The Oz Effect

My wife remembers when Dr.  Oz was just a handsome and engaging cardiac surgeon at New York Presbyterian Hospital. She graduated from Columbia P&S the same year Mehmet Oz appeared on Oprah and began his journey to being a household name. Dr. Oz has become so popular and pervasive that any “health supplement” he endorses on his show sees a huge boost in sales: the “Oz-effect.” The problem is that there is no evidence to support any of these miraculous claims he makes.  Congress recently gave him a public shaming for these shenanigans.

It is interesting to note how upset much of the press is getting with Dr. Oz. Many other programs on TV make outrageous claims about health, science, and reality. So what’s the big deal?

What Dr. Oz has done with diet supplements is fundamentally unethical because he is exploiting the goodwill extended to him because he is a doctor—a formerly legitimate doctor associated with an Ivy-league medical institution. Currently he is valuing sensationalism, viewership, and ratings over the truth as it relates to health. And while many roll their eyes or guffaw at those of us who continue to promote the Hippocratic ideal in medicine, it is clear that the backlash against Oz is so severe because he has so egregiously violated the principle that the good of the patient should come before anything else.

The internal morality of medicine goes back to Hippocrates the Aesclepiad, which is distinct from the ethics that govern mercantilism and commerce. I love this old engraving (found in Galerie Mythologique: Recueil de Monuments by Aubin Louis Millin, Paris 1811) because it so clearly shows the difference between the practice of medicine and commerce.

It shows Asclepius and his three daughters, Hygeia, Panacea, and Meditrina shunning Mercury, the god of commerce. Many would contend that modern medical practice is often indistinguishable from pure business. Indeed even the symbol of Mercury, the caduceus, is often confused and conflated with the rod of Aesclepius. If it is true that there is no real distinction between the healing profession and mercantilism then why do we hold Dr. Oz to a higher standard than any other person making wild claims on an infomercial?

It is because, just as the engraving shows, there is a deep and abiding distinction between those of us in the healing profession and those selling products claiming miraculous results. Society still expects doctors not to exploit others’ weaknesses—we must always keep their best interests ahead of our own. Dr. Oz has failed to do that. Sadly his reprimand came from Congress and not from our own medical societies.

Medicine’s diminishing status as a profession

 

I just returned from a clinical ethics consult. The scenario was all-too familiar: an elderly, very ill patient, who can no longer communicate his wishes; the patient’s family, whose goal seems to be to keep the patient alive as long as possible at any cost, insisting, over the protests of doctor and nurse, that “everything” be done; a physician who is distressed because she knows that the care she is providing at the family’s behest, while featuring the latest high-tech, gizmo- and gadget-heavy treatment, is also disproportionately burdensome to the patient compared to any benefit it might possibly give. In short, the physician feels compelled by the family to give inappropriate care, to violate the basic principle of “First, do no harm.”

I don’t have statistics to prove it, but it seems to me that this type of ethical dilemma, a conflict between patient (or family) and physician — in particular, a conflict manifested as mistrust of the physician — is becoming more and more common. Why?

There are many possible reasons, but one of the most concerning is that patients may not trust that doctors are always acting in their best interests. In other words, they may see physicians as technicians rather than professionals.

Since Hippocrates, medicine has possessed the special status of Profession, with all of the privileges that go with that title. One of those privileges has been professional autonomy: unlike the trades or technicians, which are compelled for their survival to provide whatever the market demands or will bear, the Profession of Medicine was allowed to set its own limits based on a code of ethics. Even if the market demanded that physicians provide the means to kill a person, medicine was implicitly granted the right to say, “We will not do this. We will give no deadly drug, even if asked. We will not give an abortive remedy.”

Now, however, that state of affairs seems to be changing. Some of us physicians have demonstrated that we are willing, in pivotal situations, to act in ways that, instead of adhering to the professional code, acquiesce to society’s demands for everything and everything: from eliminating the unwanted fetus, to questionable enhancement procedures, to deliberately hastening death in terminally ill patients. Because of this, I fear that our profession’s status as a profession is eroding, and along with it, our privilege of doing only what we know to be best for our patients. The more we are perceived as willing purveyors of medical techniques to the highest bidder (or the person with the best insurance), the more we will run into the ethical dilemmas rooted in the suspicion that we cannot adequately govern ourselves to do what is best for patients.