Comment of the Day: “Ethics Dunces: Ten Prominent Doctors, Surgeons and Med School Professors Who Want Columbia To Kick Dr. Oz Off Its Faculty”

The late Prof. George Wald, the best teacher I ever had. In biology, not political science. George did not acknowledge the distinction.

The late Prof. George Wald, the best teacher I ever had. In biology, not political science. George did not acknowledge the distinction.

Commenter Alexander Cheezem, who has quite a bit of expertise (also passion) on such matters, weighed in on the current controversy over the “quackery” of daytime TV star “Dr. Oz.” This time I’ll hold my comments until the end; here is Alex’s excellent Comment of the Day on the post, Ethics Dunces: Ten Prominent Doctors, Surgeons and Med School Professors Who Want Columbia To Kick “Dr. Oz” Off Its Faculty:

I’m going to have to both agree and disagree with you here. First off, I applaud Columbia University’s response and agree that the principle of academic freedom is applicable here… to a point.

Secondly, however, I’m going to have to disagree with you regarding the parallels. Linus Pauling was an embarrassment to medicine, not chemistry. Wald was overly passionate about politics, not biology. Nagel’s views on biology are an embarrassment, not his views on what he’s supposed to be actually teaching. Chomsky’s forays into political science may be an embarrassment (personally, I regard them as something of a mixed bag), but that’s not what he was the professor of, is it?

Kass, McKinnon, Harper, and Singer are closer parallels, of course, but there’s still one rather huge difference: Dr. Oz is a doctor… and runs his show as one. It is, as the comedian John Oliver put it, the Dr. Oz Show, not “Check This Shit Out With Some Guy Named Mehmet”. This is quite relevant for a number of reasons, not the least of which is that offering medical advice is within the scope of what doctors do. Offering that advice while invoking his medical license as a relevant qualification, simply put, can be considered part of the actual practice of medicine.

(Whether or not it legally counts, of course, is another matter. Medical boards are famously reluctant to actually censure doctors for this sort of crap anyway, even when they’re legally justified in doing so… but that’s another issue. His behavior is, however, covered by the enforceable portions of the AMA ethics code even without getting into matters like the reports I’ve seen/heard of him doing things like bringing reiki “practitioners” into the operating room, some of the things I’ve heard about his work at Colombia, or the one time I know of that he actually conducted a human-subjects research project on the show itself without IRB approval.)

This is important for the very simple reason that the medical profession depends on trust and trustworthiness, for much the same reasons as the legal profession does. We, both as individuals and as a society, regularly entrust doctors with tremendous power over our lives, our health, and even our freedom (see the Baker Act, for instance). When doctors fail to live up to this trust — never mind actually betraying it — people inevitably suffer and die. This is why medical practitioners are licensed — much, I might add, as lawyers are. There are even a number of parallels (and, admittedly, a number of differences) in the ethics codes and statutes.

The same, I should add, happens when patients don’t trust their doctor, when medical advice is ignored, and so on. The antivaccine movement is, in large part, fueled by mistrust of the mainstream medical establishment, for instance, and anyone who’s done a rotation in the ER will have horrific tales of the outcome of people thinking they can go off their (immunosuppressant, cancer, antiretroviral, dopaminergic, etc., etc.) medication in favor of “alternate” treatment methods (or disbelief of the diagnosis which lead to them being on it).

This isn’t the depth of it, either. We trust doctors to do things that, frankly, we would be (and are) up in arms whenever anyone else did. Just to pull out one example, doctors routinely drug innocent children into a stupor, open them up with knives, and pull out their hearts. Some doctors even do this on a regular basis. If anyone other than medical professionals were doing this, they’d be put on trial faster than you could say “habeas corpus”. As is, the doctors who specialize in this sort of thing actually have waiting lists, and parents literally beg for them to do this to their children.

By going on the air and offering the fake “advice” he does, Dr. Oz is not just being a huckster: he’s flaunting fundamental principles of medical ethics and undermining the entire profession for the sake of his ego and pocketbook. He isn’t just abusing his position: He’s abusing his medical license.

And yes, “abusing” is the proper term. It’s worse since he isn’t just a random doctor — he is, to use his self-given appellation, America’s Doctor. He is arguably the most prominent member of the profession in the world, and routinely puts himself forward as the profession’s spokesperson.

Doctors in Oz puts it fairly simply, even if they understate depth of the issue: “There are many financial, political, and scientific issues challenging American healthcare. But we say that trust is the foundation of the doctor-patient relationship for good reason. Doctors can’t help patients if patients won’t trust us to provide balanced, evidence-based information. When a doctor uses the mainstream media to consistently promote unproven or misleading medical claims, the public’s trust in doctors will inevitably erode.”

