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DBL%20Hendrix%20small.png College chemistry, 1983

Derek Lowe The 2002 Model

Dbl%20new%20portrait%20B%26W.png After 10 years of blogging. . .

Derek Lowe, an Arkansan by birth, got his BA from Hendrix College and his PhD in organic chemistry from Duke before spending time in Germany on a Humboldt Fellowship on his post-doc. He's worked for several major pharmaceutical companies since 1989 on drug discovery projects against schizophrenia, Alzheimer's, diabetes, osteoporosis and other diseases. To contact Derek email him directly: derekb.lowe@gmail.com Twitter: Dereklowe

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In the Pipeline: Don't miss Derek Lowe's excellent commentary on drug discovery and the pharma industry in general at In the Pipeline

In the Pipeline

« Asking the Hard Questions | Main | Scamorama »

January 29, 2013

Dr. Oz's Problem

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Posted by Derek

Red palm oil. Green coffee beans. Raspberry ketone. Some of you are wondering what the heck I'm making for dinner, but some of you will recognize the common characteristic: all of these have been promoted by Dr. Mehmet Oz, the most famous physician in the country.

I'm prompted to write about him by this New Yorker profile, which is excellent reading. It author, Michael Specter, tries his best to figure out why a talented, well-trained cardiac surgeon is sitting down on his own television show with psychic healers, fad-diet pushers, and the likes of Joseph Mercola. (In case you haven't run across him, consider yourself fortunate. His eponymous web site, which I will certainly not link to, is a trackless fever swamp of craziness. If you want to hear about how vaccines are killing you, or how cancer is actually a fungus, or how to heal your ulcers with vinegar and your melanoma with baking soda, well, Mercola is your man).

When Oz says that Mercola is “challenging everything you think you know about traditional medicine and prescription drugs,” it’s hard to argue. “I’m usually earnestly honest and modest about what I think we’ve accomplished,” Oz told me when we discussed his choice of guests. “If I don’t have Mercola on my show, I have thrown away the biggest opportunity that I have been given.”

I had no idea what he meant. How was it Oz’s “biggest opportunity” to introduce a guest who explicitly rejects the tenets of science? “The fact that I am a professor—one of the youngest professors ever—at Columbia, and that I earned my stripes writing hundreds of papers in peer-reviewed journals,” Oz began. “I know the system. I’ve been on those panels. I’m one of those guys who could talk about Mercola and not lose everybody. And so if I don’t talk to him I have abdicated my responsibility, because the currency that I deal in is trust, and it is trust that has been given to me by Oprah and by Columbia University, and by an audience that has watched over six hundred shows.”

Well. . .I'm not sure that that's much of an answer. In fact, if the currency that Dr. Oz deals in is trust, then you'd think that he has a responsibility not to abuse that trust by giving his imprimatur to lunatics. To his credit, the New Yorker's Specter also finds this response lacking, so he tries again. What he doesn't realize is that he's traveling up the river to the heart of darkness:

I was still puzzled. “Either data works or it doesn’t,” I said. “Science is supposed to answer, or at least address, those questions. Surely you don’t think that all information is created equal?”

Oz sighed. “Medicine is a very religious experience,” he said. “I have my religion and you have yours. It becomes difficult for us to agree on what we think works, since so much of it is in the eye of the beholder. Data is rarely clean.” All facts come with a point of view. But his spin on it—that one can simply choose those which make sense, rather than data that happen to be true—was chilling. “You find the arguments that support your data,” he said, “and it’s my fact versus your fact.”

Chilling is right. The man's a nihilist. Here we have a massively famous doctor, the public face of medicine to millions of television viewers, and he apparently believes that well, it's hard to say what works, because everyone has their own facts, you know?

A word with you, Dr. Oz, if I may. I know that you're very busy, and that your TV show takes up a lot of your time, and that whatever time you have left is probably occupied with being famous and everything. This won't take long. I only wanted to remind you that you got to wear your scrubs and your stethoscope by virtue of an excellent medical education. But the people who provided it to you (and the people who provided the knowledge that they were passing on) did not get there by assuming that everyone had their own facts. If we'd stayed with that attitude, we'd still be waving bags of magic chicken bones over the groaning bodies of cancer patients. But then, you'll probably have that on your show next week. Why not?

