But the key for viewers watching will be whether any of Dr. Mehmet Oz’s analysis of the 70-year-old Trump’s medical condition is backed by evidence and comes without conflicts of interest, according to policy of the nation’s largest doctor group, the American Medical Association.
The AMA approved directives on ethics of “physician conduct in the media” and doctor “publicity and responsibility.” In debating the resolution at last year’s meeting, physicians criticized Dr. Oz’s show as a forum for unproven medical advice and lack of disclosure when it comes to conflicts of interest.”
This project has been completed. Thank you to the hundreds of people who shared their experiences with me. There is no doubt about it: the health information that gets spread through the media is having an enormous influence on the lives of everyday people. The media and the healthcare profession need to decide what kind of influence they wish to have.
Thank you, as well, to the unflinching journalists and physicians who have helped to raise awareness about the false medical information that continues to be shamelessly and widely disseminated. While problems remain, you are beginning to change the conversation. Even Dr. Oz has improved the accuracy of the information being presented on his show. But Doctors In Oz was never just about his television show. It was especially not about Dr. Oz as an individual. It was about furthering a conversation and taking concrete actions in order to improve the health information being broadcast to millions of people. The influence of technology and media on people’s health will only continue to grow. I am not cynical about this trend; I am optimistic.
Starting this summer, I will begin a pathology residency at Yale-New Haven Hospital. You can follow my further work at my personal website. I’m excited for what’s next.
Forgive me Osler, for I have sinned
Not everyone agrees with what I’m advocating for politically. This shouldn’t come as a surprise. I’m a mere medical student, yet I’m speaking brazenly about the harm being done by misleading medical information in the mainstream media. I’m encouraging the medical profession to make substantial improvements to how we disseminate medical knowledge to the public. In the beginning I was questioned about whether this issue was really so important. So I started this website to collect first-hand accounts by providers and patients that felt misled by false medical information in the media. Over the following months I heard from so many people who were outraged and saddened by medical professionals who use the media to spread inaccurate medical advice. There was no question that doctors were being held to a higher standard, yet many in the media weren’t living up to it. But let’s just say I’ve also faced some skepticism. Here’s one less-than-supportive message:
“Who do you think you are? You are a 3rd year med student who doesn’t have a clue about healthcare in the United States. If you want an entity to tackle, go after the insurance companies that really provide the medical care in the US. Why aren’t you tackling the pharmaceutical companies? Why aren’t you tackling the physicians who prescribe medications and use technology because of kickbacks?”
A nurse wrote me that email.
When so many people distrust the profession itself, my stance will inevitably be controversial. Letter writers have confronted me with the tabloid scandals of medical history: organized medicine’s opposition to public health advancements like Medicare, doctors’ persistent habit of recommending therapies that don’t work, our ongoing coziness with the pharmaceutical industry, to name a few of the more infamous parts of our history. One message I received referred to the way most doctors practice medicine as merely “common quackery”, compared to the more interesting quackery of the doctors I’ve criticized.
In light of medicine’s sins and the subsequent distrust patients now have toward us, why do I continue to promote the idea that the medical profession should be self-regulating its public speech? Worse, why am I attacking doctors who “bravely” dare to leave behind mainstream medical dogma, a dogma so often proved wrong? Or as one person asked me, is organized medicine simply punishing doctors who dare to have “original ideas”?
Gary Schwitzer is the founder of HealthNewsReview.org, an indispensable resource for journalists, consumers, and physicians who want to understand the science behind popular news stories. Of course, when you actually look at the science behind the headlines, you’re often disappointed with how thin the empiric backing really is. That’s what makes Mr. Schwitzer’s work so challenging but necessary.
Mr. Schwitzer graciously agreed to talk with me about how the media can improve the health information they present, and what consumers can do to improve their own health knowledge.
Read below for the complete interview.
Over the last couple of weeks I’ve written about a new AMA policy authored by a group of medical students and co-sponsored by medical residents and fellows. I’ve been sharing details about how this policy came to be not because I think it is exceptionally historical, but because it is an example of meaningful political progress and professional reform being instigated by medical students.
