The recent uproar about Dr. Oz is revealing some interesting things about the wizard behind the curtain of controversy. The uproar also reveals some uncomfortable facts the media and its role in the promotion and refutation of ad hominem attacks that often conceal ulterior motives.

How Mehmet Oz Became “America’s Doctor”

Mehmet Oz owes his celebrity to his adoption by Oprah Winfrey as the “house doctor” for her talk show back in 2004. Before Oprah, Dr. Oz was merely a recently tenured (2001) professor at the Columbia University School of Medicine, where he teaches cardiovascular and thoracic surgery.  Once he joined Oprah’s entourage, however, he became a manufactured product, a brand unto himself, because of his synergistic relationship with Winfrey.

Oprah’s talk show empire was built upon a strategy of offering mildly different, sometimes holistic, and often outright alternative advice for the simple reason that offering the same advice that everyone else offers doesn’t attract attention or viewers. Oprah’s guest-shills, of whom Dr. Oz and Dr. Phil McGraw are the two most prominent examples, therefore had to offer a combination of credibility and divergence from the middle of the road positions on just about everything she touted.

Oz was a perfect match for that assignment. He was youthful, photogenic, and energetic. He had the credibility of a tenured Columbia University professor and the credulity required to pitch divergent ideas with a straight face. Like many of the other manufactured celebrities that Winfrey has befriended over the years, Oz has parlayed his tenure on Oprah into his own television programs, websites, books and a booming business as an advocate for alternative medicine.

Like Dr. Phil, who says that he makes nothing from his work on his television show, Dr. Oz claims with absolute sincerity that he makes nothing from the products he endorses. Nevertheless, in both cases, the good doctors are reaping huge benefits from their media visibility that translates into millions of viewers, book sales, website visits, and millions of dollars in the bank. Together, they represent an unfortunate and probably unhealthy incursion of entertainment into the serious business of providing health care information in an increasingly complex health care environment, offering simplistic solutions to complex problems.

The Synergy of the “Oz Effect”

Oz likes to maintain that his audience understands that he is offering “entertainment” rather than merely reliable medical recommendations but that’s a dangerously disingenuous presumption because there is evidence that millions of people rush out to buy the nostrums he promotes. Even without getting any kickbacks from the pill-makers, he earns millions of dollars each year from his Dr. Oz media empire, an empire that would not exist if he stopped offering free medical advice about the nostrums he advocates.

That is a basic maxim of advertising. If Oz doesn’t offer anything different from what everyone else offers in the way of medical advice, why would anyone watch his programs or visit his websites? His credibility with the public makes advertising time on his program worth more because they are being beamed directly to what might be described as a predisposed market….predisposed to buy what they are selling, that is.

So, while he may not be receiving direct payments from the manufacturers of the products he touts, they cite him on their websites and he cites them on his websites creating a referral loop that funnels visitors back and forth between their websites, generating huge advertising revenues for all parties, above and beyond the purchases that an Oz endorsement generates. That, more than anything else, is what really disturbs Oz critics: he’s getting rich off what they believe is bad advice.

Mehmet Oz: The Classic Overachiever

Most doctors are overachievers. They have to be to get the grades they need to get into medical school, stay there, survive it, endure internships and residencies, and pay off their student loans. Even in the context of the chronic over-achievers in the medical arena, however, Oz is just plain remarkable.

Oz grew up as the American-born son of an orthodox Muslim physician and a mother who comes from a very wealthy but secular Turkish family. (Oz served in the Turkish military to preserve his dual nationality status.) After graduating from Harvard in 1982, he completed a dual-degree program from the University of Pennsylvania in 1986 that included an M.D. from the Penn’s School of Medicine and an M.B.A. from the prestigious Wharton School of Business, while also serving as class president and student body president in medical school

Konya, the region from which the Oz family comes, is a place where the miraculous and the mundane coexist. The region has been home to generations of Sufi mystics dating back to the 13th century, when Molana Jalal-e-Din Mohammad Molavi Rumi – currently the best-selling poet in the United States – settled there. Oz describes himself as follower of Sufi mysticism, but also considers himself a follower of Emanuel Swedenborg, an 17th century Christian mystic of doubtful sanity.

The Sufis of Konya are renowned for their healing skills, which are well documented but are also well explained by their use of various hypnotic techniques, often amplified by meditation, chanting, fasting, diet and other mind-altering strategies, including the use of various narcotics.  On the other hand, many contemporary Sufis are also practicing physicians. It is not surprising, therefore, to find Dr. Oz supporting and promoting a variety of therapies for which there is no positive scientific evidence, and often much contradicting evidence, while at the same time also practicing traditional Western medicine.

Clearly, growing up in Konya, in that environment, Oz was predisposed to believe in miracles. The problem is that it a very easy stretch from believing in miracles to believing in miracle cures.

