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The Dr. Oz Effect. The Dr. Oz Show. focuses on essential health issues: the proper ways to eat, relax, exercise, and sleep, and how to maintain a healthy heart. Some of the advice Oz offers is sensible, and is rooted solidly in scientific literature. Harvard: BA
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The Dr. Oz Show • focuses on essential health issues: the proper ways to eat, relax, exercise, and sleep, and how to maintain a healthy heart. • Some of the advice Oz offers is sensible, and is rooted solidly in scientific literature. • Harvard: BA • University of Pennsylvania: MD, MBA • Columbia University: Cardiothoracic surgeon, Professor
miracle drinks and miracle meal plans • “startling,” “breakthrough,” “radical,” “revolutionary,” “miracle.” • “Dr. Oz’s Three-Day Detox”; “Eat Yourself Skinny”; “Oz-Approved Seven-Day Crash Diet” • Oz introduced raspberry ketones, an herbal supplement, as “the No. 1 miracle in a bottle to burn your fat.” - set off a wave of panic buying throughout the nation
1. show on whether it was possible to “repair” gay people (“From Gay to Straight? The Controversial Therapy”), despite the fact that Robert L. Spitzer, the doctor who is best known for a study of gay- reparation therapy, had recanted. • 2. genetically modified foods by saying, “A new report claims they can damage your health and even cause cancer.” • ” Cancer, Oz told me, “is our Angelina Jolie. We could sell that show every day.”
Typical cancer Themes • “Five Fast-Moving Cancers” • “Four Body Pains That Could Mean Cancer” • “Three Cancer-Preventing Secrets” • “What You Can Eat to Defeat Cancer.”
Advocates Pseudoscience • Reiki: hands-on healing using ki, a life force” • Not supported by science • JAMA article: a nine-year-old girl conceived and executed a test in which she demonstrated that twenty-one people who claimed to be skilled in the techniques of Reiki were nevertheless unable to detect her “energy field” more often than they would have by guessing. • When Oz told “no evidence showing that Reiki work”, responded: “Neither am I, if you are talking purely about data.
Routinely criticized by Scientists • relying on flimsy or incomplete data • distorting the results • wielding his vast influence in ways that threaten the health of anyone who watches the show. • Last year, almost as soon as that G.M.O. report was published, it was it was thoroughly discredited by scores of researchers on both sides of the Atlantic.
Consumer Frenzy • “You may think that magic is make-believe,” Oz said at the beginning of the show. “But this little bean has scientists saying they have found a magic weight-loss cure for every body type. • It’s green coffee beans, and, when turned into a supplement—this miracle pill can burn fat fast. This is very exciting. And it’s breaking news.”
What Science Says • Meta-analysis of 3 studies done: • “supplement produced, on average, a five-pound loss among study participants. • But all three studies were short term and included a small number of participants • meta-analysis authors concluded: "More rigorous trials are needed to assess the usefulness of GCE as a weight loss tool."
Oz Reply • “We did our own study on this,” he said when I asked him about it. “It wasn’t a classical medical study, of course, but for a television show it was pretty darn good. We took a hundred people, randomized them, and showed what academic studies have showed: you are not going to lose a ton of weight, but you will probably lose a pound a week for a few weeks. That’s better than placebo.” • measured answer was almost exactly the opposite of the hyperbolic message he had broadcast into American living rooms.
Federal Trade Commission Panel • Claire McCaskill: • "The scientific community is almost monolithic against you in terms of the efficacy of the three products you called 'miracles' " • "I don't get why you need to say this stuff when you know it's not true. When you have this amazing megaphone, why would you cheapen your show? ... With power comes a great deal of responsibility.”
“We can spend a lot of time, Senator McCaskill, arguing the merits of whether green coffee bean extract is worth trying or not worth trying,” Oz said. “Many of the things we argue that you do with regard to your diet are likewise criticizable… It is remarkably complex, as you know, to figure out what works for most people even in a dietary program.”
“I actually do personally believe in the items I talk about in the show. I passionately study them. I recognize that often times they don’t have the scientific muster to present as fact. But, nevertheless, I give my audience the advice I give my family all the time. I give myfamily these products, specifically the ones you mentioned. I’m comfortable with that part,” he said.”
Latest: Garciniacambogia • “Thanks to brand new scientific research, I can tell you about a revolutionary fat buster," • 2012 Show: "No Exercise. No Diet. No Effort" on the screen behind him. “ • NOTE: The Food and Drug Administration does not regulate weight loss supplements. Under current law, companies selling these products do not need FDA approval before marketing them to the public.
