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Dr. Mehmet Oz is one of the most well-known, and possibly the most influential medical doctor in America. The Dr. Oz Show is broadcast in 118 countries and reaches over 3 million viewers in the USA alone. When Oz profiles a product or supplement on his show, sales explode – it’s called “The Dr. Oz Effect”. Regrettably, Oz routinely and consistently gives questionable health advice, particularly when it comes to weight loss products, where Oz regularly uses hyperbolic terms like “miracle” for the products he profiles:

(On green coffee extract) — “You may think magic is make-believe, but this little bean has scientists saying they found the magic weight-loss for every body type.”

(On raspberry ketone) — “I’ve got the number one miracle in a bottle to burn your fat”

(On Garcinia cambogia) — “It may be the simple solution you’ve been looking for to bust your body fat for good.”

Dr. Oz has profiled so many dubious health strategies that “The Dr. Oz Effect” more accurately refers to the wasted time, effort and finances of any consumer that actually follows his health advice and purchases the steady stream of “miracles” that Oz endorses on his television show. Not surprisingly, Science-Based Medicine is probably Oz’s most persistent and tenacious critic. It’s not just that he’s high profile – it’s that Dr. Oz is a bona fide physician who ought to know better, but chooses to ignore science in favour of hyperbole. It’s the antithesis of what a health professional should be doing. And this is the root of the Oz problem: Oz can give good advice, but he regularly combines it with questionable statements and pseudoscience in a way that the casual viewer can’t distinguish between the science and the fiction. So when Oz calls something a miracle – people listen. Even when miracles show up several times per year.

When it was announced that Dr. Oz had been invited to speak by Senate Commerce subcommittee Chairwoman Claire McCaskill (D-Mo.) about weight loss scams, at least one irony meter exploded. A protégé of Oprah, his spin-off television show started in 2007 quickly became a platform for hosting other dubious “experts”, offering questionable health advice, and repeatedly profiling today’s versions of snake oil. So asking Oz to speak about weight-loss scams seemed absurd, given he’s possibly the most influential promoter of weight loss scams in America. A friend of the blog suggested that a better use of Dr. Oz would have been to hold him up as an example of the very problem he’d been asked to speak about.

Well that’s exactly what happened. On Tuesday Dr. Oz admitted that when it comes to weight loss products, hype trumps the evidence, every time. I strongly suspect that Senator McCaskill or her advisors have been reading Science-Based Medicine, as her extended evisceration of Oz (and a reference to, yes, “science-based medicine”) is a true delight to watch:

“The scientific community is almost monolithic against you in terms of the efficacy of a few products that you have called miracles,” she added. “I just don’t understand why you need to go there … You are being made an example of today because of the power you have in this space.” – Senator McCaskill

Senator McCaskill repeatedly grilled Dr. Oz on green coffee beans, one of his most absurd “miracle” supplements that he’s endorsed. Here’s the key excerpt, and I thank friend of the blog, Dr. Peter Lipson, for taking the time to transcribe it:

