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rahul k. parikh

rahul k. parikh
Location
Walnut Creek, California,
Bio
Physician & Writer www.rahulkparikh.com www.twitter.com/docrkp The information here is not direct medical advice.

Editor’s Pick
JUNE 9, 2009 11:23AM

Oprah Responds to Her Critics (sort of)

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Late last week Oprah Winfrey, amid growing criticism of how she covers health issues on her show, issued a statement defending herself:

"For 23 years, my show has presented thousands of topics that reflect the human experience, including doctors' medical advice and personal health stories that have prompted conversations between our audience members and their health care providers. I trust the viewers, and I know that they are smart and discerning enough to seek out medical opinions to determine what may be best for them."

 Specifically, her declaration was in response to a Newsweek cover story written by Weston Kosova and Pat Wingart (strikingly similar  to my piece in Salon--we were definitely out in front of our Old Media colleagues on this one!)

The statement is terse in its tenor and frivolous in its source (it was issued through Entertainment Tonight--seriously).  But worst of all, it's myopic. Oprah Winfrey, of all people, ought to know what's obvious to the rest of us:  she is a economy unto herself. Recently, CNBC documented just how powerful the words that come from Winfrey's mouth are in a special called The Oprah Effect.  The show provided numerous examples of how books and products languishing in obscurity and businesses on the verge of bankruptcy became overnight sensations when Winfrey mentioned them on her show.

While none of the examples were related to health, it's hard to believe that Oprah's giving free rein to the likes of Suzanne Somers and Jenny McCarthy, or endoring lunchtime facelifts,  couldn't persuade her audience to make bad medical choices. 

We can't prove (at least yet) that there is a Winfrey Effect on people's health, but we do have a few anecdotes. 

The Jenny Thing 

In the case of vaccines, I recall attending a medical conference shortly after Jenny McCarthy first appeared on Oprah telling people, among other things, that "If I had to do it all over again, I wouldn't vaccinate [my son]." 

It was at that conference, in speaking with pediatric colleagues from across the country, that the myth that vaccines causing autism, and the specter of parents refusing vaccines because of what McCarthy said on Oprah's show, became much more widespread.  Many doctors reported a surge of parents coming into our office worried about and refusing vaccines. 

I really have to wonder, did Winfrey and her production company do their homework when they picked McCarthy (other than their expectation that she will be a ratings and revenue boon)? First, she is the face of the anti-vaccine movement and junk science to "cure" autism, even to the point of caraciture.   According to the website Jenny McCarthy Body Count, between 2007, when she began her crusade, and May of 2009, 174 people have died and 45,596 have contracted vaccine-preventable diseases.

Second, and interestingly enough, there have been questions raised as to whether very early signs of developmental problems in McCarthy's son were missed altogether, well before "he caught autism" from vaccines.  More on this (and McCarthy's past as an "Indigo Mom" from the Respectful Insolence blog by Orac, but basically, her son demonstrated signs of sensory sensitivity consistent with very early signs of autism.  Others have noted how McCarthy described her son was a quiet "Buddha baby" and seemed to stare off into space, rather than making eye contact and engaging her mother.  That's a classic early red flag for autism. 

For now, McCarthy has veered away from discussing vaccines on her blog at Oprah.com.  Instead, she spent the month of May blogging about giving up sugar, baking cupcakes and having her hair bleached before going to the Cannes Film Festival. 

The Great Hormone "Debate" and Big Cosmetic Revenues

In an another example, that of bioidentical hormones, Dr. Lauren Streicher, who briefly appeared on the same episode with Somers (although she was stuck in the audience and had many of her more important lines edited out), mentioned in an email to me how her office was innundated with appointments after the two episodes about bioidentical hormones.  On the positive side, we can look at this as a validation of Oprah's comment that her viewers do seek out medical opinions to determine what's right.  On the other hand, if those patients come in with preconceived notions about hormone therapy, then it's going to be very difficult to convince them what they've initally seen is wrong.  Some psychologists call this selective processing--once you've learned of and accepted"a fact," then you're more likely to believe those who reinforce those views and to dismiss those who challenge your understanding of it.

All doctors have experienced how different an encounter is when patients make up their mind about a drug, diagnosis, or therapy than when they come in with research and questions from unbiased, accurate and up to date sources.  While Oprah assumes, she is one of those sources, the medical evidence, time and time again, proves her wrong.  

 We get one step closer to  proving The Oprah Effect in matters of personal health by looking at a 2005 NY Times article about Winfrey's frequent focus on cosmetic treatments.  In the case of a treatment called Thermage:

"When Thermage was first showcased on ''The Oprah Winfrey Show'' in 2003, ''the show drove so much interest that our sales reps were selling machines over the phone,'' said Stephen J. Fanning, president and chief executive of Thermage Inc., which sells machines to doctors for about $30,000.

And every time ''Oprah'' reruns one of its Thermage episodes, most recently last summer, traffic on the Thermage Web site (thermage.com) spikes to 30,000 hits for the day, Mr. Fanning said. Ten to 14 percent of the people who visit the site after seeing an ''Oprah'' episode end up visiting a doctor's office to have a facial procedure, at an average cost of $3,500, he added."

How One Woman is "Living Oprah"

Perhaps the most interesting information to date on the efficacy and safety Oprah's advice will come from a one-year social experiment conducted by Chicago resident Robyn Okrant.  Okrant writes "I was VERY curious...as Oprah frequently encourages her viewers and readers to 'Live your best life,' I wondered what it would be like if one woman committed whole-heartedly to her lifestyle suggestions." 

