We've all speculated about why the anti-scientific emotion-based notion that vaccines somehow must cause autism persists in spite of mountains of evidence to the contrary, but I think the question goes much deeper than that. The anti-vaccine movement is but one of the most visible components of a much deeper problem in our public discourse, a problem that values feelings and personal experience over evidence, compelling stories and anecdotes over science.

I'm referring to the Oprah-fication of medicine. Why Oprah? you may ask. I'm happy to tell you. Oprah Winfrey has been the host of the highest-rated syndicated talk show in television history. She has developed a media empire that few single individuals can match or beat. Clearly, she is a talented and savvy TV host and businesswoman.

Unfortunately, Oprah displays as close to no critical-thinking skills when it comes to science and medicine as I've ever seen, and uses the vast influence her TV show and media empire give her in order to subject the world to her special brand of mystical New Age thinking and belief in various forms of what can only be characterized as dubious medical therapies at best and quackery at worst.

Naturally, Oprah doesn't see it that way, and likely no one could ever convince her of the malign effect she has on the national zeitgeist with respect to science and medicine.

Consequently, whether fair or unfair, she represents the perfect face to put on the problem that we supporters of science-based medicine face when trying to get the message out to the average reader about unscientific medical practices, and that's why I am referring to the pervasiveness of pseudoscience infiltrating medicine as the "Oprah-fication" of medicine.

Over the years, Oprah has promoted a wide variety of pseudoscience and mysticism on her show. Indeed, just last week, Newsweek ran a long article entitled "Live Your Best Life Ever! Wish Away Cancer! Get A Lunchtime Face-Lift! Eradicate Autism! Turn Back The Clock! Thin Your Thighs! Cure Menopause! Harness Positive Energy! Erase Wrinkles! Banish Obesity! Live Your Best Life Ever!" It reveals just how forcefully Oprah and her credulous belief in New Age nonsense are reflected in her show.

It starts with the example of Suzanne Somers, who in January appeared on Oprah to talk about what she does to stay young. As Newsweek (whose story merits quoting) reported, "Each morning, the 62-year-old actress and self-help author rubs a potent estrogen cream into the skin on her arm. She smears progesterone on her other arm two weeks a month. And once a day, she uses a syringe to inject estrogen directly into her vagina."

The article continues, "The idea is to use these unregulated `bio-identical' hormones to restore her levels to what they were when she was in her 30s, thus fooling her body into thinking she's a younger woman." It is noted that Somers claims the hormones, synthesized from plants, are natural and risk free; Newsweek's writer rightly takes issue with the last point. Somers told Oprah that every day she takes some 60 vitamin pills – 40 supplements in the morning, 20 more before going to bed. She begins the day with injections of vitamin B12, the human growth hormone and, Newsweek reports, "wears `nanotechnology patches' to help her sleep, lose weight and promote `overall detoxification.'" After drinking wine she boosts her liver by taking vitamin C intravenously; Somers has chelation therapy to clean her blood if she breathes cigarette smoke.

The actress makes remarkable claims for hormones' ability to aid the human body. "I know I look like some kind of freak and fanatic," she is quoted saying. "But I want to be there until I'm 110, and I'm going to do what I have to do to get there." By Newsweek's account, "That was apparently good enough for Oprah. `Many people write Suzanne off as a quackadoo,' she said. `But she just might be a pioneer... ' "

Oprah's show gave doctors several chances to respond, but they were in the audience while Somers, Newsweek reports, sat onstage with Oprah, who defended her. Oprah is quoted saying "Suzanne swears by bioidenticals and refuses to keep quiet."

I've known for a while that Somers promotes so-called "bioidentical hormones." I've also realized that it is the height of stupidity for a woman who has survived breast cancer to pump herself full of estrogen in the futile and pathetic quest to reclaim her lost youth. It's just begging for a recurrence of her breast cancer. Somers epitomizes the cliché of "I'd rather be lucky than good." Either that, or her cancer was estrogen receptor-negative, but even in that case it's definitely pushing her luck to be bathing in "bioidentical" estrogens.

Oprah, reported Newsweek, "told her audience that she found Somers's bestselling books on bioidentical hormones `fascinating' and said `every woman should read' what she has to say. She didn't stop there. Oprah said that although she has never had a hot flash, after reading Somers she decided to go on bioidenticals herself. `After one day on bioidentical estrogen, I felt the veil lift,' she wrote in O, The Oprah Magazine. `After three days, the sky was bluer, my brain was no longer fuzzy, my memory was sharper. I was literally singing and had a skip in my step.' On the show, Oprah had her own word of warning for the medical establishment: `We have the right to demand a better quality of life for ourselves,' she said. `And that's what doctors have got to learn to start respecting.'"

That statement epitomizes the attitude that infuses The Oprah Winfrey Show when it comes to medical issues and science. Anecdotes trump science, and scientists should "respect" pseudoscience because of feelings and a desire for "quality of life." Indeed, these are exactly the attitudes that permeate the Complementary and Alternative Care movement and the anti-vaccine movement.

But Somers says it's mainstream medicine that doesn't have the facts. "`The problem is that our medical schools do not teach this,'" she is quoting saying in a February interview in Newsweek.

