Who is responsible for bad medical advice on TV?

I am not sure whether you have missed the storm in a teapot caused by an ongoing hearing of a US Senate Committee. The committee is investigating bogus claims by producers of dietary supplements. Dr Oz of The Dr Oz Show was castigated by Senator Claire McCaskill for ‘melding medical advice, news, and entertainment in a way that harms consumers.’ Dr Oz is an interesting character. Like the unfortunate Dr Phil he is also a product of Oprah, that masterful purveyor of everything pseudo-science. He is known to support faith healing, and homeopathy among other goodies. Dr Oz actually is a medical doctor with impeccable specialist credentials. He holds a professorship at Columbia University’s department of surgery. I have no reason to doubt that Dr Oz is anything but a superb cardiovascular surgeon. The problem with him – essentially – is that he uses his medical credentials during his show to peddle quackery. The lay audience that his show targets (courtesy of CTV in our neck of the woods) has every reason to assume that his advice has been vetted as far as the supporting evidence is concerned. That does not appear to be the case. McCaskill confronted Oz during the hearing I mentioned with the following three examples of miracle drugs promoted by him on his show: ‘(Green coffee extract) — “You may think magic is make-believe, but this little bean has scientists saying they found the magic weight-loss for every body type.”(Raspberry ketone) — “I’ve got the number one miracle in a bottle to burn your fat.” (Garcinia cambogia) — “It may be the simple solution you’ve been looking for to bust your body fat for good.” All of these supposed miracle drugs are at best placebos. Oz proceeds to calling his ‘magic’ and ’miracular’ weight-loss placebos during the hearing ‘crutches’. He claims that they help people jump-start their weight-loss programs. There is zero evidence for that claim.Oz also promoted an anti-aging substance for the efficacy of which existed no evidence at the time or today. This kind of stuff made the man a household name and pretty rich. I do think that medical professionals presenting such shows should stick to medical mainstream evidence as opposed to abusing their credentials and the trust they engender among us audience members to peddle nonsense. Ultimately, Dr Oz professional oath obliges him to ‘first do no harm’. Encouraging his audience members to purchase unproven – or worse, known not to work – concoctions is professionally unacceptable, and yes, it does cause harm.

Oprah meanwhile, who discovered and ‘made’ Dr Oz, promoted during two specials of her, at that time, top-ranking talk show a book called The Secret, a bunch of new age self-help nonsense. It sold the reading audience such remarkable insights as this: ‘You cannot ‘catch’ anything unless you think you can, and thinking you can is inviting it to you with your thought.’ So everyone, the flu you picked up, HIV you acquired, it was all a matter of inviting it with your thoughts. Oprah presented on one of her shows a woman who had developed breast cancer, proudly pronouncing that she would eschew all mainstream medicine in favour of thinking good thoughts. I don’t know how that one went for her. Oprah, whenever there was an opportunity to promote quacks on her show, went right for it. She busily promoted notorious actress Jennifer McCarthy’s conspiracy theories about vaccines and autism. On Oprah’s website under the header ‘Inspiration’ she has this to say about McCarthy: ‘ Since her son, Evan, was diagnosed with autism in 2004, Jenny has been an outspoken advocate for parents fighting the same battle.’ McCarthy actually campaigned against childhood vaccination, resulting in untold suffering among children who were not protected by their parents. McCarthy’s theories were known to be false at the time Oprah decided to promote her as much as they are known to be false today. The number of autism cases scientifically linked to vaccines is zero at the time of writing.

David T. Tayloe, a past president of the American Academy of Pediatricians expressed his concerns about the high media profile quacks can receive all too easily these days for their views this way: "I think show business crosses the line when they give contracts to people like Jenny McCarthy. If you give her a bully pulpit, McCarthy is going to make people hesitate to vaccinate their children. She has no medical or scientific credentials. It disturbs us that she's given all these opportunities to make her pitch about vaccines on Oprah or Larry King or U.S. News or whatever. We have to scramble to get equal time—and who wants to see a gray-haired pediatrician talking about a serious topic like childhood vaccines when she's out there blasting the academy and blasting the federal government?"

