A Seal of Approval

I have never belonged to the American Medical Association.  As a student I didn’t want to pay the dues. As a practicing physician I am of the opinion that the AMA has two often mutually exclusive goals (promoting physician income and patient care)  and they are doing both badly.

In the 1990’s the AMA entered into a contract with Sunbeam to get an AMA seal of approval for Sunbeam products, but due to objections the AMA backed out of the deal, in the end costing them almost 10 million dollars.

As was noted at the time:

“I think if we’d gone to trial,” Dr. Relman said on Saturday, ”probably a lot more relevant information would have been uncovered and made available to the membership. As a result of this settlement, we will never know the truth of what happened. It does not let the sun shine in.”

Yeah AMA. It is probably for good reason that only  around 29% f of US physicians belong to the AMA; I have never seen them as representing me or my patients.  Whether the AMA or physicians, I am automatically suspicious of any person or institution who puts their seal of approval on a product.  I figure they are only doing it for the money.  Not that there is anything wrong for that; I am for sale if anyone can meet my price.  Trusting endorsements is like George Carlin’s (I think) observation that he did not like doing standup for stoners since you never know if was the act or the dope that lead to the laughter. I know celebrities are paid for their endorsements; it is not conflict of interest when it is your job to sell a product. At least actors say they only play a doctor on TV.  But when professionals use their authority to recommend products, I would love to see a conflict of interest statement in the recommendation.

When I give a lecture I have to mention my conflicts of interest (COI)* and I have to specifically confirm or deny that I will mention products in which I have a financial interest^. The COI rules are nice, so you know, sort of, who has an interest in pleasing their corporate masters, although I suspect most doctors do not take COI statements seriously.  At IDSA this year most of the speakers gave their COI statements with a short, dismissive sneer and a roll of the eyes.  Me?  Potentially Biased? Puh-please.

Still, if you are going to take recommendations, as a consumer  it would be nice to know what direct, or more importantly, indirect, compensation is derived from the recommendations.  I know Dr. Weil is a pitchman for his own food, supplement and kitchen products, available on his website, and I would take his recommendations no more seriously than if he were on an infomercial promoting a Shamwow.   I also know, since he sells a rice cooker with fuzzy logic, that he has no sense of irony.

The Dr. Oz website does not sell products, just advertisements that are certainly a step up  from the SBM sidebar, so far be it from me to complain about ad dollars, although I bet he gets more from Weight Watchers than SBM gets from City Chiropractic.  Dr. Oz does not endorse specific products so that he does not have any conflicts of interest in his advice.  The closest to a COI statement I can find is in the FAQ:

“Can Dr. Oz Recommend a Specific Brand Name for a Medication, Supplement, Vitamin or Product? Can You Tell Me Where to Buy a Medication, Supplement, Vitamin or Product?
Dr. Oz does not endorse any brand name or commercial supplier. Check with your physician or health-care provider before taking any such product. ”

It would be nice if there were a bit more transparency beyond the above paragraph, but it would appear that Dr. Oz is sincere in his wish to be free of  financial taint, unlike Dr. Weil or Mercola, when making suggestions.  So what is worse? The obvious entrepreneur, selling a product, or the well intentional, but credulous, television show host? Because Dr. Oz has given his official seal of approval to absolute and total nonsense, and he is evidently doing it for free.  I would have more understanding if he were selling out;  enough money makes almost anything legitimate.

Dr. Oz gives his official seal of approval for the remedies, treatments and foods he’s most passionate about.
Oz-Approved Alternative Treatments
It’s a question people ask Dr. Oz all the time: Which alternative health treatments really work? Here are a select few that do.

Select few.  Oh good, he is not going to recommend all sorts of nonsense, but a judicious selection after reviewing the literature and to find the very few ‘alternative’ therapies that may have some efficacy.  Lets look at the list.

First up?
Moxibustion for low back pain. A swing and a miss.

“This ancient remedy involves the burning of mugwort, a small spongy herb, to facilitate healing. Moxa is applied to the acupuncture needles placed in the lower back and then lit, which results in a very mild warming sensation. This activates the nervous system, increasing blood flow and infusing the skin and muscles with the analgesic properties of the herb.”