It reported that Somers "believes doctors, scientists and the media are all in the pocket of the pharmaceutical industry," and that "Billions are spent on marketing drugs, and these companies also support academic research." Without such conflicts, "Somers can see things clearly. `I have spent thousands of hours on this. I've written 18 books on health. I know my stuff.'"

No, Somers does not know her stuff. Writing books is no guarantee that she "knows her stuff," particularly given that she clearly does not understand science and cherry-picks references to support her viewpoint, ignoring those that do not. Somers also thinks her self-taught knowledge trumps the understanding of scientists who have dedicated their lives to studying such questions deeply.

The absolute worst of Oprah's protégées is the celebrity spokesmodel for the anti-vaccine movement, Jenny McCarthy. Beginning in the fall of 2007, McCarthy, characterized as having "warrior spirit" and as a "warrior mom," has been a regular guest on Oprah, where she's been given more or less free rein to spread her gospel of vaccines causing autism and her claims that biomedical quackery can "cure" or "recover" autistic children.

McCarthy's promotion of anti-vaccine propaganda and pseudoscience is, quite simply, so egregious and such a threat to public health that even the Oprah-friendly (or Oprah-intimidated) media has become alarmed.

Reporters have tried to get a statement from Oprah. From an article on a recent TV documentary, The Oprah Effect:

"Asked if Oprah or her show endorses McCarthy's views, a representative for Oprah's program said, `We don't take positions on the opinions of our guests. Rather, we offer a platform for guests to share their first-person stories in an effort to inform the audience and put a human face on topics relevant to them.' When McCarthy's views have been discussed on the air, statements from the Centers for Disease Control and Prevention and the American Academy of Pediatrics saying that there's no scientific evidence of a vaccine-autism link have been read."

And from the Newsweek cover story:

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"She declined to be interviewed for this article, but in a statement she said, `The guests we feature often share their first-person stories in an effort to inform the audience and put a human face on topics relevant to them. I've been saying for years that people are responsible for their actions and their own well-being. I believe my viewers understand the medical information presented on the show is just that – information – not an endorsement or prescription. Rather, my intention is for our viewers to take the information and engage in a dialogue with their medical practitioners about what may be right for them.'"In other words, Oprah washes her hands of responsibility for spreading misinformation under the guise of trusting her audience to be able to distinguish good advice from bad advice.

It apparently matters not that McCarthy's claims are based on her belief in autism quackery and anti-vaccine pseudoscience. All that matters is that, by her own narrative, McCarthy has "triumphed" over the odds for the sake of her son. The compelling personal story of "empowerment" thus trumps science, and the only "balance" Oprah feels compelled to provide is a dry statement from the CDC and AAP. Philosopher and ethicist (not to mention blogger) Janet Stemwedel asks:

"Is it acceptable to give any guest you please a soapbox without taking a position on the opinions they voice from that soapbox? Is reading official statements from the CDC and AAP enough `balance' to Jenny McCarthy's views on vaccines ...?

"And, if Oprah and her producers are aware of the Oprah effect (which, really, they have to be, right?), should that awareness of their reach lead them to try to meet a higher ethical standard as far as the foreseeable consequences for giving Jenny McCarthy a soapbox?"

I have two answers to those questions: my answers in an ideal world and my answer in the real world. In an ideal world, my answers would be:

No, simply reading an official statement from the CDC and AAP as "balance" to Jenny McCarthy's idiotic and dangerous views on vaccines, which have led her to a know-nothing activism based on the arrogance of ignorance that is already eroding faith in vaccines. She uses emotion and her son to argue falsely that vaccines cause autism and that various quackery "cured" him (and, by inference, can cure other children with autism, too). Reading a dry statement from the CDC is utterly useless in combating this message. It is nothing more than what I like to call the "token skeptic" who trots out the skeptical viewpoint briefly in a formulaic method.

"Balance," after all, implies that there is enough scientific validity to a view that it is somewhere on the same planet with science. There is no "balance" between Jenny McCarthy and scientists. Jenny McCarthy is, quite simply, completely wrong about vaccines and autism. "Balance" is a sham used by promoters of pseudoscience and quackery to claim a legitimacy that they don't deserve.

In the real world, unfortunately, my answer would be this: If it gets ratings, it interests Oprah. If it fits into her apparent "spiritual" world view, it's all good to her. If it fits in with the "alternative" medical beliefs of her audience, she likes it. If it provides a message of "empowerment" (whether real or not), it is good.

The bottom line is that, when it comes to medicine and science, she is a force for ill. Her intentions may be the best in the world, but that is only why she is the living embodiment of the cliché that the road to hell is paved with good intentions. That's especially true when that same road is also paved with no mental filter of critical thinking to keep out nonsense. With great power comes great responsibility, indeed.

Unfortunately, given the infiltration of quackery into academic medicine, I'm having a hard time determining if Oprah is a symptom or one of the causes of the rise of pseudoscience and quackery over science-based medicine.

David Gorski is a surgical oncologist specializing in breast cancer and an associate professor of surgery at the Wayne State University School of Medicine based at the Barbara Ann Karmanos Cancer Institute.

This story is adapted from a longer piece on sciencebasedmedicine.org.