I like Oprah. OK, really, my wife likes Oprah, so I watch along with her from time to time. Oprah does some good things, like encouraging the reading of good fiction. Like many celebrities, when she discovers something or someone “cool” or “life-changing” she wants to share it with the world—and she can.
The problem with that is when a single person is so influential, people may perceive them and those whom they anoint as experts…
Take Dr. Phil—a guy who dispenses platitudes becomes a famous “advice-giver” for telling you the same things your grandma could. It sounds good at the time, but, like psychological Chinese food, it leaves you hungry for more. His advice, given its lack of specificity, can’t really help many. Psychotherapy is an intimate thing—it doesn’t play well in auditoriums.
The same is true of doctors—if you give advice broadly, you are either giving useless advice or bad advice. Medicine is practiced between individuals. So it was with trepidation that I watched Oprah with my wife tonight—she brought out her “favorite gynecologist”.
The doctor dispensed some generally good advice that could apply to most people (sleep and eat well, etc.), but rapidly turned down the path of crankery.
- The first real cancer vaccine…sucks? A young woman asked about the HPV vaccine. In the medical community there is a fairly broad consensus that Gardasil is a good idea. There has been some controversy, mostly regarding what level of “mandatoriness” there should be. One thing that is not medically controversial is that several strains of HPV are the major cause of most cervical cancer. This doctor falls into a typical denialist argument: to paraphrase, “No one has ever shown 100% that HPV causes cervical cancer.” Wow. This makes use of so many denialist tactics at once. It implies that there is a controversy, where in fact none exists. It sets impossible expectations—what does she mean by “100%”? It’s really quite scary that an Oprah-created expert can get up there and spout so many denialist lies to young women.
- Toxins! Hate them! A woman with night sweats was told that she needed to detoxify, and the doc went on about detoxification, sweating, detox regimens, etc. It’s almost like she never went to medical school.
- Chi, baby! She talked about injecting chi into you clitoris—I shit you not.
Oprah has a great deal of influence, and so has a great deal of responsibility, whether she wants it or not. I hope she wields it more carefully in the future.
January 18, 2008 at 12:26 am
It is sad and scary to me that you as a doctor are knocking a doctor who thinks beyond the scope of what is learned in a traditional western medicine school by referring to detoxifying and the crazy idea of chi! How can you deny the presence of toxins in our bodies and the possible benefit of lowering our load of them? Also vaccines are now given with little thought to the possible side-effects which outweigh the risk of the disease it is meant to be preventing.
January 18, 2008 at 1:18 am
And in the category “Cranks and Quacks”, it didn’t take long for an anti-vaccination crank to appear. Michelle, detox is a myth propagated by people selling detox cures. As I wrote a while ago, detox diets don’t work.
Also, are you saying the HPV vaccine doesn’t prevent cervical cancer? Because only if it doesn’t prevent cancer, do the possible side-effects outweigh the risk of the disease it is meant to be preventing (death).
Doc, I fear you will be disappointed if you expect Oprah to wield her power carefully. This is the kook who promotes “The Secret”, as well as the pseudoscience of “Dr Oz”. It’s not for nothing she is known as Wooprah.
January 18, 2008 at 6:31 am
Thats funny! Just recently, I was discussing the +ves and -ves of all these “medical” shows on a forum and my blog. I’m glad to hear that many others agree with me.
January 18, 2008 at 9:34 am
I think night sweats can be a symptom of not enough NO/NOx, not of “toxins”. Sweating would be a poor mechanism for getting rid of “toxins” and no “toxins” have been identified as being excreted by sweat. However, exposure to “toxins” does cause low NO/NOx because most toxins activate the cytochrome P450 enzyme systems to degrade them, and the P450 enzymes are pretty uncoupled (meaning they make superoxide) and that superoxide lowers NO levels.
One of the reasons for non-thermal sweating is to release ammonia to the resident biofilm of ammonia oxidizing bacteria humans evolved to have on their skin. Of course modern bathing practices have removed that biofilm, but our physiology doesn’t “know” that.
January 19, 2008 at 12:55 am
Okay, I know the body is able to get rid of toxins by itself, that’s what kidneys and livers are for. Don’t you think, however, that maybe because we inject our foods with so many preservatives and stuff that maybe they are adding more toxins to our body than would have naturally happened? Perhaps certain detoxes could help a bit in aiding our bodies getting rid of that extra stuff a tad more quickly? And I mean ones that allow you to still eat healthy lean protein and veggies and other natural foods, but you couldn’t eat fattie or salty or junk food for that week?
January 19, 2008 at 1:20 pm
Believe it or not, I was actually home, and my wife saw this show. (It was one of the rare occasions when I was home early enough to see Oprah’s show.) I couldn’t believe what I was hearing! She invoked qi! She blamed claimed that supplements and a “low glycemic diet” could cure female pattern baldness. She recommended “detoxification.”
Mixed in with sensible advice was rank quackery.
January 19, 2008 at 4:33 pm
My understanding is that female pattern baldness is the same as male pattern baldness and is due to androgens.
Androgens are synthesized by cytochrome P450 enzymes which are inhibited by nitric oxide. Low nitric oxide will lead to more androgenic effects due to greater activity of the enzymes that make androgens.
January 19, 2008 at 10:08 pm
As soon as my girlfriend gets home, i’m going to tell her i want to try out #3.
And what is cytochrome P450, and how does it both cause night sweats and female pattern baldness?
Does my Purple Tesla Shield Protect me from P450?
