COMMENTARY

Bad News: Medical Misinformation and the Ethics of TV Docs

Henry R. Black, MD; George D. Lundberg, MD

Disclosures

April 08, 2015

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Taking Television Doctors to Task

Henry R. Black, MD: I am Dr Henry Black, Adjunct Professor of Medicine at the New York University Langone School of Medicine. I am here today with Dr George Lundberg.

George D. Lundberg, MD: I am Dr George Lundberg, consulting professor in a couple of departments at Stanford University. I am editor-at-large at Medscape, after having been editor-in-chief of Medscape for 10 years. My main job is as chief medical officer of a company named CollabRx in San Francisco. I am happy to talk with you today about the interesting topic of medical news, and how to handle it.

Dr Black: One thing that stimulated my interest in what patients are hearing or seeing was an article in the British Medical Journal[1] recently that looked at data from Dr Oz's show and from a show called The Doctors. They did a very nice study to assess the accuracy of the reporting, whether they discussed conflicts of interest, and many other things.

The findings were somewhat disturbing. It seemed from their conclusions that one third to one half of what was discussed and recommended on these programs had any scientific basis. Have you had a chance to look at that? What did you think about it?

Dr Lundberg: I saw it, and I saw all the media publicity about it. Frankly, I was surprised that they got as much right as they did. I figured that a lot of the television medical news is really entertainment. It is not intended to be medical news. It is intended to generate ad sales, either directly or indirectly, and generate readership. That is what it is all about. It is more entertainment than it is news.

Dr Oz got about half of it right, and I was surprised it was that good. The Doctors show seemed to do a little bit better.

The thing that surprised me about that particular study was that these are American shows, but it was published in the British Medical Journal. Why wasn't it published in the New England Journal of Medicine, or in JAMA? This is an American problem.

Dr Black: It was broadcast internationally too, so it must be a problem in other countries as well.

Dr Lundberg: We would have to go country by country and find out. Back when we used to publish JAMA in other languages, we looked at what the news media were doing in other countries, and it was extremely variable. The level of science coverage is highly variable. The level of ethics that is involved in it, and the extent to which advertising is sold against the content of particular articles, varies in honesty from culture to culture. The BBC in the United Kingdom generally did a good job. The Guardian does a good job in terms of honest, direct reporting. This is television, however; TV is the worst, although radio is not much better, but the print media are not blameless either.

Viewers, Not Qualifications, Matter

Dr Black: Dr Oz apparently gets 2.9 million viewers per show, and The Doctors gets about 2.3 million per show, which is an enormous audience. How much of the information is reviewed by experts? Are these doctors—Dr Oz and those on The Doctors—qualified to discuss these things?

Dr Lundberg: I do not have any way to know that. To me, the problem is separating the role of a physician who is bound by the ethics of the medical profession to be honest and trustworthy, and first do no harm, and the media personality.

If someone wants to be a media personality or an opera star or the first violinist for the Chicago Symphony and also happens to be a doctor, that is fine. You can separate what they are doing in their performing role from what they would be doing if they were performing as a physician. In these two shows, however, they capitalize on the fact that these are actual physicians—sometimes prominent physicians. By so doing, they have a panache and a credibility put onto them by the fact that they are physicians—presumably licensed physicians in particular areas—and that means people ought to listen to them.

When you mix that up with hype and entertainment and the promotion of products that seem to have little or no backing from legitimate science or the medical literature, I have a real ethical problem with that. And I have a problem with the profession of medicine not trying to do something about the misrepresentation of what a doctor is and ought to be doing.

Dr Black: Dr Oz is a cardiovascular surgeon. Apparently, at one time, he was a busy cardiovascular surgeon, and now, he is giving advice about diet, exercise, and lifestyle. I don't know that I would be qualified to say what to do in the operating room, and I am not sure that he is qualified to talk about some of the things he talks about, either.

Dr Lundberg: I don't think that the television producers care whether he is qualified. They care whether he attracts eyeballs so they can sell advertising.

A Question of Journalistic Ethics

Dr Black: Is there anything that we, as a profession, ought to be doing to provide some balance? For example, this study showed that only 0.4% of the presentations mentioned anything about conflict of interest. We are so immersed right now in disclosure and conflict of interest, and this is not at all evident in what we see on television.

Dr Lundberg: The journals generally follow the International Committee of Medical Journal Editors (ICMJE) rules and disclose conflicts of interest as best as they can. Sometimes, it falls through the cracks, and there are imperfections, but they do try hard. Some of the better print media—the New York Times, the Wall Street Journal, the Los Angeles Times, and a few others—look for conflicts of interest and put those points within the articles that they publish. Sometimes they do not.

On television and radio, you almost never hear disclosures of conflict of interest on the part of the people who did the studies. Nor do you hear of conflicts of interest on the part of people who appear on television or on the radio, whether they are an interviewee, interviewer, television personality, or news reader. I have faulted that for 30 or 40 years in very public channels, including with the public news media.

When I was at JAMA, we worked collegially with the public media people and tried our best to teach them what we thought they should be doing, but conflict of interest is a huge issue. Disclosure alone does not solve the problem, but it is at least one approach to try to put people on their guard, and to encourage people to be wary about what they hear, because somebody talking about it may have a million-dollar investment in what they are talking about.

Dr Black: Are there any guidelines or rules for how this should be handled? Do journals or print media use guidelines?