I say all this as someone who has spent his career digging for facts and searching for insight. I'm a scientist, Dr. Oz, and I actually don't think that medicine, at least my end of it, is such a religious experience, at least, not the way you're defining one. My colleagues and I spend our days in the labs. Our facts had better be the same for everyone who looks at them, every time, and if they're not, well, we go back to work until they are.

We can't just go on TV right after we've dosed a few rats, you know. We'd go to jail. The FDA won't listen to anything we come up with unless it's been done under rigorously defined conditions, unless it's been repeated (over and over), and unless we tell them every detail of how we did it all. We can't come in waving our hands and telling everyone how great we are - we have to spend insane amounts of money, time, and effort to put together enough data to convince a lot of very skeptical people. Thank goodness you're not one of them. You're either the easiest person to convince that I've ever seen, or (more likely), you don't worry much about being convinced of anything. Why should you? It would limit your opportunities. That TV show isn't going to produce itself - if you stuck to people who could actually back up their assertions, what would your guest list look like?

But here's a suggestion: get someone on your show who actually knows where medicines come from, and what it takes to find one. Instead of telling people about magic beans, tell them the truth: discovering anything that will treat a sick patient is hard, expensive work. The reason we don't have a Cure For Cancer isn't because there's a conspiracy; it isn't because the Powers That Be are too stupid and greedy to recognize the wonderful healing powers of the latest miracle berry. It's because cancer is really hard to figure out. That would be a lot more of a public service than what you're becoming, which is this:

Most days, Oz mines what he refers to as his go-to subjects: obesity and cancer. . . Cancer, Oz told me, “is our Angelina Jolie. We could sell that show every day.”

I'm sure you could, Dr. Oz. But what you're really selling is yourself. How much is left?

Update: John LaMattina actually did get the Oz experience, as recounted here. And he certainly knows what drug discovery is like, but it doesn't seem to have had much effect on the show, or on Dr. Oz. . .

Comments (61) + TrackBacks (0) | Category: Snake Oil


COMMENTS

1. zzlangerhans on January 29, 2013 9:08 AM writes...

People like Oz exist because we create the space they fill. If Oz didn't fill it, someone else would. We open these spaces when we abandon skepticism and the scientific method in favor of general empowerment - as Asimov would put it, my ignorance is the equal of your knowledge.

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2. K. Capek on January 29, 2013 9:19 AM writes...

"Get someone on your show who actually knows where medicines come from"...

In fact, that has happened. In a fashion. You may recall John LaMattina, former head of global R&D for Pfizer? Right, the guy who wrote the insiders' perspective on the challenges of drug discovery in pharma. What actually prompted him to write the book? Why, his appearance on Dr. Oz. In his words:

"I was the only one from industry and there were all sorts of attacks. And everybody takes for granted that everything they say is absolutely right. "

It is the promulgation of whatever narrative happens to be a convenient commodity, along with the inability of the public to evaluate the strength of factual evidence that underlies this problem.

I mean, who wants to show up to appear on Dr. Oz's show to discover the segment is entitled "Four secrets drug companies don’t want you to know"? It's not science, that's for sure. Science provides a paltry spectacle.

Another great article from the New Yorker.

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3. Helical_Investor on January 29, 2013 9:23 AM writes...

Recommended reading. Trick or Treatment by Simon Singh*

http://www.amazon.com/Trick-Treatment-Undeniable-Alternative-Medicine/dp/0393337782

Not only does he take a look at alternative therapies, he teaches quite a lot about the hisotry of the clinical trial and modern medical practice. Great read.

Zz

* And Singh's 'Big Bang' is also a wonderful book. His ability to turn the history of astrophysics into what amounts to a page turning drama is impressive.

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4. johnnyboy on January 29, 2013 9:29 AM writes...

I think you've hit the nail on the head, Derek. Oz may be very bright, but he's succombed to a very common ailment, an addiction to fame. He'll do and say anything to justify himself, to keep chasing the dragon.

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5. Curious Wavefunction on January 29, 2013 9:39 AM writes...

"It’s my fact versus your fact."

How is that different from creationism, exactly?

By the way, cue the trolls and hacks. I am getting the popcorn.

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6. Anonymous on January 29, 2013 9:43 AM writes...

