Quackery, Celebrity and Health

Steve Hoffman
January 21, 2013
Among the dubious pleasures of self-isolation is listening to a seemingly endless stream of TV doctors as well as celebrities happy to share their health tips. Who should we believe? When assessing such claims, Steve Hoffman prescribes a healthy dose of skepticism mixed with some basic medical literacy.

Quackery, Celebrity and Health

Steve Hoffman
January 21, 2013
Among the dubious pleasures of self-isolation is listening to a seemingly endless stream of TV doctors as well as celebrities happy to share their health tips. Who should we believe? When assessing such claims, Steve Hoffman prescribes a healthy dose of skepticism mixed with some basic medical literacy.
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The 20th-century popularity of TV talk shows simultaneously gave rise to the celebrity TV doctor. Up to five times each week, we are told about new health products, cutting-edge treatments and scientific discoveries in chatty language we can all understand.

Thus, a new industry has been born. TV shows lead to book deals, which lead to newspaper columns, specialty Web sites and access to the lucrative speakers’ circuit. Celebrity doctors are omnipresent. And as society ages and the audience for TV doctors (mostly women aged 25 to 54[1]) becomes increasingly health conscious, one can only expect this industry to further ripen and grow.

Successful TV doctors perform theatre; they invite us in, speak sensationally and have a commanding presence. They use phrases such as “miraculous cure,” “unbelievable finding” and “magical treatment.” Everything works for everyone, and in the world they create for us, no problem is without a solution.

Part of what makes the TV doctor so popular is that he or she either believes the act or at least pretends well. TV doctors preach simple and positive messages of hope, and they promise miracles to those who are looking for them. They inspire belief and a religious following in people who want to improve their health and are looking for the best – and often easiest – way of doing so.

This act also works because we want it to work. Who does not want a quick fix for the thing we like least about ourselves – our flabby belly, high cholesterol, low energy or receding hairline? And we want these messages to work because we like the messengers. Unlike many of our own physicians, TV doctors are charismatic and engaging, and they are moved by our concerns. It does not hurt that they tend to have movie-star good looks, which studies of human psychology have long shown can inspire our confidence.[2] Just think about the chiseled features and dreamy blue eyes of Dr. Travis Stork, star of The Doctors, one of theUnited States’ most popular TV talk shows. He is an emergency physician and infinitely easier on the eyes than most any clinician at your local emergency room.

TV doctors fill a void left by the medical community, too. For example, they give us their time, much more than the 18 or 23 seconds that real-life doctors allow us to explain a problem before interrupting.[3] They speak clearly, reveal the secrets of science in simple sound bites and convince us with their winning smiles that we can change our lives for the better.

But if contemporary TV doctors are one part belief and another part confidence, they are seriously lacking in the science department. Quite simply, their advice can be wrong. Sometimes it can be dangerous. Yet, many of us take it in and eat it up.

Medical “advice” from the Wizard of Oz

For example, examine the science of Dr. Mehmet Oz, perhaps the world’s most successful TV doctor. In various shows and columns, this scrubs-wearing surgeon recommends taking multivitamins each day to keep all sorts of maladies away. He claims, “A multi ensures that you get all the essential vitamins and minerals recommended for each day, keeping your engine running smooth and adding protection against chronic illnesses such as breast cancer, colon cancer and heart disease.”[4]

This all sounds great, except that the claims are not true for everyone and we have known this for a while. A 2006 synthesis of nine randomized controlled trials found no important benefit from taking multivitamins to prevent cancer, cardiovascular disease, cataracts, macular degeneration or hypertension.[5] More recent studies are not any better. A 2011 prospective cohort study found no significant associations between multivitamin use and decreased mortality from all causes, cardiovascular disease or cancer. Multivitamin intake also did not correlate with any change in the likelihood of developing cancer.[6]

