- Controversial Medicine: Alternative Health, Part 1
- Controversial Medicine: Alternative Health, Part 2
- Controversial Medicine: Alternative Health, Part 3
When I first learned that Dr. Steve Novella, Yale neurologist, blogger, and host of the popular skeptical podcast the Skeptics’ Guide to the Universe was going to be on The Dr. Oz Show, I was concerned. After all, this is the same physician who had in essence given up science-based medicine in favor of media stardom based on the promotion of alternative medicine. Of late Dr. Oz has been getting worse, too, promoting pseudoscience and what can only be described, in my opinion, as quackery. The snake oil that Dr. Oz has promoted over the last several months includes Dr. Joe Mercola, one of the biggest promoters of “alternative” health, whom Dr. Oz first had on his show about a year ago and then defiantly defended in a return appearance in early 2011. Then, in a rapid one-two punch, Dr. Oz had an ayurvedic yogi named Cameron Alborzian, who promoted highly dubious medicine, including “tongue diagnosis,” to be followed a few days later by something I would never, even in my most cynical assessment of Dr. Oz, expected, namely the appearance of faith healer Issam Nemeh on his show. Worse, Dr. Oz showed zero signs of skepticism. Unfortunately, Dr. Oz wasn’t done. In rapid succession next Dr. Oz endorsed a diet that he once eschewed as quackery and then, to top it all off, invited psychic John Edward onto his show, asking Is talking to the dead a new kind of therapy? This latter episode so shocked me that I basically said, “Stick a fork in him, Dr. Oz is done when it comes to SBM.” Dr. Oz’s descent was complete, and that is now the trouble with Dr. Oz and much of the reason why in 2011 the James Randi Educational Foundation awarded him the The Media Pigasus Award for the second year in a row. I fear he very well may three-peat in 2012.
So right from the start I wasn’t very optimistic about how this whole thing would turn out. Fortunately, however, I was pleasantly surprised. Steve managed to hold his own in a completely hostile environment, with Dr. Oz asking him “Have you stopped beating your wife?”-style questions, with only minor stumbles. At one point, he even managed to hand Dr. Oz his posterior. Alas, I doubt it will make any difference to Dr. Oz’s viewers, but we can always hope to change a few minds. I also realize that, however a big deal being on Dr. Oz’s show was to Steve and many members of the skeptical movement (especially supporters of SBM), to Dr. Oz it was just one segment in one show of one season of a couple of hundred episodes. Not to detract from Steve’s achievement at all (it’s truly amazing that he managed to get on the show and do as well as he did, given how the deck was stacked against him), but to us this is big; to Dr. Oz it’s entertainment.
So what happened?
As I watched the beginning of the segment, my experience having watched several episodes of Dr. Oz’s show led me to look for the not-so-subtle signs of the story that Dr. Oz and his producers intended to portray. In such a television show, you always have to look for the story, and the story is revealed by how the issue being discussed is framed. I didn’t have long to wait. One thing I thought as I watched the opening minutes of this episode of Dr. Oz’s show is that that watching Oz really reminded me of was Kevin Trudeau. Remember him? The message he used to spread his snake oil was implicit in the title of his book, Natural Cures “They” Don’t Want You to Know About. The message is the same. It’s you (as in Dr. Oz’s audience or Kevin Trudeau’s readers) against the establishment. The Man is trying to keep you down and keep you from those natural cures that don’t rely on big pharma! So, what are you, sheeple? Or are you among the enlightened, like Dr. Oz and his viewers? Why is your doctor afraid of alternative medicine? (Yes, that was the title of the segment.) It’s an appeal both to the appeal of outsider status and to the vanity of Dr. Oz’s audience. His audience is encouraged to feel not just like a maverick, bucking the system, but to feel superior than everyone else, “empowered” to “fight the power.” Right from the start, Dr. Oz frames the issue of “alternative medicine” as the little guy versus dogmatic physicians, as “taking control” from undefined outside forces. In doing so, he paints himself as the champion of the little person, willing to risk everything to tell his audience The Truth. It’s a load of fetid dingos’ kidneys of course. Dr. Oz is fabulously wealthy and famous in a large part because he’s embraced alternative medicine and found a way to preach it to the masses, all wrapped up in a lovely bit of framing:
Today I’m taking on a controversial issue in medicine that has everything to do with helping you take control of your health. There are a lot of doctors, including me, who are putting their reputations on the line because we’re using alternative therapies in our traditional practices. But many doctors claim that these therapies are nothing more than junk science and may even be dangerous. Your doctor could be one of them. Why are they so afraid of alternative medicine? Should you be too?
