THE DR. OZ EFFECT

THE DR. OZ SHOW

focuses on essential health issues: the proper ways to eat, relax, exercise, and sleep, and how to maintain a healthy heart.

Some of the advice Oz offers is sensible, and is rooted solidly in scientific literature.

Harvard: BA University of Pennsylvania: MD, MBA Columbia University: Cardiothoracic surgeon,

Professor

SOME, NOT SO MUCH

MAGIC BULLET MINDSET

MIRACLE DRINKS AND MIRACLE MEAL PLANS

“startling,” “breakthrough,” “radical,” “revolutionary,” “miracle.”

“Dr. Oz’s Three-Day Detox”; “Eat Yourself Skinny”; “Oz-Approved Seven-Day Crash Diet”

Oz introduced raspberry ketones, an herbal supplement, as “the No. 1 miracle in a bottle to burn your fat.” - set off a wave of panic buying throughout the nation

QUESTIONABLE CLAIMS

1. show on whether it was possible to “repair” gay people (“From Gay to Straight? The Controversial Therapy”), despite the fact that Robert L. Spitzer, the doctor who is best known for a study of gay- reparation therapy, had recanted.

2. genetically modified foods by saying, “A new report claims they can damage your health and even cause cancer.”

” Cancer, Oz told me, “is our Angelina Jolie. We could sell that show every day.”

TYPICAL CANCER THEMES

“Five Fast-Moving Cancers”

“Four Body Pains That Could Mean Cancer”

“Three Cancer-Preventing Secrets”

“What You Can Eat to Defeat Cancer.”

ADVOCATES PSEUDOSCIENCE

Reiki: hands-on healing using ki, a life force”

Not supported by science JAMA article: a nine-year-old girl conceived

and executed a test in which she demonstrated that twenty-one people who claimed to be skilled in the techniques of Reiki were nevertheless unable to detect her “energy field” more often than they would have by guessing.

When Oz told “no evidence showing that Reiki work”, responded: “Neither am I, if you are talking purely about data.

ROUTINELY CRITICIZED BY SCIENTISTS

relying on flimsy or incomplete data distorting the results wielding his vast influence in ways that

threaten the health of anyone who watches the show.

Last year, almost as soon as that G.M.O. report was published, it was it was thoroughly discredited by scores of researchers on both sides of the Atlantic.

“THE MIRACLE” OF GREEN COFFEE BEANS.

CONSUMER FRENZY

“You may think that magic is make-believe,” Oz said at the beginning of the show. “But this little bean has scientists saying they have found a magic weight-loss cure for every body type.

It’s green coffee beans, and, when turned into a supplement—this miracle pill can burn fat fast. This is very exciting. And it’s breaking news.”

WHAT SCIENCE SAYS

Meta-analysis of 3 studies done: “supplement produced, on average, a five-pound

loss among study participants. But all three studies were short term and

included a small number of participants meta-analysis authors concluded: "More

rigorous trials are needed to assess the usefulness of GCE as a weight loss tool."

OZ REPLY

“We did our own study on this,” he said when I asked him about it. “It wasn’t a classical medical study, of course, but for a television show it was pretty darn good. We took a hundred people, randomized them, and showed what academic studies have showed: you are not going to lose a ton of weight, but you will probably lose a pound a week for a few weeks. That’s better than placebo.”

measured answer was almost exactly the opposite of the hyperbolic message he had broadcast into American living rooms.

FEDERAL TRADE COMMISSION PANEL

Claire McCaskill:

"The scientific community is almost monolithic against you in terms of the efficacy of the three products you called 'miracles' "

"I don't get why you need to say this stuff when you know it's not true. When you have this amazing megaphone, why would you cheapen your show? ... With power comes a great deal of responsibility.”

“We can spend a lot of time, Senator McCaskill, arguing the merits of whether green coffee bean extract is worth trying or not worth trying,” Oz said. “Many of the things we argue that you do with regard to your diet are likewise criticizable… It is remarkably complex, as you know, to figure out what works for most people even in a dietary program.”

“I actually do personally believe in the items I talk about in the show. I passionately study them. I recognize that often times they don’t have the scientific muster to present as fact. But, nevertheless, I give my audience the advice I give my family all the time. I give my family these products, specifically the ones you mentioned. I’m comfortable with that part,” he said.”

LATEST: GARCINIA CAMBOGIA

“Thanks to brand new scientific research, I can tell you about a revolutionary fat buster,"

2012 Show: "No Exercise. No Diet. No Effort" on the screen behind him. “

NOTE: The Food and Drug Administration does not regulate weight loss supplements. Under current law, companies selling these products do not need FDA approval before marketing them to the public.

