A couple of weeks ago, both Steve Novella and I criticized Dr. Mehmet Oz (a.k.a. “America’s doctor”) for not only hosting a man I consider to be a major supporter of quackery, but going far beyond that to defend and promote him. After that, I considered Dr. Oz to be a lost cause, with nothing to excuse him for his having embraced a man whose website is a wretched hive of scum and quackery almost as wretched as NaturalNews.com (in my opinion, of course). Unfortunately, apparently Dr. Oz’s defense of Dr. Mercola was only the beginning of the end of whatever minimal credibility Dr. Oz had left as a practitioner of evidence-based medicine.

This week, Dr. Oz put the final nails in the coffin of his credibility as a practitioner of science-based medicine. I realize that some would argue that he did that long ago. Fair enough. However, I always held out some hope that he might stop mixing pseudoscience like reiki with science. Then he embraced Dr. Joseph Mercola. Strike one! Unfortunately, strikes two and three followed over the last week or so.

Dr. Oz embraces the “bait and switch” of alternative medicine.

One message that we’ve been trying to get SBM readers to understand is that much of what falls under the rubric of “alternative” medicine, “complementary and alternative medicine” (CAM), and “integrative medicine” (IM) is in reality a fairly obvious “bait and switch,” as Steve Novella put it so well. The bait consists of various modalities that naturally fall into the bailiwick of science-based medicine (SBM)–or at least should. These modalities include diet, exercise, relaxation. Indeed, it irritates me to no end when various apologists and advocates for CAM claim that science-based physicians don’t recognize the importance of diet and exercise or how they can have a profound effect on health, in particular on diseases like type II diabetes. I ranted about this not long ago when i wrote about the woo of raw “living food” diets, in which “living food” advocates claim that it requires extreme raw vegan diets to “cure” diabetes. Diet and exercise are every bit a part of science-based medicine; yet CAMsters appropriate them as being somehow “alternative,” the better to bring in the real woo along with them. The pitch is, in essence, that diet and exercise clearly work and are “alternative.” Therefore there must be something to other forms of “alternative” medicine. That’s the “switch” in the bait and switch. Nowhere is this switch better demonstrated than in a segment from The Dr. Oz Show last week called Dr. Oz’s Holistic Health Overhaul.

At the beginning of part 1 of this segment, Dr. Oz appears on stage and announces his “holistic health overhaul.” What strikes me is that what Dr. Oz is supposedly “overhauling” is based on people who feel run down, who lack energy, who feel older than they are, symptoms virtually all of us feel at one time or another to one degree or another. (How is one supposed to know if one feels his or her age, anyway?) Right from the start, Dr. Oz promises that he can make you feel younger and better, all within 28 days. To do this, he immediately introduces a yoga instructor named Yogi Cameron Alborzian, who pontificates about spirituality, yoga, and how he became a yogi. As is typical for such practitioners, there are many softly lit and fuzzy shots of Yogi Cameron doing yoga poses in beautiful, natural surroundings (of course!) interspersed with shots of him talking about “mind-body” connections and how he asks his clients what they’re feeling.

In part 2, Patricia from New Jersey is introduced. Patricia is a stay-at-home mother of four boys, who describes herself as feeling “toxic, tired, and stressed-out.” Patricia’s biggest problem, according to her, is that she’s a self-admitted “junk food junkie” who doesn’t exercise. She also complains of sluggishness, feeling “hung over,” and wiped out. In response to her complaints, Yogi Cameron and Dr. Oz show Patricia her health risks, pointing out that her body mass index qualifies her as obese and that her waist size suggests that most of her fat is in her abdomen, which is known to be a risk factor for type II diabetes and a variety of other health problems. Basically, the problem is laid out. It’s (mostly) science-based. Unfortunately, the solution is a mixture of woo and science-based diet and lifestyle changes. That’s the bait. Enter Dr. Oz and Yogi Cameron and his “holistic health overhaul” in part 3 and part 4. Here’s where the switch comes in.