Okrant chronicled just that on her blog, Living Oprah.  It turns out it has been quite an challenging, exhausting and expensive endeavour.  Based on Oprah's commandments, Okrant had to buy and read a lot of books, including those by Winfrey's controversial women's health guru, Christiane Northrup. 

Okrant will be releasing a book early next year about her experience.  Here's hoping she will help us get a better handle on the impact of Oprah's pseudoscientific biases when it comes out.   But among her posts is one about the bioidentical hormone episode, which included these thoughts:

I'd much rather hear from the doctors than the woman who ran into doors for a living, in rollerskates, and then graduated to selling the ThighMaster on television. Call me walled-up and unable to trust, but come on, I can't bring myself to turn to Suzanne Somers for medical guidance. She looks terrific though. There is that at least.

Maybe someone else could speak on this - how expensive is it to take the advice given on today's show? I have no information about this, but it reeked of treatment not covered by my insurance. I don't think my insurance company is the authority on whether or not medical treatment is valid...I just can't afford certain procedures without it. I did a little research on my own as the show left me staring blankly at the tv. I found a site called womentowomen.com and was very interested. Has anyone else out there done their own research, not seen on TV, they'd like to share with the rest of us?

What SHOULD Oprah Do?

How does this Media Monarch, insulated in an ivory tower of infotainment, get the message that for ordinary folks, health is an emotional, serious, and fiscally sensitive issue?  Her dismissive response, one that shifts responsibility to her audience, suggests she really doesn't grasp the gravity her own influence.

 Maybe someone close to her will have to get vaccine-preventable disease or develop cancer from recklessly using hormones in order for that to change. But that shouldn't have to happen.  She just needs to get a good set of health advisors who can brief her on the latest medical evidence and provide true balance to her show.   She could also ask some tougher questions of her medical "experts" and invite a real discussion by putting credible doctors onstage next to her "quackadoos" instead of sticking them in the audience, displaying statements by them or leaving their insights onthe cutting-room floor. 

Yet it's hard to believe the entertainer in Oprah is capable of doing this.  After all, Jenny McCarthy, Suzanne Somers, Dr. Phil (and his wife) and others tell us that ratings come before responsibility, and that trivialities trump reasonable talk.  So maybe the best thing she can do is to steer clear of topics that deal with health and medicine. 

After all, if she trusts her viewers to seek their own medical advice, let them do just that. 

_____________________________________

www.rahulkparikh.com

www.twitter.com/docrkp

 

 

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Great article! Thanks for taking this discussion on.

It may take a malpractice suit to get "Dr Oprah" to realize her responsiblity to her audience -

http://theblogthatatemanhattan.blogspot.com/2009/06/oprah-im-not-doctor-but-i-play-really.html
free rein, not reign! Why is everyone so illiterate?
Stellaa, if they have it in your part of the country, Ross Dress for Less will sell you 800 thread count sheets, real cheap. Just not in a color you are likely to want in your home, and they won't have the pillow covers in the same color anyway.
Great post- and your previous article was spot on as well. I used to respect Oprah somewhat. I was always a bit put off by her seeming arrogance, but respected her. After she endorsed the Secret and Jenny McCarthy, though... Terrible. I wonder if she really doesn't understand her influence or doesn't care?
By and large I agree with you. But I gotta say that Neti nose pot I found out about from Dr. Oz has changed my life!

And if memory serves, long before Oprah had Jenny McCarthy on, Salon.com and Rolling Stone were happy to co- feature Robert F. Kennedy's anti-vaccine campaign.

Sure we should keep pressure on her to make sure that her experts are actually experts. Just as we should always hold the media accountable for how they present medical science. The problem is that experts are usually too busy being experts to become media pundits.

In the end it is up to family doctors and pediatricians to convince their patients to pursue the safest course of action. If they can't muster up enough authority to convincingly challenge Jenny McCarthy then they need to find another job.
well-researched, clear, easy to read. The McCarthy thing in particular has really bugged me for years. So Dangerous!

Will it (your post) make a difference? I doubt it.

Do I appreciate it? Immensely.
I gave up on Oprah a few years back, after she shoved Dr. Phil on us.
Margaret,
thanks for reading and adding the additional link
Doris,
thanks for the correction--pardon my illiteracy, I was up until the wee hours last night working on this
Stella,
what are the 800 thread sheets?
Stellaa,
never mind! I got it,
thanks for reading.
JustJuli,
I don't think she gets it, frankly. As I said, she's insulated in a ivory tower of infotainment, well beyond the troubles of most of those in her audience.
Juliet,
thanks for reading--you're right, before my time, Salon gave RFK Jr. a platform to spread his anti-vaccine views. They ended up having to make multiple corrections to his "facts."

I would like to say that convincing parents about vaccine safety is as easy as "mustering up authority" to do it, but this ends up being an emotional issue for many parents, torn between doing the right thing and feeling responsible should they not. I've had parents cry just during the discussion about it. It's usually more than one conversation and one visit. The good news, though, is that the data supports doctors who take that time often convince parents to vaccinate.
What's missing from the Newsweek piece and public consensus is that Oprah knows how much power she has very well and wields it relentlessly. As typical of all her responses, she deflects and blame and responsibility onto others. But she knows exactly what she's doing; she does nothing without calculation.
If you don't think the things Oprah says are right for you, there's a very simple solution. DON'T WATCH HER SHOW.