It is not the suggestion that a form of acupuncture, moxibustion, is beneficial for low back pain (it isn’t) that is concerning. It is the fanciful anatomy and physiology, from a surgeon, no less.  As best I can tell, the context in the last sentence is meaningless.  I realize it is important to simplify when writing for a broad audience, but that, as a rule, doesn’t include what appear to be fictional explanations.  Maybe the next suggestion is better.

Using   Rhodiola Rosea for stress relief.  Mechanism?

“…an herb that increases the body’s resistance to stress by reducing levels of cortisol”

In humans,  Rhodiola Rosea prevents the release of exercise induced cortisol. Maybe.   It is not what one would call the most robust literature.  It is always  a curiosity when an alternative medicine proponent suggests treating a symptom (actually a sign) of a disease rather than the underlying cause.

I lean towards the minimalist approach towards altering non-pathologic body physiology.  I do not treat fevers in most cases, as an example.  Fevers are a beneficial response to infection and it is a mistake to suppress them unless there is a compelling physiologic reason.  I would wonder the same about suppressing the cortisol response to stress.  Is it beneficial to suppress the stress response, or, as is usually the case, a bad idea?  Of course, he does suggest consuming it in a shot of vodka, which would reduce my stress.

0 for 2.  One more strike and you are out.

Third suggestion?

Immunity Boosters: Himalayan Salt Inhaler
If you find yourself run down, you need to boost your immunity, the body’s best line of defense against infection and disease. To help ward off infection, especially during flu season, try a Himalayan salt inhaler. This ancient remedy, a ceramic container filled with Himalayan salt crystals, is used as an inhaler to calm and cleanse your airways. The salt draws soothing moisture into your mucus membranes, making them better able to clear irritants

Again, the physiology appears to fanciful. Calm and cleanse airways?  What does that mean?  He calls it an immunity booster, but the alleged effect has nothing to do with immunity, but some odd mechanical effect.  I know I expect too much to find logic and consistency in sites such as these, but I do like to see clear thought in my physicians.  I would not pass any student who seriously tried to pass this explanation off as having anything to do with reality.

Pubmed reveals nothing on the Himalayan Salt Inhaler (or surrogate search terms), but the first hit links back to Dr. Oz (I am sure he will ask them to desist, he has done that for similar sites in the past) who say

When you inhale through the mouthpiece, the passing moisture absorbs micron particles of this incredible pure, bio energetic and mineral laden Himalayan Pink Salt that penetrates and cleanses the entire respiratory system including sinuses, nasal cavities, throat and lungs. This salt air bath flushes impurities such as allergy and asthma triggers, smoke particulate and other impurities that can distress the respiratory system. It’s perfect for treating symptoms of Allergies. Shortness of Breath, Hayfever, Cold, Flu, Bronchitis, Sinus Conditions and other Respiratory Symptoms caused by mold, fungus, smoke and pollution in the air.

They only use 250 million year old salt.  The older the salt, the more bioenergenics.

Three swings, three strikes. He is out. And that is just the first page.

Page 2 is mostly diet “cheats”; foods that let you give into  cravings without harming your diet, as well as suggestions for light based therapies for sleep  that suggest Dr. Oz is up to date on his Color Corps if not his Ioannidis, as he has a real penchant for extrapolating from every small, uncontrolled, unreproduced preliminary study to medical recommendations,  although I am giving him the benefit of the doubt.

None of his recommendations are referenced, so I am assuming the papers I find are the same  Dr. Oz has read to make his recommendations. Maybe not.  I must admit to a certain admiration for his ability to keep up with an obscure literature.  There were maybe 50,000 infection related articles last year in Pubmed. I read a fraction of those, mostly in the higher impact journals.  For my half hour podcast it takes 4 to 6 hours to find the 80 or so articles in each Podcast, and another 4 to 6 hours to read them and record the Podcast.  To find the obscure references in the low impact journals, get a copy, read it, and then come up with his seal of approval must be a daunting amount of work, even if you have a staff searching the literature for you.

Page 3, the approved home remedies, starts with a sentence I initially thought suggested the Oz family did not know the difference between a virus and a bacterium, as is not common.

The Oz family often leans on alternative therapies and is more likely to reach for zinc before they reach for penicillin.

