As “alternative medicine” migrated to become “integrative medicine” and integrative medicine grew from a few isolated centers to become a daily feature on the Dr. Oz show, concerns about claims led to a British Medical Journal article published last month. The study is entitled: “Televised medical talk shows—what they recommend and the evidence to support their recommendations: a prospective observational study.”
Not a bad subject to research, given the influence of Dr. Oz and that of a second show examined, The Doctors. According to the analysis, Dr. Oz offers an average of 12 recommendations per show. The authors' findings, and to the BMJ’s credit, the ensuing BMJ discussion, point out what glass houses we all live in. This is especially so as we shift focus from disease suppression to health creation.
The University of Alberta research team concluded: “Recommendations made on medical talk shows often lack adequate information on specific benefits or the magnitude of the effects of these benefits. Approximately half of the recommendations have either no evidence or are contradicted by the best available evidence. Potential conflicts of interest are rarely addressed. The public should be skeptical about recommendations made on medical talk shows.”
In fact, the researchers found that for 46% of the roughly 50-60 recommendations a week, there was some kind of evidence from case reports on up. They then applied a higher but still what they characterized as a "liberal” standard toward evidence and concluded that 33% made the grade.
In a BMJ forum, a reader quickly responded: “One reaction that one could have to this article is just how evidence-based the medical talk shows are compared to standard physician clinical practice.”
The authors responded: “As we note in the paper, in reviews of practicing doctors, only about three quarters of what is recommended is supported by evidence. In fact some research suggests that even for guidelines, moderate or good evidence is present for only about 50% of their recommendations. The highest level of evidence, randomised controlled trials, is present for only 10-15% of the recommendations.”
In short, the authors might have concluded that like the rest of medicine, approximately half of the recommendations have either no evidence or are contradicted by the best available evidence. The public should be skeptical about recommendations made by any healthcare professional in any circumstance.
So where does this leave us? Clearly, humility on evidentiary claims is a must for all of us. When it comes to high level evidence, we all are finding our way amidst levels of ambiguity. A recorded discussion on the BMJ site of the paper by the authors notes that they would expect significant evidentiary problems “if we record what is said in medical offices and pharmacies.”
Dr. Oz typically makes recommendations that would be expected to have a lower level of evidence than, for instance, the use of pharmaceuticals. His role is in opening listeners to options that are typically newer choices. Not only are they new. They typically have lower financial backing than conventional drugs.
Perhaps even more important is that Dr. Oz, like most of us in integrative medicine, comes from a philosophical approach that seeks to create health. What is a clinician to do in working with a patient if he or she has high level evidence for how to suppress symptoms of disease yet only an impressionistic or montage of evidence on the steps toward health creation?
As the authors state in the podcast discussion, Dr. Oz “haters” can find plenty to support their perspectives. Those for whom Dr. Oz is a champion can marshal evidence that makes the evidence-base for his claims look decent, relatively. Notably, the authors state that they are "disappointed that the overwhelming commentary seems to be that our study somehow proves that Dr. Oz or the Doctors are quacks or charlatans or worse. Our data in no way supports these conclusions.”
In all cases, we must consider the color of tinting any discussant has chosen for the evidentiary walls of his or her fragile dwelling.
Competing interests: No competing interests