It's really not that simple. If large numbers of people give up on vaccination because they saw Jenny McCarthy on Oprah, then the whole population is affected by increased risk of infection. In particular, children too young to have been vaccinated themselves will be placed at higher risk. This is where the "Jenny McCarthy Body Count" idea comes from.
I read the Newsweek article and was struck by the section about Dr. Oz, who was credited by the authors as being level-headed and all about science-based medicine. I've admired his medical opinion, and so it was all the more disheartening when he stated that it wasn't his job (paraphrasing) to discredit the other guests on the show, whether he agreed with them or not. It's my opinion that Oprah's audience would be better served with less of the "throwing pasta against the wall to see what sticks" approach to health care. Dr. Oz and Bob Greene have presented sensible diets, for instance, and we've spent hours and hours watching them lay out their cases for better eating and more exercise. Yet you would never know those shows had been on, when you see the crackpot theories of Suzanne Sommers. Either Dr. Oz is Oprah's go-to physician, or he's not. He must be mortified when he sees some of that stuff put on the air, knowing that he isn't allowe or asked to comment.
"Oprah is an economy of herself." Well said. Her producers are seeking the lowest common denominator. What's the difference between the domains she and Martha Stewart have created? Virtually none, except one isn't a convicted felon.
Oh heavens.....does personal responsibility mean anything these days? It just seems like this is a forum to dump on everything Oprah instead of saying....Hey, this is one opinion out of many....perhaps, I should just do a little investigation on my own and determine if this is something I want to pursue. It seems like people are upset with her or the guests she may invite who espouse topics that you don't agree with. Well, at the risk of sounding redundant....stop watching it! It doesn't get any less taxing than that. It seems like people will bitch about you whether you are good, bad or indifferent. Thank god it seems like she couldn't give a damn about other folks opinions....more power to her, because this would just bug the hell out of me. This just seems to be the most nonsensical post that I've read in a long time.
Interesting how people who are angry at this post for questioning the Oprah-whimsicality of her show can brush off any criticism by stating, "Don't watch it if you don't agree," which, sure, is one method. However, public discourse does allow for dissent; one could say just as easily, "Don't like the Iraqi war? Then don't watch coverage of it," or, "Don't like this OS post? Then don't respond." There's nothing wrong with social critique, and there's nothing wrong with asking Oprah to reexamine her motives and corporate responsibilities.
It's called having an opinion. You've expressed yours, please allow us the same courtesy. Thanks!
I used to think Oprah a genius: Get millions of zoned out Americans in the palm of her hand by talking trashy daytime tv one day, and then spring on them the next day the very important issue of female genital mutilation in foreign countries. Oprah used to be brilliant at weaving important causes into her fluff.

Then I heard that she was telling people to drink kale juice as a cure for their cancer.

I'm a young adult cancer patient and author of a book that teaches young adults how to get empowered about our healthcare. I recommend that we do our homework, read scientific evidence based information, and develop challenging questions for our expert doctors.

If cancer patients (who are often underdogs when it comes to time, energy, and money) can manage to find out the facts, and do our homework - certainly Oprah can manage to do the same too. Instead she preys upon people who want a feel good, quick fix solution to very real and challenging health concerns.

Oprah undoes so many efforts to increase health literacy in this country. Instead of bashing her, I would like to challenge her to head in the right direction. She is a powerful tool. We need her working for the good side.
Dr. Parikh, as a pediatrician, you have never mentioned what your own credentials are in the field of women's health and hormone therapy. Surely if you're going to take other folks to task for not being qualified in a particular area, you should let your readers know how you yourself are qualified.

As a pediatrician, you're not automatically or necessarily qualified to practice all forms of medicine, yes? A pediatrician, for example, unless he or she is trained to do so, is not necessarily skilled in the area of oncology or rheumatology, yes? And yet, as a pediatrician, you continue to speak with apparent authority here on issues in the area of gerontology, geriatrics, women's health and hormone therapy, which are areas of medicine quite different from pediatrics.

Please, do your readers the courtesy of outlining your expertise in the area of women's health and hormone therapy. Otherwise, you sound no more educated to many of us than Oprah Winfrey or Suzanne Somers.

Additionally, it would be more beneficial to women who are advancing in age and experiencing peri-menopause and menopause if you would do the very real service of exploring the issue of bioidentical hormones without the obvious bias against them that so far remains unexplained in your writing. We can't know from your articles to date what your background in bioidentical or any form of hormone therapy is, or your background in any area of women's health, and you have yet to write anything that would explain the actual issues except to simply write disparagingly of both Oprah Winfrey and Suzanne Somers. This is not helpful. In the end, it's simply another long sneer at somebody else's expense.

You offer no medical source material for us to examine; no background of experience for us to explore; no credentials for us to assess. Please do your readers the courtesy of writing something useful instead of simply offering yet another hatchet job on other people.
Thanks, Rahul! I'm sure you've also seen Deepak Chopra's defense of Oprah on the Huffington Post:

http://www.huffingtonpost.com/deepak-chopra/mainstream-medicine-and-t_b_213132.html
Thank you C. Devlin for articulating better than I did. I don't recall going to my son's pediatrician to discuss perimenopause...but maybe that's just me.
I'm not sure that attacking Rahul's credibility furthers any argument. One need not be a board-certified gynecologist to understand the principles of the scientific method or the effects of mass psychology. It's a very disingenuous tactic, to argue against the person, not the ideas.
While I wholeheartedly agree that Oprah's choice of media venue (Entertainment Weekly) to respond to serious criticism is ridiculous, I am not sure that your link to a website called "Jenny McCarthy Body Count" is less ridiculous. Certainly there is a more credible source?

