Killing Us Softly

by Dr Paul Offit

  Certainly, no one appreciates the advances of modern medicine more than Mehmet Oz. He’s a heart surgeon. He holds people’s hearts in his hands and fixes them. Oz couldn’t do this without anesthesia, antibiotics, sterile technique, and heart-lung machines. But there was one moment when it became clear that Mehmet Oz wasn’t a typical heart surgeon. During an operation, “Oz jumped up on a standing stool, peered into the patient’s chest, and said, ‘I knew we should have used subliminal tapes.’” Oz believed that surgery wasn’t enough—success also depended on tapping into his patient’s subconscious. Watching this scene was Jery Whitworth, a nurse who operated the heart-lung machine. Whitworth shared Oz’s love of alternative therapies. “After a few minutes we stopped,” recalled Whitworth, “because the operating room was totally quiet,” stunned into silence. Oz, Whitworth, and a group of believers later met secretly to discuss what would eventually become Columbia’s Cardiovascular Institute and Complementary Medicine Program. “If the higher-ups had known about these meetings,” recalled Whitworth, “they would have disbanded us.”

  Oz has used his show to promote alternative therapies ranging from naturopathy, homeopathy, acupuncture, therapeutic touch, faith healing, and chiropractic manipulations to communicating with the dead. To understand where Mehmet Oz is coming from, we need to understand where medicine has been.

  People have been living on earth for about 250,000 years. For the past 5,000, healers have been trying to heal the sick. For all but the past 200, they haven’t been very good at it.

  First, people believed disease was a divine act. In Exodus, written around 1400 B.C., God, angry at the Egyptians for their mistreatment of the Hebrews, punishes them with ten plagues, including boils and lice. In Homer’s Iliad, written around 900 B.C., the god Apollo destroys the Achaean army with a disease ignited by a flaming arrow. In 2 Samuel, written around 500 B.C., God gives David a choice of three punishments for his pridefulness: seven years of famine, three months fleeing his enemies, or three days of plague. David chooses plague, and God obliges, killing 77,000 people. Because God or the gods caused disease, healers were shamans, witches, and priests, and treatments were prayer, amulets, and sacrifices.

  Then, starting with the Greek healer Hippocrates in 400 B.C., the focus changed. No longer were diseases defined in supernatural terms; rather, they were caused by something inside the body—specifically, an imbalance of bodily fluids called humors. Hippocrates, the father of medicine, named these humors yellow bile, black bile, phlegm, and blood, likening them to four colors (yellow, black, white, and red), four elements (fire, earth, water, and air), four seasons (summer, autumn, winter, and spring), four organs (spleen, gall bladder, lungs, and liver), and four temperaments (choleric, melancholic, phlegmatic, and sanguine). Because diseases were caused by an imbalance of humors, treatments were designed to balance them, most prominently bloodletting, enemas, and emetics (drugs that induce vomiting). Malaria wasn’t caused by a parasite; it was the result of excess yellow bile from hot summer weather. Epilepsy wasn’t linked to abnormal brain activity; it was caused by too much phlegm blocking the windpipe. Cancer wasn’t caused by an uncontrolled growth of cells but by the accumulation of black bile. Inflammation didn’t stem from a vigorous immune response; it was caused by too much blood (hence bloodletting).

  Two hundred years later, in the second century B.C., Chinese healers embraced a similar concept, reasoning that diseases were caused by an imbalance of energies. Chinese healers treated this imbalance by placing a series of thin needles under the skin (acupuncture). However, because Chinese physicians were prohibited from dissecting human bodies, they didn’t know that nerves originated in the spinal cord. In fact, they didn’t know what nerves were. Or what the spinal cord was. Or what the brain was. Rather, they interpreted events inside the body based on what they could see outside, like rivers and sunsets. Chinese physicians believed that energy flowed through a series of twelve meridians that ran in longitudinal arcs from head to toe, choosing the number twelve because there are twelve great rivers in China. To release vital energy, which they called chi, and restore normal balance between competing energies, which they called yin and yang, needles were placed under the skin along these meridian lines. The number of acupuncture points—about 360—was determined by the number of days in the year. Depending on the practitioner, needles were inserted up to four inches deep and left in place from a few seconds to a few hours.

