Dr. Oz's Odyssey

The following is an excerpt from Navigant Healthcare’s Pulse Weekly. Click here for a complete copy of this week’s article.

Mehmet Oz, MD, is Vice Chairman of the Columbia University Department of Surgery and a board certified cardiothoracic surgeon trained at both Harvard and Penn. He’s best known as the host of The Dr. Oz Show which is a widely circulated daily TV show launched by Oprah Winfrey’s Harpo Productions in 2009.1

Last week, ten of his academic peers from across the country emailed a letter to Columbia University College of Physicians and Surgeons Dean Lee Goldman asking that the 54 year old Oz be removed from his faculty role. Their letter charged that the Turkish-born clinician with “manifesting an egregious lack of integrity by promoting quack treatments and cures in the interest of personal financial gain.”2 At issue: Dr. Oz’s promotion of certain weight loss products on his highly rated daily TV show and most recently his well-publicized encouragement that genetically modified foods be labeled.

In response to his critics, he issued a statement last Friday: “I bring the public information that will help them on their path to be their best selves. We provide multiple points of view, including mine which is offered without conflict of interest. That doesn’t sit well with certain agendas which distort the facts. For example, I do not claim that GMO (genetically modified organism) foods are dangerous, but believe that they should be labeled like they are in most countries around the world. I will address this on the show next week.”3

Oz is no stranger to criticism. Last year, he faced a U.S. Senate inquiry about his “endorsement” of certain weight loss products.4 As his popularity has increased, so have the attacks against the show’s embrace of alternative health.

The issues that surface in this high profile disagreement are timely but not unique to the Dr. Oz franchise. In essence, this controversy centers around 3 questions that are front and center in the health industry’s discussions about evidence-based medicine and consumer-directed healthcare:

1. How much of what’s called “alternative health” is evidence-based and how’s a consumer to know?

Consumers trust their physicians to diagnose them accurately and recommend the most efficacious treatments.  A study published in the British Medical Journal on the effectiveness of Oz’s medical advice found that 51% of his recommendations had no scientific backing and rationale, or in some cases contradicted scientific evidence.”5 But in all fairness, much of what clinicians do in the everyday practice of traditional medicine lacks scientific rigor. RAND found adherence to the evidence on average 55% of the time. Widespread variation in medical practices has been studied since Dartmouth’s Jack Wennberg launched the Dartmouth Atlas in 1973, attributing much of the variability to physician choices. The Institute of Medicine estimates 30% of the healthcare spend is for services for which the evidence is weak or non-existent, so the jury’s out on allegation one.6

So in assessing the evidence for alternative health, it’s fair to say it’s a work in process for many of its methodologies. The mission of the National Center for Complementary and Integrative Health (NCCIH, formerly the National Center for Complementary and Alternative Medicine [NCCAM]) is to “define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative interventions and to provide the public with research-based information to guide health-care decision making.” 7

2. Do over-the-counter weight loss products work?

Mehmet Oz is an avowed proponent of alternative health. He and writing pal Mike Roizen, a Cleveland Clinic clinician, have penned six New York Times best-sellers advocating healthier lifestyles and integration of alternative health with traditional allopathic methods.  He practices meditation and encourages healthy eating, stress reduction and exercise.8 In a widely publicized flap, Oz drew sharp criticism for endorsing Green Coffee Bean Extract as a useful weight-loss additive. The company, Applied Food Sciences, later paid a $3.5 million fine after the research upon which the extract’s therapeutic benefit was bogus and redacted from publication by the authors who admitted deceit. Dr. Oz was not a paid spokesman for the company and was not compensated for his endorsement. Nonetheless, he was called to testify before a Senate subcommittee investigating weight loss products and criticized for his role. 9

Since 1994, dietary supplements have been on the Food and Drug Administration (FDA) radar. A National Institutes of Health (NIH) study of supplement users found, “Many users and non-users of dietary supplements had misperceptions about these products-many believed they are evaluated for safety and efficacy by the FDA and before marketing, and that dietary supplements are safer than over-the-counter (OTC) or prescription medications. Use of dietary supplements for weight loss is common. More information about dietary supplements is necessary to correct misperceptions and encourage the use of safe and effective weight-loss methods.” But supplement manufacturers do not need FDA approval to sell their wares. By law (the Dietary Supplement Health and Education Act 1994), the manufacturer is responsible for ensuring that its dietary supplement products are safe before they are marketed.” 10

So the overweight consumer’s battle of the bulge is likely to collide with the paucity of verifiable evidence about which programs and products work, and the evidence supporting each. The regulatory framework through which these products come to market continues to be porous at best. And Dr. Oz along with millions of clinicians and consumers might have been duped.

