Interesting Op-Ed by Dr. Oz

[ski89]

http://time.com/3831926/dr-oz-criticism-answers/

Hey I stumbled upon this and found it to be a good read. While I wholeheartedly agree on the primacy of evidence based medicine, I think Dr. Oz brings up some good points on the importance of individualized care that is focused first and foremost on healing. I have found in my own life that evidence based medicine sometimes fails to meet the needs of people I know (especially for things like chronic pain, nausea/abdominal pain, fatigue, and the like). In these cases these people have found improvement in their symptoms by other means. This is the danger of holding evidence based medicine as the only acceptable avenue for healing. In other words, while anecdotes have no place in evidence based medicine, they absolutely have a place at the bedside.

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[DoctorSynthesis]

http://time.com/3831926/dr-oz-criticism-answers/

Hey I stumbled upon this and found it to be a good read. While I wholeheartedly agree on the primacy of evidence based medicine, I think Dr. Oz brings up some good points on the importance of individualized care that is focused first and foremost on healing. I have found in my own life that evidence based medicine sometimes fails to meet the needs of people I know (especially for things like chronic pain, nausea/abdominal pain, fatigue, and the like). In these cases these people have found improvement in their symptoms by other means. This is the danger of holding evidence based medicine as the only acceptable avenue for healing. In other words, while anecdotes have no place in evidence based medicine, they absolutely have a place at the bedside.

I think this is the case DOs should make for omm instead of doing research and trying to incporate it as evidence based medicine.

 

[calvnandhobbs68]

http://time.com/3831926/dr-oz-criticism-answers/

Hey I stumbled upon this and found it to be a good read. While I wholeheartedly agree on the primacy of evidence based medicine, I think Dr. Oz brings up some good points on the importance of individualized care that is focused first and foremost on healing. I have found in my own life that evidence based medicine sometimes fails to meet the needs of people I know (especially for things like chronic pain, nausea/abdominal pain, fatigue, and the like). In these cases these people have found improvement in their symptoms by other means. This is the danger of holding evidence based medicine as the only acceptable avenue for healing. In other words, while anecdotes have no place in evidence based medicine, they absolutely have a place at the bedside.

Yes, and for the most part their relief of symptoms has a name. It's called the placebo effect and nobody denies that the placebo effect is a real thing. Where Dr. Oz and the rest of us differ is that Dr. Oz thinks it's cool to market and sell the placebo effect to millions of people, enriching himself in the process. The vast majority of physicians believe this type of practice is unethical, especially when it is portrayed as something other than a placebo effect and is marketed as having some unproven physiologic effect.

Also keep in mind that much of what TV celebrities like Dr. Oz advocate has nothing to do with immediate relief of symptoms. Instead, they sell products that claim to "decrease your risk of cancer" or something equally vague without having any or flimsy evidence to support such fantastic claims.

 

[MrLogan13]

If something works then there should be evidence of such.

 

[Spinach Dip]

Anyone interested in the subject can find a great 16-minute summary here:

 

[jqueb29]

Dr. Oz is an embarrassment to the profession.

 

[ski89]

Yes, and for the most part their relief of symptoms has a name. It's called the placebo effect and nobody denies that the placebo effect is a real thing. Where Dr. Oz and the rest of us differ is that Dr. Oz thinks it's cool to market and sell the placebo effect to millions of people, enriching himself in the process. The vast majority of physicians believe this type of practice is unethical, especially when it is portrayed as something other than a placebo effect and is marketed as having some unproven physiologic effect.

Also keep in mind that much of what TV celebrities like Dr. Oz advocate has nothing to do with immediate relief of symptoms. Instead, they sell products that claim to "decrease your risk of cancer" or something equally vague without having any or flimsy evidence to support such fantastic claims.