THE OPRAH EFFECT

THE JENNY MCCARTHY EFFECT

HEALTH AND RACE

HEALTH DISPARITIESLIFE EXPECTANCYDIETTREATMENTSMOKINGACCESS TO HEALTH CARE

EIGHT AMERICAS: LIFE EXPECTANCY VARIES

Asians: 87.4; 82.1 Northern Plains Whites: 79 White Middle America: 77.9 Appalachia Whites: 75 Western Indians: 69.4 Black Middle America: 72.9 Low Income Rural Blacks: 67.7 High Risk Urban Blacks: 66.7

White vs. Black Men: 6.4 years difference White vs. Back Women: 4.6 years difference

CAUSES

Access to health care? Not entirely less variation among the Eight Americas in the rate of

health insurance coverage and the frequency of routine medical appointments than there was in life expectancy.

Lifestyle, Diet? Asians lose their "survival advantage" after they are in

the United States for a long time and have adopted an American diet and habits,

Social perceptions? high mortality in urban black men persists even when

homicide and AIDS are removed. Heart attack, stroke, diabetes, cirrhosis and fatal injuries are the major causes of reduced life expectancy in that group.

PREJUDICE AND HEALTH

ARTICLE: IMPLICIT BIAS AND PREDICTION OF THROMBOLYSIS

Does unconscious racial bias lead to differential treatment?

Methods: E-mail invitation to all 776 internal medicine &

emergency residents in 4 academic medical centers in Boston and Atlanta

Randomly assigned to see picture of black or white patient, matched for age and attractiveness, while they read clinical vignette

Asked to rate: likelihood symptoms were Coronary Artery Disease; whether they would suggest Thrombolysis; strength of recommendation

BIAS ASSESSMENTS

Explicit Bias: Direct MeasurePreference for black vs. white AmericansThermometer scaleBeliefs about group cooperativeness

Implicit Bias: Indirect MeasureRace Preference IATRace Cooperativeness IATRace Medical Cooperative IAT

IMPLICIT ASSOCIATION TEST

General Findings: Slower RT when asked to associate black face

with positive attribute

Seen as index of implicit bias

RESULTS: DOCTOR DEMOGRAPHICS

RESULTS

Doctor Demographics: Physician race predicted IAT score – Whites

higher scores Emergency room doctors smaller IAT

Explicit Bias Physicians of all races expressed equal

preferences, Rating of cooperativeness of patients

Implicit Bias Stronger association of negative attributes to

blacks

EXPLICIT BIAS RESULTS

IMPLICIT BIAS RESULTS

TREATMENT RECOMMENDATIONS

CONCLUSIONS

Implicit bias against blacks negatively correlated with likelihood of recommending thrombolysis for black

Implicit bias against blacks positively correlated with recommending it for whites

Suggests unconscious bias may influence treatment decisions

DOCTORS AWARE OF STUDY PURPOSE

LIMITATIONS OF STUDY

Selection bias in doctor sample Low response rate Academic physicians who may have less

experience in thrombolysis

Computerized presentation of patient, not actual patient-doctor interaction

Thrombolysis not recommended for patients with diabetes, hypertension, which are more likely in black patients

LUNG CANCER & RACE

Rates Black & Hawaiian American: 50% Higher than

Whites

Hispanic & Japanese American: 50% Lower than Whites

WHY?

Diet, Socioeconomic Status, Occupation ? Not Likely, once factors controlled for

Nicotine Sensitivity:

BREAST CANCER & RACE

OBJECTIVE 

“To determine if racial disparity in breast cancer survival is primarily attributable to differences in presentation characteristics at diagnosis or subsequent treatment.”

METHODS

Compared: 7375 black women 65 years and older diagnosed

between 1991 to 2005 3 sets of 7375 matched white control patients

selected from 99 898 white potential controls using data for 16 US Surveillance, Epidemiology

and End Results (SEER) sites in the SEER-Medicare database.

black case patients were matched to 3 white control populations on demographics: (age, year of diagnosis, and SEER site) presentation (demographics variables plus

patient co-morbid conditions and tumor characteristics such as stage, size, grade, and estrogen receptor status)

treatment (presentation variables plus details of surgery, radiation therapy, and chemotherapy).

Outcome Measure: 5 Year Survival

RESULTS

Absolute difference in 5-year survival 4.4% lower in black women 3.6% lower for blacks than for whites when

matched for treatment.

In the presentation match: fewer blacks received treatment (87.4% vs

91.8%), time from diagnosis to treatment was longer (29.2

vs 22.8 days) use of anthracyclines and taxols was lower (3.7%

vs 5.0%) breast-conserving surgery without other

treatment was more frequent (8.2% vs 7.3%4).