Well, here we have the latest version of Western Civilization's ongoing debate with itself: Reductive Empirical Physical Science (embodied by research chemist Dr. Derek Lowe) versus Non-reductive Non-empirical Mental Science (embodied by Dr. Oz and his website).

Unfortunately for Dr. Lowe, the resolution of this debate cannot reside within the realm of scientific evidence and experiment, BY DEFINITION. If it were ever that easy, the likes of Dr. Oz and his website would have vanished long, long ago.

However, there is a resolution, if you can "see" it. Presumably, Dr. Lowe cannot see it yet, as he is focused exclusively on molecules, and although Dr. Oz may glimpse it somewhat (I say this based on his website), he fails to communicate his insight and, as a result, gives the real impression of being a charlatan.

In my time, I have been on both sides of this debate, but these days I have freed myself from it completely and now stand to the side as a (bemused) spectator.

I end with this: both Dr. Lowe and Dr. Oz must know about Plato's famous cave metaphor and its epistemological implications. But do they really "know" that metaphor?

Mr. Dick Turpin

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7. The Aqueous Layer on January 29, 2013 9:45 AM writes...

The rub is that he has the credentials.

You can poo-poo Oprah, Springer and most of those folks, but he's got the medical/scientific background that lends faux credence to what his spouted on his show.

That is what makes his show dangerous.

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8. Jim on January 29, 2013 9:50 AM writes...

My question for Dr. Oz would be whether this point of view arose out of a descent from the very real "art of medicine" into "my facts and your facts" or if he simply just sold out.

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9. Anonymous on January 29, 2013 9:56 AM writes...

For a minute there I had to double-check that I wasn't reading a Pharyngula article.

Not that there's anything wrong it with that...

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10. Hap on January 29, 2013 9:59 AM writes...

You can approach medicine without reductionism but using testable hypotheses, no? If you can't test hypotheses (whether different forms of treatment work), although they have actual quantifiable endpoints (whether people live longer, have fewer illnesses, etc.), then they aren't really helpful, since those endpoints are what everyone (in theory) is trying to achieve.

If you could be figuring out whether what you're doing works, and you aren't, then that's a pretty good answer to whether it actually does work.

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11. Also Anonymous on January 29, 2013 10:00 AM writes...

My question to Columbia University would be "why do you allow your reputation to be damaged by having this person on your staff".

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12. psl on January 29, 2013 10:37 AM writes...

Depressing because he *IS* genuinely a really remarkable surgeon (see his bona fides); his obvious natural empathy and wisdom could be used for good.

Fame and vanity often destroy good people, piece by piece.

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13. David Formerly Known as a Chemist on January 29, 2013 11:01 AM writes...

He's simply selling what people want to buy. Look at his website and the call for future guests:

-Lose your patience too easily?
-Calling all busy moms
-Hate the way your legs look?
-Do you have a strange disorder or addiction?
-Stressed out and can't take it anymore?

Typical daytime TV fare. I doubt the Oprah crowd would be very interested in listening to the facts of how medicines are discovered, why they're so hard to find, and why they all have side effects. Dr. Oz isn't providing a public service, he's providing entertainment. The disclaimer at the bottom of the website says it all (This website is for informational and entertainment purposes only and is not a substitute for medical advice, diagnosis, or treatment).

But the show certainly communicates a lot of bogus information and gives people plenty of false hope. It's been more than once I've had my own mother share the "wisdom" she received from Dr. Oz.

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14. MTK on January 29, 2013 11:16 AM writes...

@13,

Very true.

Unfortunately, there's a fundamental mistrust of science these days. (Maybe that should be Science, not science) I guess that's just a manifestation of the fundamental mistrust in government, media, business, etc. Basically all of our institutions.

That mistrust, along with human nature where we believe what we want to believe, leads to guys like Mercola and their enablers like Oz. They're selling what the masses are buying. Nothing more, nothing less.

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15. Indre Viskontas on January 29, 2013 11:24 AM writes...

Having represented science on the Oprah Winfrey Network, (as a host of the show Miracle Detectives), I experienced first-hand the challenges of bringing a skeptical point of view to emotional events. I received a lot of hatemail etc but I also found that many viewers, while disappointed that their notion of what might have been a miracle was put to the test, were more interested in the truth behind the mystery than being lulled into a false optimism.