First, let me show why the woo that flows is not a surprise at all by referring you to Yogi Cameron’s own website and a promotional video for a book he’s written:

We learn that Yogi Cameron was a fashion model for several years and even was cast in what looks like the video for Madonna’s song Express Yourself. (He’s the buff, sweaty, half-naked worker seduced by Madonna near the end of the video.) Also on his website, Yogi Cameron opines about Ayruvedic medicine, referring to it as the “science of life”:

Before Western medicine, before homeopathic medicine, and before even traditional Chinese medicine, there was Ayurveda. This is an ancient system of healing created by sages in India over five thousand years ago. While yoga was developed as a science for the practitioner to bring balance and control to the mind, Ayurveda is a sister science developed for the practitioner to bring balance to the body.

Western medicine tends to treat a patient’s symptoms with different pills and medications without any attention to healing the cause of a disease that is feeding the symptom. It is like weeding a garden without taking out the roots; the weeds just grow back. Ayurveda works to define the cause of the patient’s symptoms and to treat the body with various methods for the sake of restoring balance to the system as a whole. These methods include eating in a way appropriate to one’s constitution, taking herbal supplements and remedies, and receiving treatments such as oil massage. Effective use of Ayurveda can help to alleviate digestive problems, allergies, insomnia, asthma, obesity, migraines, and many other bodily complaints.

The ancient sages who developed Ayurveda many centuries ago observed that our bodies are formed by three fundamental energy types or doshas. The first (Pitta) is responsible for metabolizing for the sake of processing oxygen and perpetuating life. The second (Kapha) forms our bodies, which serves as a container so that life can exist as matter. The third (Vata) shifts matter’s position in space through the act of motion.

And this is how Yogi Cameron treats his clients’ problems:

Through other Ayurvedic treatments such as Pancha Karma we also clean the inside of the body. Cleaning the inside of our system is fundamental to our wellbeing and without such cleanings we can never experience complete health and vitality, youth and vigor. When the inside of the body is clean we experience young skin and vibrate energy on the outside.

For those of you who don’t know what Pancha Karma is, it the name for five actions that make up an Ayruvedic method to purify the body. There are three stages of treatment. First, there is the pretreatment, which consists of oil therapy, massage, and something called formentation therapy. This part actually doesn’t sound too bad. Whether it cures anything or not, who knows? However, having your body oiled up and massage can’t be all bad. The formentation therapy is basically heat, either steam from herbs, sitting under the sun, or using warm blankets. Of course, this latter treatment, depending on what it is used for, is a perfectly fine science-based treatment. Be that as it may it’s the next part of the Pancha Karma that is supposed to do the purification. This consists of Nasya (nasal therapy), Vamana (emesis or vomiting), Virechana (purging) and two kinds of Vasti (therapeutic enema), Nirooha Vasti and Sneha Vasti.

Enemas? What is it with enemas? Truly, enemas seem to be the woo that knows no national or ethnic boundaries, the quackery that is truly world-wide. Fortunately, there does appear to be an alteration to this ancient art of purging in America:

Originally, this phase consisted of five practices: nasal cleansing, enemas, laxatives, emesis (vomiting), and blood-letting. Although the five practices are followed in India, the practice of emesis and blood-letting is omitted in North America.

I suppose we should be grateful for small favors in that the bloodletting is left out by our very North American woo-meisters. Dr. Oz then reveals the “switch,” describing week 1 of this plan as “detox.” For his part, Yogi Cameron helpfully chimes in that his methods “burn off toxins.” Dr. Oz then immediately asks Yogi Cameron about tongue examination. Now, there’s one thing you need to know about tongue examination. When an Ayruvedic practitioner or a practitioner of traditional Chinese medicine talks about tongue examination, he is not referring to the sorts of things I learned in medical school about tongue examinations, where we look for turgor, moistness, plaques, and a variety of other physical findings that can be indicative of disease. No, the Ayruvedic art of tongue diagnosis is very much like reflexology in that various organs are claimed to map to various parts of the tongue:

To be fair, some of the tongue diagnoses actually do agree with science-based medicine, for example, a yellow tongue being indicative of jaundice. However, someone with jaundice will also usually have yellow visibile in their sclerae, which are probably more sensitive. In reality, the Ayruvedic tongue diagnoses that match science-based medicine diagnoses are actually a classic case of being right for all the wrong reasons, and most of them are wrong, wrong, wrong, particularly the mapping of various organs to different parts of the tongue. Not that that stops Yogi Cameron from proclaiming that the “head is represented by the tip of the tongue.”