We are in total agreement except for one point. Consider the following. A new drug has been implemented in clinical trials. Lets say the researchers are hoping that it will provide pain relief for UC patients, who often do not find narcotics to be especially helpful. So the drug goes through clinical trials and does not end up being much of a success. It comes with many negative side effects in many patients and provides no significant benefit for most patients as compared to the current best practice. Nevertheless, John Doe happens to try the drug during the clinical trials and does not experience negative side effects that many others did and also happens to find that this drug is very effective in controlling his pain. But too bad for John Doe because this drug will never make it to market. So was John just experiencing the placebo effect or does his unique genetics and biochemistry explain why his body actually responded to this molecule.

The point I am trying to make is that sometimes alternative treatments work for some individuals because of their unique biochemistry. The vast majority of these are promoted for profit and personal gain, I'm with you there. But for me, when my patient comes and tells me that their [xyz] has improved and they attribute it to [abc], not only will I tell them to keep doing it (assuming I think it's safe), but I will keep it in mind for the next person I come across with the same problem that is getting absolutely no relief from treatments I propose.

 

[LSD-25]

Dr. Oz is an embarrassment to the profession.

Quoted from truth. I came into this thread to say that.

 

[ski89]

If something works then there should be evidence of such.

Absolutely. But when you say something "works" you are often talking about some kind of distribution. That is, it works really well for some and not much at all for others. This difference in effectiveness can be attributed to differences in our genetic makeup and environment. When something works for someone that is not evidence based, it doesn't necessarily mean that this is an example of placebo (a rather arrogant position in my opinion).

 

[ski89]

@Spinach Dip

Yup, he ef'd up there.

 

[DoctorSynthesis]

Anyone interested in the subject can find a great 16-minute summary here:

He makes good points. Supplements should be regulated better for safety and they shouldnt be able to make false or unsupported claims.

There is still a place for alternative medicine though.

I like the point about the amount of time oz has to fill though. Can you really blame him for resorting to junk eventually? It wrong but I understand it.

 

[ski89]

My point was not for this to be a discussion about Dr. Oz - he's obviously a polarizing figure and I don't really care to discuss him. My point was rather to discuss the pitfalls of relying to heavily on evidence based medicine.

If you are interested in what I think is a very interesting and important subject, check out these papers below

 

[MaybeDr]

"With a few clicks and some simple searches, a remarkable web of intrigue emerged—one that the mainstream media has completely missed. The lead author, Henry I. Miller, appears to have a history as a pro-biotech scientist, and was mentioned in early tobacco-industry litigation as a potential ally to industry. He also furthered the battle in California to block GMO labeling—a cause that I have been vocal about supporting. Another of the letter signees, Gilbert Ross, was found guilty after trial of 13 counts of fraud related to Medicaid. He is now executive director of American Council on Science and Health, a group that has reportedly received donations from big tobacco and food and agribusiness companies, among others. Another four of the 10 authors are also linked to this organization".


For those unaware of this fallacy:
Tu quoque (/tuːˈkwoʊkwiː/;[1]Latin for "you, too" or "you, also") or the appeal to hypocrisy is an informal logical fallacy that intends to discredit the opponent's position by asserting the opponent's failure to act consistently in accordance with that position. It attempts to show that a criticism or objection applies equally to the person making it

 

[NickNaylor]

http://time.com/3831926/dr-oz-criticism-answers/

Hey I stumbled upon this and found it to be a good read. While I wholeheartedly agree on the primacy of evidence based medicine, I think Dr. Oz brings up some good points on the importance of individualized care that is focused first and foremost on healing. I have found in my own life that evidence based medicine sometimes fails to meet the needs of people I know (especially for things like chronic pain, nausea/abdominal pain, fatigue, and the like). In these cases these people have found improvement in their symptoms by other means. This is the danger of holding evidence based medicine as the only acceptable avenue for healing. In other words, while anecdotes have no place in evidence based medicine, they absolutely have a place at the bedside.