 Dr. Oz reportedly says that he yearns for the days “when our ancestors lived in small villages and there was always a healer in that village,” and it’s easy to believe he really means that. In other words, he yearns for 13th century Konya, for a world of mystics and seers, and may very well think of himself as the modern equivalent of those ancient sages. These footnotes aren’t incidental to a discussion about Mehmet Oz; they are in fact the essential data one needs to unravel the mystery of Dr. Oz. Although he has been widely portrayed and denounced as a huckster, Mehmet Oz’s saving grace may be that he might actually believe in the snake oil he’s selling.

Cynical Shill or Gullible Dupe?

The key to deciding whether Dr. Oz is a cynical shill or a gullible dupe boils down to one simple question that only he can answer: Does he use the stuff he promotes, and do the things he advocates for others? If he does, then he is an enthusiast, and we have to collectively cut him enough slack to express his beliefs. He may be wrong, but he is honestly wrong. If he doesn’t, he’s just another snake oil salesman with a medical degree, one of many who are out there hawking their wares to an unwary world.

In a 2013 article, Forbes Magazine tabulated Dr. Oz’z  five “wackiest medical beliefs,” which include communicating with the dead and  living six years long if you have more than 200 orgasms per year. (We would love to see the raw research on that one.)  However, he also endorses Homeopathy and Reiki, neither of which get any support from the scientific community, going so far as to invite a Reiki master into his operating room during surgeries to help “harness” the patient’s own energies.

Perhaps the most telling clue to what Dr. Oz really believes are quotes attributed to him in which he admits his wife gives their children homeopathic remedies in lieu of more orthodox treatments. So, in the end, Oz may very well be another deluded dupe rather than the cynical shill some people think he is.

The Wizard of Oz Strikes Back

In his counter-attack Thursday, Oz lambasted some of the ten more or less prominent physicians who signed that ill-advised letter calling for his ouster from the Columbia University School of Medicine by pointing out the debris in their own backyards, ranging from close associations with GMO manufacturers to cases of outright Medicare fraud, but his investigators were only able to impugn five of the ten physicians. That reduces the showdown between Dr. Oz and “the group of ten” from something akin to the gunfight at the OK corral to a case of the pot calling the kettle black, if one can still use that metaphor.

Or does it?  Despite the fact that some of the signers of the “anti-Oz” letter  may themselves be somewhat compromised by their  own associations, as Oz has charged, the fact remains that ten rather high-powered doctors with no axes to grind, nor any prospect for personal  inurement stemming from their actions chose to violate one of the unwritten codicils of the Hippocratic Oath (thou shalt not criticize thy fellow physicians) in order to speak out against the celebrity physician.

Just for the record, and because it will be difficult to find them listed anywhere else, here are the ten doctors who banded together to confront Oz:

• Henry I. Miller, Robert Wesson Fellow in Scientific Philosophy and Public Policy at the Hoover Institution of Stanford University
• Scott W. Atlas, Senior Fellow at the Hoover Institution of Stanford University
• Jack Fisher, Professor of Surgery, University of California, San Diego
• Shelly Fleet, Anesthesiologist. Longwood, Florida
• Gordon N. Gill, Dean (emeritus) of Translational Medicine, University of California, San Diego
• Michael H. Mellon, pediatric allergist, San Diego, California
• Gilbert Ross, president and executive director American Council on Science and Health, N.Y, NY
• Samuel Schneider, psychiatrist, Princeton, NJ.
• Glenn Swoogger, Jr. Director of the Will Menninger Center for Applied Behavioral Sciences (retired), the Menninger Foundation, Topeka, Kansas
• Joel E. Tepper, Director McLean Distinguished Professor of Cancer Research, University of North Carolina School of Medicine.

Oz believes that the attack on him was precipitated by his opposition to genetically modified organisms (GMO) in our food supply, an opposition for which most scientists have little sympathy, but the idea that Monsanto is worried about Dr. Oz is laughable because consumers have no choice about which foods they buy. Like it or not, GMO laced foods are here to stay. There is no way to put that Genie back into the bottle. Sustainable agriculture is all well and good, but organic farming cannot feed the world’s population and everyone knows it, so arguing against GMO foods is like arguing against winter. It’s going to happen, whether or not you want it.

The Tempest in the Teapot

Oz isn’t all that worried about all this, despite his public posturing. For one thing, he has tenure at Columbia University and it is virtually impossible to defrock a tenured professor because his or her colleagues will rally around the endangered professor in order to protect the sacred concept of tenure which, in turn, also protects them. It becomes even more difficult to defrock a tenured professor if he hasn’t done anything wrong at the office, and Oz hasn’t done that. He is far more worried, however, about his future on television, claiming that “I will not be silenced,” when, in point of fact, the doctors who attacked him weren’t trying to get him thrown off television – which would be equivalent to silencing him – but were “only” trying to get him thrown off the faculty at Columbia.

That, in and of itself, points out just how silly this whole tempest in a teapot really is. The 10 Doctors (they are now a cohort group of their own) were offended, along with many other doctors, by some of the things that Dr. Oz says on television but they didn’t try to get him thrown off the air. They can’t. Dr. Oz owns the show. They never questioned whether he is a good teacher, or a good surgeon, which are the primary criteria according to which a professor of medicine should be judged first, but they are trying instead to get him ousted because they believe doing so would impair his ability to continue being America’s doctor…and they may be right about that.