I will admit that there is one mildly amusing part of this entire segment. Yogi Cameron has a rather strong disagreement about the amount of sex people should have. Yogi thinks that people shouldn’t have sex too much; Dr. Oz is apparently a randy little bugger and thinks people should have sex all the time, the thought of which is an image I don’t want in my head. Be that as it may, one thing that strikes me about this argument is that it appears to be vitalistic in nature. Yogi Cameron claims you shouldn’t have too much sex because it’s about “conserving energy,” in essence implying that sex somehow saps your life energy. This is not unlike various pre-scientific beliefs that semen is the equivalent of life energy, which is why men shouldn’t have sex before battle, athletic contests, or anything that’s likely to require a large energy expenditure.

At this point, the “bait and switch” is complete. Dr. Oz had presented the story of a typical middle class mother who works hard, doesn’t eat right, is a bit obese, and as a consequence of her lack of exercise, her work, and her poor diet feels run down all the time. A perfectly fine science-based solution to her problems would involve a change in diet to something healthier, cutting out the junk food, and adding regular exercise (all things that I myself have a lot of problem managing to do, truth be told). Instead, what Dr. Oz and his guest Yogi Cameron present is an improved diet, plus yoga, plus woo that includes tongue diagnosis, “detox,” and “Nasya lite” (given that all Yogi Cameron had Patricia do was to place some Ghee in her nose, rather than shooting water in and out of it). At least he spared her the purging and enemas, but I bet if Patricia had come to Yogi Cameron’s center those would have been part of the mix. But there’s enough there, even the classic favorite of apologists for Ayruveda and traditional Chinese medicine, the appeal to ancient wisdom, the claim that, if people have been doing this for thousands of years, there must be something to it, they must know something we don’t.

Strike two!

To mix baseball and Star Wars metaphors (hmmm, light sabers instead of bats?), Dr. Oz has two strikes against him now, but is his journey to the Dark Side complete? He’s certainly controlled his message, but has he fully released his woo? Unfortunately, Tuesday’s episode this weeks demonstrates that Dr. Oz has truly become the master of woo.

Dr. Oz: Falling for faith healing

To abuse my Star Wars metaphors yet again, if Dr. Oz’s featuring of Yogi Cameron on an episode of his show last week was the equivalent of Anakin Skywalker slaughtering a tribe of Tusken raiders for having tortured and killed his mother Shmi, Tuesday’s episode was Anakin cum Darth Vader hitting the Jedi temple with a bunch of storm troopers and slaughtering all the younglings. Either that, or it was Anakin cutting off Mace Windu’s hand, allowing Emperor Palpatine the opening he needed to kill Windu. Take your pick. In other words, Dr. Oz’s credulous treatment of faith healing definitively marks the point of no return, the point at which Dr. Oz’s journey to the Dark Side is now complete. All he needs is a Darth Vader mask. Or maybe a mask of Samuel Hahnemann. Or something.

The reason Tuesday’s episode definitively marks a point of no return for Dr. Oz when it comes to his support for quackery is because he has apparently decided to follow his TV mentor Oprah Winfrey’s example in realizing that faith healing sells. Of course, Dr. Oz, as popular as he is, is not as well established as Oprah. Whereas Oprah got John of God, complete with his “psychic surgery,” Dr. Oz gets a second tier faith healer. He gets Dr. Issam Nemeh. Of course, Dr. Oz is a surgeon; so maybe he is less easily taken in by parlor tricks in which tiny superficial incisions are made. Or maybe not. Just being a physician does not guarantee not being taken in by faith healing nonsense, as we’ve seen many times. In any case, Dr. Nemeh must be very grateful to Dr. Oz, because when you look at his website, you’ll be greeted with a message:

Welcome Dr. Oz Viewers!