I actually agree with you with respect to EBM in that its utility requires 1) extremely well-done trials with huge patient cohorts for them to be truly helpful and 2) correct interpretation of the studies. EBM has the power to be useful but I don't think it's the end all be all. At the end of the day, you're treating individuals, not populations. EBM should guide practice but not wholly determine it.

That said, I think @calvnandhobbs68 brings up a good point about Oz, which is that he's not necessarily bucking the trend against EBM. He's endorsing products that have little to no evidence at all. Add in the fact that he benefits personally from those endorsements, and you start to go down the chiropractic/homeopathic/naturopathic route in my mind. In his case, he is "treating" populations but with little no evidence to do so.

I've said this elsewhere, but I don't think Oz should be viewed as a physician who happens to be on TV. Instead, he should be viewed as an entertainer that happens to be a physician. When you take that mindset, I think it helps to interpret what he's saying - i.e., not much better than any recommendation that Dr. Phil, Oprah, etc. gives with respect to "health advice."

 

[The Helpful Aye Aye]

Did he really just slam someone for endorsing biotechnology?

 

[Mr Interesting]

I don't care too much for Dr. Oz but I caught the show just to see his rebuttal today. All I have to say is LOL.

http://money.cnn.com/2015/04/23/media/dr-oz-response-to-doctors/

 

[altblue]

I think he has a financial stake in many of these things, and this makes his points all the more interesting. He also has an MBA from Wharton apparently.

Hmmm....

 

[AspiringERMD]

For everyone with the rock-solid stance that all medications need to be clinically verified to have an effect in a significant subset of the population without risk of negative side-effects, how do you counter the fact that there has been something along the lines of 30 something drug trials for depression medications alone that have recently been exposed as presenting fabricated data, with the medications actually performing no better than placebo and actually increasing your risk of suicide? What happens when evidence based medicine falls apart because of the pressure to either develop a drug that works within the next year or get rejected when applying for future grants because your drug didn't do **** and they want someone who has a track record of "proven results"?

Citation?

 

[The Helpful Aye Aye]

For everyone with the rock-solid stance that all medications need to be clinically verified to have an effect in a significant subset of the population without risk of negative side-effects, how do you counter the fact that there has been something along the lines of 30 something drug trials for depression medications alone that have recently been exposed as presenting fabricated data, with the medications actually performing no better than placebo and actually increasing your risk of suicide? What happens when evidence based medicine falls apart because of the pressure to either develop a drug that works within the next year or get rejected when applying for future grants because your drug didn't do **** and they want someone who has a track record of "proven results"?

I think when clinical trials for a few drugs thought to treat a vaguely characterized disease are found to contain falsified data you should burn all the medications that currently exist and start from scratch.

 

[blackroses]

For everyone with the rock-solid stance that all medications need to be clinically verified to have an effect in a significant subset of the population without risk of negative side-effects, how do you counter the fact that there has been something along the lines of 30 something drug trials for depression medications alone that have recently been exposed as presenting fabricated data, with the medications actually performing no better than placebo and actually increasing your risk of suicide? What happens when evidence based medicine falls apart because of the pressure to either develop a drug that works within the next year or get rejected when applying for future grants because your drug didn't do **** and they want someone who has a track record of "proven results"?

My counter is that you don't close the university down and start mass-producing hotdogs because 10 of your students dropped out.

 

[blackroses]

double post

 

[Spinach Dip]

For everyone with the rock-solid stance that all medications need to be clinically verified to have an effect in a significant subset of the population without risk of negative side-effects, how do you counter the fact that there has been something along the lines of 30 something drug trials for depression medications alone that have recently been exposed as presenting fabricated data, with the medications actually performing no better than placebo and actually increasing your risk of suicide? What happens when evidence based medicine falls apart because of the pressure to either develop a drug that works within the next year or get rejected when applying for future grants because your drug didn't do **** and they want someone who has a track record of "proven results"?

