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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  • southerndoc1

    “Selling a cure based on imaginary evidence is immoral”

    EMRs? PCMHs? ACOs?

  • Dike Drummond MD

    And humans will always fall for the “magic pill” marketing approach. If you look back at the history of marketing … the the very first print ads two centuries ago were posters for cure alls and you can see the magic pill psychology in many advertisements for many different products and services today.

    The interesting point in healthcare/medicine is that – because of the power of the placebo effect … some people take the magic pill and actually feel better even though we know there is no physiologic effect. In part it depends on how much they believe in the person who sold that pill to them.

    Dike Drummond MD

    • NormRx

      Or as we in the industry use to say “the positive psychology of prescribing help.”

      • Dike Drummond MD

        Hey Norm … yes, the placebo effect is a powerful, wonderful and mysterious thing. I sincerely hope the techies don’t figure out a way to put it on an iPhone app. or we are all in trouble ;-)

        Dike Drummond MD

  • Vikas Desai

    no one is hearing you, people now more than ever will fall for nonsense and pay big money for it especially now there is a general backlash against physicians in this country. What Dr. Oz says(or whatever his producer tell him to say) carries more weight than some local PMD.

  • Homeless

    Like my doctor who insists that I take large quantities of vitamin D? Or that doctor 10 years ago that insisted that I take large quantities of vitamin E

  • Doc C

    There was a time where at least some of what he said might have held some semblance of truth. Now he is no better than the snake oil peddler in the old time travelling carnival – perhaps worse as I have to spend precious time undoing the damage he has done instead of providing useful counselling.

    As evidence-based practicing physicians who actually do have our patients’ interests at heart, is there truly no way for all of us as a group to get this sort of garbage off of the air?

  • Marc Kashinsky

    I’m just glad someone else besides me, recognizes Dr Oz as nothing more than a shill for the vitamin and supplement industries

  • Mark Arnold

    I think that the powdered Mg would get really exciting with a match. He probably didn’t mention Epson salt as a source for Mg. He probably didn’t mention moderate exercise during the day and 8 hours of sleep as a possible cure for fatigue either.

  • Molly_Rn

    Dr Oz is a quack! He is so far outside his expertise that it is amazing. He is also a shill for so many products that it is pathetic. Everytime I turn around I see his puss on the cover of Time magazine; I wrote a letter to the editor of Time asking for a moritorium on Dr. Oz.

  • LastoftheZucchiniFlowers

    The vilest part of Oz is that he still retains his faculty appointments at Columbia. This guy was, at one time, a practicing cardio-thoracic surgeon which we all know is most lucrative but highly exhausting. WTF happened to him? Did he just decide that it was easier to become a paid shill for the big-Vita?? He’s morphed from genuine top of the surgical food chain to the lowest form of snake oil sales with a very bad toupe. I have wasted a LOT of time in OVs explaining to pts who have seen him on the tube hawking his crap that this guy is tantamount to a QVC shrieker of cubic zirconia though he once DID real work. His WORST travesty perpetrated on patients? Has to be his human growth hormone craze which certainly promoted tumour activity in the unfortunates who believed his rant and then TOOK the drugs……..I do not understand how is he NOT being sued for huge sums and how he retains his academic posts???

  • traumadoc

    he is a quack!!! i have taught medicine and allied health for many years…..been a dr. without borders a long time…..i would love to challenge this guy to medical trivia……..the only medicine he is selling that really works is laughter!!!!!!

  • lemaman

    he should have run his hands through a pile of bullshit and said, “here is what I have for you gullible lay people…”

  • ZDoggMD

    Dr. Oz: another Sucka MD–>

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