Zinc is reccomended for colds, a virus.  Pencillin is used for Streptococci, a bacteria.  Of course, it is probably to much to expect an understanding of microbiology from someone who thinks to inhaling ancient Himalayan salt will prevent influenza.  The ‘before’ suggests equivalent options, although perhaps I misread what is in fact a comment on the epidemiology on infections in their household.

There are  6 home remedies recommended; I will take the time to comment on two.   The first is a remedy for bruises.

If applied before a bruise forms, arnica gel, a homeopathic remedy, will decrease bruising. It also acts like a topical aensthesia (sic) agent.

Acnica is not a classic homeopathic preparation, where like Oakland, there is no there there.  Acnica gel  actually has something in the product, 7%  Arnica montana, and the clinical trials on bruising showed mostly no effect.

The other is epsom salts for sore muscles. He says “Epsom salt is comprised of magnesium sulfate; when used in a bath, it’s absorbed into the skin and relaxes muscles.”

When I first read this, I thought, ‘What?’.  The skin is a remarkably impermeable barrier. It is hard to get anything past the skin that doesn’t involve a needle and there is no way a bath in epsom salts will raise serum Mg.  But there is  an internet report, never published in the peer reviewed literature, never reproduced suggesting that bathing in epsom salts in 120 degree water  (I rarely get in a hot tub above 105) for 12 minutes leads to increase in blood Mg, hardly the temperature of the standard bath.  Assuming he has the same sources I do, I applaud Dr. Oz for making a recommendation based on the most obscure reference imaginable.

The fourth page is devoted to wheat germ and on page five he endorses specific products  for sagging skin and baggy eyes. Oops. Need to update that FAQ.  “Dr. Oz does not endorse any brand name or commercial supplier.” Except when he does.  I hope he at least gets free product.

The last page are two links to Dr. Oz’s 48 hour week end detox cleanse Yep. Dr. Oz wants you to get rid of those toxins, but to do it the right way, and he proves a shopping list of foods and recipes that will clean out your toxins. I was unaware that

You want to keep your colon flowing regularly since its main role is to flush out toxic chemicals before they can do you any harm.

And here I though the colon was used for water absorption and nutrient absorption. Cholera patents must be particularly toxin free.  One more piece of information suppressed in medical school.

Wild extrapolations of minimal data, ignoring information that contradicts the stamps of approval (I assume), fanciful physiology and nonsense.  It makes the AMA look positively fastidious in comparison.

I know no secrets, except moderation, to a long, healthy life.  Most of what I do, I do for the pleasure it provides. Life is short, and in the end we all return to the mud,  so I might as well enjoy the journey.  Following  the advice on the Oz site, or Mercola, or Weil,  looks like so much work with so little enjoyment and minimal chance for benefit and the same ultimate pay off.



To data the only product of any sort I have accepted from an industry rep is a Fleets enema. When the Unasyn rep left my hospital he sent me a Fleets with a sticker on it.  It sits, unused, in my office, should there ever be an emergency requiring its use.  I do not even eat the pizza at conference.  I am interested in history and war, so I do have a lot of interest in conflicts.

^ I do have my growing multimedia empire where I sell a guide to Infectious Diseases and I am the ID blogger for Medscape.

Self Aggrandizing Addendum

I was interviewed for the ERCast on vaccines and influenza and it was posted today.  While I have not listened to it, I am sure it is the feel good romp of the season, and, really, the world does need more Mark Crislip.  ERCast is available on iTunes.

Posted in: Science and Medicine, Science and the Media

Leave a Comment (34) ↓

34 thoughts on “A Seal of Approval

  1. windriven says:

    Dr. Oz: “You want to keep your colon flowing regularly since its main role is to flush out toxic chemicals before they can do you any harm.”

    It is abundantly clear that the distinguished Dr. Oz has missed a rather more important reason to keep one’s colon flowing. It keeps one from being full of …

  2. art malernee dvm says:

    I am of the opinion that the AMA has two often mutually exclusive goals (promoting physician income and patient care) and they are doing both badly.>>>>

    In my opinion the AMA does a better job not promoting unproven medical care than the American Veterinary Medical Association does. At least the AMA pulled out of the agreement. Veterinarians who want to leave the AVMA find it difficult to obtain state board malpractice protection insurance somewhere else. So the AVMA promotes unproven medical care as the standard of care in the market place and the veterinarian who object still are members of the AVMA so they can buy malpractice insurance protection.
    art malernee dvm
    fla lic 1820

  3. DrRobert says:

    Dr. Oz is a joke. I purposefully avoid his shows, but I saw one recently where he had a tongue and ear phrenologist on and let him sit there and cold read a patient to diagnose them. Apparently Oz’s wife is a Reiki Energy Healer, so I guess he has to be friendly to these quacks under penalty of wife-induced abstinence.