Now, you’d say, let the buyer beware, and there is some truth in that. But, in the case of Dr Oz there are the necessary medical credentials to assume the man is not selling me snake oil. Sadly he does so frequently. In Oprah’s case we all knew that she had funny ideas about self-empowerment and strong thoughts and whatnot, and we also knew that she was clueless about medicine. At the same time, she managed to pick titles for her book club that outsold Stephen King. People, in very large numbers, listened to Oprah. That’s why what these sorts of people sell to us in matters of health and medicine should be held to higher standards. I wonder what obligations TV companies and cable companies have with regard to the information they transmit, too. After all, having folks like Dr Oz on your line-up and knowing that they frequently transmit health related bogus advice to your lay audience makes you to some extent responsible for bad choices audience members will make based on the advice of your medical doctor.

Udo Schuklenk teaches bioethics at Queen’s, he tweets @schuklenk

Against the use of non-certified health 'remedies' in resource poor countries

My Editorial from the December issues of Developing World Bioethics.

Homeopathy organisations have taken to the skies to help sick people in resource poor countries as well as disaster zones. The thing about homeopathy is, of course, that there is zero evidence that homeopathic concoctions have any effect beyond that of other placebos.[1]Governments such as the UK's have clamped down on the quack therapy degrees that flourished for a good number of years in parts of its university sector. In 2007 a whopping 5 BSc degrees in homeopathy were offered; today there is none.[2]

While one could appreciate these homeopaths' good intentions, it is deeply unsettling that people without proper medical training use donations provided by their supporters to travel to developing countries and essentially apply their unproven concoctions on sick and dying people. During Haiti's recent cholera epidemic, on their own account they provided ‘remedies’ to cholera patients.[3] The term ‘remedy’ is probably carefully chosen by these people who show up in impoverished Haitian communities in medical-doctor-like white coats,[4] clearly giving the impression to the undereducated local populace that they are health care professionals. This masks to the uninitiated observer as well as to the local patients that their remedies are precisely that, concoctions that have no proven medicinal value. They are not medicines. The homeopathic emperor really is naked. I didn't say it first, but it is still true.

David Shaw, writing in the British Medical Journal, reports that ‘training’ programs have been set up that ‘train’ locals in homeopathy. He writes, ‘the creation of homeopathic pharmacies increases the likelihood that Haitians will not obtain effective treatments for future illnesses. Training 38 people as homeopaths simply compounds the unethical effects of Homeopaths Without Borders' presence in Haiti, as does the attempt at legitimisation represented by their attempt to obtain official licences.’[5]

A different example: other activists reportedly traveled from the USA to virulently anti-gay Jamaica to ‘heal’ gay Jamaicans and turn them into heterosexuals.[6] Vulnerable Jamaicans were subjected to treatments that are known not to work. What is by now illegal in many jurisdictions, namely offering and providing treatments for homosexuality, is now exported to resource-poor countries. Damage is predictably done to the psychological well-being of perfectly healthy gay Jamaicans.

It appears to be the case that the developing world has become a playground for the vaguely health-related activities of activists that have been thoroughly discredited in the wealthier and better educated parts of the world. These are shocking developments.

It is an interesting question how one should approach an ethical critique of these sorts of activities, namely of well-heeled Westerners abusing their privileged situation to inflict at best unproven medical concoctions and treatments on vulnerable populations in resource poor countries. If they were professionals (say in the Jamaican case if they were psychologists or psychiatrists, or in the Haitian case medical doctors or nurses) one could report them to their professional regulatory bodies. Unfortunately, these people are not professionals, hence appeals to ethical professionalism or professional bodies fail. Appeals to common sense are also likely to fail, because who other than a fanatic would want to travel to other countries to spread the word about concoctions that they know are not taken seriously by specialist professionals in their home countries?