Dr. Nemeh has received an overwhelming response from the viewers of the Dr. Oz show. Medical office appointments with Dr. Nemeh are already filled for the next four months.

To add your name to the cancelation list, send an email with your name, phone number, and reason for treatment to appointments@drnemeh.com.

But how did Dr. Nemeh get so popular suddenly? Behold the power of Dr. Oz and his segment on Tuesday’s show entitled, Is this man a faith healer?

If you recall my discussion of Oprah Winfrey’s utterly credulous treatment of John of God, you might wonder if Dr. Oz did any better than Oprah’s staff and Oprah herself. Going in, I actually expected that Dr. Oz’s segment about Dr. Nemeh would be harder for me to deconstruct. Indeed, I expected it to be much harder to deconstruct. Dr. Oz is, after all, a cardiothoracic surgeon. Also, in the preview for the episode featuring Dr. Nemeh, there was a clip showing Dr. Oz with small pile of charts saying that he had asked to be allowed to examine the medical records of some of Dr. Nemeh’s patients. Given that and given that Dr. Nemeh is a physician himself, I figured that, between the two of them, Drs. Oz and Nemeh would be able to cherry pick cases that would appear truly convincing and thus be very difficult to refute. When that happened, I feared I’d be reduced to saying that single anecdotes are not convincing, which, while true, is a relatively hard sell to lay readers without medical training. Even some physicians remain unsatisfied by such an explanation, and it’s not hard to figure out why. Fortunately for me (and unfortunately for Drs. Nemeh and Oz), I needn’t have worried. You’ll see what I mean in a minute.

The first segment begins, as usual, with Dr. Oz introducing the topic. In this case, Dr. Oz breathlessly proclaims this to be a show “unlike any other we have done before” and describes how he has been “fascinated” by “this doctor in Cleveland.” We’re then shown several people in the audience who claim to have been healed by Dr. Nemeh, who is described as a doctor who doesn’t use drugs or procedures but “heals with his hands.” Dr. Nemeh, we’re told, uses a “high tech form of acupuncture” in his office and the laying on of hands and the use of spirit in churches and meeting halls, all to “heal.” During this voiceover, we’re treated to images of Dr. Nemeh in action, including a paralyzed patient who claims that he’s noticed some movement in his feet since Dr. Nemeh started treating him, a woman who implied that she had her vision restored, and a woman who claims that her multiple sclerosis is gone. Dr. Oz’s chief medical correspondent, Dr. Michael Roizen, tells us that he definitely believes “there’s something here,” and Dr. Nemeh himself proclaims that his goal is to “bridge the gap between science and spirituality.” Certainly, there is a receptive audience among Dr. Oz’s studio audience, as Dr. Oz cites a poll of his audience, which reveals that 86% of them believe in the power of faith to heal.

It’s in this segment when Dr. Oz shows Dr. Nemeh’s stack of medical records. Quite frankly, to me it looks like a pretty darned small stack. Be that as it may, Dr. Oz tells the audience that he’s had his medical staff investigate the cases and that he personally has discussed them with Dr. Roizen. That’s when the interview with Dr. Nemeh begins. Dr. Nemeh, it turns out, is a trained anesthesiologist who in addition to his faith healing activities sees patients at his office in Rocky River (a suburb of Cleveland). As the interview progressed, it became clear that Dr. Nemeh used a lot of different “alternative medicine” modalities in addition to his “electroacupuncture” (which is, of course, not really acupuncture at all, but transcutaneous electrical nerve stimulation, or TENS) and prayer services. Dr. Nemeh, of course, is also represented not just as the Brave Maverick Doctor but as the reviled Brave Maverick Doctor, with even his family disapproving of what he is doing. I can sympathize–with Dr. Nemeh’s family. If one of my siblings were a faith healer, I’d be pretty disapproving and embarrassed too.