Health and Race • Health Disparities • Life expectancy • Diet • Treatment • Smoking • Access to Health Care
Eight Americas: Life Expectancy Varies • Asians: 87.4; 82.1 • Northern Plains Whites: 79 • White Middle America: 77.9 • Appalachia Whites: 75 • Western Indians: 69.4 • Black Middle America: 72.9 • Low Income Rural Blacks: 67.7 • High Risk Urban Blacks: 66.7 • White vs. Black Men: 6.4 years difference • White vs. Back Women: 4.6 years difference
Causes • Access to health care? Not entirely • less variation among the Eight Americas in the rate of health insurance coverage and the frequency of routine medical appointments than there was in life expectancy. • Lifestyle, Diet? • Asians lose their "survival advantage" after they are in the United States for a long time and have adopted an American diet and habits, • Social perceptions? • high mortality in urban black men persists even when homicide and AIDS are removed. Heart attack, stroke, diabetes, cirrhosis and fatal injuries are the major causes of reduced life expectancy in that group.
Article: Implicit Bias and Prediction of Thrombolysis • Does unconscious racial bias lead to differential treatment? • Methods: • E-mail invitation to all 776 internal medicine & emergency residents in 4 academic medical centers in Boston and Atlanta • Randomly assigned to see picture of black or white patient, matched for age and attractiveness, while they read clinical vignette • Asked to rate: likelihood symptoms were Coronary Artery Disease; whether they would suggest Thrombolysis; strength of recommendation
Bias Assessments • Explicit Bias: Direct Measure • Preference for black vs. white Americans • Thermometer scale • Beliefs about group cooperativeness • Implicit Bias: Indirect Measure • Race Preference IAT • Race Cooperativeness IAT • Race Medical Cooperative IAT
Implicit Association Test • General Findings: • Slower RT when asked to associate black face with positive attribute • Seen as index of implicit bias
Results • Doctor Demographics: • Physician race predicted IAT score – Whites higher scores • Emergency room doctors smaller IAT • Explicit Bias • Physicians of all races expressed equal preferences, • Rating of cooperativeness of patients • Implicit Bias • Stronger association of negative attributes to blacks
Conclusions • Implicit bias against blacks negatively correlated with likelihood of recommending thrombolysis for black • Implicit bias against blacks positively correlated with recommending it for whites • Suggests unconscious bias may influence treatment decisions
Limitations of Study • Selection bias in doctor sample • Low response rate • Academic physicians who may have less experience in thrombolysis • Computerized presentation of patient, not actual patient-doctor interaction • Thrombolysis not recommended for patients with diabetes, hypertension, which are more likely in black patients
Lung Cancer & Race • Rates • Black & Hawaiian American: 50% Higher than Whites • Hispanic & Japanese American: 50% Lower than Whites • WHY?
Diet, Socioeconomic Status, Occupation ? Not Likely, once factors controlled for • Nicotine Sensitivity:
Objective • “To determine if racial disparity in breast cancer survival is primarily attributable to differences in presentation characteristics at diagnosis or subsequent treatment.”
Methods • Compared: • 7375 black women 65 years and older diagnosed between 1991 to 2005 • 3 sets of 7375 matched white control patients selected from 99 898 white potential controls • using data for 16 US Surveillance, Epidemiology and End Results (SEER) sites in the SEER-Medicare database.
black case patients were matched to 3 white control populations on demographics: • (age, year of diagnosis, and SEER site) • presentation (demographics variables plus patient co-morbid conditions and tumor characteristics such as stage, size, grade, and estrogen receptor status) • treatment (presentation variables plus details of surgery, radiation therapy, and chemotherapy). • Outcome Measure: 5 Year Survival
Results • Absolute difference in 5-year survival 4.4% lower in black women • 3.6% lower for blacks than for whites when matched for treatment. • In the presentation match: • fewer blacks received treatment (87.4% vs 91.8%), • time from diagnosis to treatment was longer (29.2 vs 22.8 days) • use of anthracyclines and taxols was lower (3.7% vs 5.0%) • breast-conserving surgery without other treatment was more frequent (8.2% vs 7.3%4).
Treatment differences Not Explanation for Survival Difference • Nevertheless, differences in survival associated with treatment differences accounted for only 0.81% of the 12.9% survival difference. • What accounts for difference?