    Re: the AMA, maybe they can adopt this logo:

    It is currently being used by an acupuncture office in my city. I almost had an aneurysm when I saw the caduceus being molested by a ying-yang.

  4. superdave says:

    Honestly the last week or so of entries on SBM have been too depressing to read. This is not a reflection of the quality of the site. But damn, 120 degree bath? If I remember correctly from my physiology class, that’s right about the threshold of causing physical damage to the skin (and also extreme pain).

  5. DrRobert says:

    @art malernee dvm –

    At PetCo I recently saw a brand named “HomeoVet” (or something) that was offering homeopathic heart worm pills. Who on earth makes the decision to allow these types of products to be introduced to the market?

    It’s rather unethical and, well, shitty, to offer useless homeopathic remedies as a preventative measure for something that is a real and serious threat to pets.

  6. cervantes says:

    It sounds to me like this dude must have gotten his medical degree in the Land of Oz, maybe bestowed by the Wizard along with the scarecrow’s diploma.

  7. Scott says:

    Apparently Oz’s wife is a Reiki Energy Healer, so I guess he has to be friendly to these quacks under penalty of wife-induced abstinence.

    Worse than that – it demonstrates that he really doesn’t care about science. If it were otherwise, I can’t see a philosophical mismatch that profound getting to the point of marriage.

  8. CM Doran says:

    Thank you for continuing to point out the deficiencies of “popular doctors.” All of us, even pharmacists , have deficiencies, but our ability to self-correct is important. Plus, most of us don’t have a bully pulpit like a TV show to either “sell” or give our opinions (science-based or not). I’m not sure the above people you mention take their responsibilities seriously…perhaps $$ is more important? It tends to blind a lot of people–even great scientists at times. Keep writing.

  9. ConspicuousCarl says:

    Why wouldn’t you just take a magnesium pill instead of cooking yourself, if indeed a lack of magnesium is the problem?

  10. DevoutCatalyst says:


    I had a New Agey friend that dated a physicist from Fermilab. When there’s attraction, almost anything is possible. I don’t recall the half-life of their relationship…

  11. ConspicuousCarl says:

    DrRobert on 02 Dec 2011 at 9: 49 am
    Re: the AMA, maybe they can adopt this logo:

    Dr. Oz probably has that tattooed above his ass, so when he wears low-cut jeans and an undersized t-shirt, all of the quacks know he is willing to put out nonsense.

  12. LovleAnjel says:


    Theirs was an arranged marriage. I don’t think their personal philosophies played into it very much.

  13. Scott “Worse than that – it demonstrates that he really doesn’t care about science. If it were otherwise, I can’t see a philosophical mismatch that profound getting to the point of marriage.”

    They have been married since 1985 and have four kids. Are you saying that a truly science based doctor would dump his wife for her philosophical approach?

  14. Scott says:

    I am suggesting that a truly science based person wouldn’t have liked an anti-science fruitcake in the first place. Though assuming LovleAnjel is correct, that might indeed have been moot.

  15. Quill says:

    Wow! Dr. Oz is a veritable 100% pure, natural, bioenergetic font of information! And all with the solid endorsement of “As Seen On TV!” So many questions! I should write Dr. Oz and ask if the Himalayan salts dripping down my throat will interact with the zinc lozenge I just swallowed and if so, will that increase or decrease my colon flow, especially as the salt “flushes impurities.” Where do they flush them? More colon action? And if all that flows too much and I have to sit for a long time on the toilet, will I get a bruise from the seat? Will applying arnica gel before sitting help? Or will the arnica be absorbed and interfere with the magnesium that was sucked up through the same skin while I sat in a painfully hot bath?

    Since it’s all about important, regular flow in the colon, what post bowel movement “toxins” should I look for? Lots of magnesium and zinc, maybe bound up in the wheat germ? And if all that fails to make my flow “regular” should I call Dr. Crislip and ask for that Fleets enema? (Does Fleets use “incredible” pure Himalayan salts or at least “Amazing!” salt from the Dead Sea?)

