Monthly Archives: December 2021
Compelling evidence has long shown that diagnostic imaging for low back pain does not improve care in the absence of suspicion of serious pathology. However, the effect of imaging use on clinical outcomes has not been investigated in patients presenting to chiropractors. The aim of this study was to determine if diagnostic imaging affects clinical outcomes in patients with low back pain presenting for chiropractic care.
A matched observational study using prospective longitudinal observational data with a one-year follow-up was performed in primary care chiropractic clinics in Denmark. Data were collected from November 2016 to December 2019. Participants included low back pain patients presenting for chiropractic care, who were either referred or not referred for diagnostic imaging at their initial visit. Patients were excluded if they were younger than 18 years, had a diagnosis of underlying pathology, or had previously had imaging relevant to their current clinical presentation. Coarsened exact matching was used to match participants referred for diagnostic imaging with participants not referred for diagnostic imaging on baseline variables including participant demographics, pain characteristics, and clinical history. Mixed linear and logistic regression models were used to assess the effect of imaging on back pain intensity and disability at two weeks, three months, and one year, and on global perceived effect and satisfaction with care at two weeks.
A total of 2162 patients were included, and 24.1% of them were referred for imaging. Near perfect balance between matched groups was achieved for baseline variables except for age and leg pain. Participants referred for imaging had slightly higher back pain intensity at two weeks (0.4, 95%CI: 0.1, 0.8) and one year (0.4, 95%CI: 0.0, 0.7), and disability at two weeks (5.7, 95%CI: 1.4, 10.0), but these differences are unlikely to be clinically meaningful. No difference between groups was found for the other outcome measures. Similar results were found when a sensitivity analysis, adjusted for age and leg pain intensity, was performed.
The authors concluded that diagnostic imaging did not result in better clinical outcomes in patients with low back pain presenting for chiropractic care. These results support that current guideline recommendations against routine imaging apply equally to chiropractic practice.
This study confirms what most experts suspected all along and what many chiropractors vehemently denied for years. One could still argue that the outcomes do not differ much and therefore imaging does not cause any harm. This argument would, however, be wrong. The harm it causes does not affect the immediate clinical outcomes. Needless imaging is costly and increases the cancer risk.
Yesterday, it was announced that the new German health secretary will be Dr. Karl Lauterbach. This seems a most reasonable choice (when did the UK last have a physician in that post?), and I certainly wish him the best of luck in his new position.
Lauterbach studied medicine at the RWTH Aachen University, University of Texas at San Antonio and University of Düsseldorf, where he graduated. From 1989 to 1992, he studied health policy and management as well as epidemiology at the Harvard School of Public Health in Boston, graduating with a Doctor of Science in 1992. From 1992 to 1993, he held a fellowship at the Harvard Medical School.
From 1998 until 2005, Lauterbach served as the director of the Institute of Health Economics and Clinical Epidemiology (IGKE) at the University of Cologne. He was appointed adjunct professor at the Harvard School of Public Health in 2008. He was a member of the Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen (the council of experts advising the federal government on developments in the German healthcare system) from 1999 until he was elected to the Bundestag in September 2005.
But why does his appointment put the German defenders of homeopathy in a panic? The reason is simple: Lauterbach has in the past repeatedly argued against the reimbursement of homeopathy in Germany. This is, for instance, what DER SPIEGEL wrote in 2019 (my translation):
SPD parliamentary group vice-chairman Karl Lauterbach wants to prohibit public health insurance companies from reimbursing the costs of homeopathy. “We have to talk about this in the coalition,” he told the “Tagesspiegel”. Health insurance companies in Germany are not obliged to cover the costs of homeopathic treatments. However, they can pay for it voluntarily.
Voluntary benefits by health insurers must also be economically and medically reasonable, Lauterbach argues, referring to a similar push in France. According to the French Supreme Health Authority (HAS), the funds do not have sufficient scientific effect. The Ministry of Health had previously commissioned the HAS with the examination. It is considered likely that the French government will soon abolish the coverage of costs.
