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

April 28, 2011

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.