Our show wasn't renewed for a second season, maybe in large part because we were simply too good at demonstrating that the miraculous events often (if not always) have a more naturalistic explanation that requires fewer assumptions than originally thought.

Dr. Oz wouldn't be where he is if he didn't have credentials giving him such authority. The sad part is that he seems to have forgotten the main principles that those credentials are designed to impart.

But let's not throw the baby out with the bathwater: the daytime TV audience is smart, curious and empathic. They just don't always have the background or the time or the inclination to critically sift through the information that is thrown at them and, like any one of us, prefer an easy fix to the hard work of changing one's circumstances and facing hard truths. But when the truth is presented with authority and clarity, they will accept it just as quickly as anything else Dr. Oz might suggest.

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16. Hardworking Scientist on January 29, 2013 11:25 AM writes...

I call Poe's Law on Anonmyous @6. Is this an attempt at satire, or earnest nonsense? I just can't tell...

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17. rtw on January 29, 2013 11:43 AM writes...

#12 psl - Although perhaps a remarkable surgeon, that doesn't alway equate to other areas of knowledge. Doctors in general don't know as much about drugs as one might think. In thier course work in medical school they get far less education in drugs, than a typical non PhD pharmacy student. You want to know anything about a drug.. ask a phramacist not a doctor in most cases. A lot of what a physician knows about drugs they prescribe come from the Pharmaceutical detail guys that visit the office to promote their wares. Often biased information but non the less better than nothing, given that doctors seldom have the time to do the research themselves.

I would imagine that most people that do drug discovery have a much better understanding of these things than a large percentage of doctors, particularly in the limited areas in which they do research. I would prefer to talk to my friends that work in antibacterial research for example on the merits of one drug over another against particular strains. The best doctors in my opinion work closely with a pharmacist. In todays fractured medical institution were someone might have specialists for cardiovscular, and perhaps arthritis or a neurological condition. The doctors don't talk to one another each prescribe different drugs many of which may have subtle incompatabilities. There is a danger in that when the GP may not have sufficient information to know that. I always tell my parents and inlaws to check all their prescriptions with their pharmacist.

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18. Jack klugman juror #5 on January 29, 2013 11:49 AM writes...

This is easy...always look at peoples ultimate motive. In the words of Cindy Lauper...."Money, money changes everything". Even the facts for the esteemed Dr. Oz - maybe time to pull back the curtain Toto.

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19. Jeb Bush on January 29, 2013 11:57 AM writes...

Why should Kevin Trudeau have all the fun, eh?

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20. mas on January 29, 2013 12:02 PM writes...

The decay at the bottom of the medical professions started a while ago. Try finding a dentist who will still do amalgams despite the ADA's studies proving to their safety. Why care about truth when there's money to be made?

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21. Vader on January 29, 2013 12:04 PM writes...

I stopped watching broadcast television years ago, and so while I had heard the name, I had no idea what this Dr. Oz was up to.

To me, it borders on malpractice.

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22. Vanzetti on January 29, 2013 1:01 PM writes...

Mr. Dick Turpin @6

Actually, the debate can be resolved within the realm of scientific evidence and experiment, because our various hacks make a lot of _verifiable_ claims. It's just a matter of exposing their lies again and again. Tedious work, but nothing impossible.

Also, troll harder.

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23. Vader on January 29, 2013 1:09 PM writes...

I stopped watching broadcast television years ago, and so while I had heard the name, I had no idea what this Dr. Oz was up to.

To me, it borders on malpractice.

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24. Christophe Verlinde on January 29, 2013 1:10 PM writes...

It all boils down to the gullibility of the masses who consume these types of TV shows. But why are they gullible? Because the educational system for the common person in the USA is abysmal. Only the best schools - not the average schools - teach critical thinking. Hence any pied piper can appear on TV and sell snake oil. The gullible will lap it up as ambrosian nectar.

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25. RKN on January 29, 2013 1:37 PM writes...

As an MD he's certainly not without precedent.

www.quackwatch.org/11Ind/brinkley.html

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26. Sigivald on January 29, 2013 1:43 PM writes...

Green coffee beans are undeniably awesome ... for home roasting, to have really fresh coffee.