Dr. Oz: Well, if I could disagree about whether they work or not, and I’ll move on to the issue of the words that I used. And just with regards to whether they work or not, take green coffee bean extract as an example. Uh, I’m not gonna argue that it would pass FDA muster if it was a pharmaceutical drug seeking approval, but among the natural products that are out there, this is a product that has several clinical trials. There was one large one, a very good quality one, that was done the year that we talked about this, in 2012. Listen, I’ve… Sen. McCaskill: wh..wha..I wanna know about that clinical trial. Because the only one I know was sixteen people in India that was paid for by the company that, that was in fact, at the point in time when you initially talked about this being a miracle, the only study that was out there was the one with sixteen people in India that was written up by somebody that was being paid by the company that was producing it. Dr. Oz: Well, this paper argue that there was no one paying for it, but I have the, four papers, five papers actually plus a series of basic science papers on it as well. But, but Senator McCaskill, what, if I, we can spend a lot of time arguing the merits of whether green coffee bean extract is worth trying or not worth trying. Maybe the things that we argue you do with regard to your diet are likewise criticizable, I mean should you be on a low fat diet, a low carb diet, we b…I spent a good part of my career recommending that folks have a low fat diet, but we’ve come full circle in that argument now and no longer recommend that now, many of us who practice medicine because it no longer worked for our patients. Now it is remarkably complex, as you know, to figure out what works for most people even, in a dietary program. In the practice of medicine we evolve by looking at new ideas and challenging orthodoxy and evolving them. So…so when I hold…these are the five papers, these are clinical papers, uh, and we can argue about the quality of them, very justifiably, uh, I could pick apart papers that showed no benefit as well, but, at, at the end of the day, I have clinical subjects, real people, having undergone trials, and in this case I actually gave it to member of my audience it wasn’t a formal trial, it was just an exch… Senator McCaskill: Which wouldn’t pass…the trial you did with your audience, you would not say that it would ever pass scientific muster. Dr. Oz: No, I would never publish the paper. It wasn’t done under the appropriate IRB guidance, that wasn’t the purpose of it. The purpose was for me to get a thumbnail sketch, was this worth talking to people about or not. But again I don’t think this should be a referendum on the use of alternative medical therapies ’cause if that’s the case then I’ve been criticized for having folks come on my show and talk about the power of prayer. Now again as a practitioner I can’t prove that prayer helps people survive an illness, I… Senator McCaskill: Sure, but it’s hard to buy prayer. Dr. Oz: Hard to buy prayer. That’s the difference. Sen. McCaskill: Prayer is free. Dr. Oz: Yes, prayer is free, that’s a very good point.

The episode on green coffee beans is a true case study in pseudoscience, illustrating the woeful lack of evidentiary standards Oz applies on his show. McCaskill is absolutely right: The clinical trials done on green coffee beans have been small and inconclusive and there is no way to honestly make any definitive conclusions about its efficacy. Yet rather than warning viewers to avoid it, Oz did the exact opposite. He doubled-down on this particular miracle by setting up a dubious clinical trials among his audience and didn’t even bother getting IRB approval (something that’s almost certainly unethical and against his university’s rules for experimentation on humans). Demand exploded to the point that green coffee bean is now the subject of FTC action.

As is the habit for Oz, he didn’t stray too far from his usual M.O. on the show – he extrapolates from weak clinical evidence to make grandiose claims by cherry picking the most supportive strands of evidence to give the impression of being evidence-based. Oz is a believer, no matter what the evidence says. McCaskill called him out directly on this:

I don’t get why you need to say this stuff because you know it’s not true. So why, when you have this amazing megaphone, and this amazing ability to communicate, why would you cheapen your show? – Senator McCaskill

What’s most remarkable with Oz is his simultaneous acknowledgement that the products he profiles lack credible scientific evidence and his simultaneous endorsement of those same products:

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 would give my audience the advice I give my family all the time, and I have given my family these products. – Dr. Oz.

To Oz, his show is actually about protecting the consumer – not misleading them. He even brought a slide deck to the Senate with that title:

Oz claimed that he’s backed off from using hyperbolic terms to describe weight loss products for “two years”. McCaskill, clearly having done her homework, quoted Oz from just 3 weeks ago:

Every time you cheat on your diet, I want you to grab one of these tiny, itty-bitty pills. This tiny tablet can push a lot of fat out of your belly. – Dr. Oz.

Part of the problem

What’s most ironic about Oz is that notwithstanding his weak acknowledgement of the problem with his hyperbole, he still sees himself as the victim. He’s not going to stop his breathless endorsements and quick fixes. What’s most irritating to Oz is that promoters are using his name to promote their products – and he’s not recommending a vendor:

You know … the biggest disservice I have done for my audience? It’s that I never told then where to go to buy the products.

Wrong Dr. Oz. The biggest disservice that you have done for your audience is to abuse your title of physician by telling your audience what you think they want to hear, instead of the scientific facts. While Oz may not be directly profiting from the sale of these useless products, he’s using a platform of trust to give demonstrably bad health advice to millions. It may not be illegal, but there’s no question the Dr. Oz show perpetuates the “quick fix in a pill” mythology of weight loss and distracts viewers away from taking sensible approaches to weight loss. It’s the perfect platform for countless weight loss scams, and it was nice to see Oz called out as a big part of the problem.