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Dr. Oz
Posted: 26 May 2014 12:49 PM   [ Ignore ]
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What do people on this forum think of Dr. Oz? Although he is a legitimate medical doctor with an impressive CV, I think he’s as close to a quack as anyone can be.  I’m particulaly interested in MacGyver’s opinion. Steven Novella, a legitimate MD, the host of Skeptic’s Guide to the Universe has criticized Oz’s opinions and tactics, especially his penchant for backing specious, unproven medical claims. His philosophy is anything but evidence based.  I wonder how anyone who has received an education in medicine from Harvard University can have such a lack of scientific sense when it comes to unproven medical claims. I’m surprised there hasn’t been more criticism of him in the medical community.

Here’s a revealing article that appeared in Slate:

http://www.slate.com/articles/health_and_science/medical_examiner/2013/01/can_you_trust_dr_oz_his_medical_advice_often_conflicts_with_the_best_science.html

[ Edited: 26 May 2014 09:09 PM by Lois ]
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Posted: 26 May 2014 12:54 PM   [ Ignore ]   [ # 1 ]
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Dr. Oz’s first calling is “celebrity” not medicine. He is making far more on TV and subsequent product endorsements than he ever could achieve in medical practice.

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Posted: 26 May 2014 01:05 PM   [ Ignore ]   [ # 2 ]
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More on eivdence based medicine

You might be like to check out these sites. Edzard Ernst was also mentioned in the Slate article on Oz.it looks like a good website with many articles on evidence based medicine.

http://edzardernst.com/2014/01/

Dr. Steven Novella contributes to this site. 

http://www.sciencebasedmedicine.org/

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Posted: 26 May 2014 03:21 PM   [ Ignore ]   [ # 3 ]
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I watched about two minutes worth a couple of years ago, and since then the only time I see him is as I scroll through channels while I’m on the treadmill at the Y.  And, there’s about a tenth of a second lag between the button push that got me to his channel and the one moving me past it.  I really don’t care if he and the bald headed psychologist have technical expertise; they have become entertainers, and I can’t stomach them.

I have so little interest, I didn’t even bother going to the referenced sites above.  snake

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Posted: 26 May 2014 04:25 PM   [ Ignore ]   [ # 4 ]
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Occam. - 26 May 2014 03:21 PM

I watched about two minutes worth a couple of years ago, and since then the only time I see him is as I scroll through channels while I’m on the treadmill at the Y.  And, there’s about a tenth of a second lag between the button push that got me to his channel and the one moving me past it.  I really don’t care if he and the bald headed psychologist have technical expertise; they have become entertainers, and I can’t stomach them.

I have so little interest, I didn’t even bother going to the referenced sites above.  snake

Occam

He has a lot of influence over many gullible people who don’t understand the necessity of scientific evidence backing up claims. For their sake, I care when someone is making unsupported claims, especially when he advertises himself as a mediical doctor.  A medical doctor should know better than to make claims without evidence—many of which can be dangerous.I think it’s an outrage.  I don’t watch his show, either, but I hear about his claims on the Internet. I feel obligated to point it out when I see someone misleading people who don’t know any better. He also encourages people to use these hare-brained ideas on children. He makes a lot of money doing it, too. I think he should be stopped and he should be drummed out of the AMA and other professional medical organizations.

Lois

[ Edited: 26 May 2014 04:28 PM by Lois ]
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Posted: 26 May 2014 06:00 PM   [ Ignore ]   [ # 5 ]
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Quoting Lois:

A medical doctor should know better than to make claims without evidence—many of which can be dangerous.

  As I see it, people enroll in medical schools for a number of reasons.  Three are: 1. To help people, 2. To do medical research, 3. To make a lot of money.  Unfortunately, the third motivation is not nearly as likely as it was in the past.  Oz obviously was a number 3, so he had to come up with an alternative to regular practice.

The problem is that a person with motivations 1. or 2. most likely also has fairly strong ethics, however, that wouldn’t apply to a #3. motivated person like Oz.

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Posted: 26 May 2014 06:39 PM   [ Ignore ]   [ # 6 ]
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Lois, Dr Oz has let his desire for fame trump his Hippocratic oath. He has quite frankly become a complete quack. He started life as a cardiovascular surgeon but after several stints on the Oprah show he got his own show. He was given a great opportunity to educate the public and has made a mess of it. In fact I have a poster in my exam rooms with a picture of Oz and a red circle with a line through it ( like the no smoking signs) that says “Oz not spoken here” followed by a paragraph explaining to patients that a lot of the things discussed on his show are not based on good science and that they should discuss whatever they see on his show with their doctor before following any of his advice. The sign is up primarily to let patients know that Oz is not universally well respected in the medical field even though he seems to project that image of himself and the public believes that he is.