What “being a doctor” means is subject to an ongoing, iterative process of change — from both outside forces and forces within the profession. I think as medical students we can only gain an accurate understanding of the profession if early in our training we participate in this process of professional re-construction and renewal. We need to understand that the profession didn’t stop evolving after Hippocrates.
One of my colleagues, Joy Lee, a lead author of the AMA policy we’ve been discussing, exemplifies the value of student engagement with the professional institutions that define what it means to be a doctor. In the interview below she tells me about her experience with organized medicine.
Here’s how she describes herself: Joy Lee is a third-year medical student at Rutgers Robert Wood Johnson Medical School. She graduated from the University of Illinois, moved to the East Coast, and has been re-learning how to drive ever since. When she isn’t studying or doing research, she enjoys policy wonking and eating adventurously.
Read on for the entire interview.
Recently I discussed a new AMA policy that was written by a group of medical students. You’ve heard plenty from me about why I think doctors should be active in ensuring medical information in the media is accurate. Let’s hear the thoughts of some of the other authors of this new policy.
Elizabeth Fracica, Mayo Medical School:
As a future physician, I have seen how rapidly the practice of medicine is changing due to the dramatic technological innovations we are experiencing as a society. While many young doctors are excited to use these new tools to enhance their practice, we must also ensure the core ethical values that support a trusting patient-physician relationship are not compromised in the process, as this is at the very core of our duty as a physician. I became involved in this resolution because I saw the need for us to come together as a united physician front. This policy is partially in response to Dr. Oz’s television show, but I believe this policy will also allow us to take an exciting step forward to address some of the broader questions raised by his show, and it will provide us with clear direction moving forward to ensure the needs of our patients truly come first.
Benjamin Meyer, University of South Dakota – Sanford School of Medicine:
As a medical student, I have heard stories from attending physicians involving patients who have been misled by physicians using mass media platforms to disseminate dubious medical advice. Given the high ethical standards to which physicians should be held, I am greatly dismayed by those in our profession who partake in such practices, possibly motivated by pursuit of fame or personal monetary gain. Going forward into the 21st century, physicians will no doubt continue to have abundant opportunities to use media platforms to disseminate medical advice. I feel it is timely for the AMA, as the voice of physicians, to take a strong and firm stand for evidence-based medicine and transparency.
Please continue to share your experiences with patients being misled by inaccurate medical information in the media. You can submit your story to firstname.lastname@example.org.
In an earlier post I described a policy proposal written by a group of medical students. We asked the American Medical Association to take the lead on the issue of medical ethics in the media. It turns out that medical students are not the only contingent of medical professionals willing to take a stand on this topic.
The Resident & Fellow section of the AMA co-sponsored this proposal and brought it to floor of the AMA House of Delegates faster than anticipated. They even did one better by proposing a related policy that encourages media physicians to be clear to viewers what level of evidence supports the claims they are making.
The delegates, who represent doctors throughout the country, voted to support the policy proposal as we wrote it. The AMA will now be taking the lead in crafting ethical and professional guidelines for physicians who wish to disseminate medical information in the media. The AMA will also write a report describing how physicians may be subject to discipline for violating medical ethics in the media. And finally, the AMA will be releasing a public statement reiterating our professional values and condemning doctors who use the media unethically. You can read the full text of our proposal in the prior post.
So why do these things matter? I’m sure to many this sounds like a lot of bureaucracy and little action. So the following are some thoughts. This is my own interpretation and simplified explanation. I am not speaking for the AMA in any capacity.
Julia Belluz at Vox published an article discussing the tensions between being a scientist/physician and being involved in the popular media. My views on the importance of this issue were also quoted:
A very insightful medical student at Rochester, Benjamin Mazer, has been lobbying the American Medical Association to publish media guidelines for doctors — as well as to condemn and discipline those who use the mainstream press to spread false medical information.
I asked Mazer why he made this the focus of his advocacy. “We’re on the very beginning of a technological and societal change that will allow mass media to be an important component of public health — if not the most important component,” he told me. “We need to begin the conversation about how we’re going to give people information through technology responsibly and accurately.”
Here, Mazer was again raising a conflict that Sacks foreshadowed. With the publication of his best-selling books Awakenings and Migraine, Sacks recalls in his memoir, “Suddenly I was in contact with a great many people. I had powers to help — but also powers to harm.” If only all doctors would realize the same.