Ethically, all that's left to say for the Haitian situation is that it is harmful to use such unproven concoctions and therapies on patients seeking help. It is also unacceptable to present oneself as a health care professional when one is not. For actual health care professionals providing homeopathic concoctions, the charge would be that they are acting unprofessionally by not providing standard, proven medical care. Cholera cannot be addressed with unproven homeopathic remedies. People will inevitably get hurt. For the Jamaican case, the harm to perfectly healthy people is again what is at issue. It will be distressing to these people both to undergo whatever ‘therapy’ is visited upon them, and it should be just as distressing to note that they failed, given the prevalent anti-gay sentiments in the country.

Harm is also done to impoverished communities by the fundraising activities of these organisations. Gullible donors will waste valuable financial resources that could go to actual sensible health care or development goals and that will instead be diverted toward the establishment and dissemination of quack therapies and treatments in resource poor environments.

To my mind governments in the West should police these activities in the same manner that they police the activities of sex tourists who travel to resource poor countries to exploit children. Equally, governments in Haiti, Jamaica and elsewhere should not permit their most vulnerable citizens to be abused by representatives of such organizations.

• 1
  K. Smith. Against homeopathy: a utilitarian perspective. Bioethics 2012; 26(8): 398–409.
  

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• 2
  D. Colquhoun. 2012. Complementary medicine course in varsities: how I beat the varsity quacks. The Telegraph January 31.http://www.telegraph.co.uk/science/science-news/9051103/Complementary-medicine-courses-in-universities-how-I-beat-the-varsity-quacks.html [Accessed 6 October 2013].
• 3
  L. Fox. 2013. Continuing Ed and Clinic with the Port-au-Prince Homeopaths Communitaires. http://homeopathswithoutborders-na.org/?p=1343 [Accessed 5 October 2013].
• 4
  If images on their website are anything to go by.
• 5
  D. Shaw. Homeopaths without Borders Practice Exploitation not Humanitarianism. BMJ 2013; 347: f5448.
  

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  U. Schüklenk & R. Smalling, Queer patients and the health care professionals: regular arrangements matter. Journal of medical humanities 2013; 34(2): 96.
  

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HIV dissidents - continuing crackpottery causes untold harm in Africa

I have written before about the unprofessional conduct of a small group of scientists insisting that HIV isn't the cause of AIDS, that AIDS isn't an infectious illness and importantly that medication proven to keep people with AIDS alive actually causes AIDS.

Well, these folks pretty much lost their battle for the professional and public opinion in the developed world, so they shifted their lunatic campaign to the developing world. You can find a pretty detailed analysis of their activities in Southern Africa here. South Africa in particular carries one of the highest HIV disease burdens in the world. I don't want to spend too much time dwelling on the reasons for that, except to say that this is caused by a mix of poverty, education and importantly a government propagating these minority views until very recently. The ANC government as a trusted source of information spent years sending out misleading, confusing and outright false information on HIV/AIDS.

A few days ago I received this message from an outfit in Kwazulu Natal:

The subject heading of the email ... 'HIV not a real problem its [sic!] the sugar'

The spam-type email continues:

'Dear friends,

You believe in HIV because you did not know the real facts.

We make a juice (UMLINGO WAMANGCOLOSI) that lets any one start their life again, strong and healthy.

All you have to do is stop the following food, drinks and stress:

1. SUGAR

2. Chemicals

3. FACTORY FARMED MEAT

4. MILK

5. CHEMICAL MEDICATION

6. PROCESSED FOOD

7. ALCOHOL

8. STRESS

Visit us every monday and thursday between 9 and 16.00pm at the KwaNgcolosi Court House and you will be healthy with in weeks.

KwaNgcolosi is under Hillcrest/Waterfall by the Inanda Dam just 40Km from Durban.'

I wonder how many, mostly Black, South Africans will fall for this nonsense and die a preventable death from AIDS due to this quackery!