Incidentally Steven Novella was interviewed on Oz’s show once and it was very enlightening in regards to Oz’s character. He had Dr. Novella debate some other doctor who i never heard of but who supported alt med treatments with Oz as the moderator. That was a joke. How can you have a moderator who is not only not impartial, but a strong supporter of one side of the debate. Oz dictated the flow of the debate and did not allow Dr Novella to speak for more than a sentence or two. He did everything he could to prevent Novella from discrediting alt med. In addition he seeded the audience with a couple of shills including a “nutritionist” who was involved with Alt Med and “just happened” to be in the audience. They also just happened to pick her to stand up and give a short speech in support of alt med that was longer than anything Dr Novella was allowed to say. I saw the actual show when it aired but came away thinking even less of Oz than I already did prior to the show.

Here is a link to Skepchicks site with some videos of the show
http://skepchick.org/2011/04/watch-steve-novella-on-dr-oz/

[ Edited: 27 May 2014 04:59 AM by macgyver ]
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Posted: 26 May 2014 09:08 PM   [ Ignore ]   [ # 7 ]
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macgyver - 26 May 2014 06:39 PM

Lois, Dr Oz has let his desire for fame trump his Hippocratic oath. He has quite frankly become a complete quack. He started life as a cardiovascular surgeon but after several stints on the Oprah show he got his own show. He was given a great opportunity to educate the public and has made a mess of it. In fact I have a poster in my exam rooms with a picture of Oz and a red circle with a line through it ( like the no smoking signs) that says “Oz not spoken here” followed by a paragraph explaining to patients that a lot of the things discussed on his show are not based on good science and that they should discuss whatever they see on his show with their doctor before following any of his advice. The sign is up primarily to let patients know that Oz is not well respected in the medical field even though he seems to project that image of himself and the public believes that he is.

Incidentally Steven Novella was interviewed on Oz’s show once and it was very enlightening in regards to Oz’s character. He had Dr. Novella debate some other doctor who i never heard of but who supported alt med treatments with Oz as the moderator. That was a joke. How can you have a moderator who is not only not impartial, but a strong supporter of one side of the debate. Oz dictated the flow of the debate and did not allow Dr Novella to speak for more than a sentence or two. He did everything he could to prevent Novella from discrediting alt med. In addition he seeded the audience with a couple of shills including a “nutritionist” who was involved with Alt Med and “just happened” to be in the audience. They also just happened to pick her to stand up and give a short speech in support of alt med that was longer than anything Dr Novella was allowed to say. I saw the actual show when it aired but came away thinking even less of Oz than I already did prior to the show.


Here is a link to Skepchicks site with some videos of the show
http://skepchick.org/2011/04/watch-steve-novella-on-dr-oz/

Thanks, Mac. I hadn’t heard of that fiasco with Steven Novella. I’m glad to hear you have very creatively brought attention to Oz’s antics in your office.  I wish more doctors would speak up. There has been very little criticism of him in the media that I have seen—certainly a lot less than is warranted.

Lois

[ Edited: 26 May 2014 09:10 PM by Lois ]
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Posted: 27 May 2014 06:02 PM   [ Ignore ]   [ # 8 ]
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Lois - 26 May 2014 12:49 PM

What do people on this forum think of Dr. Oz? Although he is a legitimate medical doctor with an impressive CV, I think he’s as close to a quack as anyone can be.  I’m particulaly interested in MacGyver’s opinion. Steven Novella, a legitimate MD, the host of Skeptic’s Guide to the Universe has criticized Oz’s opinions and tactics, especially his penchant for backing specious, unproven medical claims. His philosophy is anything but evidence based.  I wonder how anyone who has received an education in medicine from Harvard University can have such a lack of scientific sense when it comes to unproven medical claims. I’m surprised there hasn’t been more criticism of him in the medical community.

Here’s a revealing article that appeared in Slate:

http://www.slate.com/articles/health_and_science/medical_examiner/2013/01/can_you_trust_dr_oz_his_medical_advice_often_conflicts_with_the_best_science.html

The term charlatan come to mind, snake-oil salesman, flimflam man, take your pick! I wouldn’t listen to his advice, he’s slimy and so is Dr.Phil. Yuck!

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Posted: 16 June 2014 05:18 PM   [ Ignore ]   [ # 9 ]
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Lois - 26 May 2014 01:05 PM

More on eivdence based medicine

You might be like to check out these sites. Edzard Ernst was also mentioned in the Slate article on Oz.it looks like a good website with many articles on evidence based medicine.

I always find the term “evidence-based medicine” a bit bizarre.  “Evidence-based” as opposed to what?  What other kind of medicine is there that is legit?  Why does a significant segment of the medical community tout medicine that is not evidence-based?

