). Dr. Oz is in scrubs; the woman is given a lab coat. The woman was presumably chosen because she suffers from headaches, and the segment focuses on headache triggers. I won’t discuss what he says about triggers as I don’t really have the necessary knowledge to evaluate all his claims. However, he does recommend two herbal supplements.

First, he says, “There are over-the-counter medications that work, but I happen to love this one.” “This one” is feverfew. According to Wikipedia, “It is hypothesized that by inhibiting the release of serotonin and prostaglandins, both of which are believed to aid the onset of migraines, feverfew limits the inflammation of blood vessels in the head. This would, in theory, stop the blood vessel spasm which is believed to contribute to headaches. Feverfew may also have GABAergic effects.” “Hypothesized,” “in theory,” “may.” Hmmm.

On screen, we see the following information: “FEVERFEW SUPPLEMENTS, 125 mg/daily, 50/60 tabs–online.” Sounds like an endorsement, doesn’t it? Granted, he’s not endorsing a specific seller or manufacturer, but he’s already highlighted some of the problems with online supplement companies (they’re not always honest). Why does Oz prefer feverfew to the medications that he admits work? Well, it “gets you off taking pills all the time for your headaches.” Except that it doesn’t. Feverfew doesn’t work like aspirin: you don’t take it when you get a headache. It’s used as a preventive measure rather than as a treatment when you get a headache. As Wikipedia states, “it might take four to six weeks before they become effective.” In other words, it doesn’t get you off taking pills all the time. You have to take the pills daily. If you suddenly stop taking them, you may suffer rebound headaches (this is also a problem with conventional headache treatments, especially migraine treatments). In addition, according to Wikipedia, parthenolide, one of the active ingredients in feverfew, “was also found in 2005 to induce cell death in leukemia cancer stem cells.” So, you are taking pills; you are taking chemicals; there may be risks; it hasn’t been studied as thoroughly as conventional treatments. And finally, “results vary widely among different feverfew supplements.” This is a huge problem with supplements and one that Oz does not address.

Oz recommends another herbal supplement that can be used symptomatically for headaches, especially exercised-induced headaches: “I think [it is] a wonderful solution.” What he’s talking about is “BUTTERBUR SUPPLEMENTS, 75mg/day. 50/60 tablets–online.”  There does seem to be some evidence that butterbur can be effective in preventing and relieving headaches, particularly migraines; however, as Wikipedia notes,

Butterbur naturally contains components called pyrrolizidine alkaloids. They are toxic to the liver and may cause cancers. The concentrations are often highest in the rhizomes and stalks, and lowest in the leaves, and may vary depending on where the plants are grown. Butterbur extract should be taken only when prepared by a reputable laboratory. Long-term health effects and interaction with other drugs have not been studied.

Does that sound like something Dr. Oz’s viewers should know about and be concerned about? It does to me. I suffer from migraines, and there are times when I would try anything that might relieve them. I’ve considered a small, portable guillotine.  People have suggested butterbur to me, and so I have looked into it. What I’ve found has concerned me. Apparently it doesn’t concern Dr. Oz, though, because he doesn’t mention these potentially lethal side-effects. And, again, you’ll note that the fact that the supplement industry is unregulated adds to the risk. You need to know what you are getting, and with supplements, you often don’t.

Dr. Oz offers no information that would help his viewers determine which manufacturers are reliable and which supplements are safe. He never mentions that “natural” substances can be deadly. Honestly, it might be better if Dr. Oz did endorse specific manufacturers. Then, at least, his viewers could assume (or hope) that they are really getting a safe product. Based on the information he provides in this episode, they don’t have the resources they need to make an informed decision.

ES

12 Responses to The Dr. Oz Show: The Price is Right of Medical Woo

  1. [...] The Dr. Oz Show: The Price is Right of Medical Woo [...]

  2. [...] The Dr. Oz Show: The Price is Right of Medical Woo [...]

  3. Ken says:

    You know, the therapy of bleeding people to balance their humors was around for a long time.

    I think trepanning is the oldest therapy for which we have physical evidence. There are even some Neolithic skulls with post-operational healing of the cuts, so the patients survived for a while. Good for migraines, too, according to Wikipedia, and if we can’t trust “the encyclopedia that anyone can edit” for medical advice, who can we trust?