When I mentioned parallels between medical and legal ethics, Dr. Oz’s conduct is one of the cases where it is very easy — trivial, almost — to construct a close equivalent. Imagine a hypothetical divorce attorney who teaches at a university. He may even be good at his job and knowledgeable in his field; it doesn’t matter, although he has occasionally flirted with a few dubious legal theories. He meets a celebrity and hits it off, and gets offered an appearance or two on her TV talk show. One appearance leads to another, and he’s eventually given a show of his own, the “Lawyer Joe” show, where he talks about a variety of legal issues.

His show is wildly successful, and he soon becomes a national celebrity. He even starts referring to himself with the appellation of “America’s Lawyer” in commercials and the like. He gets product endorsements, makes a load of money, etc., etc.

But, well, there aren’t that many legal issues which could be of interest to the average watcher, and he has to make his show interesting to keep the ratings up. Sure, there are a lot, but he’s doing hour-long, weekly programs. At first, most of his advice is good, if generic (“document everything”), but over time he branches out and starts talking and offering advice about the areas of the law that he [i]isn’t[/i] an expert on, making a few errors as he does (failing to point out that some things vary by jurisdiction, for instance, or failing to mention recent legal reforms) but even this isn’t enough.

There are a few ways he could solve this: he could start focusing on individual cases, invite knowledgeable colleagues, he could go into investigative journalism and start exposing the myriad injustices littering our legal system. Instead, he starts promoting the dubious legal theories that he’d flirted with in academia. He promotes the argument from natural law as the “miracle solution” to your legal woes, argues that people on trial for capital crimes should attempt to encourage jury nullification as a defense strategy, and so on.

This works commercially, albeit not without a cost. People start noticing what comes to be called the “Lawyer Joe” effect: whenever he supports some oddball theory, the courts are flooded with people attempting to file lawsuits, defend themselves, or simply argue cases on the basis of what he’d said. Many of these people even represent themselves pro se, believing the advice from Lawyer Joe’s show to be sufficient to let them navigate the legal system on their own; others simply ignore their lawyers’ legal advice, trusting Lawyer Joe over their own attorneys.

Lawyer Joe continues unabated, his show’s advice getting steadily kookier and more bizarre as the show’s run goes on. He hosts (and gives favorable coverage to the legal viewpoints of) secessionists, Sovereign Citizens, and even starts talking about “legal solutions your lawyer thinks are crazy”.

Someone (let’s call him Mr. Lteid) manages to get themselves into legal trouble after failing to realize that one of Lawyer Joe’s strategies violated his homeowner’s association agreement and sues, claiming that his failure to warn people to consult with a lawyer prior to implementing his advice breached a duty of care; this is dismissed on the grounds that “Lteid has pointed to no authority that would lead this court to find a duty of care between a television talk-show host and his vast home-viewing audience, and Lteid fails to convince this court that creating such a duty would be sound public policy.”

Lawyer Joe takes this as encouragement, and continues his conspiracy-mongering and dubious legal advice. The courts start spending an inordinate amount of effort sorting out the consequences of his conspiracy-mongering, from the myriad frivolous liens resulting from his Sovereign Citizen show to frivolous lawsuits from people misinformed regarding their legal rights.

Eventually, ten lawyers with a history of political activism get fed up with the situation and, at least in part as a publicity stunt, write a letter to Lawyer Joe’s university, asking the school to kick him off the faculty.

Obviously, this entire chain of events is absurd. If nothing else, the legal profession would quickly recognize Lawyer Joe as an existential threat and move to correct any loopholes he exploited in the relevant rules and statutes. People would be publicly speaking up within the week about his tendency towards dubious legal advice, and the media would have a field day.

The medical field is nowhere near as good as the legal at handling this sort of thing.

This is where and why I have to disagree with your analysis: Dr. Oz’s conduct is not “tawdry hucksterism.” It is an abject betrayal of his profession and of its goals and ideals, a clear and present danger to the public health, and an existential threat to the field as a whole (although more a symptom than a root cause). It is not “small-potatoes in this [or any other] context”: it’s rampant, unchecked, and unpunished professional misconduct from a holder of a medical license.

The medical field, as a whole, has a serious obligation to fight this sort of thing. They have, so far, failed.

I applaud Miller et al. for acting. I emphatically do not applaud the method they chose. The appropriate recipient wasn’t Columbia: it was the medical board.

