That's the question posed by Michael Specter in an excellent piece in The New Yorker entitled "The Operator." It concerns the Dr. Mehmet Oz phenomenon.
It's a lengthy piece that I think is well worth anyone's time who's interested in matters of health. Understanding that various readers take things differently, I'm going to excerpt, comment, and summarize. It's certainly no substitute for reading Mr. Specter's well-crafted piece, but I hope my take on the essentials will make for interesting discussion—if not motivation to give Mr. Specter and The New Yorker a few well-deserved minutes of your time.
Dr. Oz is no slouch; and as you'll see, even his colleagues that know him best are somewhat conflicted about the wizard.
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
There is simply no way to honestly slice that, other than top 1% heroic.
I'm tellin' ya. I love The Mechanics the best. I think it must be acknowledged and granted that as much of a doctor personality Oz has become, he maintains his core proficiency in one of the most impressive medical interventions of all time—the transplant of a human heart. That must be accounted for in any fair assessment of his value-disvalue equation to society at large.
On the other hand, clearly of concern to some, Dr. Oz promotes Flim-Flam on The Dr. Oz Show that would never stand or be entertained in his operating room, and for good reason.
...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.
So what to make of that apparent contradiction? Many would have you believe that he's a net liability: a purveyor of Mish-Mash that does more harm than good. Is it that simple?
Addressing such issues, however, is part of what Oz describes as “the undiscussed conversation—the one we need to have but don’t.” He describes modern medicine as a “civil war” waged between conventional physicians and those who are open to alternative cures for maladies ranging from anxiety to cancer; he considers it his mission to walk the line that divides them. But more often his show seems to erase that line completely, with results that may be less benign than Oz and his many viewers realize. “I want no more barriers between patient and medicine,” he explained to me not long ago, as we sat in one of the show’s production offices, just outside NBC’s Studio 6A, in Rockefeller Center. “I would take us all back a thousand years, when our ancestors lived in small villages and there was always a healer in that village—and his job wasn’t to give you heart surgery or medication but to help find a safe place for conversation.”
It's quite a remarkable thing for a top heart surgeon to admit and advocate. And it's insanely easy to criticize him over the Hocus-Pocus or Woo element. It's perhaps more difficult and nuanced to understand just what he's up to.
Oz went on, “Western medicine has a firm belief that studying human beings is like studying bacteria in petri dishes. Doctors do not want questions from their patients; it’s easier to tell them what to do than to listen to what they say. But people are on a serpentine path through life, and that is the way it is supposed to be. All I am trying to do is put a couple of road signs out there. I sit on that set every day, and that is what I am focussing on. The road signs.”
I Grok. Don't you? Scientific reductionism is a very, very fine and proven tool. But, it's also a tool that by definition eliminates many huanesque elements associated with living a human life. So it's a double edged sword. That's fine. But let's at least understand what we trade away. Trading away for more precision or different understanding is perfectly fine. But it does not necessarily imply that what you trade away is garbage or useless. It's just a different, valuable way of understanding things about reality.
...I have my own ridiculous little corner of the world. A reasonably popular blog that got that way because I began taking risks blogging about various fat-loss and health issues I have zero formal qualifications to talk about. I rarely cite studies, though I read quite a few for my own understanding. I rant like a crazy person (even about Dr. Oz, a time or two), and I synthesize the work of various others, mostly. I relate my own experience, and those on-the-ground experiences of others—and blog comments generally serve the same purpose. The easiest way for me to earn outright dismissed is to deal in outright quackery on purpose (I have a past misstep or two). Overall, I've been pretty carful and I think my nose is just fine. All in all, I've been right about promoting the vast majority of what I've promoted (vitamin D, intermittent fasting, vitamin K2 (MK-4), for example).
I don't have the luxury of casually promoting what I might honestly have to call quackery, in a devil's soul-sell of helping more people more often. But, I acknowledge that Dr. Oz does, on exponential scale (like I said: my little corner is microscopic by comparison), and I get it. In other words, he enjoys luxuries I don't. And that's my problem, not his.
