In Support of Dr. Oz: The Commerce of Medical Ethics

Recently, a group of ten “distinguished” physicians demanded the firing of Dr. Mehmet Oz as vice chairman of the Department of Surgery for Columbia University in a letter that savaged him for “his lack of integrity by promoting quack treatment and cures in the interest of personal financial gain.”

On his popular television show, Dr. Oz covers health topics with extraordinary frankness, including subjects like erectile dysfunction, menopause, and bowel movements. He has conducted a highly successful television campaign against American’s poor eating habits and taught thousands, if not millions, how to choose healthy food and cook it. Dr. Oz has positively influenced Americans’ relationship to obesity by promoting knowledge about good nutrition and its corollary, the health hazards of being overweight. The medical establishment, on the other hand, has done little to address this issue, which results in some of our country’s biggest medical problems — diabetes, high blood pressure, and other serious conditions.

But Dr. Oz’s success as a physician is not what is in question. It is that he favors alternative and collaborative approaches to medicine that has deeply disturbed the professional community. Traditional medicine currently claims a proprietary right over what is ‘acceptable’ treatment.

The attitude of the Columbia doctors, several of whom have questionable ties to genetically modified food companies and others to pharmaceutical companies, and one even having served prison time for medicaid fraud, represent a continually growing trend toward “Scientism.” Those who subscribe to scientism possess an exaggerated trust in the formal application of the scientific method. Scientism rejects the value of other forms of inquiry, including philosophical, humanistic, anecdotal, and artistic. By strictly endorsing evidence-based treatments, they take ownership of medical “truth.”

The Columbia doctors’ letter reflects the hubris of scientism in its assumption that the scientific method is the only possible avenue for legitimate medical knowledge. In practice, however, nothing could be further from the “truth.” Evidence is always shifting, research always challenged by time and experience. Much of the research and treatments held to be “true” in the past have been discarded today. And today’s alternative therapies may be shown to be tomorrow’s standard.

In a recent article by Bill Gifford, The New York Times challenged the Columbia doctors’ assumption that Dr. Oz’s recommendations are pure “quackery”.

When researchers analyzed 80 ‘randomly selected recommendations from The Dr. Oz Show,’ they judged that 26 of them, or 33 percent, were supported by evidence they deemed ‘believable’. They found just nine recommendations that were contradicted by convincing scientific literature. Looked at this way, Dr. Oz is proved wrong only 11 percent of time — not ideal, but hardly ‘egregious’. (NY Times, April 26)

The American Medical Association’s push toward “Scientism” has been supported by pharmaceutical companies with whom they benefit as bedfellows. These companies provide funding for research grants and university projects that align with their financial goals. Consider this:

Of the 170 DSM-IV panel members who wrote the current ‘bible’ of psychiatric diagnosis (the DSM-IV) upon which practitioners, insurance companies, and pharmaceutical companies depend, 95 of them (56%) had one or more financial associations with companies in the pharmaceutical industry. One hundred percent of the panel members on ‘Mood Disorders’ and ‘Schizophrenia and Other Psychotic Disorders’ had financial ties to drug companies. The leading categories of financial interest held by panel members were research funding (42%), consultancies (22%), and the speakers’ bureau (16%).* These kinds of symbiotic relationships exist across the range of medical specialties. Yet, these are the people who are challenging Dr. Oz’s “integrity”.

As pernicious is the role insurance companies play in determining patient care. No insurance company places a premium on physician-patient relationships or the pursuits of collegial interactions or team-building in the service of a patient’s well-being, a disservice to doctors and patients alike. Instead, a policy of “cost-containment” heavily influences medical decisions made for any individual patient. Insurance companies routinely exercise the right to restrict a patient’s choice of physicians, controlling his or her access to care. They limit the treatments or medications a physician may prescribe, restrict referrals to specialists and follow-up visits, eliminate laboratory procedures, force providers to follow rigidly defined protocols, decline appropriate treatment as “medically unnecessary,” and limit the services of ancillary care-providers such as nurses, physical therapists, special nursing assistants, and others. Some managed care facilities even go so far as to financially reward physicians and hospitals for not providing potentially beneficial medical services in order to reach their bottom line for costs, creating an inescapable conflict of interest. It is no accident that these companies earn some of the highest corporate profits in America.