    I’m sensing a business plan coming together. Home trepanation kits: Genuine Neolithic flint choppers and herbal supplements to promote healing. I think I have everything I need in the rock garden… Basil promotes healing, right? Oh, wait, I said “supplement” so I don’t have to actually show that. But does anyone regulate surgical equipment? I guess I can just call the rocks “home therapy equipment,” not “surgical equipment.”

    • Eve says:

      Home trepanning kit–I like it! “How much would you expect to pay for this kit? $500? $600? But wait, there’s more. Order now, and we’ll send you the portable guillotine at no extra charge!”

  4. [...] (The Dr. Oz Show: The Price is Right of Medical Woo) [...]

  5. sandra says:

    Here is my letter to the Energy and Commerce Committee to hear: Free Speech About Science Act 2011 HR 1364

    Dear Chairperson’s on the Committee of the Food and Drug Activities,
    In 2010-2011, four different pieces of legislation have had provisions that concerned, in one way or another, the regulation of dietary and nutritional supplements and consequences to anyone recommending them. The root of the problems is with allopathic medical, pharmaceutical, and nursing students because natural science studies and the benefits of all natural food supplements for the treatment of and to prevent disease by supporting the body to build, repair, protect, and maintain healthy cells. Doctors of Natural Science Medicine study both conventional and natural science medicine and the medical degree is considered equal. This lack of understanding is rooted with allopathic conventional medicine doctors, nurses, and pharmaceutical students because colleges do not require extensive training in natural science to graduate. I feel, because of this lack of knowledge there cannot be any bases for opinion, ban, or legal action at all by the American Medical Association, Pharmaceutical Companies, and the Federal Drug Administration, Federal Trade Commission, or any Attorney General in any state in America. The reason Nancy Syderman MD is following around Suzanne Somers on Date Line and on morning TV screaming, “Where’s the Science?” is because the FDA is imposing Scientific and Journalism Censorship to silence and squash the natural whole foods and supplement industry. Challenged FDA Claims in Federal Court are ruling the premise about “not enough adequate science as invalid and unconstitutional.”The FDA is losing because,” it is clearly an attempt to squash the natural food and supplement industry.” The corruption by the FDA and the FTC is because of the powers to self legislate without the approval of Congress. The FDA has banned Vitamin C and little children in burn and cancer wards are needlessly suffering……I find this unforgiveable! It is time to REVOKE THEIR POWER. Where is the TRANSPARENCY FOR THE FDA AND THE FTC AND THE AMERICAN MEDICAL ASSOCIATION. WE HAVE OVER POLICING AND TYRANNY IN AMERICA!
    The President’s Cancer Panel in May 2010 reported to him that millions of Americans and especially children are going to have Cancer as the result of the constant daily bombardment of pollutants. As you may know, our First Lady has taken action as an example, by planting an organic garden, opening up access to fresh fruits and vegetables in local school systems, neighborhood markets, and promoting local farming, along with the US Department of Agriculture for encouraging families to buy and plant fruit trees with food stamps. Yet, we have the FDA banning Vitamin C and Cherry Trees and demanding Farmers to pull up Cherry Trees, and of course taking the livelihood from Farmers away. I planted 3 Cherry Trees, last year for a supply of Vitamin C.
    Vitamin C is the most research nutrient around the world Linus Pauling Institute won the Nobel Prize for his work and book on Vitamin C and Cancer. My husband was given 3 months to live and he lived 17 years. I personally decided to keep taking Vitamin C because I did not have a cold or influenza for 5 years. My sister looks 35 years old when she is 70 years old. I can conclude from our personal health experiences that Vitamin C boosts immunity.
    And because the FDA banned vitamin and minerals and the use of probiotic found in yogurt then the FTC heavily fined and started a class action lawsuit for “false immunity claims” on Dannon for Activia, an inexpensive natural solution to balance digestive health. Russia is leading the way with excellent proof for “immunity” claims for yogurt and probiotic health Obviously, The FDA cannot tell the difference between a food supplement or a manufactured pharmaceutical drug. If I want to eat yogurt with blueberries and green tea promoted by the Humane Genome Project….it is my business. If I want to take mega dosages of Vitamin C….it is my business. If I want bioidentical hormone supplements…..it is my business. The FTC comes with guns to confiscate shelve stock and pc records of small business owners and home based businesses in the middle of the night……THIS IS ABUSE AND TYRANNY OF SILENCE IN AMERICA!
    Recently, the results of many global studies on food research funded by President Clinton when he was in office, The Human Genome Project, the discovery of specific nutrients that turn off and on the Cancer genes and repair parent DNA in the Humans has given birth to tailor made solutions with nutriagenetics. The National Institute of Cancer found natural plant chemicals in vegetables and spices to stop cell division of cancer cells and the bodies immune system can tell the difference between healthy cells and unhealthy cells which it the goal of conventional toxic chemotherapy cancer treatments, and The Angiogenesis Foundation has given birth to foods that cut of proteins in the blood supply to actually starve cancers cells. We’ve come a long way baby, since the research of Linus Pauling in the 1970’s. The basic science of biology has increased 10 fold for the understanding of the life and death of cells and anti aging, and including life extension is at hand! The natural food and supplement industry has advanced with significant scientific research.
    This nutritional information is sending lobbyists to Washington DC and is pushing the FDA to impose more Scientific Censorship to squash the natural science therapies and give American’s only one choice for health….Synthetic Drugs. Covert and sneaky actions by Congressman Henry Waxman to deliberately squash the health food supplement industry in the Wall Street Reform Bill. And then more stupidity abounds with Congressman John Mc Cain for deliberately blaming and squashing the food supplement industry for natural steroids consumed by athletes. The problem lies with the “ethics of the untouchable MD’s.” And he is also shooting himself in the foot, if he wants Mexican’s to stay on their side of the border then he better let the network marketing food supplements industry to financially prosper them.
    We also have to seriously consider what has been stuffed into the National Health Care Plan authored by Congressman Henry Waxman. Congressman Bill Leahy’s Food Safety Bill is setting 10 year prison sentences for people like me recommending natural therapies and nutritional supplements for health. I have 45 years experiences and have thousands of hours in holistic alternative education.
    As a constituent it upsets me that many in Congress seem to have a fundamental misunderstanding of the nature of supplements themselves, and confusion over the legislation that currently regulates their use and safety. Regulation in the UK and Canada has only given way to synthetic nutrients being approved prescribed and marketed by Pharmaceutical Companies, and is a disaster.

