Two thousand fourteen was a tough year for Dr. Oz. In June, he appeared before a congressional committee to sullenly explain his use of terms like “magic pill” and “miracle” to describe a variety of sketchy weight-loss products. A few months later, when he asked Twitter users to submit their “biggest question,” his account was peppered with sarcastic responses like, “I just got my flu shot, when can I expect to develop autism?” Then the new year started with NY Med, a reality show in which Oz figured prominently, taking a hit for broadcasting the death of a trauma patient without consent.
Oz may be entitled to some defense — not for the magic weight-loss claims, which are mostly repulsive and embarrassing — but for the heat he’s taken lately in the wake of a study published in the journal BMJ that concluded that fewer than half of the medical recommendations on The Dr. Oz Show, and around 60 percent of the recommendations on the daytime TV hit The Doctors, were backed by any sort of evidence.
Headlines trumpeted the results: “Half of Dr. Oz’s advice is bad”; “About 50% of Dr. Oz’s recommendations are baseless or wrong.” “The public,” the study’s authors advised, “should be skeptical about recommendations made on medical talk shows.”
But is the evidence-based standard really the best means to judge the value of these TV doctor shows? If there’s no evidence for advice, does that make it baseless or wrong?
Evidence-based medicine has made enormous improvements to our practice in the past few decades, and physicians should strive to search for evidence to support virtually all important tests and interventions. But even BMJ has poked fun at our (sometimes misinterpreted) obsession with evidence, at one point publishing a research study entitled, “Parachute use to prevent death and major trauma related to gravitational challenge,” which concluded that “no randomized controlled trials of parachute use have been undertaken” and that “individuals who insist that all interventions need to be validated by a randomized controlled trial need to come down to earth with a bump.”
The impact of TV doctor shows is powerful and inevitable, and the medical establishment has gone to great lengths since the inception of the form with Medic and Dr. Kildare in the 1950s-’60s to make sure that medicine appears realistic–so much so that the expectation has become something of a standard. Producers were criticized in the 1990s when a New England Journal of Medicine study showed that patients on TV survived after CPR as much as 70 percent of the time, while in the real world the number was closer to 15 percent. Should talk-show doctors be held to an even higher standard, given that they are real “expert” physicians, and not just actors with white coats? Or is this nothing but soap-style entertainment and a chance to gawk at folks who go on the “feeding-tube diet” before their beach vacation?
By focusing on hard evidence to back up specific claims, journalists are missing two critical points: First, we should investigate the implication that patients have somewhere else to turn for advice. Second, it’s important to acknowledge the amount of trust that viewers place in the recommendations they hear on TV as compared to those that they hear from their doctor.
Access is important. The most frequent recommendation on The Doctors was to consult a healthcare professional. That seems reasonable, but maybe not so easy. In 2012, 17 percent of US adults had no usual place of healthcare whatsoever, and of those that did, only 74 percent identified that place as a doctor’s office or HMO. Others use clinics, health centers or ERs, where they often never see the same provider twice, or else nowhere at all. A significant proportion of patients that I see in the ER are there because they have no primary doctor, and even if they’ve managed to make an appointment with a physician, it is often months in the future. Why wait when I’ve got four good-looking doctors to give me advice five days a week?
Even when patients have a doctor that they identify as their primary provider, those relationships often don’t last long enough to develop any meaningful trust. But viewers’ relationships with a TV doctor can last for years. The BMJ study reported that since evidence was often lacking, “anyone who followed the advice provided would be doing so on the basis of a trust in the host or guest rather than through a balanced explanation of benefits, harms and costs.”
Exactly! That’s how patients make decisions. And when a physician that they’ve never met before recommends diet and exercise during an 18-minute visit, and then a TV doctor that they’ve respected for years recommends something wacky instead, human nature often dictates that we choose to listen to the person. Many patients have never met their HMO-assigned primary-care physician, or have changed doctors multiple times in the past few years — although few, if any, recent news articles have investigated the real numbers of how and why patients switch providers so frequently.
If we accept that viewers trust TV doctors, and that they may not have a more accessible source of information, then we ought to work to change the subjects that are emphasize don doctor TV. A television program will never replace the balanced advice of a personal physician, or be held to the standard of a full explanation of a therapy, but producers certainly can choose to focus on important and timely topics that really influence viewers’ perception of health and medicine–and possibly their behavior. The BMJ study found that more than 40 percent of the recommendations on the two shows had to do with weight-loss or dieting. No surprise, but there’s lots more low-hanging fruit out there (The Doctors recently aired a segment about a yoga class in gangland Chicago which focused on issues much more important than dieting).
In the 1960s, Bernard Cohen famously observed that the press “may not be successful much of the time in telling people what to think, but it is stunningly successful in telling its readers what to think about.” Rather than just seize the opportunity a new study affords to bash the (clearly bash-worthy) Dr. Oz and his ilk, the press can use those occasions to help shift the conversation to what TV-doctor shows are telling us to think about — more yoga in inner cities, say, and less crash dieting; more stories about global health issues and fewer about cosmetic surgery; and even some time to think about the evidence out there for the things that most of us recommend — rightly or wrongly — to our patients and our viewers alike.
Christopher Tedeschi is an associate professor of emergency medicine at Columbia University.