Dr. Oz, ethics and “med-utainment”

Dr Oz

Dr. Oz, the cardio-thoracic surgeon who has trademarked his moniker “America’s Doctor” is under fire for promoting quackery.

According to the NY Times:

The celebrity talk show host Dr. Mehmet Oz plans to respond aggressively on Thursday to doctors who have criticized his medical advice and questioned his faculty position at Columbia University, a spokesman for the show said on Monday.

In a strongly worded email sent last week to the university, 10 physicians wrote that Dr. Oz, the vice chairman of Columbia’s surgery department, had shown “an egregious lack of integrity by promoting quack treatments and cures in the interest of personal financial gain.” In particular, the doctors attacked Dr. Oz’s “baseless and relentless opposition to the genetic engineering of food crops.”

Apparently Oz plans to attack the credibility of his critics:

Dr. Oz will question the credibility of the letter’s authors, several of whom have ties to the American Council on Science and Health, a pro-industry advocacy group that has supported genetically modified foods, the spokesman said.

Oz may have a point. Some of the letter’s authors may have their own conflicts of interest. However, when you have to devote a segment of your nationally syndicated TV show to declare, “I am not a charlatan!” you may win the battle, but you are perilously close to losing the war.

The letter’s authors intended to use the national media to highlight Dr. Oz’s ethically dubious practice of promoting products that he knows (or ought to know) are quackery. They have been spectacularly successful in achieving that goal.

No, Dr. Oz is not going to lose his faculty appointment at Columbia, but that was never really in the cards. Academic freedom, the right of educators to hold and transmit controversial views, is precious. I don’t agree with much of what Dr. Oz has to say, but I defend his right to say it.

Nonetheless Dr. Oz is a medical doctor and doctors have ethical obligations. In my judgment, the most pressing question about Dr. Oz is whether he has violated those obligations.

Dr. Oz isn’t a charlatan; he just plays one on TV.

Hippocrates never worried about this kind of ethics problem. He conceived of the doctor-patient relationship as one on one, and wrote his Hippocratic Oath under the assumption that a physician has specific ethical obligations governing the medical advice he offers to his own patients. He never considered whether physicians have ethical obligations to the public at large.

By all accounts, Dr. Oz is an outstanding clinician. Moreover, no one has ever accused him of offering his own patients “quack treatments and cures in the interest of personal financial gain.” That would be a clear violation of his ethical obligations. But he has incontrovertibly offered quack treatments on his TV show, almost certainly in the interest of personal gain.

His influence is so pervasive that the British Medical Journal published a paper on the unreliability of his TV recommendations and those of a competing television show. Their conclusion:

Recommendations made on medical talk shows often lack adequate information on specific benefits or the magnitude of the effects of these benefits. Approximately half of the recommendations have either no evidence or are contradicted by the best available evidence. Potential conflicts of interest are rarely addressed. The public should be skeptical about recommendations made on medical talk shows.

I suspect that this did not come as a shock to Dr. Oz.

But Oz’s show is not a private medical consultation; it is med-utainment, a television show that incorporates the many disciplines of medical science (or pseudoscience) to provide entertainment to viewers.

Yet even as an entertainer, Dr. Oz is still bound by medical ethics. Academic freedom gives him the right to promote medical treatments that he knows don’t work. That doesn’t change the fact that it is a violation of medical ethics to do so.

Although Dr. Oz is not engaged in a traditional doctor-patient relationship with the members of his audience, he is speaking from a position of medical authority (including touting his faculty appointment at Columbia) and he is still offering medical advice to others. He is trading on his medical credentials and therefore his actions are bound by the same ethical constraints.

He has a tremendous conflict of interest and he ought to explicitly inform his viewers of that fact. His medical “advice” is determined by considerations other than what is supported by scientific evidence. These considerations include ratings, and advertising revenue. Higher ratings = more advertising revenue = more money for Dr. Oz. He’s like any doctor who prescribes a medication or treatment based on how it profits him, not on what is best for the patient. We recognize that it is unethical for doctors to take kickbacks from pharmaceutical companies for prescribing their medications. It is equally unethical for Dr. Oz to profit from promoting quackery. If he’s not offering the same medical advice to his patients as he’s offering to his TV audience, he’s violating the primary tenets of medical ethics: beneficence (benefiting the patient) and non-maleficence (not harming the patient).

There are doctors out there who offer quack treatments because they believe that they work. Their recommendations are wrong, but they’re not unethical. Dr. Oz almost certainly knows better, which means that his efforts and renumeration as a med-utainer conflict with the obligations of medical ethics.

Dr. Oz is not a charlatan; he just plays one on TV.

And that’s unethical.