And unfortunately, it gets worse: A 2011 retrospective study of 38,772 postmenopausal women even showed an association between multivitamin supplementation and increased risk of death, highlighting the possibility of harm from using “health products” that are prescribed en masse rather than tailored to an individual’s health needs.[7]

As another example of Oz’s medical follies, he recommends everyone take a daily 1,000 IU vitamin D supplement. On one show segment titled “The Power of Vitamin D,” he discussed its benefits for colon, breast and uterine cancers.[8] On another episode, “The One Quick Pill Fix,” he emphasized the importance of vitamin D supplementation for preventing over 20 diseases.[9]

In this case, some of what Oz says about vitamin D was once thought to be true, especially for people with both a deficiency of this vitamin and cardiovascular disease risk factors such as hypertension.[10] However, today’s evidence suggests otherwise. In numerous randomized controlled trials and several systematic reviews – which offer the most comprehensive and least biased information as syntheses of the best-available global evidence – no link has been found between vitamin D and reductions in blood pressure, lipid fractions, glucose, cardiovascular outcomes or mortality.[11] The United States Preventative Task Force, the Institute of Medicine and Health Canada have all judged the evidence linking vitamin D supplementation to fewer cancers to be scant.[12]

Oz also invites special guests onto his show, the “superstars of the alternative medicine movement,” who outside of the daytime TV universe are widely viewed as outright quacks. Take Dr. Joe Mercola, an anti-vaccine campaigner who warned people that the H1N1 vaccine would cause widespread Guillain-Barre Syndrome (which did not happen)[13] and who advocates using coconut oil to prevent and treat Alzheimer’s disease (which clinical studies do not support).[14] In keeping with Mercola’s anti-science stance, Oz’s series on alternative therapies took on a conspiratorial tone when discussing the medicine other doctors apparently do not want us to know about.[15] “You’ve shown you’re not afraid to test the time-honoured traditions of alternative medicine, so why is your doctor?” Oz asked, suggesting that physicians are colluding to keep patients away from effective treatments.

How real science works

It is true that medicine is confusing. Health recommendations change all the time. One day red wine is good for the heart; the next day it causes cancer. Screening for breast and prostate cancers used to be a lifesaver; now, expert panels say these tests do more harm than good for some people.[16]

But medicine is supposed to change and keep on changing. It is the scientific method that is not supposed to change: We start with a hypothesis, test it and revise our thoughts accordingly. As we conduct more and better tests, we continually update our thinking.

In science, we always remain cautious and critical. Early positive results on mice do not trigger a change in medical practice or lead to new health recommendations. Instead, we wait for human trials, and sometimes multiple human trials and other types of studies. Treatments are “proven” once enough evidence has been mustered that doctors (and sometimes government regulators) are convinced of their potential benefits, effectiveness and safety in practice.

The result is that over the past 100 years we have developed robust processes to ensure the credibility of approved health products and treatments that are prescribed by one’s own medical professional. The appearance of a product or treatment on a TV show, even one hosted by a certified medical doctor, is not one of them.

It is true that this phenomenon of celebrity doctors and medical theatre is nothing new. The days of snake oil salesmen and carbolic smoke balls for the flu are not so far behind us.

But something has changed. Science is more complex and confusing than ever. There is more research output than ever before. Scientists’ promises of looming cures for the greatest scourges have raised public expectations of what is scientifically possible. The continued expansion of mass media communications, especially TV and Internet, gives celebrities the most powerful and far-reaching microphone they have ever had. That microphone is also continuously on in this age of the 24-hour news cycle. With mandates to inform but also entertain – up to five times each week! – entrepreneurial doctors end up sensationalizing slow-paced science and packaging it in ways that are good for contemporary TV audiences but incompatible with the nature of science.

As concerning as the TV doctors’ grip on millions of people may be, they are, after all, medical doctors. Oz, for example, is board-certified in a grueling surgical specialty, a professor to medical trainees and vice-chair of the Department of Surgery at the prestigious Columbia University College of Physicians and Surgeons inNew York City. He graduated fromHarvardCollege, Wharton School of Business and the University of Pennsylvania School of Medicine.