Note the “brave maverick doctor” pose. It’s the same pose that quacks who think vaccines cause autism take. Dr. Oz then uses the fallacy of argumentum ad populum; i.e., proclaiming that, since alternative medicine has “reached its tipping point” (in his opinion, at least) and people spend $35 billion a year on it in this country, that there must be something to it. It’s a silly argument. Lots of things are very popular; popularity doesn’t equal “scientifically valid.” I do have to admit one thing that made me totally chuckle here. Dr. Oz referred to chiropractic as “chiropractics.” I mean, seriously, Dr. Oz. If you can’t at least get the terminology right about something as commonplace as chiropractic, I find it very hard to take you seriously. Very hard indeed, even more so after he trots out the “superstars of alternative medicine” that he’s showcased on The Dr. Oz Show, including Andrew Weil, the über-quack Joe Mercola, and Deepak Chopra, to name a few.
Of course, there wouldn’t be any drama if there weren’t any “holdouts,” which is how the argument is framed. It’s very clever. Dr. Oz is the brave, open-minded doctor willing to try things outside the mainstream. Skeptics and proponents of science-based medicine are portrayed as going against the flow, as negative, as “holdouts” against what is portrayed as the inevitable triumph of alternative medicine, when the moon will be in the seventh house and Jupiter will align with Mars. And Dr. Oz is persecuted for it, too. Those nasty skeptics! They’ve portrayed him as having abdicated professional responsibility and gone to the Dark Side. Yes, Dr. Oz actually did show the headlines of two RI posts, Dr. Oz: America’s doctor and the abdication of professional responsibility and Dr. Oz’s journey to the Dark Side is now complete: Faith healing quackery glorified. Never mind that neither post came from Science-Based Medicine, which is where Steve Novella blogs, among other places. They came from me. Quite frankly, the thought of Dr. Oz reading Respectful Insolence amuses me to no end, although I rather suspect that he probably never actually read it and instead my posts were somehow discovered by his producers.
Be that as it may, I’m much less amused by how Dr. Oz panders to his audience. It begins right at the very start of the segment, where Dr. Oz proclaims that you–yes, you!–his viewers (well, maybe not you, as in you who read this blog) “aren’t afraid to test the time-honored traditions of alternative medicine.” That’s because, obviously, if you watch Dr. Oz’s show, you must be a brave maverick, just like him. You’re the brave maverick, and he’s the brave maverick doctor–a perfect combination! If you’re not afraid of alternative medicine, then why should is your doctor? (Yes, Oz actually said that.) All of this was just the introduction, at which point the framing was complete. It’s Oz and his viewers against the world, which leads Oz to the very first question to Steve:
Why are there so many doctors out there–and doctors are our viewers–who don’t like alternative medicine? Why do you not want me to talk about these therapies on the show?