TREATMENT DIFFERENCES NOT EXPLANATION FOR SURVIVAL DIFFERENCE

Nevertheless, differences in survival associated with

treatment differences accounted for only 0.81% of the 12.9%

survival difference.

What accounts for difference?

CONCLUSIONS AND RELEVANCE 

“These differences in survival appear primarily related to presentation characteristics at diagnosis rather than treatment differences.”

WHY PRESENTATION DIFFERENCES?

LESS ACCESS TO HEALTH CARE

black women get less health care over all

Screening and early detection campaigns may have failed to reach black communities.

Cancer is more advanced by the time they see a doctor

TREATMENT IS MORE THAN A PROCEDURE

PERCEIVED DISCRIMINATION

Negative Impact on Health

Increased BP; Cortisol and other stress hormones

Applies to any socially stigmatized group

Can occur in absence of actual discrimination

POVERTY AND HEALTH

2013 CENSUS DATA

Median Income: $50, 895 No change since 1980

Poverty Threshold ( family of 4): $23,283

Overall Poverty rate: 15% 46.5 million Americans

Higher Rates: Black, Hispanic, children, single-mother families; age 65 or older

MEDIAN INCOME VARIES BY RACE/ETHNICITY

Asian household: $68,000

Non-Hispanic White: $57,000

Hispanic Household: $39,000

Black Household: $33,300

COLUMBIA MO STATS

HEALTH & POVERTY

Lower life expectancy

Higher rate of chronic disease: Diabetes Cancer Hypertension Cardiovascular

Reasons for Health Disparities ?

Lack of access to health care

Diet

Jobs

Environment

Lack of information about health

Peers

SAPOLSKY

Social Comparison:bottom of social hierarchy, even in

higher income groups

Social Inequality:Higher gaps associated with poorer health

MANHATTAN STRATIFICATION

Lowest 20%: $ 9,635

Highest 20%: $389,007

Highest 5%: $799,969

Income of top 5% is 80 times higher than that of bottom 20%

LOW STATUS IS STRESSFUL

Subordinate Baboons: Increased stress hormones Increased BP Sluggish recovery to a stressor Decreased HDL Decreased White Blood Cell Count Decreased Growth Factor

INEQUALITY & MENTAL ILLNESS

Major & Minor mental illnesses 3X more common in societies with higher inequalities

After controlling for age, income and educational differences: Depression s more common in states with

greater income inequality.

data from over 100 surveys in 26 countries, found that schizophrenia was about three times as common in more unequal societies as it was in more equal ones.

“dominance behavioral system.”

evolved psychological makeup, almost universal in mammals

enables us to recognize and respond to social ranking systems based on hierarchy and power.

One brain-imaging study discovered that there were particular areas of the brain and neural mechanisms dedicated to processing social rank.

wider income differences between rich and poor intensify the issues of dominance and subordination, and feelings of superiority and inferiority

A new study by Dublin-based researchers of 34,000 people in 31 countries found that in countries with bigger income differences, status anxiety was more common at all levels in the social hierarchy.

Another international study, from 2011, found in particular that self-enhancement or self- aggrandizement — the tendency to present an inflated view of oneself — occurred much more frequently in more unequal societies.

In US, scores on Narcissistic Personality Inventory rose as income inequality rose

“STATUS ANXIETY”

larger differences in material circumstances create greater social distances, feelings of superiority and inferiority increase.

growing inequality makes us all more neurotic about “image management” and how we are seen by others.

POVERTY & DECISION-MAKING

BACKGROUND

Correlation between poverty and counterproductive behavior: The poor use less preventive health care ; fail to adhere to drug regimens; are tardier, less likely to keep appointments; are less productive workers; less attentive parents

Personal characteristics???

ZHAO, ET AL HYPOTHESIS

Poverty imposes cognitive load

Constantly worrying about finances saps attention

Preoccupation is ever-present and distracting

Leaves fewer cognitive resources available to guide decisions

LAB STUDIES

Induced rich & poor participants to think about every day financial demands

Hypo: different cognitive demands for rich vs. poor

METHODS EXPTS1-3

Read 4 scenarios, few minutes apart- took cognitive tests after each

Scenarios described a financial problem the participants might experience. “Your car is having some trouble and requires $X

to be fixed. You can pay in full, take a loan, or take a chance and forego the service at the moment... How would you go about making this decision?”

Hard vs. Easy conditions

Fig. 1 Accuracy on the Raven’s matrices and the cognitive control tasks in the hard and easy conditions, for the poor and the rich participants in experiment 1.(Left) Performance on the

Raven’s Matrices task.

