Selling a cure based on imaginary evidence is immoral

In the ongoing battle to gain from our society’s scientific illiteracy, Dr. Oz has nocked another arrow. This time, he as the cure for all fatigue. I hope he’s got this right because this is one of the most common and most difficult problems to treat.

Fatigue is a tough one. Everyone has experienced fatigue at some point, and as a physician, part of my job is to figure out just what someone means when they say, “I’m tired.” One of the first distinctions is between “fatigue” and “sleepiness”. Sleepiness is often caused by sleep disorders such as restless leg syndrome or sleep apnea. Fatigue is more vague and varied. It’s also fairly miserable.

It’s rare to find a single cause (and therefore a single cure) for fatigue. Sometimes you get lucky and find a thyroid disorder or other simple problem, but more often it’s a mixture of factors such as overwork, depression, and stress. And it’s not always pathologic. If someone tells me that they’re fatigued, and they work 50 hours a week and are raising kids and taking care of parents, there’s not much to do except try to find ways to change circumstances or cope with fatigue.

But Dr. Oz breaks it down much more simply. He starts his little video with his usual medicine show gimmicks, this time a tray of grey powder. He runs his hands through it and dumps it out to reveal the word “MAGNESIUM”. Chemists in the audience may have displayed a bit of anxiety, as elemental magnesium has a tendency to ignite and explode, but when it’s powdered you sometimes get lucky and a layer of oxidation reduces (!) the risk. Or maybe it wasn’t elemental magnesium at all. Who knows?

After playing with magic Boom Powder, he explains his surprise on having learned that about three-quarters of Americans are magnesium-deficient. I was surprised too, given it’s not remotely true. A search of the literature confirms only what most doctors know, that many patients in hospitals are mag-deficient, usually due to medications or illness.

I’m not sure where he gets his “three-quarters” number, but I did find one study that asked people to recall recent meals, and found that 68% consumed less than the US RDA recommended amount of magnesium in their meals. They didn’t actually use food diaries or magnesium levels. To go from a survey of recalled meals to a hard figure on actual mineral deficiency isn’t right—it’s not even wrong. I found little else in the literature to support the assertion of wide-spread mag-deficiency.

But Oz is pretty sure about it. According to him,”low energy” is the strongest indication of low magnesium. This boring assertion is also void of meaning. What is “low energy”? Is it a subjective feeling? An objective measurement? And how do we know that this thing is at all connected to magnesium? (Hint: we don’t.)

But Oz knows that nothing proves a crazy statement like a good testimonial. He explains that symptoms of magnesium deficiency are irritability, anxiety, and lethargy. Then he has a woman describe an episode of just these feelings, one that sounds to my medical ear like a panic attack. He plays with another toy, this time a water tank and a whoopie cushion (if you have the stomach, go see for yourself). The side show tricks aren’t just boring, they’re senseless and distracting. The guest is describing a real, treatable problem and is being fed fake solutions.

He shows a clip of another woman who says:

Dr Oz, I have five kids and I’m exhausted from the minute I get up to the moment I go to sleep. I need you to help me get my energy back!

You can guess what the answer is. My answer is a bit different. The busy mom has a crazy life. She works hard. Working hard is exhausting. The cure for that sort of exhaustion is rest. Sometimes improving rest and work habits is feasible, sometimes not, but the cure isn’t valium, adderall, or magnesium. It’s empathy, compassion, and changes to families and societies that help improve our quality of life. And perhaps the judicious use of some medications.

Selling a cure based on imaginary evidence isn’t just irresponsible, it’s immoral and goes a century of medical ethics. It’s behavior unsuited to a good physician, but probably a step up from your average carney.

“PalMD” is an internal medicine physician who blogs at White Coat Underground.

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