3. What’s the fuss about the genetically modified food?

Genetically modified (GM) foods are foods produced from organisms that have had specific changes introduced into their DNA using the methods of genetic engineering allowing for the introduction of new traits such as the color and texture of the food, its shelf life and others. 11

Commercial sale of genetically modified foods began in 1994, when Calgene first marketed its Flavr Savr delayed-ripening tomato. Most GM efforts have focused on cash crops in high demand by farmers such as soybean, corn, canola, and cotton seed oil and more recently in livestock food production processes.

The industry’s GM proponents assert that food derived from GM crops poses no greater risk to human health while other opponents believe its environmental impact compromises food safety.  Oz has called for labelling foods that are GM produced as is the policy in 64 other countries, a position he has taken since the show’s inception.12  Again, it’s a tricky issue that falls on the consumer to ultimately determine who’s right.

So not surprisingly, in disputes like this, claims and counter-claims fly with reputations at stake. The letter to Columbia from Oz critics struck a nerve because he’s popular and a subset of his peers object to his sometimes non-traditional views. After all, the profession of medicine likes to police its own. It has unwritten rules in addition to its formal code of ethical conduct and its unwritten code is especially powerful: Don’t promise results to patients (they’re out of your control). Don’t draw undue attention to yourself (unless around clinical heroics or scientific discovery). Don’t criticize your peers. Don’t flaunt your income and material success. And don’t do things that are far afield of “mainstream” practice.

The odyssey of Dr. Oz seems a challenge to this entire body of unwritten rules. But it’s unlikely the 3 issues raised will be resolved in this high profile media flap.

Dr. Oz is to Millennials what Marcus Welby is to Boomers: a credible clinician with a large, loyal fan-base.  But in the end, it falls to consumers to decide who’s right on these tricky issues.

Health reform lacking an engaged consumer is likely to fall short. And engaged consumers are paying attention to Dr. Oz and online resources that augment what their clinicians say about not only their diagnoses and treatments but their supplements and food supply as well. They prefer it from their clinicians as part of their coordinated care plan, but in most communities, care coordination is inadequate or reserved only for those in certain health plans that benefit from engaged consumerism across the full continuum of health.

Dr. Oz is likely to play and bigger role in how consumers navigate their health and decide who’s right on issues like these. The Oz odyssey fills a void between the information consumers want and what their clinicians choose to share.  My hunch is consumers will figure it out for themselves.