More framing. Notice now that Oz frames alternative medicine as a preference. To Oz and his viewers, doctors who support science-based medicine don’t object to alternative medicine because it is unscientific, because there’s no evidence that most alternative therapies work and a lot of evidence that they don’t, or because it’s a false dichotomy. (Yes, I’m talking about the fact that alternative medicine is by definition medicine that has not been shown to work scientifically or has actually been shown not to work. It can never be repeated too many times in this context that alternative medicine that has been shown to work scientifically ceases to be “alternative” and becomes just “medicine.”) Oh, no, those doctors just don’t like it, as many people don’t like Brussel sprouts, or as some people prefer Coke over Pepsi (or vice-versa). It’s a preference that doctors are trying to impose on their patients, those nasty, reductionist, doctors! Worse, it’s a “Western” preference. Yes, Oz kept repeating the term “Western medicine” or “Western science,” another false dichotomy. Good science is good science; it doesn’t matter whether it was done in the “West” or the “East.”
Notice also how Oz takes on the mantle of the victim. It’s not about him talking nonsense about science and medicine, about him promoting quackery (which he has been doing a lot of in 2011). Oh, no! It’s all about skeptics like Steve trying to shut Dr. Oz up! As if we could! It’s a silly argument, obviously custom made to try to portray Dr. Oz’s critics and close-minded, dogmatic, simpletons. In reality, this is a distortion of our position. Nothing could be further from the truth to claim that supporters of SBM don’t want Dr. Oz to talk about these therapies. What we don’t want him to do is to promote them as efficacious when scientific findings indicate that they are not. What we want is a skeptical, science-based assessment of them. Despite the claim by Dr. Oz and his producers that we are “afraid” of alternative health, in actuality we crave an open dialogue based on science, both preclinical and clinical trials, not marketing hype, pseudoscientific claims, and testimonials.
After some minor stumbling, Steve explained very well how the very concept of alternative medicine is an artificial category that exists primarily to produce a double standard that favors modalities that can’t cut it based on science. Unfortunately, as is frequently the case in such “debates,” Steve was paired with a true believer, Dr. Mimi Guarneri, who did exactly what it is that I complain about all the time. She used the classic “bait and switch” of alternative medicine, claiming nutrition, exercise, and the like as “alternative” and then proclaiming them as not being “alternative.” Steve answered that quite well also, but I doubt it got through the audience. Much of the talk was dominated by herbs and supplements, rather than the more bizarre quackery that Dr. Oz has featured on his show in 2011, such as homeopathy, faith healing, and the psychic scammer John Edward. No doubt this is intentional, because herbs and supplements are at least potentially real drugs (impure drugs with highly variable quantities of the active ingredient, but drugs nonetheless). As such, they are the “bait,” used to lure in the marks, after which the “switch” is made and the true quackery brought out.
One thing that cracked me up is that Oz defined alternative medicine rather artificially by dividing it into three categories. Why three? who knows? Perhaps it’s like the Holy Hand Grenade of Antioch, you know, “…then shalt thou count to three, no more, no less. Three shall be the number thou shalt count, and the number of the counting shall be three. Four shalt thou not count, neither count thou two, excepting that thou then proceed to three. Five is right out.” Whatever the reason for choosing the number three, Oz divides alternative medicine into things you can put in your mouth, things that are done to your body, and then the “mind-body” connection. For each one of these divisions, Dr. Oz then showed a brief video promoting their glories. Particularly irritating and, quite frankly, dishonest, is how Dr. Oz at each point tries to turn around Steve’s statements about how various alternative medical therapies have been studied and found not to work into a straw man in which Steve’s words are represented as saying that there aren’t any studies. At one point, Oz even says, “I totally disagree that these have not been studied and some evidence been found to support them.” Of course, “some evidence” has been found to support that most ridiculous of quackeries, homeopathy; one has to look at the totality of evidence to know that not only is homeopathy ridiculous from a basic science standpoint but that the clinical evidence that exists is most consistent with nothing more than placebo effects.