The fact that capitalism frequently leads to corruption does not invalidate the scientific method.

 

[AspiringERMD]

 

[musicalfeet]

What if people were told upfront that the effects they may experience could be due to the placebo effect? Wasn't there a study done where it showed that the placebo effect may have a genetic component to it--and the test group that seemed to have the genetic component showed improved outcomes even when told it was a placebo. Here's the video I got it from for reference..I couldn't remember the actual study, or whether or not it was actually valid. Just something I watched last night before I went to bed that seemed to be relevant to this discussion

 

[desperadoflakes]

I don't care too much for Dr. Oz but I caught the show just to see his rebuttal today. All I have to say is LOL.

http://money.cnn.com/2015/04/23/media/dr-oz-response-to-doctors/

WOW SO MUCH CRINGE

 

[ridethecliche]

Here's a better one:

http://www.newyorker.com/news/daily-comment/columbia-and-the-problem-of-dr-oz

 

[ridethecliche]

Also, from the OPs article. First para.

"I started my show to give TV audiences advice on how to find a good life, not to practice medicine on air."

Followed in the same paragraph by :

"In the same hour-long show, a board certified doctor will discuss cancer followed by a celebrity sharing their personal weight loss story and concluding with an audience member learning to manage their money better. I don’t expect all of my colleagues to understand this marriage between conventional medicine and the broader definition of wellness that the show pursues.


----------

Well which is it dude?

Dude's where he is because of his status as a doc. Saying he can speak and make recommendations divorced from that title is ludicrous when he talks about health and wellness.

He's apparently going to do a show calling out all the conflicts of interest of all the people that signed the letter to Columbia including some of their work with industry, pharma, and gmos to try to discredit them.

He sounds more like a scoundrel politician than a doctor. If he had any credibility, he would discredit their view, not make ad hominem attacks.

The fact that there are people on this site that seem to support and defend him is frankly baffling to me.

 

[Azete]

I don't really see the issue in taking an alternative approach to medicine. Ok, so Dr. Oz may be defrauding folks into taking placebos. So what? He used his MD to make millions and has managed to help people at the same time. Where do I sign up for that life?

He has air time to fill every week, there's inevitably going to be a lot of fluff. But he's also getting his viewers (of which there are a **** ton) to be more conscientious about their health. They're (generally) eating healthier foods, being more active, and have developed a positive outlook on their well-being.

 

[medic86]

I don't really see the issue in taking an alternative approach to medicine. Ok, so Dr. Oz may be defrauding folks into taking placebos. So what? He used his MD to make millions and has managed to help people at the same time. Where do I sign up for that life?

He has air time to fill every week, there's inevitably going to be a lot of fluff. But he's also getting his viewers (of which there are a **** ton) to be more conscientious about their health. They're (generally) eating healthier foods, being more active, and have developed a positive outlook on their well-being.

That's fine and all... if he didn't peddle bull****.

That is all.

 

[pageantry]

I don't really see the issue in taking an alternative approach to medicine. Ok, so Dr. Oz may be defrauding folks into taking placebos. So what? He used his MD to make millions and has managed to help people at the same time. Where do I sign up for that life?

He has air time to fill every week, there's inevitably going to be a lot of fluff. But he's also getting his viewers (of which there are a **** ton) to be more conscientious about their health. They're (generally) eating healthier foods, being more active, and have developed a positive outlook on their well-being.

I'm from woo-woo nation (California) and this topic is Relevant to My Interests, but I want to say 1) Dr. Oz is terrible because 2) he takes advantage of poor and frightened people (that is: everyone) via their/(our) need to feel in control of their own health and thereby 3) pits them against the medical establishment. It's impossible to publicly criticize him without essentially saying to many patients "I'm not on your team." This newest kafuffle is his active continuance of that us vs. them mentality.

And, I don't like his big smarmy face.