But Oz is not the only person who influences us from afar. We have all emulated our favourite celebrities, be they models, pop singers, Olympic athletes, religious leaders or former politicians; many people buy their clothes, wear their perfumes or drink their preferred soft drinks based on such associations. This pattern becomes more troubling when we trust these public figures with our health.

Jenny McCarthy is a well-documented example. The former Playboy model tries to scare us with nonsense about vaccines causing autism; she has thus influenced the critical decision of parents about whether to vaccinate their children. But we also see more credible celebrities such as formerU.S.president Bill Clinton promoting particular diets and Adam Levine of the chart-topping pop rock band Maroon 5 serving as the face of an ADHD awareness campaign.

They, like TV doctors, are all part of a long history of celebrity involvement with science and the health product industry. Schuyler Colfax, vice-president to Ulysses Grant, spoke well about a throat lozenge. Vin Mariani – wine laced with cocaine and marketed to treat a range of ailments from insomnia to the flu – was endorsed by Pope Leo XIII, light bulb inventor Thomas Edison, author H.G. Wells, Nobel Prize-winning writer Anatole France and French composer Charles Gounod.[17]

In more recent times, actress Lauren Bacall peddled a macular degeneration medicine by Novartis, Olympia Dukakis put her face on Lidodern for shingles pain and Sylvester Stallone backed the cholesterol medication Pravachol. Australian cricket star Shane Warne promoted nicotine replacement products as his trick for keeping New Year’s resolutions to stop smoking – except that he never actually stopped smoking and was paid $200,000 Australian for his publicity efforts.

The impact of such entanglements is far-reaching. Surges in popularity for alternative therapies can be attributed to celebrities’ devotion to them. The U.K.-based academic Dr. Edzard Ernst calls alternative treatments “celebrity-based medicine,” because of the range of therapies – most backed by no evidence that they work better than a placebo – that are promoted by the rich and famous, from Kate Moss’s acupuncture to Uma Thurman’s Gem therapy and model Christy Turlington’s Ayurveda.[18]

Other famous folks, from Tina Turner to Prince Charles, to the physician of Queen Elizabeth II and even physics Nobel Laureate Brian Josephson, have used their credibility in areas such as entertainment or the natural sciences to promote homeopathy. This, despite the mountain of evidence that demonstrates that homeopathic remedies are akin to ineffectual, over-priced, sugar-water solutions.[19]

The good news is that we now have better ways of protecting ourselves from these celebrities and TV doctors and their abuses of science and scientific language. For we now unequivocally know that medical decisions are better when based on the best-available evidence; we also know that research studies are not all equal in providing the different types of evidence needed. In countries such asCanada, with publicly funded health care systems, we fortunately have access to real doctors who know us and can help us wade through the evidence regardless of our ability to pay.

Celebrities run amok in an age of information overload

This leads us to the real question: If the science of celebrities and TV doctors can be so spectacularly false, why does it pass many people’s “smell test” and move people to make decisions about their health on nothing more than a famous person’s endorsement?

Part of the problem is that our noses are insufficiently tuned to the odours of quackery. The avalanche of health information facing us overwhelms the senses, and there is a paucity of digestible resources to help us wade through it. We trust people who are famous, thinking they are better informed and more skilled than people who are not famous. Perhaps another reason is that in a democratic age, people mistakenly believe that one opinion is as good as any other, even though fact-based opinions are one thing and faith-based opinions, quite another.

Regardless, improving health literacy and arming people with knowledge is only part of the solution. Changing the systems, markets and cultures that perpetuate this abuse of science is another. The incentives and professional cultures of the media, industry, research and medical communities are not always aligned to promote our health and often contribute to the problem. For example, newspapers sometimes feature sensationalized and potentially harmful headlines to attract readership, just as health product companies naturally promote their wares to anyone willing to take them. Researchers are not rewarded for explaining their findings to patients or journalists, and doctors are not usually compensated for public outreach activities.