The utter intellectual bankruptcy of this approach was demonstrated when Dr. Oz brought in Catherine Ulbricht, PharmD, MBA[c], chief editor of Natural Standard and editorial board member of Natural Medicine Journal, who touted Natural Standard. One thing I noticed about the journal for which she is on the editorial board is that it is the official journal of the American Association of Naturopathic Physicians (AANP), which is definitely a strike against it right there. (Actually, it’s two strikes.) Naturopathy is a hodge-podge of mostly unscientific treatment modalities based on vitalism and other prescientific notions of disease that fancies itself to be science-based. In fact, as if to emphasize the connection between Dr. Ulbricht and naturopathic quacks, I found in my e-mail box a mass mailing from the AANP touting her appearance on The Dr. Oz Show. Such are the “benefits” of being on the AANP mailing list. Let’s just put it this way. Dr. Ulbricht has published at least one review of homeopathic remedies, specifically Oscillococcinum, in which she concludes that it probably works and that more studies are needed. Amusingly, in the segment that follows Steve’s segment, Dr. Ulbricht even invokes the alt-med cliche of aspirin having been derived from willow bark and being perfectly safe. Of course, natural product pharmacology is in no way “alternative” (more bait and switch), and aspirin is not without risks, sometimes life-threatening.
If there’s one area that Steve managed to score against Dr. Oz in spite of the deck being stacked against him, it’s acupuncture. Steve pointed out that it doesn’t work above and beyond a placebo. As I like to say, it doesn’t matter where you stick the needles and it doesn’t even matter if you stick the needles. The results are the same, and there is a small risk to sticking needles into people’s bodies. Dr. Oz’s reaction is very telling; he says:
There are billions of people around the world who use as the foundation of their healthcare system. It’s the basis of ancient Chinese medicine. I just think it’s very dismissive of you to say because we couldn’t take this idea that exists with a different mindset and squeeze it into the way we think about it in the West then it can’t be possibly effective.
All of which is utter nonsense. First, it’s very arguable whether there are “billions of people” who use acupuncture as the foundation of their health care system. The Chinese, for instance, are actually moving away from traditional Chinese medicine and acupuncture back towards that evil reductionistic “Western” medicine because it works. But even more telling is that Dr. Oz has fallen back on the hoariest of hoary alt-med excuses for not being able generate evidence in favor of their woo: You can’t use “Western science” to study my woo! He even claims that “Western science” can’t understand acupuncture well enough to “know how to study it the way it has to be studied.” It’s special pleading, and it’s pathetic. In fact, Steve’s response was brilliant in that it managed to point out that popularity doesn’t equal efficacy and to liken acupuncture to bloodletting, a comparison that clearly irked the Great and Powerful Oz. Whether Dr. Oz realized it, this was the one part of the show where it can legitimately be said that Steve handed him his ass, even in spite of everyone being against him. True, Oz would never admit it, but this was the one point in the segment where the mask slipped a bit and Dr. Oz looked quite unhappy.
Finally, there were two very annoying bits in this whole exchange. First, Dr. Oz appropriates the alt-med trope of “individualization” (which in alt-med, really means “making it up as you go along“), even likening his favorite woo to a “bow and arrow” or a “stealth approach” to “hitting what you want to get that works in you” and science-based medicine to a “ballistic missile approach that we have so often become comfortable with.” “Ballistic missile approach”? You mean like Tarceva, Herceptin, Avastin, and other targeted therapies designed to hit very specific molecular targets?
In his finale, Dr. Oz then solidifies the bond with his intended audience:
Alternative medicine, I think, is at the grassroots level, and because of that nobody owns it. Now, that stated, I think we got our homework to do. But I think alternative medicine empowers us, and that’s the big message–but only if you know more about it. And if it does work for you, trust me, do not let anybody take it away from you.
In other words, you brave maverick Dr. Oz viewers, don’t worry your little heads about science. Don’t listen to those buzz killer skeptics. They’re so much less interesting than cupping, acupuncture, homeopathy, reiki, and various other forms of mystical, magical woo. Be “empowered” by listening to whatever message that the latest seller of snake oil is promoting to you. “Learn” more about alternative medicine from Dr. Oz; don’t worry if the information is science-based. Be good Dr. Oz fans. Above all, use your “empowerment” to buy what Dr. Oz says you should buy and, of course, keep watching his show.