(Semi-contra Mr. Verlinde above, I think the problem is not so much that the schools don't teach critical thinking [though they're not very good at it], as that most people are lousy at learning it or doing it in the first place.

Critical thinking is hard work, after all, and the most immediate result of it is losing comfortable illusions...)

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27. Dr. Manhattan on January 29, 2013 1:43 PM writes...

Unfortunately, this kind of non-science based, new age "medicine" is foisted off on the public. Some see it for what it is, some are taken in by it. I wholeheartedly agree with Derek that it is irresponsible for someone of Mehmet Oz's background and training to provide exposure to these ill-founded and downright dangerous ideas when it comes to healthcare. I guess my only request of people who think science-based medicine is inferior to psychic forms would be please, the next time you get a serious infection, avoid using the antibiotics that scientists (who you sow mistrust in) developed. Please also avoid the use of anesthetics, blood pressure medications, diabetes drugs, etc. Use raspberry ketone instead (whatever that is...).

And as for the Bully Pulpit that is daytime television, I commend Derek for taking a principled stand in this blog. Those of us who come here regularly appreciate his insights.

As for@11: My question to Columbia University would be "why do you allow your reputation to be damaged by having this person on your staff"?

The words of Oz ring in my ear: "I am the Great and Powerful OZ...Who are you?"

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28. MoMo on January 29, 2013 1:50 PM writes...

Here we go again!

It's all because of the Oprahfication of America process!
First Dr. Phil emerges from the primordial ooze, now prominent cardiac surgeons are leaning towards Voodoo and spiritual healing!

But we are to blame, fellow scientists! Most of you out there are wussies, afraid to comment on these critical topics- except for the author exposing Oz and In the Pipeline that challenges such craziness.

We must support these guys, because right now we are slipping back to the Dark Ages!

Carl Sagan is spinning in his grave- and with advice from Oz there will be other corpses showing their disapproval by spinning as well!*

*Demetri Martin-Thank You!

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29. emjeff on January 29, 2013 2:00 PM writes...

Oz comes from a long line of Ivy-League charlatans. Remember Andrew Weil? He's still out there, waving his Harvard MD and spouting nonsense. It's all about money - I can not believe, deep down that these guys buy into any of this. What they buy into is the cash and the fame. If Oz played it straight, he'd be cancelled in a week. So he talks about green tea and cancer and takes cash from the bored, ill-educated housewives who sit there and lap it up.
Who's to blame, the marketer, or the market itself? I quote Pogo by way of an answer: "We have met the enemy and he is us..."

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30. TheHealthSatoriProject on January 29, 2013 2:02 PM writes...

While I completely agree that any idea applied in medicine (and really any public industry) needs to be thoroughly researched, it must be conceded that we have a lot of data and very few answers. Medicine rewrites itself every few hundred years and we'd be arrogant to think we finally got it right when we can't even cure acne. Most medical experiments are conducted by treating the body as a state machine, i.e. measuring an output based on a given input, but the problem is we really don't understand the inner mechanisms of our body yet and are only assuming why something happens.

The placebo effect is a great example on how subjective experience does influence the outcome of otherwise objective treatments. Pain, which has roots both in objective and subjective stimuli, is actually very well treated by both objective and subjective treatments. Many studies have been conducted on this matter and the best treatment for pain is a combination of objective and subjective treatment.

While I disagree anyone can have differing facts because facts aren't opinions, there is a lot of evidence that indicates the success of a treatment is heavily influenced by whether or not the patient believes it is going to work. With that in mind treatment becomes part personal experience... Dr. Oz is probably misusing "fact" as many people do because people tend not to believe opinions...

Just to make sure I want everyone reading this to know I abhor Dr. Oz and am not trying to defend him, but most medical "facts" are far from fact. We give advice on diet and health all the time with literally no facts on the matter yet it's the key to the health of the nation. Fact - there is no proof excess caloric consumption is the cause of weight gain. Fact - there is no proof eating fruits and vegetables are required to be healthy.

This could turn into more of a rant, but I'll stop until I find out if anyone cares...

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31. will on January 29, 2013 2:33 PM writes...

if dr. oz ever got sued for mishap during a surgery, i'd like to see him advance his "my fact vs. your fact" in response to why he was not following best medical practices

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32. student on January 29, 2013 3:25 PM writes...