Shared responsibility for this problem means there is a shared responsibility for investing in enduring solutions. The necessary system changes will not be easy, but progress is being made. People are increasingly being held accountable. Doctors are participating in the blogosphere, academics are fighting disease-mongering efforts and journalists are debunking unhelpful myths about vaccines, vitamins and viruses with the explicit goal of better informing their readers’ or viewers’ health decisions.

In the meantime, we can be assured that “miracle” products and treatments that sound too good to be true probably are. Even when a high-quality study initially suggests a treatment may be staggeringly effective, this effect usually dampens as further experiments are conducted and science progresses.[20]

In a world where celebrities and TV talk-show hosts run amok, a healthy dose of skepticism mixed with some basic medical literacy is what the real doctors prescribe. Knowledge about science is our best protection against those who abuse it.


[1] The New York Times. Haughney, C. “Today’s Key to Selling Magazines: A TV Doctor.” Available at http://www.nytimes.com/2012/07/07/business/media/dr-oz-a-tv-doctor-is-driving-huge-magazine-sales.html?pagewanted=1&_r=1&partner=rss&emc=rss.

[2] Joseph W.B. 1982. “The Credibility of Physically Attractive Communicators: A Review.” Journal of Advertising 11(3): 15-24; Patzer G.L. 1983. “Source Credibility as a Function of Communicator Physical Attractiveness.” Journal of Business Research 11: 229-241.

[3] Beckman H.B. and R.M. Frankel. 1984. “The Effect of Physician Behavior on the Collection of Data.” Annals of Internal Medicine 101(5): 692-696; Marvel M.K., R.M. Epstein, K. Flowers and H.B. Beckman. 1999. “Soliciting the Patient’s Agenda. Have We Improved?” The Journal of the American Medical Association 281(3): 283-287.

[4] The Doctor Oz Show. Dr. Oz’s 3 Key Supplements. Available at http://www.doctoroz.com/videos/dr-oz-3-key-supplements; Dr. Oz’s Ultimate Supplement Checklist. Available at http://www.doctoroz.com/videos/dr-ozs-ultimate-supplement-checklist.

[5] Huang H.Y., B. Caballero, S. Chang, A.J. Alberg, R.D. Semba, C.R. Schneyer et al. 2006. “The Efficacy and Safety of Multivitamin and Mineral Supplement Use to Prevent Cancer and Chronic Disease in Adults: a Systematic Review for a National Institutes of Health State-of-the-Science Conference.”  Annals of Internal Medicine September 5; 145(5):372-385.

[6] Park S.Y., S.P. Murphy, L.R. Wilkens, B.E. Henderson, L.N. Kolonel. 2011. “Multivitamin Use and the Risk of Mortality and Cancer Incidence: the Multiethnic Cohort Study.” American Journal of Epidemiology. April 15; 173(8):906-914.

[7] Mursu J., K. Robien, L.J. Harnack, K. Park, D.R. Jacobs, Jr. 2011. “Dietary Supplements and Mortality Rate in Older Women: the Iowa Women’s Health Study.” Archives of Internal Medicine October 10; 171(18):1625-1633.

[8] The Dr. Oz Show. The Power of Vitamin D. Available at http://www.doctoroz.com/videos/power-vitamin-d. (recommendation at 5:23 mark)

[9] The Dr. Oz Show. The One Pill Quick Fix, Pt 1. Available at http://www.doctoroz.com/videos/one-pill-quick-fix-pt-1.

[10] Wang T.J., M.J. Pencina, S.L. Booth, P.F. Jacques, E. Ingelsson, K. Lanier et al. 2008.  “Vitamin D Deficiency and Risk of Cardiovascular Disease.” Circulation. January 29; 117(4):503-511.