    And I should ask about exactly how the Oz family “leans” on alternative therapies. Do they tape them to a wall and sort of relax their back against them or do they put them on a table and gently apply an elbow? Are meridians involved?

    My gosh! The great and powerful, all-digital, in living color HD 1080p Oz is a modern marvel. I must ask my internist why he doesn’t recommend all these things.

  16. Chris says:

    Dr. Crislip:

    They only use 250 million year old salt. The older the salt, the more bioenergenics.

    Would folks be so enthusiastic about pink salt if they knew the color came from salt loving bacteria? Inquiring minds want to know!

  17. Scott
    “I am suggesting that a truly science based person wouldn’t have liked an anti-science fruitcake in the first place.”

    So you are making a judgement about the quality of a 51 year old’s medical recommendations based on your assumption of the personality of his wife when he met her 26 years ago (when she was 22 and he was 25)?

  18. windriven says:


    “Are you saying that a truly science based doctor would dump his wife for her philosophical approach?”

    Probably not until the kids were grown. How do you separate one’s “philosophical approach” from the rest of their personality? Isn’t the entire person informed by their philosophical approach? I wouldn’t want to spend the rest of my life explaining to someone why I wasn’t going to take echinacea, have my colon hydrocleansed, eat a macrobiotic rice diet, have people with a tenuous grip on reality waving their hands over me, or spend a lot of time watching Michael Moore movies or listening to Rush Limbaugh.

    Of course I never would have married someone like that in the first place.

    And – just a question – why does your question assume the science based doctor to be a male?

  19. windriven – “why does your question assume the science based doctor to be a male?”

    Umm, Dr. Oz IS male, right? I’ve never watched the show, but I thought I picked that up somewhere.

  20. Probably on all those FB banners…

  21. Scott says:

    I was offering it as additional evidence of his philosophy. The execrable quality of his medical recommendations could indicate that he’s anti-science, or it could indicate that he’ll hawk garbage he doesn’t believe in for enough money. But when you note that he’s married to someone profoundly anti-science (and that sort of attitude very rarely changes in adulthood), it would appear be a decent indication that Oz was also actually anti-science as opposed to pretending to be for the money.

    But as I already indicated, LovleAnjel’s point rather wrecks that argument so I’m not still offering it. I think it was a reasonable position in the absence of that fact, but in the presence of that fact I’m abandoning it.

  22. nybgrus says:

    Interesting turn this thread has taken. I do always love reading Dr. Crislip’s posts though – his humor is one I appreciate.

    As for the whole Rhodiola thing… I didn’t know about the cortisol. Though I did do some post-grad work on rhodiola. In fact, I was part of a presentation at the Methusulah confernce a few years back. The title was:
    Extension of Drosophila Lifespan by Rhodiola rosea Through an Anti-oxidant Independent Mechanism.

    We actually had some pretty cool data. We were indeed able to extend the lifespan of Drosophila vastly more than you could expect by supplementing them with rhodiola. At the time I left it, it was indeed very promising research.

    But it was not “alternative” and it did not apply to humans. My PI was constantly being asked for media interviews and she would always say quite clearly that this data is very interesting but it applies to flies not people. Hopefully, someday, we can find out what it is that is working so well in these flies, elucidate a mechanism (my assay just showed one way it didn’t seem to work – I tested the anti-oxidant mechanism) and then maybe apply it to humans. It was also clear that we were talking about pharmacognosy. While she was very keen to explore the potential synergistic effects of the myriad compounds in rhodiola, there was never any illusion that it was some “holistic” and “irreducible” facet of the herb in toto. Maybe it would be just one particular compound. Maybe it was 3 working together in some way. Maybe it was 10. Obviously the more there are, the more complex the research becomes. But it was never something that could somehow crumble to dust by us trying to tease out what it was (i.e. being the “evil reductionist”), like most sCAMsters would have us believe.

  23. Scott “But when you note that he’s married to someone profoundly anti-science (and that sort of attitude very rarely changes in adulthood).”

    How do you know that sort of attitude rarely changes in adulthood?