At any rate, I appreciated this article. I have always bristled at the suggestion that famous people are somehow unaccountable for their speech because they are simply providing entertainment. For whatever reason, good or bad, some people have privileged access to media outlets. These people, including Oprah, have a responsibility to use that access wisely. They open themselves up to criticism, as well as praise, by using these venues and through their influence. When Oprah Winfrey recommends something, she has every expectation that people will follow her advice; this is her job. To sell things. When those things turn out to harm society, she is culpable. This culpability is not legal, but it could impact her job. People could stop buying the crap that she promotes.

Jenny McCarthy has every right to express her doubts about the safety of vaccines. But when Oprah Winfrey gives her famous friends access to people's wallets and minds, she assumes a very important role in the vaccine debate than mere "entertainer."
Joan, really. Quoting a quack in defense of a charlatan is hardly a constructive response to criticism.
Great article, Dr. Parikh. What constantly amazes me, despite the fact that I don't watch (or ever will watch) Oprah, is how many other people do and seem to think that she's a leading expert on everything. Cars, spirituality, health, world peace - you name it.

I had the misfortune of having my son diagnosed with Autism a week after Oprah's infamous Jenny McCarthy interview. Sure, I watched that one. We had just done the test with my son and I was curious. I quickly dismissed her as a loon (and did so on an old blog. Whoo, did I ever take a bunch of hits on that one. I learned that if you want to get good blog hits and attract massive arguments, talk about Jenny McCarthy).

However, once other people started finding out that my son was diagnosed with Autism, it wasn't "Wow. That's rough. Sorry to hear about that. What can you tell me about Autism?", it was, "Hey, I heard about that on Oprah. Did he get it from vaccines? Have you started him on a gluten and dairy free diet yet, like Jenny McCarthy?" Suddenly, everyone's knowledge of Autism wasn't from good research or studying, it was from Jenny McCarthy and Oprah. Not exactly where I would choose to have people learn about Autism, personally.

Besides. I thought that for a true 360 angle on balanced journalism, you had to offer both sides of the story. Most of these health stories Oprah has done don't seem to do that. They seem more like infomercials. Heck, even real infomercials have disclaimers at the beginning to protect themselves legally. Does Oprah do that on her shows? (see, I wouldn't know. I don't watch.)

Last I checked, Oprah wasn't a doctor. But the fact that so many people take medical (and sometimes "medical") advice from her is extremely disturbing.
When she was just pushing silly spiritual mumbo jumbo (like the unreadably bad "Seat of the Soul") it was one thing. Now she's going too far.
Molly,
wish it were that easy, but Oprah is everywhere in the mediasphere. Hard to tune out her message even if you don't get it "firsthand"
Undertow,
I agree--if Oz is the medical conscience of the show, then he ought to speak up.
Kairol,
Amen! I absolutely agree with your views about the empowered patient and the need for better health literacy in this country. Fight on!
C Devlin,
I appreciate your skepticism--but let me ask you this:

Is anything I've said now and before about bioidenticals factually inaccurate, despite my bias?

BTW, nice picture
I cannot begin to tell you how pervasive the "anti-vaccine" claptrap promoted by Jenni McCarthy has become, and while it would be nice to believe that such a thing only affects the parents who are duped by it, the fact of the matter is that failure to vaccinate children affects not just those children, but the children who encounter them. Vaccination as a method of disease eradication only works if most everyone gets vaccinated. The resurgence in childhood diseases that were once rare because of vaccination (measles, mumps, rubella) is largely due to more parents opting out of vaccination.

And the problem with Oprah's denial of responsibility is that she is perfectly happy to use her show as a platform when it suits her -- promoting reading with her book club, speaking out against human trafficking -- but denies responsibility when the platform has pushed false or controversial information. Once you have a platform of that stature, you have a responsibility to use it responsibly, to vett your guests, particularly the ones with medical claims.

A few years back, Oprah's book club featured that writer who wrote an "autobiography" that turned out to be ficiticious. Oprah was so deeply chagrined at being made a fool of on her show she hauled the writer back on to the show for a public flogging. Yet she promotes Jenny McCarthy's suspect ideas without blanching.

Oprah is such a larger than life figure in our culture, and the price of that kind of notoriety is that she has to be more circumspect and responsible with what she does. In the case of medical information, she's been irresponsible, and in the case of Jenny McCarthy, downright dangerous.
I have watched Oprah off and on over the years and watched her become more and more pseudo saint like. She does, unfortunately, have way too much power. Anyone who doesn't believe that she sways a large portion of the population who watch her shows and take her suggestions seriously is, in my opinion, naive. I was watching the day she sent her first twitter -- the women were dancing in the aisles and jumping up and down with tears in their eyes. It was kind of frightening. If I were to take any information regarding my health or any other area of my life from her show - I would surely investigate and get more information from a doctor, minister, educator, or anyone else regarding the subject I was investigating. Years ago there were ideas floating that her following was cult-like. I looked up the actual definition and somehow it seems to fit her followers. It also seems to me to be curious that there are many of her charitable acts that are accompanied by a camera crew. I appreciate that she may feel that she is helping her audience and maybe there are people that need some outside direction in their lives. But in the long run the individual is the only one that can determine what is right for them personally based on many sources of input. She can certainly be one those sources. I question how altruistic she is or how power and ratings driven she is in her regard for others.
Alright, so this article was a bit less biased against ALL alternative medicine than Parikh's last article attacking Oprah, and I like that he's taking her to task... kinda.