  And that’s pretty much the way things stood until the late 1700s. Practitioners continued to offer therapies based on religious notions of divine intervention or Greek notions of balancing humors or Chinese notions of balancing energies. (Some, such as purgatives, acupuncture, aromatherapy, crystal healing, enemas, magnet therapy, hydrotherapy, and faith healing, are still around today.) But of all the therapies rooted in ancient beliefs, none was more widespread or universally embraced in the eighteenth century than bloodletting. European doctors bled their patients twice a month. Barbers, too, were perfectly willing to bleed their customers. (The red-and-white barber pole represents a white bandage wrapped around a bloody arm.) In the United States, Benjamin Rush, a well-respected Philadelphia physician and signer of the Declaration of Independence, was a big proponent of bloodletting. Rush was so influential that when George Washington suffered epiglottitis (inflammation of the flap of tissue that sits on top of the windpipe), his doctors chose bloodletting instead of the tracheotomy that might have saved his life. Five pints of blood—about half his total blood volume—were taken from Washington as he struggled to breathe. On December 14, 1799, George Washington, a man who had survived smallpox and bullet wounds, went into shock—killed by bloodletting. Sir William Osler, cofounder of Johns Hopkins Hospital, in Baltimore, delivered a fitting postscript. “Man knew little more at the end of the eighteenth century,” said Osler, “than the ancient Greeks.”

  Then medicine took a giant leap forward. Healers no longer believed that illnesses were a matter of spiritual will or humoral imbalances; rather, they defined diseases in biochemical and biophysical terms. This revolution in medical thought centered on several defining moments:

  In 1796, Edward Jenner, a country doctor working in southern England, found he could protect people from smallpox by inoculating them with cowpox, a related virus. Jenner’s vaccine eliminated smallpox—a disease that had killed as many as 500 million people—from the face of the earth. By inducing the immunity that follows natural infection without having to pay the price of natural infection, vaccines have dramatically reduced deaths from rabies, diphtheria, tetanus, polio, measles, rubella, hepatitis, chickenpox, rotavirus, influenza, yellow fever, typhoid, and meningitis.

  In 1854, John Snow, a British physician, investigated an outbreak of cholera in London that had killed more than six hundred people. Snow traced the problem to a water pump on Broad Street. After he removed the pump handle, the outbreak stopped. Snow’s observation launched the field of epidemiology and lifesaving sanitation programs.

  In 1876, Robert Koch, a German physician, isolated the bacteria that cause anthrax. Knowing that specific bacteria caused specific diseases, scientists could now find ways to treat them.

  In 1928, Alexander Fleming, a Scottish biologist, noticed that a mold (Penicillium notatum) growing in broth was excreting a substance that killed surrounding bacteria. He called it penicillin. Once-fatal diseases were now treatable.

  In 1944, Oswald Avery, an American scientist, found that DNA was the substance from which genes and chromosomes were made, allowing disorders like sickle-cell anemia and cystic fibrosis to be defined in genetic terms.

  But it was a relatively unknown Scottish surgeon who—fifty years before Jenner’s smallpox vaccine—made the single greatest contribution to medical thought. In 1746, James Lind climbed aboard the HMS Salisbury, determined to find a cure for scurvy, a disease common among sailors that caused bleeding, anemia, softening of the gums, loss of teeth, kidney failure, seizures, and occasionally death. Lind divided tw
elve sailors into six groups of two. One pair received a quart of cider every day; the second, twenty-five drops of sulfuric acid three times a day; the third, two spoonfuls of vinegar three times a day; the fourth, a pint of seawater; the fifth, garlic, mustard, radish root, and myrrh gum; and the sixth, two oranges and a lemon. Lind found that only fruits cured scurvy. In 1795, fifty years later, the British Admiralty ordered a daily ration of lime juice for sailors, and scurvy disappeared. (British citizens have been called limeys ever since.)

  Although Lind had proved that citrus fruits cured scurvy, he didn’t know why. It wasn’t until the early 1900s that a Hungarian biochemist named Albert Szent-Györgyi isolated the substance later called vitamin C, or ascorbic acid (literally, “an acid against scurvy”). Lind’s study was groundbreaking because it was the first prospective, controlled experiment ever performed, paving the way for evidence-based medicine. No longer did people have to believe in certain therapies; they could test them.

