Sep 20 2007

Heart and Soul – But No Mind

Dr. Mehmet Oz is the director of the Cardiovascular Institute at Columbia University Medical Center – he’s a heart surgeon. He is also an influential advocate of so-called integrative medicine, and as such has been one of the wedges trying to get pseudoscience and superstition into modern medicine (unfortunately with some success). He was recently interviewed on the Speaking of Faith podcast. A reading of the transcript reveals the tortured logic, confused positions, and pseudoscience apologetics typical of the integrative medicine movement.

Early on in the interview Dr. Oz relates a story that I found very revealing of his ideology. He tells us that when he was a resident he had a patient with a bleeding ulcer who had lost quite a lot of blood. The patient was a Jehovah’s Witness and her family did not want her to receive any blood. Dr. Oz relates that her hematocrit (a measure of the red blood cells in the blood) was 4. I think he meant to say hemoglobin (a similar measure of red blood cell content) – a hematocrit (normally around 40) of 4 would be truly incompatible with life. A hemoglobin of 4 (normal hemaglobin is 12-15) is also extremely low and may be incompatible with life (I have never seen one so low) but is not as absurd as a hematocrit of 4 would be.

But all that aside, the point of his story was that he was arrogant in proclaiming that the patient would surely die if she did not get the blood she needed. The family refused, and amazingly the patient survived and eventually regained her health. The lessons Oz takes from this story is the power of sincerity of the family’s faith and the folly of scientific arrogance. He said:

“Because I began to recognize that, as dogmatic as I thought I could be with my knowledge base, there were certain elements of the healing process I could not capture. And even if I was right in the science, I could be wrong in the spirit. “

As a physician, this kind of story if very frustrating. First, it is certainly not representative in that the vast majority of patients who refuse (or whose familys refuse on their behalf) blood transfusions on religious grounds after such a profound loss of blood do in fact die. Dr. Oz’s story deliberately deemphasizes this fact. Most physicians have been there, as I have. The true lesson in such stories is that when people base life and death decisions on superstition rather than reason and evidence, there are real consequences.

Second, Dr. Oz makes a straw man argument when he says he was surprised at the sincerity of the faith of the family. No one doubts the sincerity of faith. But sincerity does not equate to legitimacy or soundness. Many people are sincerely wrong or misguided.

Finally, (and Dr. Oz does this throughout his interview) I felt that Dr. Oz was exaggerating the alleged arrogance of his younger and presumedly less-wise self as a means of indirectly criticizing doctors and the medical establishment in general.

One other example of this was when he said the following:

“And in fact, you get to that point of arrogance usually in your third year of medical school. And it’s your third year because you have spent two years doing nothing but studying.”

As a physician this statement does not ring true at all – it is at complete odds with my own experience. The third year of medical school is the time of maximal humility and minimal arrogance. You have just spent two years in the classroom, and now for the first time in your life book knowledge and studying are not enough. You are thrown into a clinical situation and you realize that you actually know nothing – no medicine. All of your studying up to this point has not taught you any actual clinical skills, it has just prepared you for the learning that is now truly going to begin. The third year rotations (as they are called) are terrifying and exhilarating at the same time – but I cannot imagine how someone can see them as a time of maximal arrogance. This, and the improbable story above, lead me to suspect that Dr. Oz has a talent for making stories fit their thematic purpose.

But the core of the interview, and of Dr. Oz’s philosophy, is the relationship between spirituality and medicine, and here I disagree vehemently with Dr. Oz on his two main points. First he believes that physicians must not only respect the beliefs and cultures of their patients (which I accept) but must cater to them in a way that compromises medical professionalism. Of course, what he is really doing is inserting his own spirituality into his practice of medicine and passing that off as respect for the patient’s spirituality.

I think this approach violates a basic principle of medical professionalism – and this is an important issue not just for an individual physician but for the medical profession. Physicians need to walk a fine line in their relationships with their patients. They can be human, friendly, personable, and even vulnerable to an extent. However, they should not let their personal beliefs, whether political, ideological, or religious, intrude into the physician patient relationship. They need to keep their professional distance in order to maintain objectivity.