BUT, I do get the need for doctors who are able to straddle the woo-woo line, because I get why people don't necessarily trust so-called EBM. N=1, but I was once in a clinical study where they explicitly told us to sneak in outside medication so that we would meet testing criteria and be included in the study. The study paid $2000. I didn't do it, but a lot of people did. It doesn't invalidate the scientific method, but it has definitely made me think twice about every medication I've taken since then.

That said, if anyone is interested, Harvard has a whole program in placebo studies with some potentially good information on the responsible use of placebos. It was started by an acupuncturist. Their most recent publication was the aforementioned placebo/genetics study.

 

[ridethecliche]

There's also that entire bit about something not necessarily being safe solely because it's natural and found in nature. Even water has an LD50...

 

[Azete]

There's also that entire bit about something not necessarily being safe solely because it's natural and found in nature. Even water has an LD50...

Absolutely true. But, if I acquired a terminal illness for which there was a 10% (random number) cure rate via EBM, I'd at least explore some of the natural alternatives. I openly think the vast majority of these "treatments" are fraudulent nonsense, but I'd have a difficult time ignoring anecdotal evidence given the circumstances.

 

[ridethecliche]

Absolutely true. But, if I acquired a terminal illness for which there was a 10% (random number) cure rate via EBM, I'd at least explore some of the natural alternatives. I openly think the vast majority of these "treatments" are fraudulent nonsense, but I'd have a difficult time ignoring anecdotal evidence given the circumstances.

There's always the off chance that things magically resolve and then you'll be on Dr. Oz touting this lemonade you drank everyday as the thing that cured whatever ailed you.

If I had something with a 10% cure rate and a set expiration date, I would make a bucket list and have at it. Depends on the illness and the life year loss associated with the treatment. I've been in the room when palliative patients have wanted and received invasive surgery. I've rarely seen it end well and patients end up expiring in pain instead of going in peace.

 

[ski89]

@scrublyfe21

Fascinating and eye opening. Thanks for sharing. It's good for us future physicians to have the same healthy skepticism of the research coming out of our own field as we do of alternative medicine.

 

[ridethecliche]

Also, along the lines of "evidence based medicine is the only medicine", the point I was trying to make with the above post is that pharmaceutical fraud is prevalent, and a number of the practices we accept as "best practice" are based off of falsified data. For example the increased use of stimulants for cognitive improvement in students with "ADHD"? People love to throw amphetamines at them, but what happens when they develop a tolerance and can no longer function at a "normal" level if they don't increase the dose? There are a few buried studies I have found that show that eventually these medications don't work after a certain dosage threshold, AKA you become dependent, then suddenly there is a point where you get no benefit at all. What happens to our patients then? It's something people don't want to address, BAD SCIENCE

Except that over prescription and over diagnosis of ADHD/ADD has been something that the medical community has been talking about for quite a while...

And that's exactly the point. The process, while not perfect, is critical of itself and self corrects over time. The only come back for people that hawk solely alternative medicine is to refer to doctors as pill pushers and laugh all the way to the bank.

ZOMG CHELATION FOR EVERYONE!!!

 

[Vain Brother]

Also, along the lines of "evidence based medicine is the only medicine", the point I was trying to make with the above post is that pharmaceutical fraud is prevalent, and a number of the practices we accept as "best practice" are based off of falsified data. For example the increased use of stimulants for cognitive improvement in students with "ADHD"? People love to throw amphetamines at them, but what happens when they develop a tolerance and can no longer function at a "normal" level if they don't increase the dose? There are a few buried studies I have found that show that eventually these medications don't work after a certain dosage threshold, AKA you become dependent, then suddenly there is a point where you get no benefit at all. What happens to our patients then? It's something people don't want to address, BAD SCIENCE

pharmaceutical fraud being "prevalent" (by which i assume you mean widespread, which it is not, but for the sake of this discussion let's assume that it is) is a great reason to fix that problem. it's not an indictment of evidence-based medicine

 

[Vain Brother]

He makes good points. Supplements should be regulated better for safety and they shouldnt be able to make false or unsupported claims.