  Vaccines, antibiotics, sanitation, purified drinking water, and better hygiene allowed people to live longer. From the beginning to the end of the twentieth century, the life span of people living in developed world countries had increased by thirty years. None of this increase occurred because healers balanced humors, restored chi, or offered sacrifices to the gods; it occurred because we finally understood what caused diseases and how to treat or prevent them.

  In a sense, The Dr. Oz Show is a voyage back through the history of medicine, starting with our most primitive concept of what caused disease: supernatural forces.

  In February 2011, Mehmet Oz asked Dr. Issam Nemeh onto his show. Nemeh is a faith healer. He believes that people can be cured with prayer. One of Nemeh’s successes, Cathy, told her story. “I was so sick,” she recalls. “I was coughing up blood. I wasn’t breathing well. I had a mass in my left lung.” Oz showed the audience Cathy’s CT scan, which revealed a small, worrisome mass. “I went to see Dr. Nemeh,” Cathy continued. “And I had a two-hour visit where we talked and we prayed together. All of a sudden I took this deep breath of air. And I just kept taking breaths. I couldn’t believe how much air I was taking in. I felt wonderful.” Just like that, Cathy’s mass was gone. A second CT scan proved that her lungs were back to normal. No chemotherapy. No radiation. Just prayer. A miracle.

  Unfortunately, Cathy’s story contained several inconsistencies. First, Oz never mentioned a biopsy, suggesting that the diagnosis had been made by CT scan alone. This should never happen. Because infections can mimic cancer—and because infections are treated differently—a biopsy is required. Second, a closer look at Cathy’s CT scan showed that the mass had ragged edges, more consistent with inflammation (seen in bacterial infections) than cancer (where edges are typically smooth). In all likelihood, Cathy had a minor case of bacterial pneumonia that resolved without antibiotics, a common event. Oz’s viewers, however, were left with the notion that prayer alone had cured her. (George Bernard Shaw commented on the limits of faith healing after a visit to the shrine of Lourdes. “All those canes, braces, and crutches,” he wrote, “and not a single glass eye, wooden leg, or toupee.”)

  Another example of Oz’s embrace of supernatural beliefs can be seen during his surgeries, which look like those of any other surgeon with one exception: the presence of reiki masters like Pamela Miles, a practitioner of therapeutic touch whom Oz has featured on his show. Miles claims that she can detect human energy fields and manipulate them to heal the sick. Oz has never put Miles’s claims to the test. But it wouldn’t be that hard to do. In fact, it was done a few years ago in a study designed, conducted, and analyzed by Emily Rosa.

  Rosa asked twenty-one therapeutic touch healers to sit behind a large partition with two holes at the bottom; she couldn’t see them and they couldn’t see her. Then she asked the healers to put their hands, palms up, through the holes. After flipping a coin, Rosa put her hand slightly above each healer’s right or left hand, asking them to pick which she had chosen. If healers could truly detect her energy field, they would have picked the correct hand 100 percent of the time; if not, about 50 percent of the time. Rosa found that healers were right 44 percent of the time—no different than chance. She concluded, “Their failure to substantiate therapeutic touch’s most fundamental claim is unrefuted evidence that [their beliefs] are groundless and that further professional use is unjustified.”

  In 1999, Emily Rosa published her paper in the Journal of the American Medical Association. It was titled “A Close Look at Therapeutic Touch.” Unlike Mehmet Oz, Rosa wasn’t a cardiovascular surgeon. In fact, she had never graduated from medical school. Or college. Or high school. Or elementary school. When it came time to write her paper, she had asked her mother, a nurse, to help. That’s because Emily was only nine years old. Her experiment was part of a fourth-grade science fair project in Fort Collins, Colorado.