“In the spirit of reason and education as well as patient protection, it is also wrong in Germany for insurance companies to pay for homeopathy for marketing reasons,” Lauterbach wrote on Twitter in reaction to the decision in France. His demand is not new. Lauterbach had already spoken out in 2010 for a ban on the assumption of costs.
Many observers expect that Lauterbach – after getting the pandemic under control (not an easy task by any measure) – will indeed stop the reimbursement of homeopathy. Germany’s largest homeopathy producer reacted swiftly and is currently running an expensive campaign with full-page advertisements in German newspapers trying to improve the much-damaged public image of homeopathy:
In the advertisement above, for instance, it is implied that homeopaths are all in favor of vaccination. Regular readers of my blog will know that this is not true…
… and so does Dr. Lauterbach!
In 2013, Zuckerman et al. conducted a meta-analysis of 63 studies that showed a negative intelligence-religiosity relation (IRR). Now a new meta-analysis with an updated data set of 83 studies has re-addressed the issue.
The new analysis showed that the correlation between intelligence and religious beliefs in college and non-college samples ranged from -.20 to -.23. There was no support for mediation of the IRR by education but there was support for partial mediation by analytic cognitive style.
In 2012, Canadian scientists tested the hypothesis that an analytic cognitive style is associated with a history of questioning, altering, and rejecting (i.e., unbelieving) supernatural claims, both religious and paranormal. In two studies, they examined associations of God beliefs, religious engagement (attendance at religious services, praying, etc.), conventional religious beliefs (heaven, miracles, etc.), and paranormal beliefs (extrasensory perception, levitation, etc.) with performance measures of cognitive ability and analytic cognitive style. An analytic cognitive style negatively predicted both religious and paranormal beliefs when controlling for cognitive ability as well as religious engagement, sex, age, political ideology, and education. Participants more willing to engage in analytic reasoning were less likely to endorse supernatural beliefs. Further, an association between analytic cognitive style and religious engagement was mediated by religious beliefs, suggesting that an analytic cognitive style negatively affects religious engagement via lower acceptance of conventional religious beliefs.
Some time ago, I reported about a study concluding that a higher religiousness/spirituality is associated with a more frequent use of supplements or additional therapies in individuals with endocrinopathies or metabolic diseases. As so-called alternative medicine (SCAM) has been shown to be associated with worse outcome, addressing religiousness/spirituality which stresses the responsibility of the person for his life might offer an additional resource and should be further studied.
Finally, the findings of a recent study suggest that beliefs in an engaged God were associated with greater mistrust in the COVID-19 vaccine. This association was amplified for Hispanic and lower-educated Americans. The authors argued that beliefs in an engaged God may promote distrust of science, reduce motivation to get vaccinated, and derive comfort and strength by placing control over one’s life in the hands of a loving, involved deity.
There are, of course, other factors involved in the complex relationships between intelligence, religiosity, SCAM, and vaccination hesitancy. Yet, it seems clear that such links do exist. I agree that it is well worth investigating them in more detail.
By guest blogger Ken Harvey
Loretta Marron was the catalyst. The ‘critical thinking’ bug hit her as a child, reinforced by a BSc in Physics. If something didn’t sound logical, she couldn’t let it go. She had to check. She killed many a party by disputing misinformation – with evidence.
TV advertisements for magnetic underlays got her going, then homeopathic remedies, followed by ‘natural’ cures for cancer. To investigate outlandish claims and submit complaints, she needed to consult with experts. These included Professors John Dwyer (Medicine and Immunology) and Alastair MacLennan (Obstetrics and Gynaecology). They were always willing to help.
They also had concerns about universities teaching pseudoscience, such as ‘subluxation theory’ in chiropractic and ‘meridians’ in Traditional Chinese Medicine.
In late 2011, Professor Dwyer proposed that Loretta join forces with Professors Alastair MacLennan, Marcello Costa (neuroscientist), and Rob Morrison (science communicator) to form a new organisation promoting scientific evidence in health care. Friends of Science in Medicine (FSM) was born. John Dwyer was the inaugural President and Loretta Marron Chief Executive Officer (CEO).
The aim was to emphasise the importance of basing Australian health care on scientifically sound research and established scientific knowledge published in peer-reviewed journals of accepted standing. Valuing scientific rigour is especially important in an age where unsubstantiated health claims are rampant and scientific consensus is ‘imbalanced’ by the views of extremists.
FSM’s focus is helping consumers and health professionals to make more informed choices about medical interventions, medicines, and medical devices. We do this by submitting complaints about unethical practice, analysing policy, making submissions, encouraging regulators to act, and being a credible source of expertise for the media and others. We also encourage tertiary institutions and medicine and health sciences students to critically appraise therapeutic products and services as part of the courses offered.
Currently, FSM has more than 1,200 leading scientists, clinicians, lawyers, and consumer advocates as supporters. We also work closely with organisations such as Australian Skeptics and Choice (Australian Consumers Association).
I took over as President from John Dwyer in 2019. Loretta remains FSM CEO. The founding members continue their involvement as consultants. Ten years on, it’s worth reflecting on what has been achieved and the ongoing challenges.
An appendix lists some of the areas in which FSM has been involved and the outcomes achieved (often with the help of others).
Unethical promotion of therapeutic goods and services remain an ongoing concern. The advertising of therapeutic goods is subject to provisions in the Therapeutic Goods Advertising Code, first promulgated in 1999. Until July 2018, complaints about alleged Code violations were heard by the Therapeutic Goods Advertising Complaints Resolution Panel (CRP), thereafter by the Therapeutic Goods Administration (TGA).
FSM members submitted numerous complaints to the CRP and analysed the outcome. If a complaint was upheld, the CRP could only ‘recommend’ that it be removed. If it was not, the complaint was referred to the TGA for action. We found that certain companies consistently ignored the determinations of the CRP and, when referred to the TGA, took resulting action.
In July 2018, FSM engagement with numerous consultations and reviews eventually resulted in the TGA taking over the advertising complaint system. The TGA was given stronger investigative and compliance powers and a revised, legally enforceable advertising code. However, given the TGA’s previous track record, we continued to submit complaints, including many previously upheld by the CRP, but for which promotion continued.
An analysis of the first 12 months of the new system found that the TGA had classified most complaints as ‘low priority’. These were either ignored or closed by sending the advertiser a ‘Regulatory Obligation letter’ which stated that no further action would be taken. While the letter sometimes worked, often it did not. Stronger compliance powers were rarely used. The new complaint system was also less transparent than the one it replaced. For those low priority complaints with published outcomes, no details of the product, advertiser, or alleged Code violation were published, and no follow-up was recorded. Of 121 higher priority complaints, 79% failed to meet their key performance indicator, time to closure in 60–90 days. These included complaints about dangerous sports supplements and ineffective weight loss and hangover products.
In August 2020, an independent review of the first two years of the TGA’s compliant system was published. The study noted an unexpectedly high volume of complaints since the TGA took over the advertising complaints system, producing a large and growing backlog. A government-appointed consultant (ThinkPlace Pty Ltd) stated that providing more resources would not be in the public interest. Instead, they recommended a more cost-effective and efficient approach: amalgamating all complaints into an information database from which the TGA could consider compliance priorities.
As a result, complaints were closed by sending complainants a letter stating that their complaints will be used for ‘intelligence’ to set priorities. The TGA said risk assessment informed whether a complaint was converted into a case for investigation or stored in their information database to determine future compliance priorities. Therapeutic goods associated with COVID-19 were declared ‘priority 1’, while weight loss, hangover, and four other products groups were said to be ‘priority 2’.
A focus on COVID-19 stimulated the TGA to deal with some of these complaints more effectively. However, apart from token action on individual products, no systemic action was taken on weight loss, hangover products and many other objects of our complaints.