No surgeon gets as far as Oz has at New York-Presbyterian without talent and a compelling desire to lead; beta males choose other professions. Yet Oz has limited regard for what he considers the surgical personality. “Let me explain why surgeons are assholes,” he said. “Surgery is controlled arrogance. You think you can take a knife to someone’s chest and help him. Who thinks that way? Certainly no normal person. You need that confidence, that certainty to do it.” We were sitting in his office at New York-Presbyterian, shortly after the operation had concluded. Covers of various publications that have featured Oz were mounted on the walls, along with his diplomas from Harvard and the University of Pennsylvania. He produced a large bag of blueberries and offered me some. He is rarely without blueberries, almonds, or easy access to the “green drinks,” made mostly from cucumber, spinach, apples, and herbs, that he often mentions on his show. Oz doesn’t follow any of the miracle cures or fad diets that he trots out so regularly for his audience. He eats like a Paleolithic hunter-gatherer and exercises daily. He never takes an elevator when he can use the stairs; the one time I saw him do so, he told me he was embarrassed by his indolence, a word nobody else could possibly associate with him. [emphasis added]
But here's the rub with me. At the outset of all of this "health blogging," I was a bit bright-eyed and convinced, and I always operate in 4th gear. Eventually, due to the action in my own comment threads principally, I began to have certain doubts about certain things (the low carb calories don't count message being a notable example). See, Paleo back then was a pretty narrowly implemented deal. Did wonders for most people relative to crap-in-bag or box; but the problem with people generally is that they're somewhat conditioned to seek out a prescription and follow it.
What I've learned over the years—to my relief and joy, actually—is that there really is no prescription for one & all, mostly just a few sane proscriptions. The basic template is sound: real foods (meat, fish, fowl, vegetables, fruits—nuts if you like) available to our way-back ancestors and that you prepare yourselves. Fortunately, there's no single mix that works for everyone. Your ancestors might have turned right instead of left coming out of Africa. Then, some went south while others went north and in the end, we're all generalists. We're all able to survive on real food, but precisely what mix works best for you and yours is highly individual and likely has something to do with things like whether your ancestors braved an ice age, or spear-fished and ate fruit in the tropics, or all the permutations in-between.
...And then there's the placebo effect, and the whole sort of "spirituality" that goes with it. Not only are some people more susceptible to food toxins, some are highly resistant to mind toxins. And vice-versa. Here:
I told Oz that I was aware of no evidence showing that Reiki works. He cut in: “Neither am I, if you are talking purely about data. But this is one of the fundamental disconnects between Western medicine and what people often refer to as complementary medicine. Not everything adds up. It’s about making people more comfortable. I offer things like massage therapy, and offered Reiki if people wanted it. I did not recommend it, but I let people know it was their choice.”
Consider a scenario. You're just a blogger like me—or a reader & commenter—and you don't have a TV show with millions of viewers. It's very easy and obvious to wax on, and laugh about the idiocy of people who take stock in such woo woo. I well know: because I do it all the time, and institutionalized religion is an equally favorite target of mine. But what can I really say contra that hocus-pocus when it really helps any individual in obvious or measurable ways?
I recently ranted about friends & family praying for my dad when he nearly died of a septic infection last weekend, brought on by a kidney stone lodged in his ureter. But, that rant was not at all about how the comfort my dad got from knowing people had his well being in heart & mind may have helped, or even about how his own beliefs that such invocations can summon supernatural powers. Rather, I got irritated over the cheap and easy metaphysical significance those who proffer prayers assume for their prayers. "...I'll pray for you. There. Thank me. I'm so soopers po3erzfuls."