In the next part of the segment, Dr. Oz tells the audience to judge for themselves whether Dr. Nemeh is a faith healer on the basis of the patients of Dr. Nemeh’s whose story he will tell. Of course, as an academic surgeon (which Dr. Oz was for a long time before turning to woo and, given that he is still a professor of surgery at Columbia University, technically still is even though he long ago abandoned science in favor of nonsense), Dr. Oz should know that single anecdotes say at best little or nothing and at worst mislead. The plural of “anecdote,” as we say, is not “data.” Yet anecdotes are what he provides–and then only two of them. No science. No statistics. No real detailed case reports. Not even a mention of scientific studies to be presented along with the human interest anecdotes, other than late in the segment, when he mentions the infamous intercessory prayer study that failed to find that prayer works in helping cardiac patients heal after their surgery. All we see are testimonials and utterly unconvincing cherry picked clinical test results.

First up is a woman named Cathy. Cathy is presented as having a mass in her left lung and states that she was “so sick” that she was coughing up blood. A CT scan is presented, which does show a worrisome mass in the lower lobe of the left lung. We are not informed whether Cathy is a smoker, which would have made me even more worried if I were Cathy’s physician. In any case, Cathy describes a two hour visit with Dr. Nemeh, who, she reports, used acupuncture, “infra-ray light” (whatever that is; probably she meant “infrared” light), and prayer to treat her, after which her breathing got much better. Later, a PET scan was ordered, and–miracle of miracles!–the mass was gone. The problem with this anecdote, as regular readers of this blog can probably spot right away, is that there was no tissue diagnosis. In the story, it is implied that the mass was some sort of horrible lung tumor. Yet her doctor violated the cardinal rule of oncology: He never got a tissue diagnosis; it’s unclear if he even tried.

Whatever Cathy’s pulmonologist did or didn’t do, that mass could have had any number of nonmalignant explanations, including tuberculosis, sarcoidosis, focal pneumonia, or fungal infection, to name a few. Whatever it was, if the Cathy’s physician thought it was cancer, he should have gotten a core needle biopsy. Indeed, reading between the lines, I wonder if Cathy’s doctor really thought the mass was cancer. The fact that he ordered a PET scan implied that he thought it might be (although infection can light up on PET as well), but his failure to obtain a biopsy expeditiously implies that he either wasn’t very sure or that he doubted that the mass was cancer.

All in all, it’s a somewhat confusing case, but there is no evidence whatsoever other than the post hoc ergo propter hoc fallacy that, just because Cathy got better after seeing Dr. Nemeh, it must have been Dr. Nemeh’s woo that cured her. To be fair, Dr. Oz points out the possibility that the mass might have been infectious in nature, but in reality to me he didn’t sound as though he really believed that. In fact, he came across more as playing Devil’s advocate than anything else. Unfortunately, Cathy’s doctor (Dr. Kelly) was not particularly skeptical and served up a custom-made quote that Dr. Oz read on the air, completing the picture of faith healing having cured Cathy.

Next up is a woman named Dr. Patricia Kane, who is introduced as having been diagnosed with idiopathic pulmonary fibrosis (IPF) in 1995, when she was told that she probably had less than five years to live. IPF is a disease in which the lungs develop scar tissue for reasons we don’t understand (hence the label of “idiopathic”), gradually decreasing air exchange. In Dr. Kane’s case, we are informed that she underwent a biopsy that confirmed the diagnosis. We are not really informed whether Dr. Kane has gotten better, but, as you might expect, idiopathic pulmonary fibrosis is a disease with a highly variable rate of progression that can range from a very rapid scarring of the lung with concomitant loss of lung function to slow progression that takes many years or even to long periods of time (years) with no detectable progression. Overall, the five year survival is reported to be between 30% and 50%, with this caveat:

Keep in mind that researchers have noted a considerable variation in these life expectancies based on the factors that were mentioned previously.

