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Dr. Brian McDonough:
It is a dramatic study, a British medical journal report, which takes a look at shows like Dr. Oz, The Doctors, and other popular shows and says that as much as 50 percent of the information is not evidence based. Joining us today is Chief Science Officer, Dr. Joe Perrone. He is with the Center for Accountability in Science, and he is a researcher who takes a look at this and other issues that more or less measures the education that we get through the media. If you want to know a little bit about Dr. Perrone’s background, he has his Doctoral Fellowship from Harvard University, graduate of the University of Delaware, and he’s worked closely with many funding agencies in the Ministry of Health to develop strategies for the use of diagnostics in public health programs, and he’s served as Vice President for Business Development and Technology Transfer for the University of Maryland Biotechnology Institute. He also worked with the World Health Organization, so your background is varied. When you look at programs like this, where the public takes the information and sometimes they act on it, what is the obligation of people who are hosting programs like that?

Dr. Joe Perrone:
Well, I think the obligation for me is rather obvious, is that they relay to the audience that the information that they’re portraying may have an anecdotal piece of evidence, but not necessarily a compelling amount of evidence. I would even suggest that they, unless they know that a particular recommendation or intervention that they are suggesting it has a consensus of good science behind it, that they not present it. Or if they are going to present it, present it in a way to perhaps even warn the audience to be careful about claims that are made by other groups and other people, about certain interventions and probiotics, or whatever the case may be, that the claims made are, or could be, rather questionable. So I think that’s where their primary obligation would lie.

Dr. Brian McDonough:
When you look at the British Medical Journal report, what they did was they looked at a representative sample of about 479 recommendations from Dr. Oz and 445 recommendations from The Doctors. According to their study, they said one in three and one in four of the recommendations by Dr. Oz and The Doctors, respectively, had no evidence that could be found behind their statements. That is a large piece of information that 20 to 25 percent, or 33 percent of the information is not evidence based, especially in a world where most of us are being raised when we talk with our patients, that we should be giving evidence-based recommendations.

Dr. Joe Perrone:
Oh, no, absolutely, and I think that’s why this study has gained so much traction. Is that it’s the most recent study that has been more comprehensive. There have been other comments by other scientists, researchers and clinicians over the years on a one off type of thing on one particular recommendation that they’ve made, but I think this is the most broadest one in which the authors of this particular study basically took a random sample of 40 episodes of The Doctors, and 40 episodes of Dr. Oz, and looked at what they called strong recommendations, and what I call sort of more fuzzy type of recommendations, and looked to see if there was absolute science behind what they were proposing. As you said, on average, about 40 percent of the recommendations had no real scientific basis for a recommendation being made for the use of a particular bean or diet or something along those lines. Yes, this is rather scandalous, but you know, it really falls on the heels of Dr. Oz having to sit before Congress also a few months ago.

Dr. Brian McDonough:
Well it’s interesting when you bring that up. Certainly that got a great deal of attention, as well it probably would, to have a physician in front of Congress. That it got to that point, but that the programs continue. Is that a concern to you?

Dr. Joe Perrone:
Well, I’ve been watching the program more and more now and have been recording it afterwards, and I think Dr. Oz has toned down a lot of his miracle cures. I am not seeing much of those any more.

Dr. Brian McDonough:
So that’s good obviously for a lot of reasons. Now in fairness to Dr. Oz and to The Doctors, really, as someone who has worked in the business for 25-30 years in broadcasting, I do medical news reports, so I report on studies. They’re one-minute spots, I do a program like Primary Care Today where we talk about information, but it clearly isn’t the entertainment side of things. The Doctors and Dr. Oz, let’s face it, it’s about ratings, it’s about numbers, it’s about syndication. The dollars are big, but you really are on the same realm as Dr. Phil, Oprah, Geraldo, Maury Povich, and right down the line. That’s who they’re competing against. Do you see concerns that a health program is in that type of venue, because there is a lot of pressure obviously to stay on the air, compete, and get those numbers? If you just talk about basic information, like it’s important to exercise, the best way to loose weight is through proper diet and caloric balance, you may not get those big numbers hour upon hour.