In other words, the power of prayer is certainly real. But the reality of it is not at all object based. Rather, and very importantly, it's entirely subject based. Accordingly, I don't think it far fetched to imagine that Dr. Oz's actual experience as an actual asshole surgeon has humbled him over the years—as inexplicable improvements and recoveries can't be exclusively assigned to his surgical talent and prowess. He well understands it can't be assigned to a superman in the sky. But he also understands, and makes the critical distinction, that it can be assigned to the subject's own power and will, and that whatever strictly illogical reasons abound, they're nonetheless often powerful and effective.
Alas, isn't he just submitting himself to acting in the highest traditions of a gentleman who's primarily concerned with helping people? He did everything a man can do to be a top human mechanic; and in the end, found that sometimes, his own capabilities only take the job so far? ...That perhaps, all those people praying on bended knee, humbly sincere in surprising number, can help in ways that no gentleman of his stature could possibly dismiss?
He helps people, the more the better, and if he has to make way for a delusion or two, then that's what he has to do and does.
Oz often says that he is just trying to present people with all their options, because they are sophisticated enough to make decisions for themselves. But some options are more beneficial than others, and medical experts are morally bound to explain the difference, as David Gorski told me recently. Gorski, an associate professor of surgery at the Wayne State University School of Medicine, is the managing editor of the influential blog Science-Based Medicine. “Oz has a huge bully pulpit, with the entire Oprah empire behind him,” he said. “He can’t simply dispense with facts he doesn’t find convenient.” Scientists often argue that, if alternative medicine proves effective through experimental research, it should no longer be considered alternative; at that point, it becomes medicine. By freely mixing alternatives with proven therapies, Oz makes it nearly impossible for the viewer of his show to assess the impact of either; the process just diminishes the value of science.
Hmm. Given what I've just argued, it seems to me that it's easy enough to classify prayer and other spiritual "interventions" as placebo which, if not classified as "medicine" rather than "alternative medicine," perhaps ought to be. It's been "prove[n] effective through experimental research;" and in fact, is a core principle of intervention studies, especially those involving drug testing.
So, is Oz's real "sin," then, that he simply allows people to think it's still hocus-pocus, woo woo, and "alternative?" Further, isn't that really just a "white lie," then? Or, perhaps: "alternative lying?"
In many respects, Mehmet is now an entertainer. And he’s great at it. People learn a lot, and it can be meaningful in their lives. But that is a different job. In medicine, your baseline need has to be for a level of evidence that can lead to your conclusions. I don’t know how else you do it. Sometimes Mehmet will entertain wacky ideas—particularly if they are wacky and have entertainment value.”
I dunno. Sin on top of sin? Or, someone who really understands what we're all up against, concluding that it's best for individual people to know more about more things and to take personal responsibility and eventually, sound control of themselves and those they love? And who's better positioned? And, if it takes a show about "the miracle of acai berries" to interest someone enough to kind of get into personal health as a hobby or interest, does it really matter that much, given the logical assumption that most will keep searching and learning? Happened to me. Happened to a lot of people.
The annoying thing about acquiring human knowledge is that you start at an ignorant place. Is it possible that Dr. Oz knows which ignorant, not typically harmful places are some of the best starting points? He's smart, obviously. Isn't it a mistake to assume otherwise?
The era of paternalistic medicine, where the doctor knew best and the patient felt lucky to have him, has ended. We don’t worship authority figures anymore. Our health-care system has become impersonal, mechanized, and hollow, and it has failed millions of people, many of whom want to find a way to regain control of their own medical decisions. As Oz likes to say, Marcus Welby—the kindly, accessible, but straight-talking television doctor—is dead.
And Dr. Oz is alive, well, and immensely more popular than Welby. In the widest scope of human interest you can imagine, is he really doing more harm than good? Is he really doing any measurable harm at all? Look at it this way: is he looking the other way as regards errors—even promoting them at times—because the most important thing is the underlying message? What's that? Self awareness, self management, self testing (rinse, wash, repeat.)