  Emily didn’t win the science fair. “It wasn’t a big deal in my classroom,” recalled Rosa, who graduated from the University of Colorado at Denver in 2009. “I showed it to a few of my teachers, but they really didn’t care, which kind of hurt my feelings.” Emily’s mother, Linda, recalled that “some of the teachers were getting therapeutic touch during the noon hour. They didn’t recommend it for the district science fair. It just wasn’t well received at the school.” The press, however, felt differently. Emily appeared on the news on ABC, CBS, NBC, and PBS and was featured in specials by John Stossel, the BBC, Fox, CNN, MSNBC, Nick News, Scientific American Frontiers, the Discovery Channel, NPR’s All Things Considered, the Today show, and I’ve Got a Secret. Her story was reported by the Associated Press, United Press International, Reuters, Time, and People magazine and appeared on the front pages of the New York Times and the Los Angeles Times. When she was only eleven years old, Rosa spoke at Harvard University in place of the absent Dolores Krieger, the inventor of therapeutic touch and winner of Harvard’s tongue-in-cheek Ig Nobel Prize for her claim that human energy fields felt like “warm Jell-O or warm foam.” The next day, Emily gave her Harvard speech at MIT. Emily Rosa is listed in Guinness World Records as the youngest person to publish a paper in a peer-reviewed medical or scientific journal.

  Mehmet Oz’s fascination with supernatural forces didn’t end with faith healers and therapeutic touch. Later, when he picked John Edward to educate his audience, Oz entered the world of the occult.

  Edward is a psychic who communicates with the dead (like the Whoopi Goldberg character in Ghost, except without the crystal ball and robes). Oz featured Edward on a show titled “Are Psychics the New Therapists?” “We’ve had more requests [from our viewers] to join this show than any other we’ve ever done,” gushed Oz. “More than weight loss, more than cancer, more than heart disease. The topic? Do you believe we can talk to the dead?” Oz explained that Edward claimed to have helped thousands of people communicate with loved ones in the afterlife. “A session with a medium can be extremely therapeutic,” said Edward.

  Oz’s interest in the occult came from his experiences in the operating room: “As a heart surgeon, I’ve seen things about life and death that I can’t explain and that science can’t address.” To Mehmet Oz, John Edward had a gift that was beyond the reach of science. “I want you to know that your mom is okay,” Edward told an audience member. “She has a dog with her.”

  Although Oz promotes Edward’s powers, James Randi—a stage magician—doesn’t buy it. Randi has appeared on The Tonight Show Starring Johnny Carson as well as Penn & Teller: Bullshit! In 1986, after receiving the MacArthur Foundation “genius” award, Randi decided to use the money to expose psychics. He now offers $1 million to anyone who can demonstrate clear evidence of paranormal, supernatural, or occult powers. Edward has never taken Randi up on his offer.

  Edward may have utter conviction in his own powers; however, according to James Randi, some psychics employ two basic strategies: “hot reading,” which uses information obtained from the audience before the show, and “cold reading,” which fishes for
information during the show. Randi calls this “hustling the bereaved.” When their readings are wrong, they claim they have been confused by “energies” emanating from different families. When they have had enough wrong guesses, they claim that the “energy is being pulled back.” Oz, who is either remarkably trusting, painfully naive, or simply pandering to a gullible public to enhance advertising revenue, never questioned Edward’s special gift. “What happens when you start hearing voices,” he enthused.

  In addition to touting therapies born of the Old Testament notion that supernatural forces caused disease, Mehmet Oz promotes thousand-year-old natural remedies rooted in ancient Greece, China, and India, featuring two men he calls his “Superstars of Alternative Medicine”: Andrew Weil and Deepak Chopra, both of whom recommend a variety of therapies (such as acupuncture, plants, herbs, oils, and spices) originally designed to balance humors and restore energies.

  Andrew Weil is a balding, white-bearded, slightly overweight man with the demeanor of a guru. A graduate of Harvard Medical School, Weil did an internship at Mount Zion, in San Francisco—a hospital located next to Haight-Ashbury, the epicenter of the hippie counterculture of the 1960s. In the spirit of Ken Kesey (the subject of Tom Wolfe’s The Electric Kool-Aid Acid Test), Weil fit right in, choosing to study hallucinogenic drugs. In 1972, he published his first book, The Natural Mind, in which he claimed that hallucinogens can “unlock” the brain and—in a chapter titled “A Trip to Stonesville”—that “stoned” thinking makes people more insightful. He even celebrated psychosis. “Every psychotic is a potential sage or healer,” he wrote. “I am almost tempted to call psychotics the evolutionary vanguard of our species.”