A prescription for media doctors — unregulated, and serving six million ‘patients’ per day

July 30, 2015

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A television news anchor who exaggerates his experience is demoted, but doctors on television who exaggerate their expertise across all branches of medicine, prescribe unsubstantiated, costly and potentially harmful treatments, and leave other doctors to manage the fallout continue without censure.

Too much bravado by a news anchor should not provoke more outrage than too little vital prescription information from a doctor. Television doctors are engaged in the practice of medicine, with all of the attendant obligations to be trustworthy. They are potential sources of valuable information — or harmful misinformation. Brian Williams’ “Walter Mitty-isms” are harmless compared to the potential costs and health consequences of haphazard media medicine.

The American Medical Association (AMA) agrees with our position that practitioners of media medicine are not exempt from their responsibilities as doctors. At its June meeting, the AMA announced that it will issue ethical and disciplinary guidelines for media medicine. Specifically, these guidelines will encourage media physicians to adhere to evidence-based medicine, insist that they disclose whether their positions “are based on published peer reviewed evidence, standard of care, or personal opinion,” and make recommendations for disciplinary measures against media physicians who offer dubious medical advice.

The recognition that media doctors are practicing medicine by the nation’s largest organization of physicians is major and long overdue news. It opens the door for possible regulation of media medicine and also for a more cooperative relationship between practitioners of traditional medicine and those, like Dr. Mehmet Oz, who take a non-traditional approach, frequently advocating alternative remedies.

The stakes are high: “The Dr. Oz Show” and “The Doctors” are making medical recommendations for a total of about 6 million virtual “patients,” which is more than any other U.S. practicing physician, medical group or hospital.

We don’t agree with the argument, made by physicians from across the country, that academic institutions should sever ties with physicians on television. Media doctors are still trained physicians, and many people report tremendous health benefits from their recommendations.

In response to our inquiries about the role of media medicine and the potential dangers of some on-screen prescriptions, media doctors seemed receptive to ideas about regulation, and also about developing a more cooperative relationship with mainstream physicians. A spokeswoman for “The Doctors” stated via email: “We look forward to enhanced standards and guidelines for ALL physicians who have media platforms.” In a prepared statement to Reuters, Oz said: “I share the values and concerns raised in the resolution proposed by the Residents and Fellows of the AMA.” However, he  also wrote, “Often, this advice must be translated and presented in new ways so that it is accessible to patients and compelling enough to garner attention.”

We need guidelines to ensure that these “new ways” provide sufficient accurate information to patients.

According to a study published in the medical journal BMJ, more than half of the treatments prescribed by physicians on programs such as “The Dr. Oz Show” and “The Doctors” have no credible science basis. In response to this study, Oz wrote in Time magazine that 50 percent approximates “the amount of randomized clinical trial data underlying conversations in physician’s offices” — in other words, only 50 percent of the medical advice prescribed by physicians in their offices is supported by this particular type of trial, which is the gold standard.

While many doctors do make herbal, holistic, off-label or other recommendations to patients, these are usually based on experience and scientific studies, though not always the randomized clinical trial that Oz refers to. A prescription based on a physician’s scientific review, even without full validation by a randomized clinical trial, is very different from a prescription lacking any scientific credibility.

A common thread among media doctors is the prescription of alternative medicine, such as herbs and other natural remedies for common diseases such as obesity. These are simple, sometimes expensive solutions that appeal to a large number of people, despite the fact that most have not undergone clinical trials to prove that they work.

As Columbia medical faculty, we’ve seen the unintentional consequences of “miracle cures” promoted with insufficient caveats. We recently encountered a patient with diabetes who suffered an amputation after substituting a tele-prescribed probiotic for her regular medication. Another patient developed rhabodmyolysis — the toxic breakdown of muscle, which can lead to kidney failure —  as a result of taking various alternative weight loss remedies, including chromium, guarana, and Garcinia Cambogia, all of which have been promoted in media medicine even though medical literature has noted them to be potentially toxic to muscle. Like any treatments, the anticipated efficacy and potential side-effects of non-traditional medicines needs to be disclosed to the patients.

“The Dr. Oz Show” and “The Doctors” declined to comment on the issue of providing more safety information regarding on-air prescriptions.

These types of scenarios illustrate the need for better regulation of media doctors. In a traditional medical office, a doctor would be liable for malpractice for making recommendations without providing warnings about possible side effects or interactions with other diseases, as well as telling the patient if the treatment is known to be effective and, if so, how effective and over what time period. (“I don’t know” is an acceptable answer here.)

The AMA is not a regulatory body, and its efforts to establish practice and disciplinary guidelines for media doctors — at the encouragement of medical students, residents and fellows who brought the issue to its attention — are only the beginning. Media executives, organizations such as the AMA, and state and federal legislators (who define the legal responsibilities of doctors) should work together with television doctors to ensure that media medicine is practiced ethically and responsibly.

In a 2013 New Yorker profile Oz said that  academic medicine is a “fortress” whose walls he will tear down, and Western doctors do not want questions from their patients. We believe that most doctors, including those in academia, are always learning from colleagues and from their patients who may have alternative views.

Media medicine is not going away. It can be a valuable source of information if physicians practice it properly, providing viewers with the same information that they would give to patients in their offices — such as the scientific evidence behind a prescription, disclosures about side effects, and reasons to call their doctor if follow-up issues occur or an illness persists.

Since this is a new and unregulated branch of medicine, some space must be allotted for the inexperience of youth — but not too much. The pending directives from the AMA are a positive sign for the future of medicine, regardless of where the shingle hangs.

Until the responsibilities of television doctors are more clearly delineated, our medical advice is to take what your media doctor prescribes — with a healthy dose of skepticism.

This column reflects contributions from a diverse group of faculty at the Columbia University Medical Center.

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