Further, it should not be the mission of the physician to tend to the spiritual needs of a patient. It is simply too personal. I admit there is a fuzzy line here. It would be appropriate to suggest to a patient that they might seek out help or advice in dealing with personal or spiritual problems, but physicians should stop short of becoming spiritual guru’s to their patients.

The second, and far greater, mistake that Dr. Oz makes is in confusing spirituality with pseudoscience, and thereby recommending the latter in an attempt to promote the former. Dr. Oz believes we need to treat the spirit, and therefore it is OK to use medical modalities that are magical in nature. This is a profound mistake, and is at the core of the CAM and integrative medicine movement.

Dr. Oz says:

“So let’s take a big area of energy. And whether energy exists or not at the macro level, at the level of the human being, is a difficult thing to tell. But we define life at the level of the cell by whether or not you have an energy level in the cell that’s different from the energy level outside the cell. That’s what life is. So if you aggregate those cells together into an organ, the heart, and you put those organs together into a body, the human, why would we think that we wouldn’t have energy that’s measurable and could be affected to make you feel better?”

In the misguided name of spirituality, Dr.Oz has uttered abject scientific nonsense. What energy, exactly, is he talking about? Cells maintain an electrical gradient across their membranes. These gradients can be measured. We have worked out much of the purpose that cells put the flow of electrical current to. Some organs use electrical currents to function – like the brain, the heart, nerves, and muscles. But other organs do not. I know of no role for electrical conduction in the liver or lungs, they are simply not conductive organs. It also does not follow that the whole organism uses electrical fields or energy in some mysterious and apparently undetectable way.

And none of this in any way is a justification for any particular CAM modality. Dr. Oz uses his very confused and vague reference to “energy” to justify acupuncture and homeopathy. He is arguing that because there is an electrical gradient across cell membranes, that homeopathic remedies (which are essentially water) must have some mysterious and unmeasurable form of “energy” that vaguely affects the “energy” of the body. This is pure pseudoscientific rubbish.

He moves onto the standard CAM apologetics when he says:

“The big challenge: It is very difficult for folks to invest the resources to truly study these modalities. And because they are underfunded, it is often impossible to envision a mechanism to truly “prove,” quote, unquote, that a therapy can be effective. “

The very existence of the NCCAM defies this statement. The truth is there have been many studies of various CAM modalities, they simply have not provided any convincing results. Dr. Oz is simply dismissing the dismal performance of dubious CAM modalities in the light of science. The truth is, if there were any true potential to these modalities the preliminary research would show it and this would spawn more definitive research. Even still, political pressure has made funding available beyond what is justified by the science, and this still has not validated any spiritual modality of medicine.

It was no surprise that he also defended the efficacy of prayer, despite the overall negative character of the literature, and instead made a lame excuse to the effect that people will see what they want to see in the studies.

He also says:

“It’s just that if we’re truly going to achieve maximum healing, maximum impact, we ought to take any tool that’s at our disposal, and that includes nonscientific approaches, as long as we have evidence that they don’t hurt the patients.”

The inherent self-contradiction was apparently not evident to Dr. Oz. How can you have evidence of safety if the approach is nonscientific? Evaluating evidence is a scientific endeavor. He is also assuming that at least some nonscientific approaches are effective, but again how will we know this without looking at the evidence? Once you are considering evidence, then you are doing science and the only question is – are you doing good science or bad science? Dr. Oz and other integrative proponents would have us rely upon bad science, as long as we call it something else (i.e. “alternative”).

This is the core insanity of the CAM/integrative movement. They make many flowery statements about spirituality, energy, being open, respecting other cultures, etc. but when it comes down to it the only thing that matters is this: does the treatment work and is it safe. The only way to know is to do careful observations under controlled conditions and systematically evaluate the results (by the way, we call that doing science). They either do not understand what science is or pretend not to, or they simply ignore the fact that a “nonscientific approach” means that you are making poor observations, using logical fallacies, cherry picking the evidence, or committing other intellectual errors. Science is not an aesthetic choice, a philosophy, or a cultural construct – it is simply using valid logic and careful and systematic observation to test claims and ideas. Therefore a nonscientific approach does not do those things.

So in the end, despite his compelling stories and feel-good philosophy, Dr. Oz is advocating that doctors use treatments based upon sloppy reasoning and poor evidence. It really comes down to that. Everything else is an elaborate distraction.


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