Paul

Sources
1“Mehmet Oz Biography,” tvguide.com, retrieved May 2, 2010; “Harpo Productions and Sony Pictures Television To Launch Dr. Oz,” Oprah.com, June 13, 2008
Debra Goldschmidt, “Physicians to Columbia University: ‘Dismayed’ that Dr. Oz is on faculty,” CNNApril 18, 2015; Tessa Berenson, “Group of Doctors Tells Columbia University to Fire Dr. Oz,” Time, April 17, 2015
Elahe Izade, “Dr. Oz responds after prominent physicians call for his firing from Columbia University,” Washington Post, April 18, 2015
4 “Hearing on Protecting Consumers from False and Deceptive Advertising of Weight-Loss Products,” US Senate Committee on Commerce, Science & Transportation, June 17, 2014; “Dr. Oz gets scolded by senators over weight loss scams,” Fox News By Associated Press, June 17, 2014, retrieved February 24, 2015
5Christina Korownyk, associate professor of family medicine, Michael R Kolber, associate professor of family medicine, James McCormack, professor of pharmacy, Vanessa Lam, research assistant, Kate Overbo, research assistant, Candra Cotton, pharmacist, Caitlin Finley, research assistant, Ricky D Turgeon, pharmacist, Scott Garrison, associate professor of family medicine, Adrienne J Lindblad, associate clinical professor of family medicine, Hoan Linh Banh, associate professor of family medicine, Denise Campbell-Scherer, associate professor of family medicine, Ben Vandermeer, biostatistician, G Michael Allan, professor of family medicine, “Televised medical talk shows—what they recommend and the evidence to support their recommendations: a prospective observational study,” British Medical Journal, December 17, 2014, 349:g7346
6D.L. Sackett et al., Editorial, “Evidence based medicine: what it is and what it isn’t,” British Medical Journal, January 13, 1996, 312:71; J.E. Wennberg and A. Gittelsohn, “Small Area Variations in Health Care Delivery,” Science 82, December 14, 1973, no. 117 (1973): 1102–1108;http://www.nejm.org/toc/nejm/348/26/; M.R. Chassin et al., “How Coronary Angiography Is Used: Clinical Determinants of Appropriateness,” Journal of the American Medical Association, 258, no. 18 (1987): 2543–2547; Elizabeth A. McGlynn, Ph.D., Steven M. Asch, M.D., M.P.H., John Adams, Ph.D., Joan Keesey, B.A., Jennifer Hicks, M.P.H., Ph.D., Alison DeCristofaro, M.P.H., and Eve A. Kerr, M.D., M.P.H., “The Quality of Health Care Delivered to Adults in the United States,” The New England Journal of Medicine, June 26, 2003, DOI: 10.1056/NEJMsa022615
7The National Center for Complementary and Alternative Health (NCCIH), “At A Glance,” US Department of Health & Human Services, retrieved on April 18, 2015
8“Mehmet Oz Biography,” tvguide.com, retrieved May 2, 2010; “Harpo Productions and Sony Pictures Television To Launch Dr. Oz,” Oprah.com, June 13, 2008

9 “Hearing on Protecting Consumers from False and Deceptive Advertising of Weight-Loss Products,” US Senate Committee on Commerce, Science & Transportation, June 17, 2014; “Dr. Oz gets scolded by senators over weight loss scams,” Fox News By Associated Press, June 17, 2014, retrieved February 24, 2015; Pillitteri JL, Shiffman S, Rohay JM, Harkins AM, Burton SL, Wadden TA, Use of dietary supplements for weight loss in the United States: results of a national survey,” NCBI, April 16, 2008, Obesity (Silver Spring), (4):790-6. doi: 10.1038/oby.2007.136, Epub January 24, 2008
10 “Q&A on Dietary Supplements,” U.S. Food and Drug Administration (FDA), retrieved April 18, 2015; Saunders, Russell. “Dr. Oz Green Coffee Bean Study Retracted,” The Daily Beast, October 20, 2014, retrieved February 24, 2015
11 Terrie Hallenbeck, How GMO labeling came to pass in Vermont,” Burlington Free Press, April 27, 2014, retrieved May 2014;  http://www.burlingtonfreepress.com/story/news/politics/2014/04/27/gmo-labeling-came-pass-vermont/8166519/Center for Food Safety.http://www.centerforfoodsafety.org/issues/311/ge-foods/about-ge-foods
Michael Specter Michael “The Operator: Is the most trusted doctor in America doing more harm than good?” February 4, 2013. Profiles. The New Yorker 88 (46): 40–49. Retrieved 2015-01-09http://www.newyorker.com/magazine/2013/02/04/the-operator
12 Ginger Pinholster, “Legally Mandating GM Food Labels Could Mislead and Falsely Alarm Consumers American Association for the Advancement of Science (AAAS), Board of Directors, October 25, 2012; Report 2 of the Council on Science and Public Health: Labeling of Bioengineered Foods,” American Medical Association, 2012, retrieved April 18, 2015 

The opinions expressed in this article are those of the author and do not necessarily represent the views of Navigant Consulting, Inc. The information contained in this article is a summary and reflects current impressions based on industry data and news available at the time of publication. Any predictions and expectations noted herein are inherently uncertain and actual results may differ materially from those contained in this article. Navigant undertakes no obligation to update any of the information contained in the article.

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