First, the premise of Parikh's argument seems to be that people who watch Oprah will act on the advice of every guest on her show, and that this will be expensive. Granted, acting on the advice of just the anti-vaccine talking heads could have disastrous consequences, and Oprah should be taken to task for this (though there is A LOT wrong with the way we give vaccines, which Parikh never bothers to mention).

However, buying ONE or TWO herbs/alternative therapy books/ab rollers, whatever, isn't going to break the bank, and I don't see how these things are worse than video games or movies or chia pets or whatever. Oprah is on television every day -- she's going to have guests ranging from out there to middle of the road. Nobody is going to buy every product on the show, like the "Living Oprah" woman, and anyone who does has problems that go beyond Oprah.

The problem with Dr. Parikh, and many outspoken Western Doctors, is that they take an entirely negative and superior tone, never mentioning that many people go bankrupt and become ill from supposedly effective mainstream medical treatments. If Dr. Parikh didn't sound like such a pompous ass, he might reach more people.
Like most guys, I'd rather pluck my eyeballs out with toenail clippers than watch Oprah.

That said, let me point out a few things in her defense:

1. This post points out that "According to the website Jenny McCarthy Body Count, between 2007, when she began her crusade, and May of 2009, 174 people have died and 45,596 have contracted vaccine-preventable diseases"

BUT it doesn't say how many people died or contracted these types of illnesses in the similar period BEFORE McCarthy went on Oprah. Without those numbers we have ZERO basis for comparison and the quoted numbers, statistically, MEAN NOTHING!

This is either really shoddy reporting, or else the web site quoted or this poster is purposely trying to mislead us.

2. Yes, McCarthy's baby MIGHT have demonstrated some autistic indicators at an early age, but that does not mean definitively that he would have been autistic. It is still possible that SOMETHING triggered some genetic predisposition in him.

3. The reason that parents of autistic children are grasping at straws is because the medical community has FAILED MISERABLY in figuring out what is causing the AUTISM CRISIS!

And it is a crisis. It's shameless when some in the medical community write it off to a difference in methods of reporting. They are like ostriches sticking their heads in the sand. There is a HUGE problem and medical researches haven't made much headway in figuring it out.

4. Just because Oprah is successful doesn't mean that her content should have to be approved by the elite in any particular field. I hate censorship above all else because it allows a self-righteous, sanctimonious elite with their own particular agenda to determine what information the public gets.

If Oprah dissemenates information that ends up hurting people, let her be sued. Otherwise, don't cry like a baby because she's not selling your particular viewpoint.

So, if this poster or the attorney general or whoever else wants to start their own TV show touting traditional medicine and urging people to behave like sheep and not even search for any solutions to their problems that haven't been approved by the elite in the medical community - then Good Luck with that - until then address the REAL medical problems, not Oprah touting this or that, which is merely a RESULT of the medical communities inability to diagnose and treat certain conditions.
I wonder if it's not vaccines alone, but vaccines as a possible tipping point for infant bodies & brains otherwise undermined by what we're doing to the environment? This little article was an eye-opener for me.

Toxic chemicals: A ‘silent pandemic’
More than 100,000 industrial chemicals are contaminating the air, water, and our homes, causing a ‘silent pandemic’ of brain diseases in children, a new report warns. Neurotoxin experts Philippe Grandjean and Philip Ladrigan say the widespread use of pesticides, cleaning products, glues, and other chemicals represents
an uncontrolled experiment on developing brains, with little or no research on its impact. It’s already been shown that minute amounts of lead, mercury, and PCBs can cause serious brain and neurological damage. Researchers say that tons of other, unregulated chemicals being poured into the environment could be causing an increased incidence of autism, attention deficit disorder, cerebral palsy, and retardation. “The human brain is a precious and
vulnerable organ,” says Grandjean, a professor at the Harvard School of Public Health. “Even limited damage may have serious consequences.”
THE WEEK, November 24, 2006
Dr. Parikh.... I'm sitting here stymied that you'd say this in response to my message: "BTW, nice picture." Apart from the fact that my not having a picture posted with my name has nothing to do with anything, I'm really startled by such snarkiness from a physician we're apparently supposed to trust has some credibility to impart here. Maybe you'd like to explain the comment?
Of course we should listen critically to any advice, any source, especially when it relates to health advice. But is Oprah responsible for knowing the ultimate truth on every subject she explores? Or is she perhaps doing us a service by bringing in opposing views on subjects of controversy.

In the end, each of us is responsible for our own choices.

One of the ironies here is that the author warns us against believing everything we hear from Oprah, because she is so popular and many people believe what she says (or her guests say).

Given that medical treatment (aka iatrogenesis) is one of the leading causes of death in this country, I think those same rules of skepticism ought to apply to medical science and practice as well.

It behooves all of us to remember that science is a process, not an event. Look back 50 and 100 years and see how medical care has changed (some for the better, some perhaps not). The point is, we have not arrived at the final truth. Pure medical research is fully 100 years ahead of current medical practice (the current community standard) of medicine. Medicine is currently being practiced based on a very dated basis, essentially, an out of date paradigm. Paradigms tend to shift as the holders of the old paradigm die out, as vested parties tend not to change their minds.

So what? It means that the current medical 'truth' will inevitably change, probably radically. What is considered appropriate treatment in today's medicine will most likely become quaint and be considered 'dangerous' in the future.

