Jan 30 2013
“Medicine is a very religious experience. 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. You find the arguments that support your data, and it’s my fact versus your fact.”
- Mehmet Oz
The above quote is from a recent article for the New Yorker by Michael Specter about Dr. Oz, the most currently popular TV doctor. Specter described this sentiment as “chilling.” To me it sounds like a manifesto – a postmodernist attack on the scientific basic of modern medicine.
In my experience, this sentiment is often at the core of belief in so-called complementary and alternative medicine (CAM). In order to seem respectable and infiltrate the institutions of medical academia, proponents of CAM will say that their treatments are evidence-based and that they are scientific. They have a serious problem, however – their treatments are not evidence-based and are often grossly unscientific. Whenever someone bothers to look at their evidence and examine their science, therefore, they start to backtrack, eventually arriving at their true position, a postmodernist dismissal of science resembling Oz’s statement above. I have heard a hundred versions of the Oz manifesto from CAM supporters.
As with the postmodernist critique of science itself, there is a kernel of truth to the notion that science has its limits (which makes the sentiment more insidious). Scientists are humans, they have their biases and flaws, scientific studies are imperfect and often conflict, and there are often multiple opinions on specific clinical practices. Where postmodernists fall off the cliff, however, is in concluding from this that science has no legitimacy, that it is entirely a culturally-determined narrative with no special relationship to external reality.
This view, while flirted with by philosophers of science, has been rejected because it neglects the fact that science uses a valid method of justification. The process may be messy, but over time scientific evidence can objectively resolve differences of opinion. Experts can eventually agree on what works and what doesn’t, and from that a standard of care emerges. High quality evidence can become so overwhelming that there is no room left for personal opinion.
Short of a solid consensus, science-based practitioners can follow a hierarchy of evidence – we can base our practices on the best evidence currently available. CAM practitioners also fail to follow such a hierarchy of evidence. This observation was echoed in the New Yorker piece by Dr. Eric Rose, Oz’s surgical mentor:
But I think if there is any criticism you can apply to some of the stuff he talks about it is that there is no hierarchy of evidence. There rarely is with the alternatives. They have acquired a market, and that drives so much. At times, I think Mehmet does feed into that.”
Oz, at least, acknowledges the lack of evidence for some of the treatments he offers or recommends.
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.”
The above statement is the Oz manifesto put into practice. “Western” medicine (always a red flag for quackery when that term is used) deals purely with data. Oz, however, blithely dismisses data by stating that “not everything adds up” therefore he can offer whatever people want. He then tries to cover himself by stating that he is only offering such treatments, not recommending them. This is thin cover, however – when a physician offers a treatment to their patient, that is a recommendation. Oz tries to walk this line on his show as well, stopping short of outright endorsement of many of the CAM modalities he presents on his show. He often lets his guest do the promotion.
Sometimes, however, he crosses over that line. In a recent segment Dr. Oz promotes homeopathy as a “natural” and “gentle” alternative to “Western” medicine. You can view these segments online, where it states:
Looking for an all-natural solution for your aches, pains and common colds? Dr. Oz reveals how you can replace your over-the-counter medications with homeopathic solutions. Plus, medical doctors reveal their favorite homeopathic remedies!
Oz flat out endorses homeopathy in this segment, stating that his family has used it for three generations. He then invites a naturopath, Lisa Sarnet, to discuss homeopathy. She repeats all the old CAM propaganda talking points – homeopathy is natural, Western medicine only treats the symptoms and not the cause of disease, and that homeopathy is “holistic.” Oz asks her if homeopathy can be used in conjunction with Western medicine, and she states that she uses homeopathy to transition patients off of their medications. That sounds like using homeopathy instead of evidence-based treatments. Oz accepted this without comment.
We have discussed homeopathy many times – it is a pre-scientific superstition that has been utterly rejected by modern science. Its principles have no basis in reality, and clinical studies show that it simply does not work. Viewers of the Dr. Oz show, however, were offered the recommendation to throw out their medications and replace them with magic potions.
Being unscientific and ineffective is not a problem, however, if you follow the Oz manifesto – cherry pick your facts, dismiss inconvenient science as religion, and do what feels good. That, it seems to me, is the enduring legacy of Dr. Oz.
The Oz Manifesto also highlights a point we have been making at SBM for years – CAM is nothing short of a full-frontal assault on the scientific basis of modern medicine. Its proponents are often coy and evasive on this point, at least those who know how such statements will be perceived by academics. There is simply no other way to interpret their agenda, in my opinion. Oz gives us a glimpse into this agenda – medicine that is based on what feels good, which often means what sells well in the marketplace, not on science and evidence.
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