Dr. Oz, like Dr. Drew before him, is a vile contemptible piece of stinking garbage that ought to be thrown into the non-recyclables bin.

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33. RM on January 29, 2013 3:40 PM writes...

Jim@8 - this point of view arose out of a descent from the very real "art of medicine" into "my facts and your facts" or if he simply just sold out

There's a third possibility - there wasn't any "descent" as Dr. Oz never bought in to the scientific method in the first place.

I think we delude ourselves if we assume that because you have a science/medical degree, you "believe in" science. It's certainly not needed to get an MD - memorize the answer to the questions they expect of you and the procedures they expect of you, and you can get a degree, even if you think your teachers are misguided in their way of thinking. You can even do that for a PhD, though the self-directed-research nature of a science PhD might make that slightly less likely.

As rtw@17 mentions, becoming an expert at cardiac surgery doesn't mean you are knowledgeable in other fields. Heck, it doesn't even mean you believe in the processes which lead to the knowledge you employ daily. You could be the best at cutting open chests the way you were taught and still think that other ways of treating the condition are equally valid, for those who would prefer to use those ways.

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34. Curious Wavefunction on January 29, 2013 3:44 PM writes...

@28: "First Dr. Phil emerges from the primordial ooze"

Careful now, no point in insulting primordial ooze.

And as someone above said, it's definitely about the money; to paraphrase Sinclair, "It is difficult to get a man to say something, when his salary depends upon his not saying it."

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35. Anonymous on January 29, 2013 4:08 PM writes...

One thing that hasn't been mentioned is that of all the medical specialties, surgery is one of the least scientific. Placebo controlled clinical trials are remarkably hard to do when your treatment arm is open heart surgery. Orthopedics is similar. Their professions do have some hard clinical outcomes data, but are also large swathes of accumulated folk wisdom that has not been rigorously tested. If you ever doubt me, go to three different orthopedists while complaining about ankle pain. One of my close friends did it, and got an ankle brace from the first one, a recommendation not to wear ankle braces and to exercise it thoroughly to strengthen it from the second, and a recommendation for immediate ligament surgery from the third.

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36. Doug Steinman on January 29, 2013 4:22 PM writes...

I think it comes down to integrity. Dr. Oz obviously has no scruples and he lacks integrity. Furthermore, by giving credence to crackpots and charlatans, he violates the Prime Directive of Medicine which is "Do No Harm." It is clear that he values money and fame more than he values using his education to make a positive difference in this world. I guess that doesn't make him a bad person but it certainly makes him a bad physician.

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37. Lane Simonian on January 29, 2013 4:40 PM writes...

Nothing terrifies the pharmaceutical industry and its backers like the prospects that people like Dr. Oz are sometimes right. The idea that drugs are always more effective at treating diseases than natural products is no more supportable than the idea that natural products are always more effective at treating disease than drugs. Take immunosuppressants: they treat symptoms rather than causes of disease and in the process compromise our immune systems. It makes infinitely more sense to use antioxidants to treat the cause of inflammation. And some of the best antioxidants come from plants as they are what plants developed over millions of years to protect themselves against disease.

There are literally thousands of scientific studies specifying the mechanisms by which the correct natural products delivered in the right amounts in the right places can be used to treat disease. The overwhelming numbers of these studies come from outside of the United States or by foreign nationals working in the United States. In this country only a drug solution will do (even the synthesizing of medicines from natural products had declined in recent years) and thus these studies rather than built upon are ignored and when this is not possibly the people who produce them or disseminate them are demonized.

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38. Hap on January 29, 2013 5:31 PM writes...

Bullets, microbes, and oncogenes don't care about your facts or how certain you are of their correctness - when it's a bullet or a cancer cell against your "facts" and your certainty, your facts are not equal to theirs. Their nature does not change by how convincing your arguments are, while your arguments generally become less convincing after your death has added a datum to the oppposition's arguments.

Perhaps people are looking for certainty? I guess that certainty would seem to correlate negatively with how much you know about something (and thus how valid your arguments are) - a reasonable red flag in science and medicine is when your certainty is disproportionate to the amount and quality of data supporting it. If people want certainty, then how else are they going to get it other than from people too smart to know better or from those immune to conscience?