Columbia medical faculty: What do we do about Dr. Oz?

According to a 2012 survey in Physician Practice, 29% of physicians in private practice have other jobs, some of which involve the media. There is now a huge population of "virtual patients" whose health and purchasing behaviors are influenced by the increasingly popular group of physicians offering medical advice on the airwaves. What happens when a doctor's job in media-medicine collides with office- or hospital-based medicine? Dr. Mehmet Oz is a case in-point. A recent letter from 10 physicians to the Dean of the Faculties of Health Sciences and Medicine at Columbia University College of Physicians & Surgeons states that Dr. Oz is "guilty of either outrageous conflicts of interest or flawed judgments" and that because of this "Dr. Oz's presence on the faculty of a prestigious medical institution unacceptable." Dr. Oz is scheduled to devote a good portion of his on-air show today to rebutting this letter.

We are members of the Columbia faculty who recognize that the Dr. Oz Show performs a public service by bringing alternative therapies which are generally under-researched and under-regulated into the public forum. However, a 2014 report in The BMJ (formerly the British Medical Journal) reported that less than half of the recommendations on his show are based on at least somewhat believable evidence. This report raises concerns that Dr. Oz's presentations of anecdotal therapies as "miracle cures" occur in the absence of what we see as obligatory discussions of conflicts of interest, possible side-effects and evidence-based medicine (or lack thereof). Many of us are spending a significant amount of our clinical time debunking Ozisms regarding metabolism game changers. Irrespective of the underlying motives, this unsubstantiated medicine sullies the reputation of Columbia University and undermines the trust that is essential to physician-patient relationships.

The weaknesses in the professional balance sheet of Dr. Oz's pixel practice should not, in and of themselves, disqualify him from his day job as a professor in the Department of Surgery at Columbia University. He was hired by Columbia as a faculty member in 1993 on the basis of his skills as a physician. He continues to receive excellent peer reviews and patient satisfaction ratings. Those accolades are earned and his Columbia employment should not be terminated without better demonstration of on-site performance failure. It does not follow that complaints about his on-air medical practice will be addressed by demanding that he leave his other job in which he excels.

The difficulty in resolving the dilemma of Dr. Oz raises other more important issues. Specifically, we need to re-evaluate the roles of the health sciences and government in broadcast medicine and what are the responsibilities of media physicians to their patients? The American Medical Association issues guidelines for physician professionalism in social media that focus on privacy, but eschews recommendations regarding doctors' responsibilities in public. A scientist presenting clinical trial results at an academic conference is required to disclose conflicts of interest, medication side-effects and contraindications, and to distinguish evidence-based from hypothetical applications. Doesn't the burgeoning population of virtual patients deserve similar consideration from physicians generating virtual prescriptions?

Our governmental regulations regarding obscenity and commercial speech specifically state that radio and television receives " less than full protection " under the First Amendment. Stringent broadcast scrutiny with restrictions when necessary could be applied to protect public health against physician recommendations of treatments without clear disclosure regarding their possible side effects and true substantiated efficacy. An independent supervisory body functioning as an FDA regarding alternative medicine, similar to the German Commission E , would significantly curtail outrageous claims of miracle cures and would also support better utilization and understanding of alternative, non-western medicine by identifying the contexts in which it is effective scientifically rather than empirically.

Non-evidence based medical recommendations presented without the appropriate caveats are costly and potentially harmful. However, unless these foibles can be shown to render Dr. Oz inadequate or ineffective at Columbia, there is no justification for forcing him to resign from a well-earned position in academic medicine.Regulatory guidance addressing the tension between his two positions is potentially a far better solution that could result in improved health care both in the doctor's office and in the media. What happens to Dr. Oz is less important than what happens to us, as virtual patients, going forward. We recognize that any outside intrusion into the public space can become invasive rather than therapeutic, but the expanding influence of Professors of Media-Medicine on public health mandates this discussion.

We support Columbia's commitment to faculty freedom of expressionin public discussion with the caveat that physicians offering medical advice carry a great responsibility for honesty and accuracy to the public and their peers.(see last sentence in article for position) The medical and legislative communities give insufficient scrutiny to media-medicine. Barring such scrutiny, Dr. Oz might begin each program with a simple disclaimer: "The opinions expressed on this program may not be evidence-based or part of accepted medical practice and have no endorsement from Columbia University."

Michael Rosenbaum, MD; professor of Pediatrics and Medicine at Columbia University Medical Center

Joan Bregstein, MD; associate professor of Pediatrics at Columbia University Medical Center

Dana March, PhD; assistant professor of Epidemiology at Columbia University Medical Center

Michelle Odlum, PhD, MPH, DEd; Provost's Postdoctoral Research Scientist, Columbia University School of Nursing

Elizabeth Oelsner, MD; instructor in Medicine, Columbia University Medical Center

Katherine Shear, MD; Marion E. Kenworthy professor of Psychiatry, Columbia University School of Social Work, Columbia University College of Physicians & Surgeons

Tal Gross, PhD, assistant professor, Department of Health Policy and Management, Columbia University

Sumit Mohan, MD; associate professor of Medicine, Division of Nephrology, Columbia University Medical Center.

The authors have all completed fellowships in the Columbia Public Voices Op-Ed program.

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