“Mehmet is a kind of modern evangelist,” Eric Topol said when I called him at the Scripps Research Institute, where he is a professor of genomics and the director of the Translational Science Institute. Topol, one of the nation’s most prominent cardiologists, founded the medical school at the Cleveland Clinic and led its department of cardiovascular medicine. “He is keenly intelligent and charismatic,” Topol said. “Mehmet was always unique, but now he has morphed into a mega-brand. When he tells people the number of sexual encounters they need each year to improve their lives in a specific way, or how to lose weight in three days—this is simply lunacy. The problem is that he is eloquent and talented, and some of what he says clearly provides a service we need. But how are consumers to know what is real and what is magic? Because Mehmet offers both as if they were one.”
I'll offer this. Place a bet you really can't afford or surely don't want to lose. Here's the bet: Who trusts you more? When push comes to shove in competently deciding health matters largely for yourself, does Mehmet or Eric trust more that you're ultimately capable of sound decisions?
Place your bets. You know where I'll place mine. This is not really about infallibility or accuracy, but about positioning. You are best positioned to understand you, and to act accordingly. For all the heroic doctorly knowledge and expertise, that's one physical reality that cannot be substituted. Oz gets this. He's leveraging that understanding.
He continued, “It all seems to be in the service of putting on a show. And, when you add it up, that seems like something other than medicine. It’s more like medutainment.” Topol was not the only voice to offer that kind of comment. One day, I asked Oz whether he minded that many of his medical peers criticized him for following the dictates of daytime television more than the demands of scientific truth. “I have always played offense,” he responded. “So I don’t care what people call me. I used to. I felt that to say I was an entertainer was dismissive. But it is part of what I have to do. I want to get my message across to people who are not going to get it in other ways. And I can’t do that if I am not palatable to the people who watch the show.”
What a white liar! Huh?
Wouldn't it be funny if in the end, Oz turns out to be right? How would that work? No, not right about any of the hocus pocus he allows on his show; rather, doing what he needs to do to get his more fundamental and essential message out: you need to figure a few things out and you need to begin trying things out on yourself.
Isn't it potentially that Oz is simply more humble that his background and experience would have you imagine? Is that it? Is it as simple as that he really, really wants to help people to become their own little doctors and trusts them to do that?
While in the meantime, bone to my Paleo readers, he can introduce stuff like this: (the problem with wheat; and the cholesterol con; on Dr. Oz.)
Oz refers to the academic world as a “fortress,” and he is determined to tear down its walls. In the past, his enthusiasms, even when unsupported by data, have usually fulfilled the Hippocratic oath to do no harm. Lately, however, he seems to have moved more firmly into the realm of tenuous treatments for serious conditions. On one recent episode, “Dr. Oz’s 13 Miracles for 2013,” he included “a revolutionary new way to live years longer: it’s red palm oil.” He went on, “Its red color is perfect, because I think of it as a stop sign for aging.” I asked Oz several times why he promotes that kind of product, and allows psychics, homeopaths, and purveyors of improbable diet plans and dietary supplements to appear on the show. He said that he takes his role as a medium between medicine and the people seriously, and he feels that such programs offer his audience a broader perspective on health
...Well, I have a bottle of red palm oil on my counter. It's fabulous on scrambled eggs (and just about everything, really), as we learned at MovNat.
“Ultimately, if we want to fix American medicine we will need skeptical and smart patients to dominate,” he said. “They will need to ask the hard questions, because much of medicine is just plain old logic. So I am out there trying to persuade people to be those patients. And that often means telling them what the establishment doesn’t want them to hear: that their answers are not the only answers, and their medicine is not the only medicine.” But, when he tells his audience, with no credible evidence, that red palm oil may reduce the risk of Alzheimer’s disease, is he empowering people? Or is he encouraging them to endanger their health with another “miracle”?
I dunno. Coconut oil, similar to red palm, looks pretty promising and another doctor found that out by reading patent applications of drug companies trying to cash in on what one can essentially do on the beach with a machete. I've done a few blogs on it going back, linking to promising research, too.