We are not told whether Dr. Kane had any of the factors associated with a less malignant course for IPF. I’m left to conclude that she is almost certainly a woman who is fortunate enough to be an “outlier” on the survival curve. Like all such patients who are lucky enough to be outliers and who chose “alternative” medicine, Dr. Kane underwent conventional therapy and Dr. Nemeh’s quackery, after which she did better than predicted and–of course!–attributed her much better than expected outcome to the faith healing. Again, Dr. Oz plays the “skeptic” a little bit (but only a very little bit) by challenging Dr. Kane gently with the possibility that the diagnosis was mistaken, which, while most definitely a possibility, was not the only possibility. More likely is the possibility that, as I mentioned before, Dr. Kane is fortunate enough to be an outlier.

Dr. Oz finishes this segment by interviewing Dr. Jeffrey Redinger. Remember him? He’s the same physician who was taken in by John of God, and he lays down the same sort of barrage of credulous nonsense that he did when he commented on John of God for Oprah Winfrey:

What I think at this point is that we are just not physical beings, we are also spiritual beings, physical beings need oxygen and spiritual beings need love. One research questioned I believe is whether there is a connection between love and healing? That is something that modern science is begining to tiptoe into.

Finally, in the next segment (which, unfortunately, does not appear to be on Dr. Oz’s website), we’re treated to what has to be one of the most pathetic faith healings I’ve ever seen. A woman named Mary Beth is brought up on stage. After she states that she has lower back problems that she attributes to arthritis, Dr. Nemeh does his thing. The best Mary Beth could come up with was that she felt “a little” better afterward. I don’t know about those of you who saw this episode, but I was so not impressed by this “healing” at all. Indeed, I was left scratching my head and thinking, “This is the best Dr. Nemeh could come up with?” You know that if Dr. Nemeh could come up with better cases, he would have brought them with him to Dr. Oz’s studio. For instance, where’s the paralyzed patient who said he was getting some motion back? Why wasn’t his case featured? What about the woman who claims her MS is gone? Why wasn’t she featured? It makes me wonder if the evidence for these patients’ claims is even weaker than the evidence for the “healing” of Dr. Kane or Cathy. Not that any of this stops Dr. Nemeh from proclaiming:

You don’t have to be religious, you don’t have to have faith, you can be an Atheist, what matters is we were talking before about one very important principle, the love that we have. Because the heart of God himself is Love. No you don’t have to have any faith to be healed.

Imagine how relieved I am to hear this. Strike three! Or dip Dr. Oz in a lake of lava and slap a black metal respirator suit on him, whichever metaphor you prefer. Dr. Oz is done.

I often wonder how a man as obviously intelligent and well-trained as a surgeon as Dr. Oz can fall for such utter tripe. In his case, I suspect that it’s become more about the fame, the money, and the image that has developed as “America’s doctor.” Whatever the reason, Dr. Oz’s journey to the Dark Side is complete. When Dr. Oz left Oprah, he was but the learner. Now he is the master. The master of woo. Yes, yes, I know the analogy is flawed in that it inappropriately likens Oprah to being one of the good guys (i.e., Obi-Wan Kenobi), but I just love that line.

Unfortunately, it’s not just Dr. Oz, though, who suffers from a profound lack of skepticism and critical thinking when it comes to medicine. It’s all too many physicians. After all, Cathy’s doctor apparently believed that she had been the beneficiary of some sort of miraculous healing solely on the basis of the thinnest of thin evidence. And he is a pulmonologist! This should serve as a reminder to us physicians that, unless we apply skepticism, science, and critical thinking to our practices, we are just as prone as anyone else to confusing correlation with causation, the post hoc ergo propter hoc fallacy, and, above all, an over-reliance on our own personal experience and anecdotes. Indeed, from my perspective, it is the over-reliance on personal experience and anecdotes that is most prone to leading physicians astray, and physicians have to learn how not to confuse “my clinical experience” with science. Instead of educating about this pitfall, Dr. Oz, sadly, has apparently tried to capitalize on it to promote faith healing and other forms of quackery. In my opinion of course.

Also in my opinion, I’ll try to find different metaphors next time.