Imagine if there was a movement in the scientific community for “evidence-based science” (a redundant term, I know).  What would that say about science in general?

I wonder what common medical treatments are not evidence-based.  Off the top of my head: vitamins;  arthroscopic knee surgery;  A lot of sports medicine is quite woo-woo-ish (magnet therapy for instance);  Every independent study of antidepressants have found evidence for their efficacy rather lacking (placebos outperformed them in 52% of clinical trials by drug companies—of course those trials were not published and had to be obtained through the Freedom of Information Act);  Electroconvulsive therapy (ECT) for depression and other psychiatric conditions does not outperform sham ECT.

That’s all I’ve got at the moment.

That being said, even woo woo and unproven treatments can be beneficial due to the placebo effect—assuming they are otherwise harmless.  Which makes antidepressants and ECT rather suspect as good medicine, IMHO.

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Posted: 16 June 2014 06:14 PM   [ Ignore ]   [ # 10 ]
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I think a common alternative to “evidence based medicine” is “personal profit based medicine”.  There are always charlatans who make up their “evidence” without any data to back it up, and are able to sell a great deal of “snake oil medicine” to unquestioning people.

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Posted: 16 June 2014 08:10 PM   [ Ignore ]   [ # 11 ]
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The term “evidence based medicine” really would be more accurately called RCT ( randomized control trial) based medicine. The term was created to distinguish treatments which were based on good scientific evidence as opposed to those which were based on theory and experience alone. The use of clinical RCT’s is a relatively recent phenomena. That’s not to say that medicine was not based on science in the past but many treatments were assumed to be beneficial and sensible because they were based on strong knowledge of anatomy and physiology. Common sense seemed to indicate that the treatments made sense so these treatments were prescribed with a certain level of confidence.

In many cases this worked. If a patient has appendicitis and you don’t remove the appendix there is a high mortality rate. If you remove the appendix nearly all of your patients will survive. An RCT is not necessary. Knowing the anatomy and physiology and observing the outcome was sufficient to determine the treatment was the correct one.

The benefits or side effects of other medical treatments may not be as obvious because they are marginal or take many years to be seen or they occur in only a small percentage of the people who are treated. For this reason it is important to have large RCT’s in order to get objective evidence upon which to decide if the benefits of a treatment outweigh the risks. This is what we mean by evidence based medicine. The medical field is now making great efforts to go back and re-examine many of the treatments we have assumed to be beneficial in order to determine which ones meet this new and better standard.

Use of the placebo effect is a controversial one but one which I believe medical professional should not participate in. Use of the placebo effect requires that a physician mislead or lie to a patient. Doing so undermines the very trust that is critical to a good doctor patient relationship. In addition, supporting the use of unproven or fraudulent treatments condones the use of pseudoscience in a society where science illiteracy is a huge problem. Physicians are members of the scientific community and as such they should never promote ideas and treatments which are based on fake science.

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Posted: 17 June 2014 10:35 AM   [ Ignore ]   [ # 12 ]
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I agree with Macgyver, however, there is also a fair amount of “profit based science” from the pharmaceutical companies, in that their testing of new products tends to have a bias toward being successful.  Two examples come to mind:  An aspirin substitute offered in the 1950s that caused major birth defects, children born without limbs, etc.  And the use of diethyl stilbesterol to inhibit miscarriages - a) it didn’t work, and b) it often caused defects in the internal and external genetalia of the baby, male and female. 

Quoting Mac:

Physicians are members of the scientific community and as such they should never promote ideas and treatments which are based on fake science.

The problem is, just as the citizens get lied to by their governments, physicians often get lied to by big pharma.  Quite often it’s the practicing doctors who catch and report the failures that should have been prevented by more honest testing prior to supplying the physicians with the medications.

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Posted: 17 June 2014 02:59 PM   [ Ignore ]   [ # 13 ]
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I would actually disagree that EBM=randomized clinical trial based medicine. That’s a bit of a myth/misconception that has been around for a long time. It is addressed in some of the earliest characterizations and defenses of EBM, such as THIS ONE by David Sackett, one of the movement’s founders. I also talk about it in many of my lectures to veterinarians on the subject, so for anyone really interested HERE are some links to presentations I’ve given on what EBM is and why it matters to clinicians.