The point is that grandstanding for the status quo is short-sighted. Humility is in order. Sincere questioning of the truth we are told is always healthy.

Dr. Parikh: Admit what isn't known. Be honest with your readers about your own specialty and the limitations of your training and experience. Educate us on the basis of your opinions rather than simply serving up a generous helping of your own prejudice: you did magnificent chop jobs on vaccination and childhood food allergies in prior columns, without ever citing a single resource, study, or journal article to back you up, or acknowledging the huge part that money, politics, and power play in shaping the medical advice we receive.

To me, this puts you in the camp of an unquestioning follower of the current power structure.

This is an invitation to open your mind, Doc. Be part of the conversation, not just the person who drops in and says, "I know/we know the answers. Be silent and commend yourselves over to our great wisdom."

What we want, what is valuable, is to hear what the cutting edge of our understanding is, what the true strengths and weaknesses of our current approach are, and how honest science (not suppression of heresy) might proceed.
cdevlin,
sorry just trying to be friendly, not snarky.

apologies
@undertow:

If one of the central points of Parikh's message here is the fact that Oprah and Somers and others like them don't have credentials regarding these issues, then surely it's reasonable for us to ask what Parikh's credentials are.

And if, as you say, "One need not be a board-certified gynecologist to to understand the principles of the scientific method," then the same would apply to both Oprah and Somers.

To question someone's credentials is not by definition an attack on their credibility. I think there are a number of readers here who are genuinely interested in what Dr. Parikh's actual credentials are in the area of women's health.

As someone else noted above, she didn't go to a pediatrician to discuss her perimenopause. Neither did I. Would you?

It's not unreasonable to ask what a particular physician's credentials are. And in fact I'd say it would be foolish not to.
Dr. Parikh, thank you for the apology.
Nonpartisan Truthseeker,

thanks for reading and for your comments--let me begin by agreeing with you on a couple of points:

--Docs are anything but omniscient. It's called practicing medicine for a reason. Being open to patients' views and new information is something I take very seriously.

--Science is a process, like you said. But more importantly, it's a discipline/method that allows us to get to truths, without ideology.

Both those things being said, I'm open to alternative and complementary views. I just want them to see put to more scientific and social scrutiny by their champions like Oprah.

Take the example of probiotics--studies have shown they are useful to reduce infectious and antibiotic-associated diarrhea in children. Many of us have adopted their use in our practices as a result of studies that provide the data to support their safety and effectiveness. On the other hand, there's no good data to support the use of bioidentical hormones "the Somers way" or that vaccines cause autism. To me, that kind of scrutiny (or lack of respect for it) is where the science diverges from ideology.
cdevlin,

you are welcome. I also saw your post on "attacks" on credibility. I don't take your questions or skepticism personally. I would ask, however, that we focus on the strength of support behind the argument rather than the person behind it.
Well written, well presented, well done...Oprah exceeded the level of her competence so long ago that even she believes she is as smart as her money tells her she is....What has made Oprah so successful is not so much Oprah as the shallowness of the women, yeah I said women, who follow her and flock around the fluff she puts on her show like pigeons on popcorn in a park.......
Good point, Dr. Parikh. All therapies should be subjected to open and complete scientific scrutiny, and subscribe to the principal of 'first do no harm.'

According to data provided by the CDC and other government sources, iatrogenesis (adverse effects of medical treatments and advice caused by mainstream therapies: drugs, radiation and surgery) now ranks among the top 3 causes of death in the U.S. overall. This should be a major call to action within the mainstream medical community, let alone closer scrutiny…and is precisely one of the things that sends people looking for un-conventional therapies.

Ironically, non-conventional therapies are typically expected to be subjected to double-blind studies which were designed for drug testing. Double-blind studies are often not an appropriate method for testing something other than a drug: you can't easily create a true neutral placebo for something that isn't a pill or a shot.

Double-blind can thus become ‘double bind’ as for the most part new alternatives are only allowed into the 'club' of sanctioned therapies if they pass drug-like studies…but if, for example, it is a touch-based therapy, including most forms of bodywork, healing touch, chiropractic, acupuncture, etc. then the model of drug testing no longer serves as a fair and productive test protocol. Therapies that are tailored to the individual patient and thus unlikely to be effective in standardized trials also are poorly served by drug style trials. Such trials often assume that the underlying causes of a diagnosed condition are identical among the population, rather than recognizing the unique metabolic issues, nutritional deficiencies, etc. that each individual may have. Double-blind studies have other shortcomings as well when applied to non-drug testing.

To effectively test, and thus prove the value of many non-conventional therapies, two things need to happen, and they both rest at the feet of the mainstream medical community, for they are the gatekeepers. The first is to consent to and support funding of neutral testing for unconventional therapies (witness the steadfast resistance of the AMA, OTA, NCI and other groups to fairly and openly testing new methods of cancer treatment). Secondly, to move beyond the double bind, it must cooperate with the development of an array of reasonable methods of testing for those therapies that don’t properly fit into current double-blind testing protocols, such as outcomes testing.

Only then will the proponents of such therapies be able to answer questions and critiques of their efficacy on Oprah and in other public forums on a level playing field. The question is, will this elite club consent to open up their membership rolls in the spirit of true scientific inquiry?
While I tend to agree with your argument, there are two sides to every coin. The medical world is often very close minded, authoritarian and condescending of whatever hasn't issued from their big money world of pharmaceuticals.

Twenty-nine years ago, probably when Jenny McCarthy was still being vaccinated herself, my son had some bad reactions to vaccines. Coincidentally, there was a spate of newspaper articles about negative effects of pertussis vaccine.