Dr. Joe Perrone:
I think you hit the nail on the head. Yes, it is a concern about these particular shows that are geared towards a lot of entertainment value. We have been talking in the office and talking with other people about this, and really I think again you’ve touched upon a very important characteristic of these shows. Over the years, they must have had probably 100 different dietary programs for people to lose weight, when I think Dr. Oz and The Doctors know very well that if you were to recommend people that, look, you have a solid balanced meal every day, don’t overeat; I know that sounds very easy, but you would not have an episode after that. So I concur completely that this is an issue. I think they can make real medical issues entertaining. I think Dr. Oz actually does a good job on some of that when he talks about medical and disease conditions. He also touches upon things that are, I would say, a little bit distasteful that one would not want to have over a dinner conversation. And one of the episodes I saw that I thought was very important, and quite informative was when he was telling people that they really should take a look at their poop. That is something that is very important, and it is not something that comes up in normal casual conversation, as you might imagine.

Dr. Brian McDonough:
If you are just tuning in, you are listening to Primary Care Today on ReachMD. I am Dr. Brian McDonough, your host, speaking with Dr. Joe Perrone. He is Chief Science Officer with the Center for Accountability in Science, taking a look at a study in the British Medical Journal, which took a look at shows, in particular, Dr. Oz and The Doctors. They probably could have picked some others, but clearly these were two of the leading medical shows. It’s interesting that there was not a report about Sanjay Gupta, CNN, and what I would call more news-oriented hour specials such as that, where it appears at least that there isn’t as much of the drama and histrionics as in these other shows.

Dr. Joe Perrone:
Well, again, as we discussed earlier on, these people command a significant audience and much more than Dr. Gupta does or CNN; it is a news spot. This is a dedicated half-hour program to health, both The Doctors and Dr. Oz, or an hour, excuse me, and they’re big business. Consequently, when you’re in the forefront, people tend to look at you a little bit more than when you are picking up the rear.

Dr. Brian McDonough:
Now you mentioned, and I agree with you. I don’t see Dr. Oz as much as clearly you’ve been watching it and making it your business to look at him and understand what’s going on, I don’t see him quite as much, but I certainly, like most people, have seen him on occasion. And it is entertainment and clearly there is the ability to keep the guests for a long period of time, but he also has a traditional medical background. He certainly has practiced at certain points in his career, and he’s been able to see patients and know what patients are all about. So with that all in mind, do you think appearing before Congress and having to deal with that maybe more or less put him in a position where he felt I have a great obligation to do this in a different way, or do you think it’s maybe just a change in programming?

Dr. Joe Perrone:
Well I can’t speak to his motivations of course, but I would guess that it probably spoofed him a little bit. I think this British Medical Journal is probably going to take The Doctors’ and Dr. Oz’s producers back into the conference room and to discuss how they’re going to want to move forward. But yes, Dr. Oz does apparently still see patients, and look, he’s very personable, and he’s quite knowledgeable, and I would have a sneaking suspicion that his patients trust him tremendously, so I doubt that he is going to lose any patients at least. How long this show ultimately survives will, I guess, depend on continued ratings and whether or not this British Medical Journal article explodes into a greater issue around the kind of advice that he is giving to people and the ethics of doing that in consideration of his continuing to have a medical license.

Dr. Brian McDonough:
Dr. Perrone, we talked a little bit about evidence and the roll of evidence, and clearly our audience is well aware of the importance of using evidence-based decision making as part of their process, but of course, everything we do isn’t always based on evidence. There may not be studies. Certainly, experience seeing patients in practice directs us in directions where we go. Is it appropriate then if, lets say, Dr. Oz or one of The Doctors believe in their own experience that an herb or some sort of supplement worked and there was no evidence for it, but they go ahead and talk about it? Is that enough when you, in your opinion, have the pulpit of a major television program, whereas, a physician in private practice may say it. What do you think?

Dr. Perrone:
I think it is appropriate, and I don’t see any reason not to do that as long as he states the caveat that, “Look, this is in my own experience with my patients that I know very well. If you want to try something like this, I would suggest very strongly that you do a little homework and then go talk to your own physician, and see what that physician says about it.” I used to travel quite a lot internationally, and I was exposed to turmeric in India as an antimicrobial, and quite frankly, it works very nice on a cut to prevent an infection and there is probably very little literature associated with it. I would perhaps recommend that to a colleague, but if I was on a television show, I might suggest that, Look, around the world this particular spice is used as an antimicrobial. We have experience throughout history of using plant-based materials for various pharmaceutical properties, but I need to let you know, this is my own personal experience, and I need you to understand very clearly that there is not a lot of publication, and many of your doctors may not actually agree with me on this.” So as long as the caveat is presented, and not in a way with sort of a wink and a nod, I think I would not have any real particular issue, unless he’s recommending something that could be potentially extremely dangerous to someone, or in fact, have a guest on his show like this Moms Across America lady who suggested that she took her son off of GMO foods, and his autism disappeared, that is very irresponsible.

