The speed of science

 A reader sent me the following nutrition advice that she came across while browsing Dr. Oz’s website:

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.

So what’s a television host to do? He needs fresh content to fill his show. Not to mention his conglomerated media empire of websites, radio shows, books, and magazines. Another reader, “JA,” correctly points out that Dr. Oz style shows “depend on breakthroughs:”

To keep his show going with its viewership, he needs to cover amazing breakthroughs in health for five shows a week times however many weeks a year he is on.  Assuming 30 weeks per year, that is 150 breakthroughs PER YEAR he has to trumpet.  It is unbelievable that there are that many discoveries possible.

News reports on medical breakthroughs, but only when they happen.  They do not depend on breakthroughs to keep them on the air.  Dr. Oz does.

As exhausting as this must be for Dr. Oz, imagine how exhausting it is for his viewers. “LB” writes:

Over the past three years, I have purchased everything Dr. Oz recommended for losing weight. I finally began to notice (Been in the Oz zone) every day there was a product better than the previous day. The health food store rolled their eyes when I again asked for Dr. Oz’s latest fat cure.

Finally, I quit watching, and I still have some partly-filled bottles of those miracle pills that didn’t do a thing for me. His program no longer holds a place in my “series recordings,” and I have found in a pinch I would rather watch cartoons.

We find it funny when shows like Dr. Oz seem to promote a “miracle” diet one week, only to contradict it with a new diet recommendation the following week. But patients can feel the same frustration just by reading the news or getting conflicting advice from different physicians.

Medical science rarely feels “settled” in the minds of our patients, and they’re right. It seems like doctors either recommend treatments, only to have future studies disprove those recommendations, or we wait too long to recommend a treatment that turns out to, indeed, be life-saving.

We shouldn’t be surprised when patients feel fatigued or apathetic. Even our most earnest recommendations sometimes end up sounding like that restrictive diet proposed by Dr. Oz’s website. And patients probably feel even worse if we merely respond “who knows?” to their questions without providing specific guidance.

The sheer speed and variability of Dr. Oz’s recommendations clearly call into question their usefulness. Dr. Oz is often willing to make medical recommendations to millions of people based only on animal studies, before a drug has even been tested in humans. But deciding exactly how much evidence is needed before making a recommendation to a patient is a struggle all doctors face.

January 20, 2015 | Benjamin Mazer