I didn't think I would be writing about this, but, then again, I seem to say that fairly frequently. Be that as it may, on Friday I wrote about a letter sent to Lee Goldman, MD, the Dean of the Faculties of Health Sciences and Medicine at Columbia University complaining about Dr. Mehmet Oz's promotion of pseudoscience on his television show, which reaches millions. When I wrote my post, my first reaction was somewhat supportive, but with reservations. However, as I read your comments and thought about it some more, I started having second thoughts. Then, over the weekend, I had a rather prolonged exchange on Twitter during breaks in the action at the American Association for Cancer Research (AACR) Meeting in Philadelphia, which I'm attending now. The more I thought about it, the more I became convinced that this letter, written by Dr. Henry I. Miller of the Hoover Institution, and signed by several doctors with ties to the American Council on Science and Health (ACSH), was an incredibly bad idea. This evolution in my thinking was helped along by other developments over the weekend.

I'll explain. I also might regret having continued my commentary, but, then, when did that ever stop me before? (Actually, you'll never know when, if, or how many times that's ever happened.)

In my post, I also described my discomfort with Dr. Miller and the signatories of his letter. For instance, the Hoover Institution isn't exactly known for its promotion of good science, given its history of denialism with respect to human-caused global climate change. Then, of course, I'm not exactly a big fan of ACSH, either. It's frequently on the right side of science, but seemingly only when that position aligns with industry positions. It's the reason why I didn't accept an offer to be on the board of scientific advisors of ACSH a few years ago.

Before I go on further, in the interests of full disclosure, I must confess my own issues with the approach Dr. Miller and his cosignatories took. As many of you know, there have been several attempts by quacks and antivaccinationists over the years to make trouble for me at my place of work. Not too long ago, a patient of Stanislaw Burzynski complained to my dean about my posts deconstructing her testimonial that she has been telling as "evidence" that Burzynski cured her of advanced breast cancer. As odd as it seems given how vociferously critical I have been of Dr. Oz's promotion of quackery on his TV show (remember, I'm the one who coined the term "America's quack" to describe him), I must admit that seeing Miller make trouble for Oz at his job over his extracurricular activities rubbed me the wrong way. True, I suppressed my distaste when I wrote my post last Friday, so powerful is my dislike for Dr. Oz and what he does on his TV show. But it didn't stay suppressed for very long. It has been argued that with Oz it's different, because Oz promotes quackery while I promote (or at least like to think I promote) good science and medicine, but even if that's true I can't help but remember that a key purpose of a letter to a person's employer is intimidation into silence or, in Oz's case given his popularity and the security of his position, to cause embarrassment and to provoke a response.

Now here's the problem. Regardless of whether I think it's a good idea or not or simply an attempt at bullying to write a letter like this, and even though Miller's letter was correct from a scientific standpoint about Dr. Oz, if you're going to write a letter like this it's generally a good idea to know what your goal is in doing so. What, exactly, is it you're trying to accomplish by writing a letter like this? Is it to get Dr. Oz fired? That's never going to happen, given that Dr. Oz has tenure and, unfortunately, it would take a hell of a lot before a university would try to remove a tenured professor. Indeed, as I've sarcastically mentioned, given that Dr. Oz is the director of the "integrative medicine" program at Columbia, promoting the "integration" quackery with science-based medicine is basically a big part of his job description! In a real world, that wouldn't be the case and what Oz does would be a problem, but, thanks to quackademia, it's no longer shameful to do that; whole divisions and departments in various academic medical centers are devoted to it. Oh, sure, quackademics like Oz wouldn't accept that characterization of what they do as valid, but I would counter that, other than featuring psychics like John Edward or Theresa Caputo on his show, what Oz does on his show is not really much different in terms of message than what he probably at Columbia: Promote acupuncture, naturopathy, homeopathy, and traditional Chinese medicine, among other things. Again, surely Dr. Miller must know this. so I assume that his goal was not to actually get Dr. Oz fired. Indeed, Columbia issued a statement supporting Oz on the grounds of academic freedom very rapidly, and, even in the unlikely event that Columbia were to fire Dr. Oz over his show, it would remove one of the likely strongest restraints that keeps Dr. Oz from going even deeper into the woo.

So what was Dr. Miller's goal?

Obviously, it was to create embarrassing publicity for Dr. Oz and Columbia University. After all, if Dr. Miller were really looking to cause problems for Dr. Oz he should have at least mentioned that Dr. Oz did a "made for TV" clinical trial he dubbed the "Green Coffee Bean Project" without bothering to obtain institutional review board (IRB) approval, something that is a direct violation of Columbia University and New York Presbyterian Hospital's (NYP) Human Subject Research Protection Program, which explicitly requires IRB approval for any clinical trial done by any Columbia University faculty member and NYP-affiliated faculty regardless of regardless of the location where the research is done. Now, as I pointed out, there is a slight gray area here, because clearly Oz's dubious green coffee bean clinical trial was not federally funded, but institutions that receive federal funding are required to abide by the Common Rule, which requires IRB approval of all human subjects research. Miller was either unaware of this issue, didn't realize that this was really the only "in" skeptics have to get Columbia to pay attention, or didn't care about it because what he really cares about is Oz's attack on GMOs. Mentioning that Oz conducted a dubious clinical trial for TV that was not approved by the Columbia/NYP IRB would have been a far more damning thing to mention with respect to possibly forcing Columbia to do more than issue a brief statement full of bromides about "academic freedom" than his pointed mention that Dr. Oz trashed GMOs on one of his shows.