The basic principles of EBM are that clinical practice should be based on a critical assessment of the available scientific evidence to the greatest extent possible, with habit, tradition, personal experience, anecdote, and reasoning from theory all taking a back seat. The scientific evidence is then categorized and ranked in terms of its reliability an predictive value. MacGyver is correct that the RCT, and systematic reviews or meta-analyses of multiple RCTs, is considered the gold standard, but it is NOT the sine qua non of evidence-based medicine. EBM is about making the most rational, science-based decisions possible based on a systematic assessment of the available evidence, even if no RCT-level evidence exists. This is especially true in disciplines for which the evidence base is weak, as in veterinary medicine. And, as he also points out quite correctly, there are plenty of situations in which RCTs are inappropriate, yet EBM is still a useful approach to making clinical decisions. Here’s what Dr. Sackett has to say about the role of RCTs in EBM:

Evidence based medicine is not restricted to randomised trials and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical
questions. To find out about the accuracy of a diagnostic test, we need to find proper cross sectional studies of patients clinically suspected of harbouring the relevant disorder, not a randomised trial. For a question about prognosis, we need proper follow up studies of patients assembled at a uniform, early point in the clinical course of their disease. And sometimes the evidence we need will come from the basic sciences such as genetics or immunology. It is when asking questions about therapy that we should try to avoid the non-experimental approaches, since these routinely lead to false positive conclusions
about efficacy. Because the randomised trial, and especially the systematic review of several randomised trials, is so much more likely to inform us and so much less likely to mislead us, it has become the “gold standard” for judging whether a treatment does more good than harm. However, some questions about therapy do not require randomised trials (successful interventions for otherwise fatal conditions) or cannot wait for the trials to be
conducted. And if no randomised trial has been carried out for our patient’s predicament, we must follow the trail to the next best external evidence and work from there.

The opposite of EBM is probably best characterized as “opinion-based medicine,” in which individual clinicians derive opinions about interventions from the opinions and advice of mentors or opinion leaders and from their own experience, and the use of scientific research to inform these opinions is indirect, haphazard, and inconsistent. EBM provides both better information, by privileging more reliable forms of evidence over less reliable forms, and better information management, by formalizing the synthesis of evidence into systematic reviews, clinical practice guidelines, and other formats that are convenient for clinicians to use but based on more reliable foundations than the advice of key opinion leaders.


As for Dr. Oz, anybody see the shellacking he got from Senator Claire McCaskill today? grin ‘Bout bloody time!

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Posted: 17 June 2014 03:26 PM   [ Ignore ]   [ # 14 ]
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mckenzievmd - 17 June 2014 02:59 PM

As for Dr. Oz, anybody see the shellacking he got from Senator Claire McCaskill today? grin ‘Bout bloody time!

Claire McKlaskill is my new hero!  Bravo senator!  Bravo!

“‘Bout bloody time” indeed!

edit: added yet another exclamation point!

[ Edited: 17 June 2014 05:05 PM by BugRib ]
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Posted: 17 June 2014 05:04 PM   [ Ignore ]   [ # 15 ]
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mckenzievmd - 17 June 2014 02:59 PM

The opposite of EBM is probably best characterized as “opinion-based medicine,” in which individual clinicians derive opinions about interventions from the opinions and advice of mentors or opinion leaders and from their own experience, and the use of scientific research to inform these opinions is indirect, haphazard, and inconsistent. EBM provides both better information, by privileging more reliable forms of evidence over less reliable forms, and better information management, by formalizing the synthesis of evidence into systematic reviews, clinical practice guidelines, and other formats that are convenient for clinicians to use but based on more reliable foundations than the advice of key opinion leaders.

I think one of the biggest dangers in medicine is what I would call “Anecdote-Based Medicine” (ABM).  In fact, that’s basically what the vast majority of all medical practice was for centuries until maybe the late 1800’s.  Most of the things doctors did up until that point did more harm than good.  Yet, these highly-educated doctors would swear by their treatments because of confirmation bias—if the patient got worse it was in spite of the treatment, and if they got better (i.e. survived the harm the doctor was doing to them and then got better because of their body’s own healing ability) it was because of the treatment.  This is part of why homeopathic medicine and other woo became such popular treatments for a time—because they did no harm and thus “worked” better than mainstream medicine.

Sadly, I think there’s still quite a bit of ABM in modern medical practice—particularly in the field of psychiatry.  Every independent study on antidepressants and ECT has failed to find good evidence for their efficacy (but lots of evidence—and proof—of harm), yet these treatments continue to be used at a massive scale since psychiatrists “know they work because I’ve seen patients benefit from them” (classic ABM).

And since I keep harping on much of what psychiatrists do, let me just state for the record:  I am not a Scientologist with an anti-psychiatry agenda (though I do worship Xenu).

(For a good rundown on the lack of evidence for the efficacy of antidepressants from a reputable source, I highly recommend reading The Emperor’s New Drugs by Irving Kirsch.)

edit: capitalized “Scientologist”, grammar

[ Edited: 17 June 2014 05:10 PM by BugRib ]
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