Dr. Mehmet Oz has arguably become one of the more famous media spokespersons introducing integrative medicine topics to a broader population. Unfortunately popularity can generate vulnerability to criticism and naysayers. Recently, a medical student named Benjamin Mazer, submitted a recommendation to the Medical Society of the State of New York and the American Medical Association, suggesting that TV media personalities, and Dr. Oz in particular, should be subject to regulation. His proposal was that information provided should be treated much like expert witness testimony in a court of law. He went on to suggest that he would like to, “bring down Dr. Oz”, and that the statements made by Dr. Oz, ‘have no medical basis’. This seems a disproportional position for a second year medical student to have taken, especially given the level of clinical acumen that one would have acquired at this stage in his training. His position, to me, appears imbalanced in that he portrays Dr. Oz as, ‘having no medical basis’, but stops short of providing examples evidential to his opinion. Nonetheless, given that medical training does little to provide students with exposure to a broader range of therapeutic options I am not particularly surprised to hear such commentary. So it wouldn’t be unusual that a younger, less experienced clinician would be inclined to take a more narrow view of a complex decision-making process. I did find it interesting that in one of his interviews from Vox that the patient encounter he described as a motivator for his actions involved a 60-year-old female patient who had type 2 diabetes and cardiovascular disease. Dr. Mazer’s frustration was that he had prescribed standard diabetic medications, and the patient, having recently watched Dr. Oz, declined to take the medications. Instead, she wanted to do a trial of green coffee bean extract, which had been discussed on his show as potentially helpful for weight loss. No further comment was provided about that patient encounter. Dr. Mazer was not in support of this individual patient doing a trial of a natural remedy, even in the context of potential benefit for weight loss. This patient encounter does underscore a significant clinical problem with Medical School education. Most physicians are not informed about nutritional supplements, or studies that have demonstrated efficacy. In fairness, some medical media personalities have presented overly hyped encouragement regarding various natural remedies. Some may be helpful, but others may be potentially problematic in a given individual. Often the proclamations are designed as marketing tools rather than exchanges of legitimate therapeutic information. That having been said, I think one could reexamine the doctor-patient relationship in this unique situation. Dr. Mazer jokingly refers to the so-called “Oz Effect.” I have heard many physicians make similar humorous references. Dr. Oz has been a highly regarded clinician and surgeon, and has been a great spokesperson contributing information helpful to improving many lives. Many physicians, including myself, are often asked questions by patients who have watched a television program offering medical advice on various therapies. I can’t speak to the uniqueness of Dr. Mazer’s patient in this situation. I would speculate that, from the patient’s perspective, she would have preferred to engage in a dialog regarding her therapeutic options. This would have done substantially more to enhance the doctor-patient relationship. Perhaps a better approach would have been for the doctors to advise the patient that they were unfamiliar with this particular therapy, but would look into it, and then they could dialogue with her about potential options. I seems this did not occur. It is interesting that there are a number of published studies on a green coffee bean extract. PubMed, the National Library of Congress database, lists 25 publications. It is not an entirely ‘unproven’ concept as what seems to be inferred. I think in this situation one would recognize that weight loss in an overweight person is associated with general improvements in overall health, cardiovascular risk, and diabetes. As a matter of fact, I have seen very often that type 2 diabetes will disappear entirely with weight loss and physical activity. I would say that if the green coffee bean extract were something that she could take for a prescribed period of time, and it showed some benefit in weight loss, and was well-tolerated, it would have been be a reasonable inclusion. I would also appreciate the fact that this woman had some potential concern of being placed on diabetic drugs. Recent studies which have shown an increase in cardiovascular risk in patients given multiple medications to achieve ‘optimal’ diabetic control. One such study, the ACCORD trial, studied optimal regulation of lipids (cholesterol), blood pressure, and blood sugar, but was halted two years early when the data demonstrated an increase in cardiovascular risk with the drug therapy. As it turns out, optimal glycemic regulation may not be a significant contributor to cardiovascular risk, but that remains to be defined. The important issue is that if this individual patient could have initiated a natural therapy that was cost effective with minimal or no side effects that could potentiate weight loss, I would speculate that those initial improvements could provide the encouragement to embrace other health supportive options including an optimal diet control, and perhaps other nutritional supplements which may be helpful in glucose regulation. However, experience in the last 20 years has reaffirmed the importance of actively listening to patients. A well-known adage is, “if you listen to a patient long enough, they will tell you everything you need to know”. In this age of 2 minute HMO managed care visits adequate time to listen rarely occurs.