More recently, the TGA’s complaint database for 2018 -2020 has been removed and replaced by a new database containing only a few complaints pre-2021. In addition, the fields of many ‘products’ and ‘responsible person’, are missing. The TGA say that migration of data to the new system is continuing. Meanwhile, complainants now only receive an automated acknowledgment.
Transparency remains a problem as there is no clear indication of how many complaints the TGA receives, what they are about, how many are filed for ‘intelligence’’, how many are actioned, and what outcome eventuates.
Given this lamentable state of affairs, in association with Australian Skeptics, it is proposed to publish reports on all complaints submitted to the TGA in 2022 and their outcomes. Past experience shows that documenting problems, pointing out underlying issues and putting forward solutions can produce progress. But patience and persistence are required.
FSM has grappled with unethical advertising of pseudo-medical interventions. Controls differ for practitioners regulated by the Australian Health Practitioner Regulation Agency (AHPRA) and those regulated by State and Territory Health Complaints Commissioners. The former includes medical practitioners, pharmacists, nurses, chiropractors, osteopaths, and Traditional Chinese Medicine practitioners. The latter includes naturopaths, homeopaths, and practitioners of western herbal medicine.
FSM has held regular meetings with AHPRA senior managers. We have also met several of their national boards and attended stakeholder forums. Chiropractic was an initial focus. Many practitioners advertised that chiropractic care in pregnancy could shorten labour duration and prevent caesarean delivery – despite the absence of evidence. Pregnant women were warned that labour often resulted in the newborn babe’s spinal misalignment, which could lead to numerous problems unless put right by regular chiropractic adjustments. It was also claimed that chiropractic ‘adjustments’ could improve attention deficit hyperactivity disorder, infantile colic, and ear infection.
In 2015, FSM submitted hundreds of complaints to AHPRA, alleging that chiropractic websites were in breach of both s.133 of the Health Practitioner Regulation National Law Act 2009 and the Chiropractic Board of Australia’s Guidelines for advertising regulated health services. These provisions prohibit advertising which is false, misleading, or deceptive, creates an unreasonable expectation of beneficial treatment, or can encourage the indiscriminate or unnecessary use of health services.
Five years have passed since the Chiropractic Board first asked practitioners to ensure that their websites met legal advertising requirements. Over this time, the Board’s sole approach to this problem was educational. Although chiropractors consistently had the highest advertising complaints of all practitioners (38 per 1,000 chiropractors in 2013–14), no penalties nor disciplinary action had been applied for advertising offences.
FSM argued that repeated advertising offences required appropriate penalties. We also pointed out that some practitioners now invited patients to consult them about services they were no longer permitted to advertise. We said that limitations should be placed on chiropractic practice which lacked evidence.
AHPRA responded that, although it could act on misleading advertising, it had no power to restrict the scope of practice of chiropractors (or other registered practitioners). We said that, if lack of good evidence makes it illegal to publicly advertise a treatment, then it should be equally illegal to offer it to patients privately; after all, the real harm is caused by the treatment, not the advertising.
In 2019, following damning publicity and further representations, the Victorian Health Minister eventually instructed Safer Care Victoria (SCV) to undertake an independent review of the practice of chiropractic spinal manipulation on children under 12 years. The result was a recommendation that spinal manipulation should not be provided to children under 12 years of age, for general wellness or for the management of conditions such as hyperactivity disorders, infantile colic, or ear infections.
The Chiropractic Board has also stated that chiropractors are not trained to apply any direct treatment to an unborn child and should not deliver any treatment to the unborn child. Neither should they provide materials, information or advice that is anti-vaccination in nature. After numerous complaints from FSM members, the Chiropractic Board finally referred a prominent anti-vax chiropractor, Simon Floreani, to the Victorian Civil and Administrative Tribunal (VCAT). His registration was suspended for 6 months, and conditions placed on his re-registration.
