Patients should be skeptical about claims and recommendations made on mainstream television medical talk shows, according to a Canadian media study published online December 17 in the British Medical Journal.
In many cases, investigators found that specific details on the magnitude of benefit or harm and the cost and inconvenience of following recommendations were lacking, and evidence supporting them was contradictory or absent. Viewers had little basis for informed decision making.
The prospective observational study, led by Christina Korownyk, MD, associate professor, family medicine, University of Alberta, Edmonton, Canada, randomly recorded 40 episodes each of the widely watched programs The Dr. Oz Show and The Doctors from early January 2013 to early May 2013 and assessed all recommendations made on both shows.
These influential internationally syndicated shows, which in 2012 to 2013 each attracted 2 to 3 million daily viewers, typically featured a host or hosts and guests discussing one to five health topics per episode and making an average of 11 or 12 recommendations to consumers, some of which were stronger than others. On both shows, the visitors made a substantial proportion of health recommendations: 65% on Dr. Oz and 33% on The Doctors.
To critically assess the content of these shows, experienced evidence reviewers independently searched and then, as a team, evaluated the evidence for 80 pieces of advice, randomly selected from what they considered stronger recommendations.
The most frequent topic on both programs was general medical/public health advice ("Get vaccinated"; "Sneeze or cough into your sleeve to prevent the spread of germs"), followed by non-weight-loss dietary advice; for example, on immune-boosting diets. The combination of dietary and weight-loss advice represented 43.2% of the topics discussed on Dr. Oz and 16.8% of those on The Doctors.
On Dr. Oz, the recommendations were most often dietary (39.2%; eg, "Carb-load your plate at breakfast"), although the researchers reported no direct links to specific dietary products. On The Doctors, the most common advice involved consulting a healthcare provider (17.8%): "Go to your primary care doctor or talk to their nurse before going to the [emergency department] to help relieve the load in the [emergency department]." Potential conflicts of interest of hosts and guests were acknowledged only four times out of 924 recommendations.
On both shows, exercise took a definite back seat to diet, with dietary advice accounting for 39% of recommendations vs 5% for exercise on Dr. Oz and 10% versus 5% on The Doctors.
On either program, a specific benefit was mentioned for only about 40% of recommendations. Even less commonly mentioned were the magnitude of benefit (<20%), potential harms (<10%), costs (<15%), and potential conflicts of interest (<1%). "We did come across a couple that had evidence of harm associated with them, and we are compiling this data now," Dr Korownyk told Medscape Medical News.
Overall, the Alberta investigators found that 87 of the 160 recommendations assessed (54%; 95% confidence interval, 47% - 62%) had some level of published evidence to support them. Believable or somewhat believable evidence supported 33% of recommendations from The Dr. Oz Show, and 53% on The Doctors.
Conversely, believable or somewhat believable evidence was found against 11% (Oz) and 13% (Doctors) of the recommendations. For slightly more than 1 in 3 (Oz) and 1 in 4 (Doctors) recommendations, no evidence was found. "Approximately half of the recommendations have either no evidence or are contradicted by the best available evidence," the authors write.
Among the limitations of the study, the authors acknowledge the shows' complexity, the subjective nature of much of the advice, and the difficulty of distinguishing between what was said and what was implied. They raised the question of whether medical talk shows should provide more than entertainment. "If the shows are perceived as providing medical information or advice, viewers need to realize that their recommendations may not be supported by higher evidence or presented with enough balanced information to adequately inform decision making."
The study was partly supported by a research scholarship through the University of Alberta. The authors have disclosed no relevant financial relationships.
BMJ. 2014;349:g7346. Abstract
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Cite this: No Evidence for Most TV Medical Advice, Study Shows - Medscape - Dec 26, 2014.
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