Questioning Dr. Oz

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Dr. Mehmet Oz is known as "America's Doctor," and it's not much of a stretch.

Though he is a medical specialist -- an acclaimed cardiac surgeon -- Oz offers health information on just about any topic, from diet to child care to sex, through a television show that averages 3.7 million viewers a day, six best-selling health guides, columns in Esquire and Time, and a Web site.Millions turn to him for advice, looking for an authority figure to make sense of the flood of medical information available online and in the media.

Much of the material Oz provides is solid, but some medical experts express reservations about his approach, saying Oz's ventures also offer advice unsupported by science.

Oz has called the rotavirus vaccine "optional" -- a risky view, according to experts. He tells people to examine the shape and sound of their bowel movements closely -- a silly idea, specialists say. He invited a doctor to his TV show who has helped spread the idea that cancer can be cured with baking soda. On his Web site, another doctor endorses a group that promotes unproven autism treatments.

Oz declined to be interviewed, but his spokespeople say the doctor's mission is to give his audience information from multiple perspectives. His "Ask Dr. Oz" feature offers answers not only from prestigious medical centers such as the Cleveland Clinic but also from alternative medicine practitioner Deepak Chopra and from Dove, maker of skin care and beauty products.

"The purpose of the site is to provide users with as much information as possible and allow the users to differentiate between what they find helpful and what they do not," Oz's spokespeople wrote in response to questions.

But more information is not necessarily better, as not all perspectives are equal in medicine.

"We have this population that is thirsty for a little sip of a drink ... and we are gushing them every day with this powerful fire hose," said Gary Schwitzer, a University of Minnesota professor and publisher of HealthNewsReview.org, which rates medical news reports. "It is ineffective and it can be dangerous."

Science is not a democracy where people's votes decide what is right, said infectious disease specialist Dr. Paul Offit, director of the Vaccine Education Center at The Children's Hospital of Philadelphia. "Look at the data, look at science and make a decision based on science that has been published," he said.

In a guide called "YOU: Having a Baby," Oz and his co-author express concern about whether rotavirus vaccines cause a rare intestinal complication called intussusception. The book suggests "you opt out of this one until more data are available -- unless your child is in day care or other high-risk circumstances."

But the question of whether the rotavirus vaccines cause intussusception has been settled, according to the American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the World Health Organization, which all recommend the vaccines. Data from millions of doses in the U.S. have not shown a link.

Rotavirus infections, which cause vomiting and severe diarrhea and can be fatal, hospitalized tens of thousands of children annually in the U.S. before vaccines were available, according to the CDC.

Oz's book also uses the term "reasonable" to describe an alternative vaccination schedule favored by parents worried about giving their children too many vaccines too soon.

"It shows you that he is a cardiologist and not an immunologist," said Offit, co-inventor of the RotaTeq rotavirus vaccine. The immune challenges presented by vaccines are trivial compared with those faced by babies every day, he said. "It is a drop in the ocean," he said. "If our species were overwhelmed by vaccines, we would be in trouble."

Oz's baby guide recommends books by Offit about vaccines and autism. But it also recommends "Saying No To Vaccines," by an activist who compares immunizations to playing with a loaded gun.

Oz's representatives said the book's vaccine advice is "based on lengthy, in-depth and well-understood knowledge of epidemiology and the immune system as well as consultation with a pedigree of experts."

The doctor's aim was to provide a platform for many points of view on vaccines. "None are favored over another," they wrote.

That inclusive spirit also explains why Oz's Web site, doctoroz.com, includes an entry on autism written by Dr. Jacob Teitelbaum, author of "Beat Sugar Addiction Now!"

Teitelbaum, who does not treat autism, advises parents to ignore doctors who warn against natural therapies for the disorder. He labels as "excellent" the group Defeat Autism Now!, which has promoted risky and unproven treatments explored in a Tribune investigation last year. And he singles out an acupressure therapy for autism that, he says elsewhere on Oz's site, "uses muscle testing to see if you go weak when holding an allergen."

In an interview Teitelbaum said he has asked the Oz site to delete his reference to Defeat Autism Now!

Oz's representatives said of the entry: " 'The Doctor Oz Show' Web site answers the questions of health with multiple points of view and creates a collective IQ centralized in one place for people to learn and act."

Popular entries rise in rank on the page, they said, while less popular ones fall. As of Thursday, Teitelbaum's entry was listed second in the Web site's section on autism.