  24. DBonez5150 says:

    I suspect Dr. Oz, despite being an MD and surgeon, and his wife are probably convinced that “their science” is very real and effective and that they are probably extremely content with each other. I imagine they think “their science” happens to be the “other” science that can’t be tested by “normal, reductionist methods,” that “their science” is individualized, responds well to positive thinking and the “powers of the mind.” By having the same point of view with their obvious, ridiculous slant towards woo, they can fully support and embrace each other’s methods, purported mechanisms, and promotion of similar products. A delusional marriage that was made in woo-heaven!

    @ nybgrus

    Sounds like you’re missing a fantastic opportunity at wealth. Simply data-mine your own work, use your MD as “proof of effectiveness,” begin making fantastic life-extending claims about rhodiola, and fully embrace the dark side of woo and become a supplement manufacturer. Flies, humans, what’s the difference? You’ve got the holy-trinity of woo; A research paper, credibility as a doc, and life-extending claims! You’ll be rich!

    Ah, but alas, I suspect you’re like me and have a conscience and need to sleep at night. Looks like Dr. Oz does not, however.

    Great post Dr. Crislip!


  25. weing says:

    “Of course I never would have married someone like that in the first place.”
    You gotta be kidding me. It depends on how hot she is. If she believes nonsense, she’s more likely to believe my bull****.

  26. Lytrigian says:

    @DevoutCatalyst — Having a scientific education, or even working in the sciences, is no prophylactic against this kind of thing. Jack Parsons, one of the founders of the Jet Propulsion Laboratory, was a disciple of Aleister Crowley.

    His association at that time with Scientology founder L. Ron Hubbard is amusing to read about.

  27. nybgrus says:


    I have this feeling that we would laugh endlessly over beers, if we had the opportunity.

  28. nybgrus says:


    Yes. In fact, I just made a comment to that exact effect referencing Phil Plaith at Neurologica today.

  29. DevoutCatalyst says:

    “I was interviewed for the ERCast on vaccines and influenza and it was posted today.”

    Great stuff. You don’t have to be a Crislip completist to enjoy this one. (But then, that applies to everything Mark does.)

  30. Janet Camp says:

    “Cholera patents must be particularly toxin free. One more piece of information suppressed in medical school.”

    I laughed so loud that the weenie dog ran and hid under the bed.


    I don’t think an arranged marriage lets Oz off the hook. As far as I can tell, he promotes his wife’s reiki nonsense and chooses to embrace her wooness. So what if he didn’t “choose” her? Besides, sometimes marriages are “arranged” between people who already like each other anyway–it’s just a matter of whether or not the parents approve.

  31. DrRobert says:

    Speaking of wives believing goofy things..

    I just showed her this, and how Oz supports homeopathy.

    Since she’s a Dr. Oz fan, she tries to justify it as “well maybe some peoples version of homeopathy is different than others. there are some compounds you can put on your skin to numb them.”

    ….. typical person, when their beliefs are challenged, bends the truth in any way possible.

  32. Ali771 says:


    “It is currently being used by an acupuncture office in my city. I almost had an aneurysm when I saw the caduceus being molested by a ying-yang.”

    Maybe that’s about right. The caduceus is associated with commerce and alchemy.

    (see confusion with the caduceus)

  33. nitpicking says:

    “Epsom salt is comprised of magnesium sulfate; when used in a bath, it’s absorbed into the skin and relaxes muscles.”

    Me, reading: “WHAT?!”

    Next sentence, Dr. Crislip: “When I first read this, I thought, ‘What?’.”

    I’m not a doc but I have a couple of bio degrees. The whole point of skin (or one of them) is surely being impermeable. And does Dr. Oz really want to modify the electrolytic balance of his readers’ bodies in an uncontrolled way by having them absorb magnesium from a bath?

  34. nybgrus says:


    lol. That kind of got me too. Except that for me, taking a 120+ degree bath is no big deal. My father was Soviet Russian, and I’ll tell you what. Those saunas and jacuzzis they take – yeah. Crazy hot. I’ve done the full on Russian sauna – 200ish degrees with a guy that fans the hot air over you before beating you with willow branches soaked in ice water.

    And indeed, you can absorb a fair bit through your skin. Mercury for example. Or nitroglycerin paste (the funny thing is we always put it over the heart, but really, it could be on your butt and it would have the same effect).

    But yeah, in this case, it sure is ludicrous. And I mean that seriously, despite the sarcastic tone it seems to have taken in context.

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