FSM has not just been concerned about chiropractors. We have complained (with varied success) about medical practitioners promoting stem cell therapy for multiple sclerosis, Traditional Chinese Medical practitioners claiming that acupuncture can treat infertility and dubious laboratory tests used in complementary and alternative medicine.
In conclusion, the peddling of unproven and sometimes dangerous remedies has existed throughout human history.
There will always be companies (and individuals) who put the pursuit of profit before ethical behaviour. There will always be advocates for de-regulation and regulators captured by industry. To protect consumers there must be opposing forces. That is the role that FSM is proud to play, along with colleagues from the sceptical community and consumer movements.
FSM activities and outcomes (often in association with others), 2011-2021.
- Removal of extravagant claims for acupuncture from the World Health Organization website and instigation of a WHO evidence review.
- Involvement in the 2015 Review of the Australian Government Rebate on Private Health Insurance for Natural Therapies. This led to removal of cover for therapies that lacked evidence such as homeopathy, iridology, reflexology and naturopathy (currently being reviewed again to see if additional evidence exits).
- Removal of unproven/disproven courses or modules from Australian universities.
- Removal of continuing professional development (CPD) points required annually by relevant registered practitioners for a number of AltMed courses.
- Following complaints to the TGA, removal of some illegal medicines not on the Australian Register of Therapeutic Goods (ARTG).
- De-listing some complementary medicines and medical devices (such as ‘bio-resonance’ machines) lacking evidence.
- Getting the TGA to declare two products of self-declared ‘Foods for special medical purposes’ illegal therapeutic goods and have them removed from the market-place.
- Publishing academic articles, in peer-reviewed journals, documenting regulatory problems investigated and solutions suggested.
- Publishing articles in lay media on current problems including in The Conversation, MJA Insight and Pearls and Irritations (around 200 over the last 5 years).
- Responding to consultation requests from the TGA, Medical Boards, National Medicines Policy Review, and others.
- Achieving the suspension of anti-vax chiropractor Simon Floreani’s registration.
- Stimulating the Chiropractic Board to publish standards on pregnancy and paediatric care.
- Responsible for the setting up of AHPRA’s ‘Advertising Compliance’ section, including their pilot auditing system (yet to report).
- Responding to requests for information from journalists.
- Correction of misinformation from the Victorian government’s ‘Better Health’ Channel.
- Providing a complaints avenue for people who want to remain anonymous.
The ‘Control Group Cooperative Ltd‘ is a UK Company (Registration Number: 13477806) is registered at 117 Dartford Road, Dartford, Kent DA1 3EN, UK. On its website, it provides the following statement:
The Vaccine Control Group is a Worldwide independent long-term study that is seeking to provide a baseline of data from unvaccinated individuals for comparative analysis with the vaccinated population, to evaluate the success of the Covid-19 mass vaccination programme and assist future research projects. This study is not, and will never be, associated with any pharmaceutical enterprise as its impartiality is of paramount importance.
The VaxControlGroup is a community cooperative, for the people. All monies raised will be re-invested into the project and its community.
Volunteers for this study are welcome from around the world, providing they have not yet received any of the SARS-CoV-2 vaccinations and are not planning to do so.
So, the Vaccine Control Group (VCC) aims at recruiting people who refuse COVID vaccinations. The VCC issues downloadable and printable COVID-19 Vaccine self exemption forms that you can complete (either online or by hand) supplied by: Professionals for Medical Informed Consent and Non-Discrimination (PROMIC). The form contains the following text:
COVID-19 vaccines, that have been administered to the public under emergency use authorisation, have been
associated with moderate to severe adverse events and deaths in a small proportion of recipients. There are currently insufficient available long-term safety data from Phase 3 trials and post-marketing surveillance to be able to predict which population sub-groups are likely to be most vulnerable to these reactions. However, clinical assessments have identified a range of conditions or medical histories that are associated with increased risk of serious adverse events (see Panel B). Individuals with such medical concerns, along with those who have already had COVID-19 and acquired natural immunity, have justifiable grounds to not consent to COVID-19 vaccination. Such individuals may choose to use alternate approaches to reduce their risk of developing serious COVID-19 disease and associated viral transmission. UK and international law enshrines an individual’s right to refuse any medical treatment or intervention without being subjected to penalty, restriction or limitation of protected rights or freedoms, as this would otherwise constitute coercion.