There is also room for Dr. Joseph Mercola, who was a guest on "The Dr. Oz Show" and is labeled on Oz's site as "a highly esteemed pioneer" in alternative medicine. Mercola, who is based in Hoffman Estates, spoke on the show about krill oil. Mercola sells the oil on his Web site as "support" for joint comfort, liver function, heart health and a dozen other things, though he did not promote his product on the show.

Oz's site does not mention that the FDA twice sent Mercola warning letters about claims he made about other products. A Mercola spokesman said he has removed claims not supported by clinical research. Mercola also has written on his Web site about the unorthodox idea that cancer is a fungus treatable with baking soda.

"For it to be a fair discussion, we must include a multitude of voices and opinions, even those that may be controversial," Oz's spokespeople wrote.

The idea is to have "a conversation with America about health and wellness, in a way that we have never done on TV before," said Susan Wagner, senior medical producer of the syndicated "Dr. Oz Show."

In December an episode focused on chronic fatigue syndrome, a mysterious ailment scientists know little about. The journal Science had recently published a study reporting on evidence of a retrovirus called XMRV in about two-thirds of patients diagnosed with the syndrome.

The show started with a dramatic introduction -- "Today on the Dr. Oz show: Could the secret to your exhaustion be a retrovirus?" -- and featured a discussion between Oz and Dr. Donnica Moore, a women's health specialist.

"For the first time, we can say with confidence: We know this is not all in your head, we know this is not depression, and we know you don't have a midlife energy crisis," Moore said. "What we do know is that this is a serious, potentially debilitating neuro-immune disease that has an infectious component."

That kind of certainty is rarely justifiable weeks after publication of a paper. Indeed, weeks after the episode aired, other research groups began reporting that they had failed to replicate the study's findings.

"It's premature to conclude that XMRV causes CFS," Columbia University virologist Vincent Racaniello wrote in an e-mail. "It is still very much up in the air."

Moore also told Oz's audience that the virus was not contagious by air but may be by blood, that 10 million people may be infected and that a $400 commercial blood test is available to detect XMRV.

But according to Racaniello and Columbia University retrovirus specialist Stephen Goff, little is known about how the virus is transmitted, how many people may be infected, how the virus affects people, where it came from or the usefulness of the test.

When contacted, Moore said some of her statements were edited out of the program.

"The positive impact far outweighs any nitpicking about whether we were successful in being able to convey every aspect of the story," said Moore, adding that she posted a lengthy discussion of the topic on Oz's site.

Wagner, the medical producer, said the show was legitimately reporting on news. There were no factual errors, she said. "I hope we are not splitting hairs," Wagner said.

Schwitzer said the problem is bigger than splitting hairs.

"At the end of the day, are you really helping to educate people?" he said. "Are you making the picture more clear or do you have people's heads spinning like Linda Blair in 'The Exorcist' "?

"It's important to get the science right because millions of CFS patients are listening," Racaniello wrote. "I get dozens of e-mails from them wanting to know how they can treat their XMRV infection, and it's not even proven to be the cause. Programs like this need to be much more measured and critical, and less sensationalistic. But measured and critical doesn't make a good TV show, I suppose."

ttsouderos@tribune.com

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Wading through the glut of online advice

You have been having headaches recently, so you do what any 21st century headache sufferer does: You sit down at the computer, type in "headache" and find yourself with millions of sources of information.

We have access to more medical information than ever, forcing us to become savvier, more skeptical consumers. The first step in surviving the blizzard of information is to know who is providing it.

"If you can't find who's behind a site -- who publishes, who writes, who owns, who influences -- skeptical antennae should shoot out of your head," said Gary Schwitzer, publisher of HealthNewsReview.org, a Web site that scrutinizes media reports on medicine.

Beware conflicts of interest. "Look for disclosures," Schwitzer said. "Take them into account in weighing the veracity of the information. Tune up those skeptical antennae if you don't see disclosure."

Schwitzer said consumers can evaluate evidence with the same criteria used by him and his team. Good reports, he said, will:

*adequately discuss costs.

*avoid disease-mongering, or medicalizing normal life.

*evaluate the quality of the evidence.

*quantify the potential benefits and harms in absolute, not relative terms. In other words, are we talking about reducing a risk that is already remote?

*establish the availability of the approach. Is this an experimental treatment years away from widespread use?

*use independent sources and identify conflicts of interest.

*compare the new idea with existing options.

Above all, talk to your physician about medical issues, including that headache. All the reading on Google won't, in the end, determine whether the pain is caused by stress, a brain tumor or even, according to Wikipedia, Hashimoto's thyroiditis.

-- Trine Tsouderos

Copyright © 2014, Los Angeles Times
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