In any case, as thoughtlessly as Miller and the ACSH acted, they did managed to get a fair amount of national press coverage, and the ACSH is virtually giddy over the press reaction:

Although, for years, Oz has been criticized in countless blogs and opinion pieces, which have appeared on a wide variety of websites, this is the first time that a coordinated effort to expose Oz for who he really is has generated a massive and unified response. It also puts Columbia University in the position where they have to either take action or defend their actions, or lack thereof. ACSH’s Dr. Josh Bloom, a long time, vocal critic of Dr. Oz said, “Every once in while the right thing happens. This is one of those times. The line between ‘doctor’ Oz and ‘TV personality’ Oz has been blurred for a long time, leading many American’s to equate the two, and, in doing so perpetuating the ‘fame equals credibility’ myth. Dr. Miller’s letter has done much to dismantle this myth. It is well past the time that people finally learn the difference between real medicine and entertainment.”

Um. No. Dr. Miller's letter created a momentary press kerfuffle that is fading. One little letter to Dr. Oz's dean is not going to "dismantle" the myth that "fame equals credibility." To claim otherwise is the height of hubris. In fact, if there was a recent event that did more to tarnish the Dr. Oz brand, it was Senator Claire McCaskill's magnificent roasting of Dr. Oz in front of her Senate panel over his breathless promotion of various dietary supplements as the latest, greatest weight loss miracle ever. Then, late last year, the British Medical Journal published a study that showed that half of what Oz recommends on his show has either no or little evidence to support it. Indeed, if you want to see how far Dr. Oz's star has fallen, just witness what happened last November, when Dr. Oz's social media team asked Twitter to ask him questions under the hashtag #OzsInBox and Twitter went wild mocking him for his promotion of quackery.

In fact, part of the reason I've come to conclude that Dr. Miller's letter was a spectacularly bad idea is that it appears ready to backfire on him. That's because one thing Miller accomplished without a doubt is to piss off Dr. Oz. (No doubt that was intended.) Don't get me wrong. I'm all for pissing off Dr. Oz over the TV snake oil peddler he's become, but, I wonder, did Miller stop to think what the consequences might be if he actually succeeded in publicly embarrassing Dr. Oz in the national media without a clear idea of what his endgame would be? I don't think so, and Dr. Oz is in the process of responding. First, Dr. Oz released this statement on Facebook:

I bring the public information that will help them on their path to be their best selves. We provide multiple points of view, including mine which is offered without conflict of interest. That doesn't sit well with certain agendas which distort the facts. For example, I do not claim that GMO foods are dangerous, but believe that they should be labeled like they are in most countries around the world. I will address this on the show next week.

Basically, you can see where this is going. Dr. Miller is a huge booster of GMOs, having served as the founding director of the FDA Office of Biotechnology, and you can bet that it didn't pass unnoticed that what provoked Miller to write his letter was not so much Dr. Oz's promotion of quackery but rather a specific fear mongering segment on The Dr. Oz Show about GMOs, in particular the non-browning apple. Not suprisingly, in his response, Dr. Oz is painting himself as not being anti-GMO but only "pro-information." What will Oz say in his show next week? I think there's a good hint in the insinuations in his brief statement above.

While Dr. Oz is, for the moment, predictably taking the high road, his admirers and fellow travelers, equally predictably, were not. Predictably, they were attacking Miller and his cosignatories as industry shills. The batshit crazy version of this shill gambit comes from—who else?—Mike Adams, in a pair of posts, entitled Vicious attack on Dr. Oz actually waged by biotech mafia; plot to destroy Oz launched after episode on glyphosate toxicity went viral and Mainstream media FAIL: Sleazebag doctors attacking Doctor Oz have histories of criminal fraud and ties to Monsanto's "Discredit Bureau". Indeed, if you want to see a textbook example of an ad hominem attack, look no further than to Adams' repeating allegations against John Entine that he physically abused his wife, which, even if true (and I haven't been able to find any source other than Mike Adams to back up this claim, although the court documents look authentic), has nothing whatsoever to do with whether or not his arguments about GMOs are correct from a scientific standpoint.

Mike Adams was, as far as I could tell, first out of the gate with the shill argument, and, Mikey being Mikey, he turned the crazy up to 11. However, there are people who are much more in control of their impulses and whose business model doesn't depend on being as incredibly outrageous and incendiary in his rhetoric as Mikey's does. For instance:

It is important for physicians who invoke their medical degrees while endorsing products to make their allegiances and financial ties very transparent — and Dr. Oz deserves to be held to this standard. But by that standard, Dr. Miller and other self-described “distinguished physicians” on this letter also have some explaining to do. Miller, whose employer, the Hoover Institution, is often described as a “Republican-leaning” or “conservative” think tank, has interests of his own. A molecular biologist by training, Miller spent 15 years at the FDA before his fellowship at Hoover; throughout both jobs, he has been a consistent and ardent promoter of genetically engineered foods (or GMOs — the “O” standing for “organism”). And in his advocacy, Miller is positively prolific. A quick web search reveals dozens upon dozens of articles and opinion columns touting the benefits of GMOs to consumers, developing economies and agribusiness — and a seemingly equal number attacking those that warn about the possible risks of what are sometimes called “Frankenfoods.” Miller was a leading voice in opposition to California’s Prop. 37, the 2012 ballot initiative seeking clear labeling of products containing GMOs, and, in the 1990s, was an equally prominent voice in a tobacco industry-backed campaign to discredit the science linking cigarette use and cancer.

You get the idea.

The same meme is showing up in even mainstream media accounts. For instance, in this segment Bob Arnott, former NBC Chief Medical Correspondent echoes the very same "shill" argument, saying that all ten signatories have "industry ties" and that the industry is "furious that he's [Dr. Oz] has taken on genetically modified crops" and described the letter signatories as "industry henchmen who are after Dr. Oz." He even mentioned that the current acting president of the ACSH, Gilbert Ross, spent time in prison for Medicaid fraud. Heck, Arnot even accused ACSH and Miller of astroturfing. True, he does say that Dr. Oz peddles misinformation that would be like a "Brian Williams scandal" if it were on network TV and unfavorably compares Dr. Oz with Sanjay Gupta on CNN, but his attack on Miller and company is devastating.

And, yes, this is the way that Dr. Oz is going to go, as shown in this story on CNN Money (appropriately enough). Dr. Oz is planning to devote a full episode, probably Thursday's, to a response to the accusations of quackery. In other words, he's taking advantage of the letter to gin up his ratings, and his attacks will resemble, no doubt, a toned down version of Mike Adams' attacks. No, he won't mention domestic violence, but you can bet that he'll mention Dr. Ross' conviction for Medicaid fraud and Dr. Miller's past advocacy. You'll be amused at the rationale:

The special episode "is the last thing we want to do," a person associated with the show said on Sunday. But Oz and his representatives have concluded that it is necessary because of the "intimidation" they perceive from the doctors.

Nonsense. Dr. Oz's producers see a chance to take advantage of the publicity and to strike back at the same time. Dr. Miller threw his best punch, and now Dr. Oz is going to punch back:

Oz won't just read the one-paragraph statement he issued last Friday. Instead, he'll devote the majority of the episode to his response. "We plan to show America who these authors are, because discussion of health topics should be free of intimidation," a spokesman for the show said. The details, including the Thursday air date, are subject to change. The episode will be taped on Tuesday or Wednesday.

Can Miller take what Oz dishes out? Probably. Does it matter? Probably not. Is Miller's message about Dr. Oz's promotion of quackery and pseudoscience going to get lost in the counterattack that will paint him and his cosignatories as industry shills seeking revenge on Dr. Oz for having questioned whether GMOs are safe? Almost certainly.

In fact, I'll go even further and suggest that Miller's letter, after the initial embarrassment it caused Dr. Oz, is probably now seen by him and his producers as a godsend that gives them the pretext to counterattack and to tar all the physicians—not just Dr. Miller and company, but other bloggers, me, and all the rest of us who have been criticizing Dr. Oz for the last five years over his promotion of quackery and pseudoscience—as being industry shills of some kind and to make it stick in the public mind. I'm sure he'll find a way to go after Julia Belluz over at Vox.com as well, given that her excellent article on the making of Dr. Oz as a quack (my interpretation) was published the same week as Miller's letter. That's the narrative Dr. Miller has handed to Dr. Oz on a silver platter.

I tend to be a bit conservative in my preferred tactics taking on pseudoscience like that promoted by Dr. Oz, tending to prefer countering his misinformation and supporting activities like Ben Mazer's careful documentation of patients who have been harmed by Dr. Oz's medical advice. More recently, Ben has been working to persuade the AMA to issue a public statement that "reiterates the importance of evidence and transparency to the profession" while asking the AMA "to craft guidelines on how doctors can ethically use the media to help the public" and "to issue a report on what disciplinary pathways might be available for doctors who continue to spread bogus medical information in the media."

I'm not opposed to splashy PR moves in general. I just think that they should be smart and thought through, with a definite goal in mind other than stirring up trouble. Dr. Miller's little publicity stunt failed this test on every level, and, worse, could wind up backfiring spectacularly, leaving the rest of us who care about all the quackery Dr. Oz spreads, not just his fear mongering about GMOs, to deal with the consequences.