When it was time for my son to have his third DPT shot, I asked the nurse who was preparing the needles to hold off because I wanted to talk to the Dr. about the pertussis effects. My thought was to ask for the DT without P at most, but to talk it over with the Dr. The nurse dismissed me brusquely and opened the vaccine.

The pediatrician's reaction to my question seemed like surpressed rage though I said that the newspaper article were only an alerting factor for me, not conclusive. She wouldn't discuss any part of the issue but made some remarks about fear and lay people. I insisted on DT only and changed doctors.

When it came time for my son to enter public school I had to have a doctor sign off on his vaccinations since he hadn't completed the pertussis series. I explained why I had refused the shot and talked over my son's symptoms with the new doctor, a family practitioner who said that the pertussis shot had been absolutely contraindicated in his case and signed the statement.

Behaviors and responses like the pediatrician's are all too common and a huge reason why people like McCarthy and Sommers develop large followings.
Two words: critical thinking. It's not Oprah's fault that people are stupid.

Oh, and if you're going to link to a word, at least spell it right. That's caricature.
thank you for this excellent post. i can't even watch Oprah anymore because she has become so grandiose and because she lives in her own abundant Oprah world. she seems to have no idea how regular people live, so i'm so glad taht you mentioned the cost related to all of her recommendations. it's unconscionable to be so removed from what the average person is struggling with. that became so clear to me when she had a show about people in economic peril and she could barely look at or focus on the actual people. then she has shows on fundamentlist polygamists and women who went to jail for killing fathers and husbands and they all had her rapt attention. that was it for me. after years of adoring her, i had had enough.

so i'm grateful for the medical analysis. i read that it was the themerisol in the vaccines, the mercury, that was linked to autism. i have no idea but to advise people to go with no vaccines at all!!! that is horrfying. enough from me. now i don't have to read the Newsweek piece. :) love love lov and gratitude
http://open.salon.com/blog/bryan_johnson/2009/06/08/oprah_reports_you_decide
I am first reading about this here -- your post drew me -- so I may be missing some nuance of the situation. Given that, here's my two cents.

Oprah is an entertainer. She hosts a talk show. Sure, she's powerful. Sure, lots of people take the advice given on the show. I think that, while she may wish to be especially conscientious with regard to health stories, she can't be held accountable for the views of every guest who comes on her show.

I think she needs to start running a disclaimer after each show, if she doesn't already: The views expressed by guests are not necessarily shared or endorsed by Oprah Winfrey or Harpo Productions. There. I'm sure she can get a lawyer to write it up a little better for thousands of dollars.

I mean, really.

Besides, don't medical "experts" who make claims in print of broadcasting often run disclaimers, urging people to check with their own doctors before acting on a piece of advice? Given our culture, in which people often don't do their own research and fact-checking, that sure seems prudent to me.
(That should read "print or broadcasting", above.)
Thanks for this interesting and always timely commentary on a very important issue. As a medical and consumer health librarian I prefer not to take on ignorance directly, but hope to help people learn how to critically evaluate health information wherever it's located - Oprah, internet, advice from family and friends, or elsewhere. Yes, as some have pointed out - it's our personal responsibility to learn how to evaluate this information - but in truth, we don't always take time to do so, and we don't always know how. By providing an enormous public forum to Jenny McCarthy and others without also questioning their messages, Oprah is bypassing an incredible opportunity to help Americans become informed health consumers at a time when this is more important than ever. Instead, she is strengthening the voices of doubt. You know the ones: the Reader's Digest '10 things your doctor may not have asked! (that may kill you!)); the current of distrust that runs through our culture. Please don't misunderstand me here: there is much that needs to be remedied in our healthcare system, and much to be learned. Doctors are not gods. But the remedy for lack of certainty in healthcare is not snake oil - it is education and open public discourse. As a public figure, Oprah has spoken against ignorance in many ways, and I respect that. In this, however, she has clearly abdicated her role.

She could still have Suzanne Somers on the show, but balance those claims with tough questions that should be asked of anyone, not just those that go against the grain. Jenny McCarthy's claims should be examined - not alone, buttressed by the subtext of distrust in healthcare - but alongside what is known and tested (evidence based), and what is not yet known, because of course there is plenty of that.
I agree that presenting a counter-balance to controversial health claims would be ideal.

CarolinaMoon, it sounds like you're doing your part on the education front. Thank you, and belated thanks, Rahul, for an interesting piece and discussion.
suzlipman,

thanks for reading--a disclaimer is a good first step. the next step is for her to actually hold her guests accountable for ideas outside of the medical mainstream that 1) have no science to support them 2) could be unsafe
Oh Yeah... Oprah Winfrey is Satan Incarnate... Anyone with a smidgin of common sense would turn away but that's the problem here, the people that watch her show and read her books and take advice from that bovine piece of work probably deserve whatever happens to them. Book Club Indeed... I wish I could drop my IQ by about forty points so that I could enjoy "Memoirs of a Geisha"or "The Tale of Edgar Sawtelle". This, THIS is what passes for criticism today?
Hmmm...starting off with the Jenny McCarthy bodycount kind of took me aback. The assumptions are so unscientific, I can't believe you would give it any more credibility than you give Jenny M.

Then, saying doctors don't like when people come to them believing in something. Since we're now a society that has commercials offering all kinds of cures telling you to "ask your doctor", the internet to diagnose your own illnesses, social networking to discuss them, I can't believe that isn't something you have to go through ALL the time. Maybe Oprah has a wider spread reach? More authority? But I can't believe it's unusual.

