Ranit Mishori, MD, is a Professor of Family Medicine at Georgetown University School of Medicine. She is a member of the HealthNewsReview.org team of reviewers.
Earlier this month, Mehmet Oz, MD celebrated his 1,500th “Dr. Oz” show. Oprah Winfrey, Gayle King and Martha Stewart made appearances, proffering congratulations and discussing everything from mercury in fish to the #metoo movement.
I felt less jubilant: In the decade that The Dr. Oz Show has been on the air, it hasn’t been unusual for me to encounter patients who ask about topics, treatments and suggestions mentioned on the program and another popular medical show, “The Doctors.” The advice my patients tell me they’ve heard on these shows often does not square with what I know about the medical evidence.
While I may know that TV shows should be considered entertainment, my patients may not. After all, in our culture, a white coat and a “Dr.” title is a powerful symbol for a trustworthy person of knowledge.
TV shows likes these are, in part, why the American Medical Association recently formalized a set of guidelines titled “Ethical Physician Conduct in the Media,” which recognize our responsibility to use our knowledge and skills “for the benefit of the community as a whole.” It also highlighted the risks when medical advice is not appropriately conveyed or does not reflect the standard of care.
It was that phrase–“standard of care”–that brought me back to a project I worked on in 2013 assessing the accuracy of health claims and recommendations made on “The Dr. Oz Show” and “The Doctors.”
The idea for the project came while I was speaking to colleagues about our experiences with “Dr. Oz phenomenon” — an exasperating situation involving answering a patient’s questions about claims they heard on the show. “Should I eat that berry to lose weight? Will that root extract boost my immunity? Can that supplement really prevent cancer?”
There are times when we know right away the answer is an emphatic no; other times we aren’t so sure. It is always possible we might miss some important new study and need to check the source of the information. With patients who are not simply inquiring, but instead telling us they were doing something based on a Dr. Oz recommendation, it also raises questions for us: Are there any harms that we should warn them about?
For the project, we sought to answer: What are the shows’ sources of information? Are they valid? Reliable? Trustworthy? And do they reflect “the standard of care?”
What we found: The recommendations made on these shows only occasionally follow evidence-based guidelines. Often, we couldn’t find any literature citation (such as a medical study) to confirm the claims made on the show. The costs and harms of the suggested treatments were often overlooked. And, the hosts on the show frequently hawked products made by companies that advertise on the show.
My colleague Dr. Jeffrey Weinfeld, medical librarian Michele Malloy, and I enlisted a group of medical students to tape and view all episodes of “The Doctors” and “The Dr. Oz Show” airing during a full month.
Our students logged all the health recommendations made on the shows, and noted whether harms or costs were discussed, and if a source or reference was given for the health recommendation. Our students also watched and noted the advertisements aired during the show and tracked whether advertisements were related to the show’s content, possibly suggesting a conflict of interest.
We counted more than 300 health recommendations, and we randomly selected a subset of them for further analysis. Our analysis included categorizing each statement into one of several “levels of evidence” based on a standard evidence-based medicine best practice resource (the Oxford Centre for EBM), and searching the medical literature to find the source of the information.
We further classified each source we found for the on-air recommendation into the following categories: 1) significantly supports claim, 2) supports claim but with limited statistical strength, 3) supports claim with extrapolation (i.e. animal study, in vitro, very small sample size), 4) unclear, 5) no source identified matching claim.
While it was common for the shows to make medical recommendations, these recommendations typically didn’t include discussions of the risks or costs of treatment:
Nor did the recommendations typically follow evidence-backed guidelines:
More than half of all recorded shows had content linked directly to advertisements:
The literature supporting the recommendations was weak, and sometimes non-existent:
We started the project having serious questions about the quality, validity and accuracy of the advice given during daytime health talk shows, and at the end, we weren’t reassured.
Our results lent further support to the general feeling among many scientists and clinicians of the shows’ sub-par level of evidence and low quality of information.
Many of the studies we identified as potentially providing support for the claims made on the shows were problematic–with only a few people enrolled, or they were animal-based, or “test tube” studies. If these sources we found are indeed the sources of information used for the shows, then it appears the show researchers frequently relied on preliminary findings–in lab animals, tissue samples, or very small human trials–and then applied them to everyone.
This practice is at best misleading to the general viewer, and potentially harmful to viewers and patients with serious or chronic illnesses.
Finding a match or a source in the literature for a recommendation made on the show – even when the searching was conducted by highly skilled individuals with years of experience combing the medical literature – proved to be extremely time-consuming. It would be especially challenging for a lay person to find sources: Our searches were conducted with access to subscription databases and journals not always available outside of academic settings.
Given their huge popularity, these shows aren’t likely to go away. Instead of presenting dubious claims, they have an opportunity to be leaders in health promotion and education. The AMA guidelines mentioned earlier provide important starting points to bridge that gap.
At a minimum, my colleagues and I believe that these TV shows must:
Transparency must take priority, allowing viewers and healthcare providers to find the information sources used to back their claims. This can easily be addressed by providing the citations or links on the shows’ websites, after or during the rolling of the credits, or by putting them at the bottom of the screen. At the moment, it doesn’t appear that anything like this exists–an “important message” from Dr. Oz is all we could find about the claims made on the site. We could find no sources or disclaimers on the The Doctors web site.
We also think the shows could raise their ethical standing by acknowledging when a product or brand being discussed on the show is linked to an advertiser. As the very least, there could be disclosure at the bottom of the screen in the final credits, or on the shows’ websites, that explains the connections.
Show staff should develop or adopt internal review criteria that are responsible and viewer-centered, perhaps adapting already existing standards of quality health reporting such as those suggested by HealthNewsReview.org.
At the same time, we continue to encourage our patients, the viewers of these shows, to embrace skepticism and to recognize that TV entertainment is not, and should not be, a source for high-quality medical advice.
As one Twitter commenter recently noted on a Dr. Oz tweet promoting a segment about detoxing with tea: “One good way to start a detox is to stop listening to Dr. Oz.”