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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.

Footnotes

*COI:

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

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