Not long ago, a patient and I challenged his insurance company’s requirement for me to provide a psychiatric diagnosis that would qualify him for third-party reimbursement.

Jim came to see me after the untimely death of a close friend with whom he had an intense, long-time relationship. The friend had helped Jim during a period of “darkness” in which he was dealing with issues related to coming out at an older age. Highly educated with an advanced degree in philosophy, Jim was profoundly against the labeling or codifying of his behavior required to file his claim, a point of view that I have argued for most of my professional career. He also did not want a diagnosis on his record that would follow him for the rest of his life. Instead, Jim and I submitted a statement to his insurance company, to whom he had paid premiums for the past 35 years, in which we eloquently detailed the complexity of his feelings as they related to recent life dilemmas. We wrote it together.

As expected, the insurance company rejected his claim on the basis that it did not provide the required diagnosis and DSM code. We, in turn, appealed the rejection, for which we received this surprising response. An ‘independent psychiatric consultant,’ we were informed, had determined that Jim was “depressed.” The insurer would provide reimbursement for 10 sessions of “Cognitive Behavioral Therapy” with the condition that Jim would also take anti-depressants. Most shocking was that the ‘independent” psychiatric consultant’ had come to this decision without ever interviewing Jim, the patient whose health was in question. It became clear during my conversation with the consultant that he was vehemently against any form of talk-therapy, insisting there is no research to support its effectiveness. Not surprisingly, the approach he favored was pharmaceutical, the cheapest, most efficient method for any insurance company.

Jim and I decided to appeal his case to the highest arbitration committee in NY State. With the encouragement and active involvement of a legal advocate, we agreed to maintain our position — to refuse to provide a standard diagnosis or a treatment plan that aligned with the insurance company’s interests. Of course, the matter was quickly expedited — the arbitration committee supported the insurance company’s position. To vote otherwise would have meant endangering the entire insurance system currently in place.

To say that Dr. Oz has promoted treatments “in the interest of financial gain” is like “the pot calling the kettle black.” If the Columbia doctors’ accusations are true, it may not be admirable, but it is not without the added context of evidence that has historically rendered many of them guilty of the very thing of which they accuse him. The American medical-industrial complex is driven by profit. The overuse of diagnostic tests, unnecessary surgeries, inflated costs of treatments, and the overprescribing of medication, particularly by those promoted by pharmaceutical companies with rewards such as lavish “informational” vacations, have been well documented. So too has the cost to patients, whose financial stability is often compromised as a consequence of the price of unnecessary treatments or treatments sans perceived benefit, or which may even be harmful.

Medicine is a very messy endeavor; and despite what ideologues think, its practice is as much an art as it is a science. Different practitioners will interpret treatment in different ways based on personal experience and intuition, regardless of what the evidence-based research dictates. Nothing in the practice or the science of medicine is a settled issue. During my past 40 years as a psychotherapist, I have witnessed the landscape of the mental health profession undergo dramatic changes. Models of therapy that were once considered mainstream have fallen out of favor and innovative models, once frowned upon, are now part of the established tradition.

Ultimately, it is the integrity of the entire American medical system that should be in question, not those visionaries like Dr. Oz who seek to challenge and improve it.

* (Financial Ties between DSM-IV Panel Members and the Pharmaceutical Industry Lisa Cosgrove,Sheldon Krimsky, Manisha Vijayaraghavan, Lisa Schneider,University of Massachusetts, Boston, Mass., and Tufts University, Medford, Mass,, USA).

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