January 19, 2008 at 11:36 pm
deadalus is a very pleasant and kind commenter—with a very strong attachment to NO metabolism. Nitric oxide is fascinating (really, trust me), but like all cutting edge research, it will likely end up being very important in some areas, and irrelevant to others. No single biological system explains “everything” (except chiropractic—i dig that).
cytochrome P450 is actually very relevant to every day pharmacology, but thankfully not in too much detail. These days, I can plug drug names into a computer and find out a list of interactions, including P450 metabolism and effects on drug levels.
Jeez, medicine’s hard!
January 19, 2008 at 11:42 pm
@Orac
I haven’t seen too much on detox in general lately (although I have some posts on poo woo and liver pills) but I think it might be time for a bit of a smackdown on detox.
January 20, 2008 at 10:04 am
Thank you PalMD.
There are about 60 cytochrome P450 enzymes in humans that are important in the synthesis and metabolism of many important chemicals that humans. That includes synthesis of all the steroids. Steroid physiology is complex because there are multiple enzymes making and acting on multiple substrates in multiple tissue compartments. They are all “coupled”, that is the concentration and metabolism of one affects all the others.
The “interactions” that PalMD mentioned occur because different P450 enzymes have different affinities for different compounds and are regulated differently. Some drugs will cause the upregulation of specific P450 enzymes which will then increase the metabolism of other drugs. Some drugs inhibit specific P450 enzymes. The anti-coagulant warfarin inhibits the P450 enzyme that makes a clotting factor
http://www.cmaj.ca/cgi/content/full/177/4/369
Which is why it is used as rat poison, and to prevent blood clots. It is only the dose that makes the difference.
The P450 enzymes are all heme enzymes, that is they have heme (which is an iron atom held in a specific ring structure) and the iron atom in that heme latches on to (usually) O2, makes it more reactive and then uses it to oxidize the substrate. NO also binds to that iron, many times more strongly than O2, and that interaction is uses to regulate the activity of the enzyme. With NO bound to the iron, the enzyme is non-reactive.
The NO regulation of P450 enzymes is well known for several. It probably applies to all of them but the research to confirm and understand the details of that hasn’t gotten that far yet. It is known for testosterone synthesis.
High androgens cause male and female pattern baldness. High androgens also cause characteristic hirsutism
http://www.femalepatient.com/html/arc/sel/oct02/article02.asp
My hypothesis is that hirsutism is actually a feedback mechanism to increase NO/NOx production by the bacteria I am studying. More hair increases the warmth and humidity of the particular niches on the body where these bacteria grow, they produce more NO/NOx, more is absorbed and then more NO then inhibits the P450 enzymes and reduces the amount of androgens produced. High androgens also tend to be associated with the metabolic syndrome and elevated blood sugar. My hypothesis is that this is due to reduced mitochondria biogenesis also due to low NO/NOx. Less ATP from mitochondria means more from glycolysis. It takes 20 times more glucose to make the same ATP via glycolysis as from mitochondria. 5% less ATP from mitochondria requires twice as much glucose for glycolysis.
I see hair growth as a long time constant regulatory pathway, night sweats as a short time constant regulatory pathway to release ammonia to these bacteria also.
January 20, 2008 at 5:13 pm
Please don’t put Dr.Phil on the same level as Grandma. She is much more reliable
January 20, 2008 at 5:35 pm
Thanks for the lulz.
I know that my grandmother’s advice was certainly more reliable. And, she could tell you to call a real doctor when you needed one.
January 20, 2008 at 10:31 pm
sure, sure… but did your grandmother ever give away free cars to people? come on… FREE CARS! and some other stuff too. if her heart is that BIG? how could she ever be wrong about anythng? i remember the days before oPrah and it seems to me there were a whole-lot of unhappy, unfocused, middle class folks, with lets face it, not a huge amount of hope or self-esteem. but now? well, there are books being read, wars being fought… and cures (at a pretty good cost, really) for just about anything that might be causing personal malfunction. i, for one… hope never to return to those dark times, before oPrah. (B.O.)
and don’t forget about the free cars.
January 20, 2008 at 10:34 pm
I can has free carz?
January 21, 2008 at 2:56 am
Has anyone considered the possibility that that poor girl’s night sweats could be caused by, well, tuberculosis?
January 29, 2008 at 3:23 pm
[...] HPV and Cervical Cancer Posted by PalMD under Uncategorized I recently told you about the shameful appearance on Oprah of a gynecologist who openly denied the connection between human papillomavirus (HPV) and cervical cancer, and spoke [...]
January 30, 2008 at 11:25 pm
[...] complex and beautiful than is dreamt of in the quacks’ philosophies…“. He points out that someone should be telling Oprah some of these hard cold facts about medicine more often [...]
February 6, 2008 at 3:55 pm
Sorry to post on such an old entry, but i thought i had seen the Oprah free cars thing somewhere. I had a neighbor that was a paraplegic, with one of those nifty vans that had a lift and the lock for the motorized wheelchairs, fancy steering wheel that did everything from one location…
It got stolen. One of the friends of the family called Oprah’s agents and told them what had happened, and she had a brand new van of the same specifications delivered to his house. I’d heard the story as a teen as we were going somewhere in the van, he was very emotional about it because it was just very very kind of her.
That doesn’t excuse preaching nonsense, of course. But shows gotta book guests, and Oprah has been around so long she’s scraping the bottom of the barrel. She might do better being put out to the pasture at this juncture. Who knows.
Anyhow, i thought of this this afternoon, and was discussing it with my SO, and i wanted to remember where i had seen it.
February 6, 2008 at 4:22 pm
I do think she has often used her position for good. But anyone with power needs to be careful.
Linky: http://www2.oprah.com/tows/pastshows/200801/tows_past_20080117.jhtml