Dr Lundberg: There are lots of rules for journals. The ICMJE has quite stringent rules, and although they are voluntary and journals do not have to follow them, the leading journals generally do. For the public media, there is a society for professional journalists that has rules. In fact, the International Center for Journalists (ICFJ) has rules for how the public media ought to work, but that does not mean people are going to follow them.

What should the American Medical Association (AMA) should be doing about physicians who purport to be physicians, but are in fact Bourbon Street barkers? The AMA does not take any action because the only thing they can do is discipline members or throw them out of the organization—but a minority of US physicians are members of the AMA, so there is limited recourse.

Then there are the state medical associations. Most physicians are members of their state medical associations, and these have ethics committees. Maybe they should take action if the person is a member. If the person is a member of a hospital or a university staff, there ought to be rules for professionalism and ethical professional behavior that ought to be enforced.

Around the time that the BMJ published the study, the US Senate had to have hearings on a public scolding for Dr Oz by Senator McCaskill. It was embarrassing to all physicians that that had to happen. Why is the Senate of the United States doing what the medical profession ought to be doing?

Dr Black: Do you think it had any impact?

Dr Lundberg: There is a study for you. Somebody ought to do a systematic study of what was said before and after the Senate hearing to see whether the error rate reported in the BMJ study improved, worsened, or was unchanged. That would be a good follow-up study. It is not a controlled study. It is time-limited, but it is a before-and-after study to see whether it made a difference. I hope it did, but I do not know. I never watch those shows.

Keeping Tabs on Medical Reporting

Dr Black: Do you have any thoughts about why our patients trust what they hear so easily?

Dr Lundberg: P.T. Barnum said there is a sucker born every minute. That was then, and this is now. Steve Barrett has been running Quack Watch out of Princeton, North Carolina, for a very long time, and Gary Schwitzer runs Health News Review, a wonderful site that reviews all the main medical news every week.

You can go online and sign up to receive Gary's newsletter, and find out whether he gave Nancy Snyderman five stars or a slap in the face about how she performed on the Today Show. You can read about how the Wall Street Journal, the Los Angeles Times, the Des Moines Register, or CBS Radio did in the medical news reporting that week on Health News Review. That is a great service that Gary has been providing for a long time.

Unfortunately, TV is generally the worst, although a lot of the other programs much better. WebMD, the owner of Medscape, where we are appearing, generally and Every Day Health and MedPage Today, the competition, generally get good grades, although sometimes not. There are people out there who know how to do this and are doing it right, but not much in the major media.

Dr Black: Maybe this is an unrealistic idea, but I would like to see a page or two pages per issue that discuss what the public is hearing from TV or from the press and how much of it is accurate, and how much of it is not. Patients are hearing it, and they are not hearing the opposite, so doctors need to have some way to answer when a patient asks for something that is potentially harmful. They need to be able to say, "Well, you might have heard that on the Dr Oz Show or on The Doctors or on some other show, but it is not right."

Dr Lundberg: The great thing about Medscape Medical News and MedPage Today medical news is that they are so timely that by the time a report is out in the major journals or out there for the public media, in general it is possible for physicians to have already read about it. That was one of the reasons we had an embargo at JAMA and other journals. Generally, the news media do follow those embargoes, so it is possible for there to be a lead time during which JAMA and the New England Journal of Medicine can reach the doctor's desk and be available for the doctor to read before the news media come out with stuff. That is a legitimate reason for embargos to exist.

There are people and companies that are trying to help doctors be able to have the information the same day that patients come in with breaking medical news, but that is entirely different from what Dr Oz and Oz-type characters might come out with, which may not have any timelines at all because it is not from the medical literature. That is a lot harder for doctors to deal with in terms of a post hoc criticism column in the New England Journal of Medicine, JAMA, JAMA Internal Medicine, or Annals of Internal Medicine (the big four).

You are suggesting that the editors assign someone (in addition to what JAMA does in its medical news section and has been doing for many decades very well) to write a one-page "Eye on the Media" column, or something like that, with a scoring system. That is a very proper concept. It is absolutely within the capability of the staffs of editors of at least three of the four journals, and it is a great idea. I hope somebody picks it up and does it.

Dr Black: It reminds me of what the US Food and Drug Administration (FDA) does with package inserts. There is one package insert for doctors and healthcare professionals, and another one for patients that helps them understand what the package insert is saying.

Dr Lundberg: The FDA does the best it can on educating the public, and if you pick up a prescription at one of the pharmacy chains, there is information required by the FDA for the patient who is going to use that drug. But I would bet that the number of patients who actually read that information is relatively small, and much of that information applies to only one half of 1% of the people who take the drug. There is a place for editing that kind of information to draw attention to the important things that have a statistical likelihood of potentially hurting someone.

I don't think we should lose sight of the fact that in beating down medical reporters, we in medicine also have a lot to learn, because the science is hard. Reporting the science is hard. Peer review is noble and necessary but often faulty. There was an article in JAMA Internal Medicine[2] recently that demonstrated that the FDA gets information about research misconduct and puts in the coffers of their files. These are studies that are already in print or about to go to print, but they never marry up the information they have, and are ignoring, with the studies that appear in print. There are a lot of things we can be doing a whole lot better in medical science, medical editing, and medical reporting.

Dr Black: Thank you so much for your time and opinions about this. This has been a longtime interest of yours and of mine as well, and maybe we can make a difference somehow.

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