I have received many messages that are critical of this project. Rather than defend Dr. Oz directly, they usually question the importance of this whole endeavor. I have been asked why I’m not “taking on” the hospital lobby, insurance companies, or big agriculture. Of course, I have also received plenty of emails telling me to “stay within my paygrade” as a medical student and to wait until I can write prescriptions before trying to share my opinion. (Sometimes I’m given both suggestions in the same message.)
I hope Vox’s article helps to show that Doctors In Oz is not looking to
provide all the solutions, but rather to expand a conversation that is central to the future of medicine and public health.
Many doctors have written to me with concerns that trying to curtail the promotion of dangerous medical ideas in the media may lead to heavy-handed regulation of what physicians say in general. These physicians who wrote to me agree that Dr. Oz and others like him are spreading false medical information, but they still worry about the unintended consequences of taking action.
Doctors feel it’s important to be protected when they talk to their patients about complex medical topics. What actually constitutes “good” medical information is not always easy to know.
Even Dr. Oz recently claimed that his critics were trying to stifle his right to “free speech.” Freedom of speech, of course, also extends to Oz’s critics, who are predominantly private individuals trying to be truthful in their critiques. However, what if official regulatory bodies wished to take action?
In order to get a better perspective on how free speech comes into play with doctors in the media, I talked with I. Glenn Cohen of Harvard Law School. He is an expert on the intersection of law, medicine, and ethics and a director of the Petrie-Flom Center for Health Law Policy, Biotechnology & Bioethics.
Read on for the complete interview.
This week, I was interviewed on CNN about my work on this website. I was joined by Dr. David Katz, a physician at Yale, who is also friends with Dr. Oz. During the interview, Dr. Katz said the following about the dangers of false information on TV shows like Oz’s:
This idea that there’s harm? To my knowledge, there is absolutely no proof of net harm. Actually, it’s a testable hypothesis.
Dr. Katz inadvertently endorsed the importance of the Doctors In Oz project. I have heard the phrase, “What’s the harm?” too many times to count while trying to discuss medical quackery in the media with physicians. Your first-hand experiences are a powerful tool to show that patients act on the information they hear in the media. If the information being disseminated is bogus, it has the power to be extraordinarily harmful. If we use the influence of the media to spread accurate information, however, we can greatly improve the public’s health. Let’s test that hypothesis.
Organized medicine has predominantly taken a passive approach to quack doctors who spread misinformation. While groups like the American Medical Association have policy on the books asking doctors to disseminate scientifically-accurate medical advice, they have not used their large budgets and clout to publicly criticize the doctors who chronically ignore their ethical obligations.
Medical students are now asking the AMA to actively defend the integrity of the profession. Joy Lee, a medical student and member of the AMA-MSS Committee on Legislation and Advocacy, led the creation of the following resolution. I am one of its co-authors. This resolution is not a hasty attempt to stir controversy, but was carefully written with input from multiple stakeholders. It asks the AMA to issue a public statement that reiterates the importance of evidence and transparency to the profession. It asks the AMA to craft guidelines on how doctors can ethically use the media to help the public. Finally, it asks the AMA to issue a report on what disciplinary pathways might be available for doctors who continue to spread bogus medical information in the media.
In June this resolution will be brought before the Medical Student Section of the AMA, where we will ask for the sponsorship of medical students from across the country. Following this vote, we hope the medical students will bring the resolution before the entire AMA House of Delegates.
I couldn’t be more proud of my fellow medical students. Medical students remain in many way the conscience of medicine. All resolutions are open to amendment and public discussion throughout this process. We will continue to revise our policy request and engage in this important discussion. We’ll share updates on this blog.
Please continue sending your stories and perspectives. I’ll be using the experiences shared with Doctors In Oz in my official testimony for this and other policy resolutions.
Julia Belluz at Vox.com has written an extensive analysis of the many medical professionals who are criticizing Dr. Oz for his dangerous quackery. She also discusses the work we are doing here at Doctors In Oz.