Dr. Brian McDonough:
It’s interesting when you talk about things like that. I know that in 20 years of doing television with Fox, in its various stages through newscasts, we were always told you’re supposed to have your opinion of one person and a counter-balancing opinion of another and you as the expert can come on. Now obviously, if we were talking about the dangers of cigarette smoking, you could have someone else, but it went without saying the evidence was overwhelming. But on something like that, where you’re talking about Moms Across America, you could have that, but you really should provide the balance of someone saying well, wait a minute, is this irresponsible? How can you say that or whatever to at least present the other side?

Dr. Perrone:
Absolutely, and I think that’s been one of the major criticisms, at least of Dr. Oz, is that he very often does not provide that balance.

Dr. Brian McDonough:
Moving on from Dr. Oz and The Doctors, because they were the two parts, clearly, of this British Medical Journal study, but onto the Internet and the growth of information. For instance, I talked about 20 years in the television news business. Well, at the time, when I worked in that business, it was very relevant because a lot of people watched the news. They still watch the news, but clearly not to the numbers they used to. They’re getting information. The news is coming to them essentially where they want to get it. With that being said, from your perspective, there could be a lot of information, and we know there is a lot of information out there, that is being pushed through the Internet, through YouTube, through other sources, which can be just as damaging, in fact, far more damaging, than what we’re even seeing on these programs. What advice do you have for physicians listening, health care providers listening who want to guide their patients because of all these alternatives and potential problems?

Dr. Perrone:
Well first of all, obviously, a clinician that has a patient that’s coming to him and says, “Look, I saw this on the Internet, what do you think?” First of all the physician may have to be familiar with the particular intervention that the patient is talking about. If it’s really something weird out of the jungle of South America, the physician may know nothing about it, and I would caution him or her to tell their patient that, “Look, before you do any of this stuff, do bring it to me as you’ve done. I would appreciate that. If I can, I’ll look into it, but in the interim, until we learn more about this, I would suggest very strongly that you do not use this particular substance, compound, bean, flower, or whatever the case may be.” Then, generally telling your patients if they are bringing it up about the Internet is that you just have to be extremely skeptical, and it is very difficult these days. I read stuff on Facebook, and I am astounded of the opinions that people have. It’s just incredible. Actually, sometimes it’s a little depressing.

Dr. Brian McDonough:
Now on the other side of it, to put a little positive spin, I will tell you that when patients come in and they’ve read things, it is a very exciting opportunity as a practicing physician because it does encourage discussion and conversation, so that is a good thing, and I think we encourage our patients to be more knowledgeable. It’s just that it used to be limited knowledge that you could get, and now it seems to be all over the map. Some of it great, some of it not so great, and then it’s really tough to dissect it. Getting back to your point on diet, I always remember what a Dr. Albert Stunkard told me. He was in his 90s at the time, and he was at the University of Pennsylvania, and I was interviewing him about diets, and I said what do you think? It was about some book, it was something like the broccoli diet or something, and I said, “Is the broccoli diet the answer?” And he said, “Take a look at this bookcase. What are all these books?” And I looked at them, I said, “They seem to be books on diets.” He goes, “Exactly.” This bookcase and I’m telling you there were hundreds of books, are all the books that I’ve collected over 50 years of diet books, and you know what they have in common? And I said, “What?” He goes, “None of them work.” “He says it comes down to calories in and calories out, that’s your answer,” and I thought, boy, that was probably the best sound byte I ever had. But to your point, it doesn’t give you an Emmy award, an Oscar award, ratings, and millions and millions of dollars.

Dr. Perrone:
No, that was my point earlier, is Dr. Oz said, “Energy in, energy out, they got to be equal. If you have energy in that exceeds the energy output, you’re going to gain weight,” but that would be the end of his show.

Dr. Brian McDonough:
Dr. Joe Perrone, I want to thank you for joining. It was a fascinating program on Primary Care Today. I really appreciate your taking the time to join us.

Dr. Perrone:
It was a pleasure, thank you very much.

Dr. Brian McDonough:
This is Dr. Brian McDonough. If you missed any or part of this discussion, please visit ReachMD.com/PrimaryCareToday. You can download the podcast and learn more on the series. Thank you for listening.