I also don’t think Miller and his colleagues were the right ones to act… but discussing the reasons for that goes beyond the scope of this comment (and, frankly, this has gone on long enough, both in length and in writing time). You may want to check out Orac’s coverage over at Respectful Insolence, however. (I can and will provide links if requested.)

I’m back.

I don’t exactly disagree with Alexander so much as think he’s practicing law without a license—Kidding!—by making a technical distinction that makes no material difference in the context of the original post.

It’s true that Mehmet Oz is using his medical license as authority to give out quack health advice, which is sort of in the area of medicine, but how is that different in practical terms from the late George Wald using his Harvard professor status, fame as a teacher, and Nobel Prize in Biology to assert credibility in….peace? Foreign affairs? Military theory? Southeast Asian geopolitics? Communism? If anything, what Wald was doing was worse. He was abusing a Nobel Prize to assert and achieve authority in areas in which he had no expertise whatsoever.  Alexander appears to think it’s somehow more unethical when the legitimate credential is arguably misused in the same field. I don’t see why. I think it’s worse when an unrelated credential is used to make the public trust advice from someone who is unqualified to give it. Either way, however, it is still abuse of trust. The particular credential is just a device to obtain that trust.

Most of the public doesn’t pay attention  to the details and limitations of credentials: the only thing they care about is whether the alleged expert is smart, educated, and has been in some way validated by honors and acclaim. All of the professionals I discussed were in a broad sense abusing their legitimate credentials and fame to assert authority and wisdom that don’t follow from their actual accomplishments. Is this really different from a thoracic surgeon—Oz’s specialty—giving out general health and nutritional advice on TV? He’s abusing his medical license and title, Wald was abusing his Nobel Prize and Harvard professorship; Pauling was abusing his Nobel and his fame. Current examples of the same phenomenon are Dr. Ben Carson, who knows no more about political leadership than your grocer, and Senator Rand Paul. (For some reason, Republicans have always been big on misapplied credentials: n the Bush years, Dr. Bill Frist was a hack Republican Senate leader based on a medical degree.)

Is Oz practicing medicine on the show? His defense is that he isn’t, and like it or not, he has a big precedent, literally and figuratively: fellow Oprah creation Dr. Phil, (she specializes in anointing questionable health-related media stars) who calls himself a doctor on the show—“runs the show as a doctor,” in Alexander’s words—has avoided any sanctions despite the fact that he isn’t a doctor any more. His license was pulled decades ago. However, it has been ruled that he is engaged in “‘entertainment”—free speech—not the practice of medicine. He has no patients, and neither does Oz. I am very confident that if a medical board challenged Oz and tried to take his license based on his TV persona, it would be blocked in court, and rightly so. That doesn’t mean that what Dr. Phil and Dr. Oz do isn’t unethical. It is. But it is no more unethical for Dr. Oz to make people trust his dubious assertions about weight loss aids when he isn’t a nutritionist than it was for Prof. George Wald to try to indoctrinate his biology students in a biology class from a position of authority that he knew more about the best interests of the free world than President Lyndon Johnson.

The ethical offense is abusing authority, credentials and fame in all of these cases. I understand: Alexander thinks that abusing the title of doctor to validate quackery is worse. I don’t.

9 thoughts on “Comment of the Day: “Ethics Dunces: Ten Prominent Doctors, Surgeons and Med School Professors Who Want Columbia To Kick Dr. Oz Off Its Faculty”

  1. My only response to this is to mention that the term “Doctor” is common usage for a profession and it is not one. It is a degree, generally post-graduate and is awarded after several years of academic study. I am reminded of a woman at a party who made the comment “I thought you were a real Doctor”, after being introduced to Dr. B. F. Skinner (a rather famous behaviorist).

  2. A few points:

    (1) If you look, you’ll note that I explicitly pointed out the distinction I was drawing. While academic freedom is applicable to Dr. Oz’s conduct as a professor, it is emphatically not applicable to his conduct as a doctor. I am not describing his actions as misuse of a credential (although they are, given his tendency to comment outside his area of expertise); I’m describing them as professional misconduct.

    The credential he’s abusing also isn’t a degree, certification, or prize: it’s a license, with all that entails.

    (2) Dr. Oz’s defense isn’t that he isn’t practicing medicine on his show. He claims — verbatim — that it “is not a medical show.” This is not a minor difference, and the claim is patently absurd.

    (3) Dr. Phil was never a doctor. He was a psychologist — different ethical codes, different licensing authorities and statutes, different professional communities, different… well, you get the idea.