I do wonder, after reading this, what scientific value this ‘study’ might have (nowhere could I find relevant methodological details about the ‘study’). In search of an answer, I found ‘Doctors & Health Professionals supportive of this project’. The only one supportive of the VCC seems to be Prof Harald Walach who offers his support with these words:
A vaccine control group, especially for Covid-19 vaccines, is extremely useful, even necessary, for the following reasons:
- We are dealing with a vaccination technology that has never been used in humans before.
- All studies that have planned a control group long term, i.e. longer than only 6 weeks, have meanwhile been compromised, i.e. there are no real control groups around, because those originally allocated to the control group have mostly been vaccinated now. So there are no real control groups available.
- Covid-19 vaccinations are one of the biggest experiments on mankind ever conducted – without a control group. Hence those, who are either not willing to be vaccinated or have not yet been vaccinated are our only chance to understand whether the vaccines are safe or whether symptoms reported after vaccination are actually due to the vaccination or are only an incidental occurrence or random fluctuation.
Comparing unvaccinated people and those with a vaccination history regarding Covid-19 vaccines long term is important to determine long-term safety, because in many instances in the past some problems only were seen after quite some time. This can happen, if auto-immune processes are triggered, which often occur only in very few people. Hence, it is also important to have a long-term observation period and a large number of people participating.
Prof. Dr. Dr. phil. Harald Walach
This does not alleviate my doubts about the scientific value at all. Prof Walach, promoter of so-called alternative medicine (SCAM) and pseudoscientist of the year 2012, has in the past drawn our attention to his odd activities around COVID and vaccinations. Here are three recent posts on the subject:
- Prof Harald Walach is really unlucky
- Is Prof Harald Walach incompetent or dishonest?
- COVID-19 vaccinations: Prof Walach wants to “dampen the enthusiasm by sober facts”
In view of all this, I do wonder what the VCC is truly about.
It couldn’t be a front for issuing dodgy exemption certificates, could it?
Anthony Fauci is the American physician, scientist, and immunologist who serves as the director of the National Institute of Allergy and Infectious Diseases (NIAID) and the Chief Medical Advisor to the President. I have never met him in person but, from all that I know about him, I have great respect for him and his work (he also happens to share with me a John Maddox Prize for standing up for science; he received it in 2020 and I in 2015). Not everyone, however, shares my admiration for Fauci.
This week Lara Logan, a host on Fox News’ streaming platform Fox Nation, confirmed Godwin’s law by comparing Dr. Anthony Fauci to Josef Mengele, the Nazi doctor who performed some of the most horrific experiments on Jewish twins at Auschwitz Concentration Camp during the Third Reich: “This is what people say to me: He doesn’t represent science,” the former “Logan of Fauci, the longtime director of the National Institute of Allergy and Infectious Diseases. He represents Josef Mengele … the Nazi doctor who did experiments on Jews during the Second World War in the concentration camps. And I am talking about people all across the world are saying this! Because the response from COVID. What it has done to countries everywhere. What it has done to civil liberties. The suicide rates. The poverty.”
She made the comment during an appearance on “Fox News Primetime,” following a rant about how there was “no justification for putting people out of their jobs or forcing mandates” for a disease that has death rates “that compare very much to seasonal flu.” (The death rate from COVID-19 is up to 10 times higher than that of most strains of the flu.)
Only hours after the comments by Logan, the Fox News host, Tucker Carlson has compared Dr Anthony Fauci to Italian fascist World War II dictator Benito Mussolini. Holocaust comparisons have become a common feature of protests against COVID-19 strategies. Conservative politicians and media personalities have repeatedly compared vaccine mandates and pandemic restrictions to the treatment of Jews during the Holocaust.