    First, supplements are not drugs. They are vitamins, minerals, herbs, and micronutrients–substances found in food and in nature, not created in a laboratory. Why? Because they are not drugs–because they are not patentable, and their manufacturers will never have patent protection–they should not be regulated in the same way that patentable drugs are. To subject them to the vast cost of FDA approval would simply drive supplement producers out of business, leaving drug companies with a complete monopoly.

    Sincerely,

  6. [...] the “pseudo-skeptics” have actually been saying about Steve and Dr Oz, and literally the first post I found was by two people whose full names and résumés are on their [...]

  7. JKT,MD says:

    This is the classic marketing of celebrity. If you’re charming & persuasive you can “sell” most anything. The problem here is that: 1) some of these fad diets, latest exotic “miracle” foods or procedures are presented simplistically, have risks and/or are cost-porhibitive; 2) if there is a paid incentive for the endorsement, the “down” side is never brought forth. This has been the history of big Pharma sponsored reseach; 3) the latest (?greatest) next big thing always captures the media spotlight, but, infact, many of these nutritional “breakthroughs” are just re-discovered. They have been merely “dusted off” and repackaged for another generation of “suckers”.

    An older MD

  8. Bob says:

    Well, at least he hasn’t brought back goat gland transplants. And when it comes to negative results, pharmaceutical companies should make all of their results public. Absolutely.

    RJB

    • Ken says:

      I thought that was the point of those horror stories they recite during the drug commercials. You know, “May cause asthma, intestinal bleeding, kidney disease, nausea, paranoid schizophrenia, or brain cancer; do not take if you are pregnant or ever hoping to become pregnant.”

      The weirdest ones are where the drug is a sleep aid or something equally trivial, and still has this list of ghastly side effects. I guess it just indicates how much money the company has already invested by the time the FDA studies come in; dammit that pill’s going on the market!

  9. Bob says:

    A sleeping pill that may cause or exacerbate insomnia. :)

  10. 1500 calorie meal plan…

    [...]The Dr. Oz Show: The Price is Right of Medical Woo « Skeptical Humanities[...]…

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