Dr. Oz’s detractors are not right, however, about whether he should be permitted to teach medicine. People who have worked with Oz in the operating room are vociferous with their praises of his skills. Eric Rose, one of the leading cardiovascular surgeons in the United States, hired Oz to work on his transplant team at New York Presbyterian Hospital, and extols his intelligence and his skill as a surgeon. When asked, however, if he would refer patients to Oz, who now only works one day a work in the surgical theater, Rose reluctantly said no, adding that he considers Oz to be more of an entertainer than the rock star surgeon he once was.

One of the reasons that it is called practicing medicine is that you have to do just that, continually practicing your techniques in order to stay sharp and remain focused through hours-long surgeries. Oz doesn’t do that any more, which suggests that his skills may be degenerating and that would make him a less desirable teacher, but none of his medical critics have yet made that point.

Oz has been called onto the carpet by the U.S.  Food and Drug Administration for his claims that some apple juice contained significant amounts of arsenic.  A subsequent study by Consumer Reports, however, actually validated those claims, so it has to be admitted that Oz – who is, after all, a very smart man – isn’t always wrong.  Far from simply exonerating Oz, Consumer Reports conducted several additional studies that demonstrated a causal link between inorganic arsenic and lead consumption and the increasing incident of Type II Diabetes in the United States.

Nevertheless, he has also been called to the floor by a Senate Committee chaired by Missouri’s Claire McCaskill. who proceeded to slice and dice Oz for his role in promoting useless weight loss remedies.  Perhaps the unkindest cut of all came from the prestigious British Medical Journal (BMJ) . which conducted an exhaustive review of Dr. Oz episodes airing from January to April of 2013.  A team of experts reviewed a random sample of 40 programs aired during that period and found that 54 percent of the medical information provided during those episodes were scientifically sound.  Some 39 percent of these were related to weight loss issues.

The Media Conundrum

The Dr. Oz controversy may very well be a tempest in the teapot that will soon blow over, but it highlights some serious concerns about the conjunction between the media and the medical establishment.

First and foremost of this concerns is the growing belief that rapid escalation of pharmaceutical costs are due, at least in part, to the massive advertising budgets expended for the promotion of a wide range of drugs, with newer drugs getting marketing boosts from the advertising pressure.  The American  Medical Association recently proposed a ban against direct to consumer pharmaceutical advertising on the grounds that advertising costs are making some drugs unaffordable.  Front line physicians also report increasing pressure from patients to prescribe drugs on the basis of information the patients have gleaned from advertising messages, despite evidence that the newer drugs are no more effective than cheaper existing drugs and often come with more negative side effects.

Dr. Oz doesn’t contribute to that particular issue because he doesn’t tout – for the most part – tout prescription drugs.  He does, however, promote over-the-counter nostrums (and especially weight loss products) with little or no evidence to support their efficacy. However, what he does contribute to is the bewildering blizzard of claims, counter-claims and anxiety-generating news reports about various challenges facing patients who want to live long and prosper.

However, what Dr. Oz, and his cohorts do is even worse. They are helping to raise the anxiety levels of Americans who are already very nervous about the cost and quality of their health care.  With his empire of print, broadcast and internet properties, with regular columns appearing in half a dozen publications, and interlocking relationships with a broad array of media celebrities, Dr. Oz is virtually inescapable, and he uses that dominance to promote false cures for real problems. (He was the first man ever to appear on the cover of Women’s Day magazine 2012,  and has appeared more often than any other celebrity.) The problem with this is that the sheer volume of “information” that Oz produces makes it more difficult for consumers to figure out the increasingly complicated landscape of American medical care.

His solution to the attack on his professional standing was, however, classic.  Using a combination of multiple appearances on his own television program, as well as guest appearances on other programs, numerous posts on his own and other, friendly websites, he turned the attack on him into a bonanza of free publicity that, rather than making him disappear from the boob tube, has made him even more visible.

In the media distorted world in which we appear to be living, information is valued according to the source of the information, rather than the factual content.  This is at least in part due to the fact that few people have the ability to discern fact from supposition and, even when you have that ability in your own occupation, that doesn’t mean you have equal powers of discrimination outside your own field.  This becomes even more important, and perhaps tragic, when people who have become celebrated for their achievements in their area of expertise begin to pontificate on subjects outside their areas of expertise.

Oz is a cardiothoracic surgeon, not a nutritionist, and he would probably be outraged if a nutritionist were to give out advise about cardiac treatments, but he feels perfectly comfortable about pontificating about weight loss remedies. There’s a good old Greek word for such  behaviors:  Hubris.

The failure of his critics to stifle him has made him appear invulnerable to many potential critics, while exonerating him in the eyes of millions of Dr. Oz fans, proving that it isn’t what you say that matters, or even how you say it. What matters is only how often you say it.

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