When the letters are meaningless

Let’s just dispense with something right away, shall we?  Dr. Mehmet Oz is a far more accomplished physician than I will ever be.  From the recent profile of “America’s doctor” in The New Yorker:

Oprah Winfrey first referred to Mehmet Oz as “America’s doctor” in 2004, during one of his earliest appearances on her television show. The label stuck. Oz was a rare find: so eloquent and telegenic that people are often surprised to learn that he is a highly credentialled member of the medical establishment. Oz graduated from Harvard University in 1982. Four years later, he received joint medical and M.B.A. degrees from the University of Pennsylvania. He then moved to Columbia and New York-Presbyterian Hospital, where, as a surgeon specializing in heart transplants, he has served as vice-chairman and professor in the department of surgery for more than twenty years. (He still performs operations there each Thursday.) Oz also directs Columbia’s Cardiovascular Institute and Integrative Medicine Program, which he established in 1994, and has published scores of articles on technical issues, such as how to preserve muscle tissue during mitral-valve replacements. He holds a patent on a solution that can preserve organs and one on an aortic valve that can be implanted without highly invasive open-heart surgery.

Those are some impressive achievements, and it would be ludicrous to aver that Dr. Oz doesn’t deserve a great measure of respect for them.  Indeed, I almost feel sheepish, pissant little private practice pediatrician that I am, for daring to criticize him as a physician.

Almost.

Because, as the above excerpt indicates, Dr. Oz is only really a doctor one day a week nowadays.  Nowadays Dr. Oz spends the rest of his time as a highly-successful television personality.  And underneath the patina of faux legitimacy his genuine medical triumphs confer is a distressingly large pool of snake oil.

“The Dr. Oz Show” frequently focusses on essential health issues: the proper ways to eat, relax, exercise, and sleep, and how to maintain a healthy heart. Much of the advice Oz offers is sensible, and is rooted solidly in scientific literature. That is why the rest of what he does is so hard to understand. Oz is an experienced surgeon, yet almost daily he employs words that serious scientists shun, like “startling,” “breakthrough,” “radical,” “revolutionary,” and “miracle.” There are miracle drinks and miracle meal plans and miracles to stop aging and miracles to fight fat. Last year, Oz broadcast a show on whether it was possible to “repair” gay people (“From Gay to Straight? The Controversial Therapy”), despite the fact that Robert L. Spitzer, the doctor who is best known for a study of gay-reparation therapy, had recanted. (Spitzer last year apologized to “any gay person who wasted time and energy” on what he conceded were “unproven claims.”) Oz introduced a show on the safety of genetically modified foods by saying, “A new report claims they can damage your health and even cause cancer.” He also broadcast an episode on whether the apple juice consumed daily by millions of American children contains dangerous levels of arsenic. “Some of the best-known brands in America have arsenic in their apple juice,” he said at the outset, “and today we are naming names.” In each of those instances, and in many others, Oz has been criticized by scientists for relying on flimsy or incomplete data, distorting the results, and wielding his vast influence in ways that threaten the health of anyone who watches the show. Last year, almost as soon as that G.M.O. report was published, in France, it was thoroughly discredited by scores of researchers on both sides of the Atlantic.

The article is lengthy, and goes into a great amount of detail about the kind of stuff and nonsense that comprises a sadly sizable amount of Dr. Oz’s airtime.  Furthermore, the estimable Orac at Respectful Insolence has covered the topic, and I hate to offer up a second-rate version of what someone else has already done well.  Interested parties are politely directed there.

But there’s something particular that I want to make clear.  As a physician, I do not view Dr. Oz’s attention to homeopathy or the latest whiz-bang supplement that will do nothing but separate customers from their money as a sign of admirable open-mindedness.  Touting fad diets and offering a platform for debunked junk science is not an indication that Dr. Oz is unconstrained by professional bias.  It is not a complement, expansion or blossoming of his medical practice.  It is a betrayal.

Doctors aren’t scientists per se, at least not those of us whose practice is entirely centered on patient care.  But science informs (or at least is meant to) everything that we do.  Knowledge of the scientific evidence in support of any given clinical practice is necessary to be a competent physician, and competence is one of the two necessary qualities of any good medical provider.  (The other is compassion.)  Stoking your audience’s interest in remedies and rituals with no scientific evidence to support them is to turn your back on what makes medicine work.

What infuriates me about Dr. Oz is that his entire career as an entertainer is premised on his expertise as a surgeon.  His medical training lends the appearance of intellectual rigor where there is none.  It confers ersatz respect to products, viewpoints and people who deserve none.  At this point in his career (with the exception of one day per week), those letters behind his name aren’t a credential, they’re a sales gimmick.

Deepak Chopra is another ready example of this kind of misapplied legitimacy.  His gimcrack theories and blandly palatable pop psychology sell a lot of books, many with the gleam of his MD right there on the cover.  Make no mistake — what he peddles isn’t medical advice, no matter how sage his musings about Jesus or the afterlife or whatever.

These men and people like them dilute and pollute our understanding of what medicine really is.  Reiki and homeopathy and “applied kinesiology” and all the rest of it aren’t medicine, at least not until their boosters and practitioners can cough up some evidence that they actually do some good beyond the placebo effect.  (You’ll forgive me if I refrain from holding my breath.)  By promoting these forms of quackery, chicanery and shoddy or misrepresented science, Dr. Oz erodes his legacy as a physician.  The letters behind his name do not legitimize what he is doing.  Rather, he delegitimizes them.