The US is sadly not alone. In Germany and Austria, such comparisons between the atrocities of the Third Reich and COVID vaccinations have become common too. In Germany, this has gone so far that the judiciary is now taking action against people who compare Corona politics with the crimes of Nazis.
Personally, I find these comparisons not just stupid but despicable, and I agree that they should be outlawed. Journalists, in particular, must know that by employing this type of rhetoric, they act against all decency and undermine our efforts to protect the public from the pandemic. I, therefore, feel that Logan, Carlson, and anyone else who descends that low should be prosecuted.
Dr. Mehmet Oz is one of the most influential promoters of outright quackery. I once (many years ago) met him at a meeting where we both were lecturing. My impression was that he does not believe a single word he speaks. Oz later became a TV star and had ample occasion to confirm my suspicion.
Oz’s wife, Lisa, is a Reiki master and has spoken widely of her insights into energy and health. Mehmet Oz appeared as a health expert on The Oprah Winfrey Show. In 2009, Winfrey offered to produce a syndicated series. The Dr. Oz Show debuted in September 2009 and became the most successful promotion of charlatanery in the US. During a Senate hearing on consumer protection in 2014, Senator Claire McCaskill stated that “the scientific community is almost monolithic against you” for airing segments on weight loss products that are later cited in advertisements, concluding that Oz plays a role, intentional or not, in perpetuating these scams, and that she is “concerned that you are melding medical advice, news, and entertainment in a way that harms consumers.” This judgement was supported by a 2014 analysis published in the BMJ; here is the abstract:
Objective To determine the quality of health recommendations and claims made on popular medical talk shows.
Design Prospective observational study.
Setting Mainstream television media.
Sources Internationally syndicated medical television talk shows that air daily (The Dr Oz Show and The Doctors).
Interventions Investigators randomly selected 40 episodes of each of The Dr Oz Show and The Doctors from early 2013 and identified and evaluated all recommendations made on each program. A group of experienced evidence reviewers independently searched for, and evaluated as a team, evidence to support 80 randomly selected recommendations from each show.
Main outcomes measures Percentage of recommendations that are supported by evidence as determined by a team of experienced evidence reviewers. Secondary outcomes included topics discussed, the number of recommendations made on the shows, and the types and details of recommendations that were made.
Results We could find at least a case study or better evidence to support 54% (95% confidence interval 47% to 62%) of the 160 recommendations (80 from each show). For recommendations in The Dr Oz Show, evidence supported 46%, contradicted 15%, and was not found for 39%. For recommendations in The Doctors, evidence supported 63%, contradicted 14%, and was not found for 24%. Believable or somewhat believable evidence supported 33% of the recommendations on The Dr Oz Show and 53% on The Doctors. On average, The Dr Oz Show had 12 recommendations per episode and The Doctors 11. The most common recommendation category on The Dr Oz Show was dietary advice (39%) and on The Doctors was to consult a healthcare provider (18%). A specific benefit was described for 43% and 41% of the recommendations made on the shows respectively. The magnitude of benefit was described for 17% of the recommendations on The Dr Oz Show and 11% on The Doctors. Disclosure of potential conflicts of interest accompanied 0.4% of recommendations.
Conclusions 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.
During the presidential campaign in 2016, Oz supported Trump and hosted him on his TV show. In 2018, Donald Trump appointed him to the President’s Council on Sports, Fitness, and Nutrition, Oz was criticized as an example of choosing “pundits over experts”. Recently, Oz announced he intends to run for the U.S. Senate as a Republican.
In April 2020, Oz also spurred controversy because he said that children should be sent back into schools despite the fact that the novel coronavirus pandemic had only just begun and there were no vaccines or therapeutics yet available. “I tell you, schools are a very appetizing opportunity,” he said, claiming that resuming classes “may only cost us 2 to 3 percent in terms of total mortality,” according to his “reading” of medical journals. The mistake was so substantial that Oz later provided a kind of half-apology, saying that he “misspoke.”