[11] Elamin M.B., N.O. Abu Elnour, K.B. Elamin, M.M. Fatourechi, A.A. Alkatib, J.P. Almandoz et al. “Vitamin D and Cardiovascular Outcomes: a Systematic Review and Meta-analysis.” 2011. The Journal of Clinical Endocrinology & Metabolism. July; 96(7):1931-1942; Pittas A.G., M. Chung, T. Trikalinos, J. Mitri, M. Brendel, K. Patel et al. “Systematic Review: Vitamin D and Cardiometabolic Outcomes.” 2010. Annals of Internal Medicine March 2; 152(5):307-314; M.D. Witham, M.A. Nadir, A.D. Struthers. 2009. “The Effect of Vitamin D on Blood Pressure: a Systematic Review.” The Journal of Hypertension. Oct;27 (10):1948-1954; D.L. Cohen, R.R. Townsend. “Should We be Recommending Vitamin D Supplementation for Hypertension and Cardiovascular Disease Prevention?” The Journal of Clinical Hypertension (Greenwich) 2012. November; 14(11):816-818; McGreevy C., D. Williams. 2011. “New Insights about Vitamin D and Cardiovascular Disease: a Narrative Review. Annals of Internal Medicine December 20; 155(12):820-826.

[12] Kuehn B.M. 2012. “USPSTF: Taking Vitamin D and Calcium Doesn’t Prevent Fractures in Older Women.” The Journal of the American Medical Association. 308(3):225.

[13] De Wals, P., G. Deceuninck, E. Toth, N. Boulianne, D. Brunet, R.M. Boucher, M. Landry, G. De Serres. 2012. “Risk of Guillain-Barré Syndrome following H1N1 Influenza Vaccination in Quebec.” The Journal of the American Medical Association. July 11;308(2):175-181.

[14] Science-based Medicine. “Dr. Oz Embraces Joseph Mercola.” Available at http://www.sciencebasedmedicine.org/index.php/dr-oz-embraces-mercola/.

[15] The Dr. Oz Show. Controversial Medicine: Alternative Health, Pt. 1. Available at http://www.doctoroz.com/videos/alternative-medicine-controversy-pt-1.

[16] U.S. Preventive Services Task Force’s recommendations for adults. Available at http://www.uspreventiveservicestaskforce.org/adultrec.htm.

[17] Gerald M.C. 2010. “The Right and Fall of Celebrity Promotion of Prescription Products in Direct-to-Consumer Advertising.” Pharmacy in History 52(1): 13-23.

[18] Ernst E., M.H. Pittler. 2006. “Celebrity-based Medicine.” Medical Journal of Australia 185 (11): 680-681.

[19] Kassab S, Cummings M, Berkovitz S, et al. Homeopathic medicines for adverse effects of cancer treatments. Cochrane Database of Systematic Reviews 2009; (2): CD004845. doi: 10.1002/14651858.pub2; Heirs M, Dean ME. Homeopathy for attention deficit/hyperactivity disorder or hyperkinetic disorder. Cochrane Database Syst Rev 2007; (4): CD005648. doi: 10.1002/14651858.pub2; McCarney RW, Linde K, Lasserson TJ. Homeopathy for chronic asthma. Cochrane Database Syst Rev 2004; (1): CD000353. doi: 10.1002/14651858.pub2; McCarney R, Warner J, Fisher P, Van Haselen R. Homeopathy for dementia. Cochrane Database Syst Rev 2003; (1): CD003803. doi: 10.1002/14651858; Vickers AJ, Smith C. Homoeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndromes. Cochrane Database Syst Rev 2006; (3): CD001957. doi: 10.1002/14651858; Altunc U, Pittler MH, Ernst E. Homeopathy for childhood and adolescence ailments: systematic review of randomized clinical trials. Mayo Clin Proc 2007; 82 (1): 69-75.

[20] Pereira T.V., R.I. Horwitz, J.A. Ioannidis . 2012. “Empirical Evaluation of Very Large Treatment Effects of Medical Interventions.” The Journal of the American Medical Association. October 24;308(16):1676-1684.

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