And so, this is one area to consider where Oz may have a leg up on his critics. By allowing himself the luxury of spending some of his capital on dubious stuff—while attracting viewers who are fans of such dubious stuff—he gets to reap the reward of stumbling onto something where there might be a real there, there...from time to time.
None of his critics are even remotely so positioned. In essence, Oz is acting similarly to a pragmatic business guyl with a goal in mind. Hshe doesn't know exactly how to get there, and by practical necessity, is willing to entertain all the mostly infeasible approaches, in hopes of finding the truly feasible.
...Oh, wait...that other guy, Dr. Mercola, hasn't come up yet, so here:
I had no idea what he meant. How was it Oz’s “biggest opportunity” to introduce a guest who explicitly rejects the tenets of science? “The fact that I am a professor—one of the youngest professors ever—at Columbia, and that I earned my stripes writing hundreds of papers in peer-reviewed journals,” Oz began. “I know the system. I’ve been on those panels. I’m one of those guys who could talk about Mercola and not lose everybody. And so if I don’t talk to him I have abdicated my responsibility, because the currency that I deal in is trust, and it is trust that has been given to me by Oprah and by Columbia University, and by an audience that has watched over six hundred shows.”
I was still puzzled. “Either data works or it doesn’t,” I said. “Science is supposed to answer, or at least address, those questions. Surely you don’t think that all information is created equal?”
Oz sighed. “Medicine is a very religious experience,” he said. “I have my religion and you have yours. It becomes difficult for us to agree on what we think works, since so much of it is in the eye of the beholder. Data is rarely clean.” All facts come with a point of view. But his spin on it—that one can simply choose those which make sense, rather than data that happen to be true—was chilling. “You find the arguments that support your data,” he said, “and it’s my fact versus your fact.”
Ha! Yea, that's The Holy Grail being channeled, there. Certainty.
In simple terms, there is a distinct difference between understanding that there is such a thing as absolute truth, and knowing what it is. Never confuse them. What's really fundamentally going on is a "war" between those with different ideas of how to arrive there. I am soundly with the more sciency, objective, hard data and evidence folks.
But that speaks more to method than to absolute effectiveness, though I'm pretty convinced my method is best long term. In the end, I think we all really want the truth and it's undeniable that such truth is sometimes arrived at through things like snap human intuition—or whatever—that we have a hard time explaining on purely rational, data-driven grounds. ...The fact is, that's really more of a problem for the hard-data types—in that it sheds light on human limitations—than it is for the intuitionists, who already understand such human limitations.
A further rub is that it's often very difficult in dealing with humans, to convince them that some truth is the real result of had-nosed data collection and analysis, and not some flash of savant brilliance. The latter is so very sexy by comparison.
“From our very first day, we have had one simple mission for this show,” Oz began. “To empower you to take control of your health.” [...]
As Oz walked off the stage, after the show, he looked at me, smiled broadly, and said, “I could spend the rest of my life doing bypass surgeries, but what would that make me? A surgeon. With this show, we can do much, much more.”
Being honest never necessarily means you're right. You can be honestly wrong, and we have all been there at times. I'd just rather be honestly wrong than dishonestly anything else.
So I have no honest choice but to salute Michael Specter and The New Yorker for a fine, honest piece that really leaves it up to you to decide. That's real journalism.
And I solemnly salute Dr. Mehmet Oz as well, for both the real, data-driven, no-shit and no-excuses contributions he's made to the lives and lives saved of all those people and loved ones over the decades; and as well, for his willingness to risk his earned accumulated capital in general respect and professional regard, to chart a course he appears to understand, in the pursuit of individual knowledge, responsibility and action.
...Because in the end, you have more power and potential effectiveness over you and yours than any doctor. Dr. Oz clearly understands that; but the road there is bumpy, messy, and unpaved. I suppose he understands that, too.