Oz’s dubious medical advice wouldn’t be such a problem if people saw the show as merely entertainment — if they simply watched the show but didn’t take its claims to heart. But it’s clear viewers really do heed his advice. There’s the case of a man who followed Oz’s suggestion of curing insomnia by pouring uncooked rice into socks, heating them in a microwave, and wearing them to bed. The man got second- and third-degree burns on his feet. He sued, but the case was thrown out because the judge determined that Oz cannot establish a physician-patient relationship through TV.
Not everyone agrees with the judge’s reasoning. Rochester New York medical student and blogger Benjamin Mazer has been publishing anonymous stories sent into him from health professionals about the impact Oz has had on patient care.
There are a lot more perspectives to share. The dissemination of medical information through mass media and the internet is in its infancy. The healthcare system will only increase its reliance on technology-mediated medical care. We must continue pursuing a nuanced discussion of the ethics of mass medicine.
We are continuing to collect and share the experiences of medical professionals and patients who contact us. We will also be sharing the opinions of legal experts on what the legal landscape looks like for doctors who deliver medical information through the mainstream media. Finally, we continue to pursue policy changes within organized medicine.
Tom Rifai, MD, FACP writes:
From my perspective as a board certified internist and Fellow of the American College of Physicians, as well as an expert clinical metabolic nutritionist, I believe there is “macro harm”, i.e. cases in which something Dr. Oz said led to immediate, measurable substantial untoward harm — but there’s also the very significant concern of massive “micro harm”, which may not be measurable in any single person immediately — but is critical from a public health perspective.
Massive “micro harm” might be best described in terms of the “distraction effect”. That is, when Dr. Oz mentions a supplement or unproven remedy of some sort, a huge number of people end up spending significant time worrying about where to get “it”, what the best source is, etc. and being distracted from spending time on the simple — admittedly “boring” — but critically important evidence-based lifestyle factors of movement. These include both exercise and non-exercise activity time and sitting time, as well as focusing on a moderate calorie, primarily whole and minimally-processed plant predominant, low salt-added eating style ranging from Vegan to plant predominant Flexitarian.
Behavior modification specialist docs like myself also get distracted during the clinical office visit by questions from patients on recommendations from Dr. Oz that would be better spent on evidence-based pursuits. In a time crunched medical system, this massive degree of micro harm to society is not irrelevant. I have spent hours upon hours simply trying to counter misinformation from Dr. Oz and getting patients back to baseline rather than being able to spend time moving them forward on the already very difficult path of therapeutic lifestyle change.
We’ll now continue our interview with Paul Crane, the founder of UltimateFatBurner, a popular website devoted to science-based supplement reviews.
See the first part of our interview here.
BM: What kind of response, if any, have you gotten from the manufacturers of dietary supplements?
PC: Most supplement manufacturers, I think, recognize that free speech allows us to share our opinions without recourse, and even if they don’t, are smart enough to know about the “Streisand effect” — that in the course of trying to suppress something they don’t like, they inadvertently draw much more attention to themselves and their products than had they just left well enough alone.
Having said that, we’ve received more than our share of “cease and desist” notifications over the years. We always deal with these exactly the same way — post the document live on our web site, draw attention to it on social media channels and our newsletter list and so on.
In other words, draw as much public attention to it as possible. This public shaming is usually enough to make them go away, but not always. Sometimes our lawyer has to respond with an equally nasty letter of his own.
When you first hear the website’s name, UltimateFatBurner, you’re bound to think it’s just another hastily-constructed marketing tool for the latest fad supplement. But browse the website and you’ll soon find it’s a venerable database of science-based supplement reviews. When words like “miracle” or “revolutionary” are used, they’re put into skeptical quotes. Instead you’ll find reviews full of phrases like “control group” and “clinical trials”. This isn’t your typical supplement website.
Paul Crane, the founder of UltimateFatBurner, was kind enough to answer some of my questions about his years-long battle to put a scientific soul into the supplement industry monster.
BM: Could you tell me how you got started with this website and what your credentials are for writing about this topic?
PC: A friend of mine took me to the gym to have a workout in 1989, and I took to it like a fish to water. It was this growing interest in weight training and body building that ultimately lead to a fascination with supplements of all shapes and sizes.
The following foods feed fat cells, so steer clear!
