Do we need Dr. Oz and his megaphone?

I had an interesting Twitter exchange with Dr. Leana Wen from the Baltimore City Health Department tonight. She had tweeted out that Dr. Mehmet Oz had been in town and stopped by to visit with her and some community members:

And here:

Several folks on Twitter, two of whom are healthcare providers with a ton more experience in medicine and public health than I will ever have, voiced their concern. For example, Dr. P Mimi Poinsett tweeted:

Dr. Judy Stone, a personal friend of mine and wise in the ways of many things, tweeted:

When I weighed in with my opinion that Dr. Wen’s welcoming of Oz was a bad thing, and that he was well-known for promoting quackery (as Orac has covered here and here), Dr. Wen responded to me thus:

That link in her tweet goes to this article by the president-elect of the American Academy of Family Physicians. (Dr. Filer is from York, PA, right down the road from me and Baltimore.) In the article, Dr. Filer states that she was invited to a taping of the “Dr. Oz Show,” but that she had some apprehension about it:

“You need to understand that our members aren’t happy with some of your advice,” I told him. I also let him know that family physicians are spending too much of our valuable time explaining to patients why we don’t recommend some of the products and ideas they’ve seen on his show.”

Nevertheless, she was persuaded into being on the show:

“So here was a risk with a potentially huge benefit. This was an opportunity to talk to millions of Americans about the importance of family medicine and the critical role that primary care plays in health care. I could give this audience, which hasn’t always received evidence-based information, a better understanding of who we are and what we do as family physicians.

As I considered it, the conclusion that I drew was that the benefits would outweigh any risks if I could reach viewers who don’t have a primary care physician and make them realize that they should. Incredibly, that goal was accomplished before the show was ever broadcast.”

In other words, Oz has a big megaphone that reaches millions of people, and Dr. Filer was going to use it to promote the very reasonable and good advice that everyone should have a primary care provider.

"Hear ye! Hear ye!"
“Hear ye! Hear ye!”
After the taping of the segment, a person reached out to Dr. Filer for more information. Dr. Filer concludes her post with this:

“This effort already helped at least one person in the studio audience. My hope is that viewers who see the episode on TV or online will find their way into our exam rooms. Americans need to understand the value and importance of what we do. For people to hear our message, we may have to take a few bold risks.”

The criticism that I have of this — and of Dr. Leana Wen welcoming Oz into Baltimore — is that the kind of audience that Oz likely attracts is not one that is very open to evidence- and science-based medicine to begin with. If that were the case, then he would not need to promote quackery on his show. He would not need to invite John Edward and have a show about speaking to the dead. There would be no need for Oz to sell products for detoxification and such.

On the other hand, do people who subscribe to quackery need to be told about the lack of benefits of it and potential harms? Yes, absolutely. Although they may not want to listen, we in public health and medicine must do our due diligence and try and inform the public of the dangers of Supplements, Alternative and Complementary Medicine (aka “SCAM”). But going on Oz’s show — or rubbing elbows with him — without challenging him on his years of promoting quackery kind of makes whatever you have to say to promote good medicine fizzle out. He still gets to sit on his pedestal and promote quackery tomorrow, next week, and next year.

As Dr. Mark Crislip is fond of reminding us, mixing cow dung with pie doesn’t make the pie taste better, and the cow dung still tastes awful. I passed that on to Dr. Wen because — as someone who cares deeply about Baltimore just like she does — I am very worried that she tried to sweeten Oz’s cow dung but ended up souring the apple pie. She may have gotten some air time with him, but at what cost? What will be the impact?

You may be asking what would be a suitable alternative to Oz’s “megaphone,” and that is a valid question to make. My only answer is to go back to the wisdom of my parents and others who have told me time and time again that actions speak louder than words. The work that Dr. Wen and her team are doing in Baltimore is making waves. People are paying attention, especially those of us who have been tasked with guiding our public health studies and practice toward Baltimore. While I don’t have the Nielsen ratings on how many African American kids with single-parent households in violence-torn neighborhoods of Baltimore watch the “Dr. Oz Show” on a daily basis, I’m going to bet that it’s a low number, and that there are far better and louder ways to reach them and others who are in need of some very serious assistance without reaching out to Dr. Oz and his megaphone.

Finally, all I have to say to Oz is this: