Friday, January 31, 2014

Is it safe to take advice from the Dr. Oz Show? Judge says it's at your own risk.

America's Doctor?

Since his earliest appearances on The Oprah Winfrey Show, Dr. Mehmet Oz is often referred to in the media as America's Doctor.  With his weekday daytime TV show reaching an estimated hundreds of thousands of households (although reported to be dwindling), a significant number of Americans have come to take advice from him as if he was their personal doctor. They have opened their hearts and minds to him as if he were the doctor who examined them, knows their medical history, overall lifestyle, and daily psycho-social challenges, and has assumed responsibility for their health; a doctor who only has their best interests at heart. In an era of ubiquitous health advice found on the web, in print media, and TV, and an increasing reliance on such advice by the general populace, it would not seem to be too far-fetched to take medical advice from Oz, a licensed and practicing physician who can legally dispense such advice. Or would it be?

My Doctor Said...

One gentleman named Frank Dietl, 76, who lives in Southampton, New Jersey, thought it was safe to take such advice. Not a good move. Here’s what happened to Frank after watching the April 17, 2012, episode of the NBC show titled "Dr. Oz's 24-Hour Ultimate Energy Boost Plan," during which Oz offered advice on what he called "my night sleep special." 

Oz’s advice centered on a "Knapsack Heated Rice Footsie," a pair of socks with uncooked rice -- "just enough to fill the toe of the sock" -- and heated in a microwave oven. He told his audience to "put this in the microwave until it's warm [and then]…put the socks on your feet and go to bed.”  According to Oz, "when you do this and lie for about 20 minutes with those socks on in bed, the heat will divert blood to your feet to your heat" and "when your feet get hot, guess what happens to your body. It gets cold. Your body will automatically adjust its core temperature and as it gets cooler, you're going to be able to sleep better because your body has to be cold in order to be sleepy. He recommended this in combination with a cup of Rooibos Tea to reduce "tensions, headaches and irritability," would help facilitate sleep. He went on to add that "If you can do this the right way, you're going to be thanking me for years to come."  

Dietl, a diabetic with peripheral neuropathy in his feet, which means he has loss of sensation, followed Oz's advice thinking it applied to him because Oz made no verbal disclaimers (discussion ahead on Oz's written disclaimers). The result was that due to Dietl's inability to feel that the socks were too hot, he suffered third degree (the worse type of) burns.  He sued Dr. Oz and his producers and distributors -- including co-defendants NBC, Sony Pictures Television, ZoCo Productions and Oprah Winfrey's Harpo Productions-- claiming that Oz neglected his "duty and obligation to warn viewing audience as to the possible effects of following the advice offered" and "to warn against certain effects of said medical advice as to those persons suffering from other additional medical conditions."

Specifically, the civil lawsuit filed in a New York State court stated that "Dietl was severely injured, bruised, and wounded, suffered, still suffers and will continue to suffer for some time physical pain and bodily injuries and became sick, sore, lame and disabled and so remained for a considerable length of time." 

Oz Is Not Your Doctor

Six months later, in October 2013, Oz deservedly had the lawsuit against him dismissed because the judge in the case felt that no doctor-patient relationship existed between Dr. Oz and his studio audience.  According to Judge Saliann Scarpulla who wrote in a brief decision dismissing the claim, the plaintiff, "Dietl has pointed to no authority that would lead this court to find a duty of care between a television talk-show host and his vast home-viewing audience, and Dietl fails to convince this court that creating such a duty would be sound public policy."

At the hearing, Dietl's attorney told the judge that what the plaintiff was arguing was not a "quasi physician-patient relationship" but that Oz still breached a duty of care by providing negligent medical advice. Specifically, Dietl believes that Oz should have warned the audience of the dangers related to the at-home remedy if not properly prepared as well as the dangers if the audience had prior medical conditions.

The judge, however, still believed this argument amounts to one of a physician-patient relationship and was unwilling to accept a legal theory that would create a duty of care just because a physician looks into a camera and addresses an unseen audience.

For once, I have to side with Dr. Oz and agree with the judge. 

The Oz Disclaimers

I think Dietl's first mistake was not heeding the fine print on the disclaimer that flashes on the screen at the end of each Dr. Oz Show episode.  Here's the disclaimer:

“Please note: This show is only intended to provide general information and is not specific medical advice.  You should consult with your own healthcare professional before altering or beginning any course of treatment.  ZoCo is not responsible for any losses, damages or claims that may result from your medical decisions and you are strongly encouraged to do your own research prior to any medical decisions you make." 

On Oz's website, which contains summaries of his shows plus other info, the disclaimer goes even further, when it states "This website is for informational and entertainment purposes only and is not a substitute for medical advice, diagnosis or treatment."

Now try to imagine your reaction if your own doctor made such statements to you. Some people may say that these disclaimers are merely a protection against lawsuits in a highly litigious society and Dr. Oz really does want you to take his advice--given all the research he claims has been done by his "team" in vetting such advice--without consulting anyone else. If you’ve watched his show then you heard him say words like "I'm telling you what to do."  

Should You Take Medical Advice From the Dr. Oz Show?

Nevertheless, a judge says the Dr. Oz Show does not have a doctor-patient relationship with you. The disclaimers on the show and website state that Oz and his guests don't expect you to take their medical advice without first consulting a legitimate source. The disclaimer states don't just take their word on anything, do your own research. 

Dietl’s second mistake was taking medical advice from a TV show that offers such advice for “entertainment purposes only” and may not care what happens to you if you take such advice because if it did, the show would otherwise explain the associated dangers like you may burn yourself. Or when Oz says everyone should take a baby aspirin, he would warn about possible bleeding and other horrible side effects (like one I got).

I think the facts are clear. The Dr. Oz Show is pure entertainment and as the show displays on its own, the info provided “is not specific medical advice” and “you are strongly encouraged to do your own research prior to any medical decisions you make  

Finally, really good advice from the Dr. Oz Show.

Tuesday, January 28, 2014

The Longevity Paradox: Why Is Living to 100 Easier for Some People Than Living to 90 is For Most?

Are you curious to know the 'absolute rules' that if followed will always add many more years to your life? 

If you are reading this expecting me to provide you with such rules, let me apologize in advance.
I have searched for them for the past three years by speaking with over 1,000 senior citizen patients, including several over one-hundred years old, and by reading over 50 books, 40,000 clinical studies/abstracts, and countless online articles, and I am sorry to say that I don't believe they exist. Among books like The Blue Zones, The Longevity Project, Successful Aging, The Art of Living Long, A History of the Human Body, etc., I just can’t find any clearly proven advice. I’ve studied material from the Okinawa, New England, and Albert Einstein College of Medicine Centenarian studies, read publications from the SENS Research Foundation and available proceedings from International Longevity conferences. 

The reason there doesn’t seem to be any absolute right answer is because when it comes to living fifteen or more years beyond the average life expectancy there appears to be a paradox. (In fact, in the late 90s, a compendium of studies was published with the title, The Paradoxes of Longevity.)
Take smoking for example. There is no question regarding the association of cigarette smoking with lung cancer. Cigarettes are considered dangerous and responsible for producing debilitating lung diseases, which can sometimes—but not always--be lethal. Not every cigarette smoker develops lung cancer, and for that matter, not every lung cancer patient previously smoked or had major exposure to second-hand fumes or other chemicals.   

In Daniel Buetner's book The Blue Zones, he reveals five places, such as Sardinia, Italy and Nicoya, Costa Rica, scattered around the globe that harbor relatively high concentrations of centenarians, people aged over 100. He ascribes their longevity to living a certain healthy lifestyle. It often comes down to the food they eat, the physical activity they do, their attitude towards life and family, etc.  However, in these same areas there are plenty of friends, family, and neighbors who lived remarkably similar lives and yet died much earlier. Not surprisingly, in searching out the life expectancy for these ‘Blue Zone’ areas, I found that they are for the most part only a few years higher than life expectancies in other parts of the world with far fewer centenarians and that’s after you average in the centenarians. 

Yet, books and articles are published incessantly offering the ‘secrets’ and ‘keys’ to living to 100 if you follow a few similar rules such as eating properly, being physically active, getting the right amount of sleep, managing stress well, being social, etc. But do these actions always matter? If you lived the optimal life, will you add many more years to your life? The answer is complicated.
For some people, living a sub-optimal life may result in premature death such as in the case of the morbidly obese person who develops heart disease and type 2 diabetes, and succumbs early. Commonsense and plenty of supporting science affirms the notion that certain lifestyle activities, such as a sedentary life and poor eating habits may lead to premature chronic diseases such as diabetes, heart disease and cancer. But, ‘may’ is not always. 

To prove my point, let me share my own recently completed informal, admittedly unscientific, but revealing research project. The project involved accumulating all the stories about centenarians published online in 2013. Most of the stories were identified through a Google alert email for the keyword "longevity." After identifying over 50 stories, I searched each story for the centenarians' 'secret' or 'key' to longevity. I created a chart of the first 50 individuals I randomly came across that offered a reason for the centenarian's extended longevity.

Here are the results.  

The oldest centenarian was 114, with many having turned 100 just last year. 35 were women and 15 were men.
Here are the reasons they gave. It adds up to 50+ reasons because some offered more than one:
18 attribute it to (hard) work and physical activity

10 attribute it to regular alcohol consumption

6 attribute it to strictly never drinking or smoking

14 attribute it to a good attitude towards life and/or to their faith

1 to Anacin pills

1 to love of roller coasters

1 to good doctors

1 to cafe lattes (long before they became popular)

1 to marrying a man thirty years younger

1 to eating bacon

1 to eating Italian food

1 to eating junk food

1 credited  cigarettes and 1 credited cigars (and yet, no lung cancer)

2 claimed no explanation

Since I put this chart together, I came across four more stories for 100, 104, 108 and 109 year
olds. The 100 year old claimed his longevity was due to eating lots of strawberry ice cream,
just like his father did, who lived to 104. The 104 year old credited her longevity to her love
of eating chocolate and drinking hot chocolate.  The 108 year old stated that it was in part
due to never marrying and avoiding the accompanying decades of stress. The 109 gave her
key to longevity as not eating a lot and never between meals.

Now as you review this list, it should be clear that there were no absolute reliable and
consistent reasons as to why any of them lived past 100. In fact, scientists at Albert Einstein
College of Medicine and at Boston University, who have been studying centenarians for many
years, concur that there is no single absolute explanation for centenarian longevity. The current
thinking is these longevity winners possess a number of small genetic variations that work
together as a group to confer benefit to them. According to Thomas Perls, a Boston University
professor of medicine and director of the New England Centenarian Study, "Twenty percent of
the population has the genetic wherewithal to get to be 100."

So what does that mean for the eighty percent that represent the rest of us who may not enjoy
such gene variations? Should we even bother to engage in a healthy lifestyle if there are no
guarantees or absolutes? Why deny ourselves that piece of chocolate cake or bother to get out
of our chairs and move at all if good health and longevity simply come down to winning the
gene lottery?

The answer is that even though there are no absolutes when it comes to your health, there are
probabilities and possibilities.

A healthy lifestyle increases the probability of a healthy life even as the possibility for poor
health, like the inexplicable cancer, still exists. An unhealthy lifestyle increases the probability
for poor health like heart disease and cancer, even though the possibility does exist that you
will escape such devastating illnesses and still live to 100 like the few who did in the review
cited above. On this point, the preponderance of scientific evidence is clear, although not
absolute. For me it all comes down to what Louis Pasteur once said, which is that "Chance
favors the prepared mind." In other words, sometimes we make our own luck.

So the next time you read an article claiming that one thing or another is the absolute way to good health and extended longevity or books like Grain Brain or Wheat Belly that claim that certain foods are absolutely bad for you, you should realize that such absolutes simply don't exist (although I can't only say that with absolute certainty).

So beware of people claiming they have absolute answers for you. They can't be certain; no one can today, although the future may tell a different story (See my previous post about the inevitability of death).

The old adage that one man's poison may be another man's food should come to mind. What works for one person, may not work for another. You may still live to 100 by eating junk food, smoking, and never exercising. You won’t be the first and probably not the last. You could also win the next Powerball lottery. But if I were you, I wouldn't place all my bets on it, especially, when it's your life and health at stake. 

 I can’t tell you if that’s an absolute lesson worth learning, but it’s pretty darn close.

Monday, January 27, 2014

Whom Can You Best Trust For Good Health Advice?

I recently read a number of articles regarding patients who either second-guess or greatly mistrust their doctors.  Under such circumstances, this apparently increasing number of patients fail to adhere to their doctor's direction(s) and either do not fill prescriptions, take their prescriptions sparingly, or take action contrary to the doctor's advice.

This may not be surprising given the ubiquitous nature of health advice now available through various media outlets, including, TV, radio, print and internet, almost countless newsletters put forth by universities, government, non-profits and commercial entities, and a whole slew of unrelated websites. Scenarios often play out that patients consult such sources prior to the physician visit or immediately thereafter. With many patients feeling that their doctor hardly spends enough time with them, with visits often lasting between 6 and 15 minutes, and with the doctors on average interrupting patients within 26 seconds of explaining why they came in, it isn't surprising that patients are growing more suspicious and turning to alternative sources.

It that wise? The answer is both yes and no. It is wise to become an active participant in your health care and there is beenfit in reading up about your disorder and prescribed treatment. But second-guessing or ignoring your doctor's advice without informing him or her is not prudent. Relying on some alternative generic media source that isn't specifically aware of your medical history, gender, social and family history, lifestyle and diet, stressors, support system, etc. can be outright dangerous. When dealing with alternative practitioners, you could be believing and following the advice of a less qualified and educated person than your physician. Just because they give you the time, and show great compassion and understanding, doesn't make them more capable of helping you.

I'm not saying that there aren't alternatives to prescriptions and that sometimes one is actually better off with such alternatives.  What I am saying is that it's hard to know when you have come across such a viable alternative when such sources usually want to profit from their advice by selling you something (yes, it's true, physicians also profit from their advice, but they usually don't sell things). Even when they don't try to sell you something, the question remains are they strictly relying on science that has been properly vetted or are you just a guinea pig.  My experience is that many of these sources often overstep their boundaries and advocate for unproven or even sometimes repudiated solutions. Worse, they can load you up with a potentially dangerous combination of pills.

A friend of mine, whom I recently helped, was put on a total of ten dietary supplements, some multiple times a day, by a nutritionist for what he said was basically a history of constipation and a family history of diabetes. A thorough review of the supplements revealed that there was much overlap between the products, with some of the nutrients reaching levels more than 50 times the recommended dosages.  Nevertheless, my friend told me that the supplements had solved the constipation. As we continued to speak, he added that he was also taking aloe vela for the constipation, which turns out to have good scientific evidence to support its use for this indication. I explained that he could eliminate all the other products and take the aloe vela alone with some additional fluids to see if that worked for him.

By the way, it took me over 45 minutes to look up and review the ten products, and total the dosages due to the multiple takings, and over an hour to explain to my friend the pros and cons (more cons than pros) of taking the products he was on. The key point I eventually shared was that the risks of combining all these products was unknown and the benefits associated with some of the products were either limited or known to be worthless. The final analysis presented an unknown risk versus limited benefit, and therefore, logic dictated that he should stop taking the pills.

Obviously, you may not have a friend like me who can spend nearly two hours uncompensated reviewing your medical situation with a knowledge of both medicine and alternative medicine,and who can advise you without an agenda.

So what can you do?

I think it starts with finding the right physician, someone who has invested at least a modicum of time in understanding that the prescription pad is not always the first, best, or only solution. Find a physician you are unlikely to second guess and/or with whom you will not feel uncomfortable voicing your concerns. A good physician remains your best bet for getting good health advice as opposed to lots of other people prescribing untested, unregulated, and possibly dangerous alternatives. I know that it's not easy to find such a physician, but it's unlikely if not impossible if you don't look. So instead of spending hours on the internet reading every article you can find about what ails you, invest in a search for a physician with whom you can develop a more trustworthy relationship.

Physicians are not perfect. But at least they are regulated and monitored and if you want to improve your odds of getting good health advice, they are still your best bet.  As Mark Twain once quipped, "Don't take advice from a health book. You could die from a misprint." This advice equally applies to websites, TV doctors, and various other media and print sources. They almost always have a statement disclaiming any responsibility for what happens to you. When was the last time your doctor gave you such a disclaimer?