A Mani et al. Science 2013;341:976-980

Published by AAAS

EXPT 3 RESULTS: INCENTIVES FOR CORRECT ANSWERS

Fig. 3 Accuracy on the Raven’s matrices and the cognitive control tasks in the hard and easy conditions, for the poor and the rich participants in experiment 4.(Left) Performance on

Raven’s Matrices task.

A Mani et al. Science 2013;341:976-980

Published by AAAS

FIELD STUDIES

464 sugarcane farmers living in 54 villages in the sugarcane-growing areas around the districts of Villupuram and Tiruvannamalai in Tamil Nadu, India.

These were a random sample of small farmers (with land plots of between 1.5 and 3 acres) who earned at least 60% of their income from sugarcane and were interviewed twice—before and after harvest—over a 4-month period in 2010.

Tested pre and post-harvest

Fig. 4 Accuracy on the Raven’s matrices and the cognitive control tasks for pre-harvest and post-harvest farmers in the field study.(Left) Performance on Raven’s matrices task.

A Mani et al. Science 2013;341:976-980

Published by AAAS

ALTERNATIVE EXPLANATIONS FOR FARMER STUDY ?

Nutrition?

Physical Exertion?

Practice Effects?

CONCLUSIONS

“evoking financial concerns has a cognitive impact comparable with losing a full night of sleep”

“effects we observed correspond to ~13 IQ points. These sizable magnitudes suggest the cognitive impact of poverty could have large real consequences”

NOMINATED, DIDN’T WIN

POOR LEO!

IMPACTS SOCIAL STATUS

EXCEPTIONS TO THE RULE

COMMUNITY

SOCIAL SUPPORT NETWORK

Definition: perception and actuality that one is cared for, has assistance available from other people, and that one is part of a supportive community

Types of Support: Financial, Emotional, Companionship

Sources: Church, Co-workers, Pets, Organizations

Impacts on Health: Positive OR Negative

LAY REFERRAL NETWORKS

Definition: Network, outside of medical establishment, to whom one goes for medical advice

Sources: Friends & Family, Internet; “Folk Practitioners”

Impacts on Health: Good OR Bad

FUTURE OF MEDICAL VISITS?

SHARED APPOINTMENTS

Format: 10-15 patents seen together; 90 minute appointment

Stats: 12.7 % Family Physicians; sign agreement not to reveal confidential info

Goal: Share experiences, symptoms, questions Provide role models to other patients Provide social support network

DO THEY WORK?

randomized study in patients with 800 Type II diabetes patients

4 years later: Lower blood glucose Lower BMI Lower BP Lower cholesterol

FAMILY INFLUENCES

MODELING

MOTHERS ARE INFLUENTIAL

Children more likely to smoke if mother, rather than father, does

FACTORS DETERMINING MODELING

Observational Learning or Modeling: learning that occurs when person observes and imitates behavior

Incentive conditions: reward or praise

Similarity of Model Study with injection phobia

If model is someone we admire

VALUES

HEALTH HABITS

firmly established and performed automatically.

Set by age 11

Difficult to change

TEACHABLE MOMENT

window of receptivity to health information

More likely to lead to behavioral change

PRE-NATAL INFLUENCES

PRENATAL LIFE AS PREPARATION

Environment Provides Information

Fetus Knows What to Expect: Feast or Famine; Calm or Stress

Adjusts metabolism and other physiological processes in anticipation

Problematic when prenatal information is unreliable

“Surely we are all out of the computation of our age, and every man is some months elder than he bethinks him, for we live, move, have a being and are subject to the actions of the elements, and malice of diseases, in that other world, the truest microcosm, the womb of our mother”

-THOMAS BROWNE

FOAD: FETAL ORIGINS OF ADULT DISEASE

Food We Eat ( or don’t eat)

Stressors

Prescription Drugs/Endocrine disruptors

Poverty/Alcohol

Intrauterine environment

DUTCH “HUNGER WINTER”

INTERGENERATIONAL TRANSMISSION OF OBESITY

MOTHER’S FOOD CHOICES

PTSD: LIKE MOTHER, LIKE CHILD

Prenatal exposure leads to basal cortisol changes in children

“warning” for dangerous world

WHAT ABOUT CIGARETTES, ALCOHOL?

Bisphenol A Phtalates

PLASTICS

HYPOTHESIZED BPA EFFECTS

Reproductive system defects

Obesity Aggression Diabetes Breast/thyroid

cancers Prostate/testicular

cancers Decreased brain

sexual dimorphisms

Sources of BPA Plastics Canned Goods Cash Register

Receipts Paper Currency Dental Fillings Infant formula Breast Milk

Statistics Found in urine in

92% adults Found in fetal

plasma and placental tissue

Higher levels in children

Effects found at 25 ng/kg

FDA Dose set at:

50ug/kg body weight