    (4) A medical board doesn’t need to yank Dr. Oz’s license to help rein him in. Given the extent to which he’s in the public eye, a simple letter of censure would go a long way… and there are plenty of other methods I can think of which don’t even require that level of action.

    (5) You argue that “it is no more unethical for Dr. Oz to make people trust his dubious assertions about weight loss aids when he isn’t a nutritionist than it was for Prof. George Wald to try to indoctrinate his biology students in a biology class from a position of authority that he knew more about the best interests of the free world than President Lyndon Johnson.”

    This is false: The appropriate comparison would be Dr. Wald hypothetically going on TV as a biologist, engaging in self-promotion until he became the most popular and well-known biologist in the world, and then accepting payment for attempts to indoctrinate his fanbase in Young Earth creationism.

    (6) The responsibilities of a doctor, or any member of a medical or allied health profession, extend beyond merely seeing patients. They include responsibilities to the public health, to their colleagues, and to their profession itself.

    Dr. Oz’s conduct is the ethical equivalent of a lawyer advocating that people ignore the law — treason to the fundaments of what it means to be a doctor. More importantly, in a sense, he’s made himself into a material danger to the integrity of the medical profession and to the public health.

    That said, these responsibilities also extend to Miller et al., as I will revisit below.

    (7) With all of the above said, the topic of the discussion here isn’t Dr. Oz’s conduct, per se — I brought that up in regard to the overall situation and the context of certain actions. The matter we’ve been discussing is the ethics of Miller et al.’s letter.

    (8) Opinion 10.015 of the AMA Code of Medical Ethics reads, in part: “The relationship between patient and physician is based on trust and gives rise to physicians’ ethical obligations to place patients’ welfare above their own self-interest and above obligations to other groups, and to advocate for their patients’ welfare.” (Emphasis added.)

    Other health professions are a great deal more explicit about this. For instance, Section A.7.a of the American Counseling Association’s code reads: “When appropriate, counselors advocate at individual, group, institutional, and societal levels to address potential barriers and obstacles that inhibit access and/or the growth and development of clients.” (A.7.b requires them to get consent before doing so for an identifiable individual client.)

    Now, while doctors are a Hell of a lot less likely to deal with fuzzy and ephemeral factors such as “growth and development” than counselors are, the general ethical principle remains the same. Individual doctors have a responsiblity to advocate for their patients’ health and welfare; doctors, as a profession, have a responsibility to advocate for the public health.

    Dr. Oz has made himself into a noticable, substantial danger to the public health, to doctor-patient relationships throughout the country, and to the health of anyone who watches his show. Doctors, and the medical profession as a whole, have a corresponding responsibility to rein him in.

    (9) Miller et al.’s letter was intended as a means to this end — an end which they, as noted above, had an obligation to persue.

    (10) The above doesn’t even get into the threat Dr. Oz represents to the medical profession itself.

    (11) Obviously, a justified or ethical end does not justify unethical means. While we have disagreements about the extent and nature of Oz’s misconduct, we both agree that his known conduct as a Columbia professor does not merit dismissal (I initially wrote “professional consequences”, but then realized that it would be overly broad: what he’s done as a professor does, for instance, warrant being passed up for offers of future positions, and his conduct is a pretty clear indication that the school shouldn’t trust him with further responsibilities).

    (12) Urging Columbia to fire Dr. Oz on the basis of his quackery shows a disrespect for his freedom as an academic and for academic freedom in general.

    (13) That said, if I were an administrator at a clinic, practice, or hospital Dr. Oz was working at, I’d fire him.

    (14) This is why I said that the medical board, not Columbia University, was the appropriate recipient of that letter. They, not Columbia, are the organization tasked with overseeing Dr. Oz’s conduct as a medical professional. Columbia, by contrast, deals with him in his role as a professor.

    (15) I never suggested that they should use the board’s reporting system to file a license complaint in the formal sense. That… is a different matter, and the difference between the two is the difference between sending a letter of complaint to a government office and filing a compaint with the court. That said I should have, in retrospect, mentioned the medical association as well.)

    (16) Whether or not they’d be able to pull or revoke his license is actually entirely beside the point in this case — see “publicity stunt”. I’m generally not all that fond of people filing complaints or suits which they know aren’t likely to prevail due to lack of legal grounds, but there the ethical pressures here help counter that a good bit.

    (17) Whether there are alternate approaches — posible other publicity stunts, etc. — which could have worked here is almost beside the point.

    Anyway, there are a few other points I could make, but this is getting rather absurdly long… again. I know I restated a lot of my initial argument in this, but at least it’s hopefully a bit more clear.

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