* Carbohydrates, with the exception of vegetables. Avoid bread, rice, pasta, cereal (including oatmeal), potatoes, beans and all crackers, cookies, and refined manufactured products.
* Liquid calories and juice, including homemade fresh juices, non-dairy creamers, skim milk, rice milk, soymilk and sports beverages, vitamin water, and especially alcohol!
* Fats, including healthy fats such as nuts, seeds, avocado, and oils until your body begins burning fat for fuel
* Dairy products, including all types of milk, yogurt and cheese (even if they are fat free)
The reader correctly points out that this doesn’t leave much food left for people to “safely” consume. She was particularly disturbed by the prospect of not being able to put low-fat milk in her coffee anymore, which she heard Dr. Oz specifically prohibit on his radio show.
Medical science simultaneously feels fast and slow. Every day, there’s a news story about a potential breakthrough. Yet years go by while people suffering from hundreds of diseases wait for effective treatments. The process of evidence-based medicine is not linear.
In this blog post I’m going to talk about a subject that has gotten significant media attention: Dr. Oz and his dubious recommendations of supplements and fad diets. This anecdote isn’t a success story or a tragedy; it’s about the complexities of working with real patients as individuals and not as “viewers.”
First, my own recent experience in clinic.
I walked into the room and greeted a friendly, middle-aged woman (I’ll call her “Angela”) who was here for a “regular checkup.” Immediately, I saw the familiar marker of a patient who is engaged in her medical care: her prescription bottles were brought in from home and already organized on my desk.
This was my first time meeting Angela, though she had been a patient at the clinic for years. I asked her what brought her in today. She said her blood pressure had been high in the past. She had been given some medications to take. I looked at her chart and saw that her blood pressure today was 146/98, slightly elevated according to standard recommendations. However, I looked at her past blood pressures, and they had been markedly higher — up to 185/102. Over the past year-and-a-half they had been gradually trending downward.
“America this is quite serious.
America this is the impression I get from looking in the television set.
America is this correct?”
— Allen Ginsberg, “America” (1956)
Welcome to the Doctors In Oz Blog. We’re using this forum to share first-hand accounts and debate the role of mainstream media in disseminating medical information.
I’m starting this blog off with a startling and somber story. Not all the stories we share will be so tragic, but I’m choosing this one because it’s a reminder that patients listen. Doctors will gripe about how patients aren’t “compliant” with their medications. Our advice about diet and exercise will often fall on deaf ears. But still, patients sometimes listen. And when they do, we better be sure the advice we’re giving them is reasonable and safe.
Here’s what “JK” writes about her father:
“I just read online that you are gathering info about bad advice that Dr. Oz has given. My dad had a heart attack and had 5 stents placed in his heart. These stents were specifically coated with a material that required the patient to take aspirin and Plavix [to prevent clotting]. He was watching Dr. Oz, who said that Plavix was not necessary, so he stopped taking it. About a month later, he had another massive MI [heart attack] and coded and had to be shocked back to life. The hospital cardiologist asked him about medications when they found a clot at the site of the stent. My dad admitted to following Dr. Oz’s advice and not asking his own cardiologist. He learned that lesson the hard way and doesn’t listen to Dr. Oz anymore.”
Skeptical readers may laugh when they hear about someone who believes a “television doctor” instead of their own physician. And it’s unlikely that Dr. Oz was encouraging people who underwent heart procedures to stop taking Plavix. The perception of everyday viewers, however, is vital to consider. Television shows often feature fear-inducing warnings about rare side effects. Shows will bring on a guest (often unqualified) to generate enough doubt in the viewers’ minds that they apply general medical information to their own individual case.
Patients are listening to us, and we need to take their trust seriously because when a doctor gets on TV and millions of people tune in, you can be sure they’re taking him seriously.
A television show can provide all the excuses it likes. Legal departments can assure us there is no doctor-patient relationship here. Disclaimers can beg us to seek advice from our own physicians. But we’re far from the days when anyone can deny the power of flash and prestige. Put a charismatic doctor with impeccable credentials on television and people will listen. Does the prospect of someone listening to a doctor’s advice now frighten or amuse us? What can we do to change this?
Let us know your thoughts and experiences. We’ll keep sharing them.