There is still a place for alternative medicine though.

I like the point about the amount of time oz has to fill though. Can you really blame him for resorting to junk eventually? It wrong but I understand it.

when you say there is a "place", what you mean to say is "market"

 

[einsteinm]

Nvm. Didn't see someone already posted this.

 

[DoctorSynthesis]

when you say there is a "place", what you mean to say is "market"

Placebos work.

 

[hossle12]

You can't just shut your eyes on unproven techniques/supplements/diets/way of life just because they haven't been proven through experimental trials. Dr. Oz promotes lifestyle changes that may or may not benefit users. He doesn't advocate ditching your doctor and modern medicine. Think Eastern and Western medicine. Both have their pros and cons. Let's not put this guy down all together.

 

[ski89]

pharmaceutical fraud being "prevalent" (by which i assume you mean widespread, which it is not, but for the sake of this discussion let's assume that it is) is a great reason to fix that problem. it's not an indictment of evidence-based medicine

Good point. It's not that evidenced based medicine is inherently flawed, it's a matter of determining whether we have enough evidence to make a legitimate claim about a particular treatment.

 

[ridethecliche]

I'm not saying that modern medicine is fraudulent and that everyone should go to someone for "spiritual healing" to solve their issues, but you have to admit that the process of developing drugs is in itself flawed as things go right now. Negative studies aren't published, so we don't see how often something REALLY works. If you have a drug that is shown by 5 studies to be 50% more effective than the previous generation, but you have 10 studies that don't publish because their results are negative, and those results actually show that those who get no benefit actually die within 6 months, is that drug actually safe? Our current standards would say yes because those negative studies aren't published so nobody knows about them, and in the clinical setting those deaths are attributed to things such as other co-existing conditions or a lack of timely care.

I'm not sure you understand how drug development trials work. You're confounding drug development trials and drug comparison trials.

Also, the types of trials that you mention, i.e. showing no effect on a certain subset of patients relative to existing therapy, are studies that are often published especially in oncology.

Just because the process of drug development isn't perfect, doesn't mean that a totally untested realm of 'treatment' is advisable. That's pretty much the definition of a fallacy.

 

[RutgersAR]

Just because the process of drug development isn't perfect, doesn't mean that a totally untested realm of 'treatment' is advisable. That's pretty much the definition of a fallacy.

I'm so thankful to see this in the thread somewhere. It seems that the go-to argument in this thread is the False Dichotomy or False Dilemma fallacy.

You can't just shut your eyes on unproven techniques/supplements/diets/way of life just because they haven't been proven through experimental trials.

Well ibuprofen hasn't been proven through an experimental trial to cure stage 3/4 cancer, but I doubt it is going to do anything. This is a non-argument. Anecdotal evidence is next to useless in proving something is effective. Its the classic case of a disease having a 10% survival rate, someone takes a supplement (in addition to their actual treatment), and then gets better. What do they say cured them (hint, not the actual treatment)? In reality, they got better because they were in that 10% group. People who take the supplement and then die generally don't spread the word.

We need evidence based medicine because without it we get to listen to 100% of those that took the supplement and survived and we hear about 0% that took it and died.

 

[ridethecliche]

Evidence based practice is important to separate the signal from the noise. A lot of things can help a lot of different patients. Medicine is tailored to the norm, not to the outliers. This is why a lot of bioinformatics style studies are important. There's a lot we don't know and until we can identify groups that therapies can benefit, we're not helping anyone with lots of noise.

There's a reason drugs of limited efficacy end up being approved for other things. That's a testament to the fact that there's a lot we don't understand, but we need to try different things to figure out to approximate reality.

 

[allantois]

More nonsense from Dr. Oz on the meaning of dreams!

http://www.doctoroz.com/article/5-most-common-recurring-dreams