BTW - equating the reaction to Thermage to other treatments seems somewhat misguided to me. There are very few places women can hear about elective surgery outside of magazines and talk shows (and the surgeon who is selling his wares). I have no idea what Oprah said on her show - I don't watch her - but, in a world where most celebrities deny they've had anything done, I guess this was very candid?

I'm not saying there doesn't seem to be a problem here but it sounds like no one knows what the problem really is except an entertainment talk show host without any medical background is very popular.
Maybe I should have offered my own disclaimer here as well: I don't watch Oprah Winfrey. I don't read Suzanne Somers or any other celebrity for medical advice. But I also don't simply, automatically believe any essentially op ed piece written by a physician on any old subject related to medicine either. That is not a personal attack on anybody.

But I do try to learn as much about my own health as I can, and I go out of my way to find competent, knowledgeable physicians who have experience and credentials related to the subject I need to know something about.

And so because I am a menopausal woman who suffered an extreme decline in health over the years and was referred by one physician to another physician who treats menopausal women, I am dismayed when a popular magazine such as Salon behaves so irresponsibly by accepting articles on women's health written by a physician who has a specialty in something that isn't remotely related to women's health. How is that helping women who actually need solid information to base their health care on?

While on the one hand it is perfectly reasonable to expect Dr. Parikh to have some solid experience and knowledge related to the Jenny McCarthy/children's vaccines issue, considering he's a pediatrician who would be expected to understand something about child vaccines, it is not at the same time reasonable to simply accept he knows anything at all about bioidentical hormones.

I've asked twice (here and in response to the earlier piece posted in Salon itself) what Dr. Parikh's experience is treating menopausal women, and still Dr. Parikh hasn't answered that essential, and, presumably, simple question.

I would no more accept a pediatrician's assessment of bioidentical hormones than I would go to him for heart surgery, if he doesn't have any experience in that particular field.

What Salon should do instead is invite a physician to write an indepth article on the matter of bioidentical hormones who actually has experience treating menopausal women. It defies logic that instead so many people are simply taking the word at face value of a physician they don't know personally, who hasn't offered any credentials in the area he speaks to, and who himself has suggested too many people are too willing to simply take the word of total strangers (celebrities) at face value simply because they are celebrities.

I don't know Dr. Parikh. The only thing I know about Dr. Parikh is that he is apparently a pediatrician and that he continues to write negatively about bioidentical hormones in a way that is completely contrary to my own physician's knowlege and that of the physicians of many of my acquaintances, family and friends. Physicians who have many years experience in the area of women's health.

I would like to reiterate, again, that I have no personal quarrel with Dr. Parikh. My interest is only insofar as it pertains to a significant area of women's health that he continues to misrepresent for reasons I frankly don't understand.

I'll end with a link to a women's health site with information about bioidentical hormones that may be of use to women who would like to explore the issue for themselves a little further. The site is authored by a number of practicing physicans and nurses who specialize in women's health -- ob/gyn's, np's, and others.

http://www.womentowomen.com/bioidentical-hrt/default.aspx
C. Devlin: Do you have any problem with the FDA approved bioidentical hormones used for hormone replacement like Vivelle, for example, that I use?

You are giving Dr. Parikh a beating about bioidenticals when what ACOG and other societies seem to be concerned about with non-FDA regulated bioidenticals are issue of standardization of dosage, compliance with good manufacturing practice and the belief that these hormones are in any way "safer" than non-bioidentical hormones. Hell, if you've got an estrogen sensitive cancer brewing, estrogen is estrogen. (I oversimplify, but I think you get my point.)

Speaking of Vivelle, gotta go put on a new patch...
I am in complete agreement. I've never been an Oprah fan. Not only is she out to lunch medically (as you've so intelligently shown us) but she is totally clueless when it comes to dealing with real life emotional issues. Maybe Oprah needs to experience the down side of her cycle in life in order to contain more accountability and develop genuine compassion. I do not wish bad things to happen to her, but I do wish she would learn about what real suffering is.
I'm not "beating up on Dr. Parikh." Perhaps you might as well ask Dr. Parikh what his own thinking is on the subject of Vivelle. My primary issue with Dr. Parikh's several articles on the subject of bioidentical hormones is that he chiefly focusses too much energy on the apparent negative influence of celebrity on health issues, which in turn garners a huge onslaught of mindless responses from readers who know nothing about the issues, only that they find Winfrey and Somers distasteful, and who then lump the issue and the celebrity together, negatively, without actually bothering to understand the actual issue.

Do I have a problem with Vivelle? Since I don't know anything about it, well, no. Does Dr. Parikh have a problem with Vivelle? I don't have a clue. You might better ask him.
To Doris Allen...Not EVERYONE is illiterate? That is called globalization and is an incorrect way of speaking. Thanks.
THANK YOU for this. I had been really concerned that Oprah had not addressed the Newsweek article, which I thought was necessary and important for the national science/medicine discussion.
Oprah is the best...Gonna miss her show..

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Remember when Oprah was cool and then not and then cool again? She's back to not being cool. She wanted to many people to vote for Obama, and now look. Way to go - using your major influence to get him into office.. and for what??? Sorry, but trying to flatten my Belly After Pregnancy is hard when I'm angry. I'm out of here.
I also gave up on Oprah a few years back, after she shoved Dr. Phil on us.

Regards,
Sussy
UK
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