Transcript, Novella on Dr. Oz Show

Last corrections: April 29, 2011

THE DR. OZ SHOW
CONTROVERSIAL MEDICINE: WHY YOUR DOCTOR IS AFRAID OF 
ALTERNATIVE HEALTH
AIRED: APRIL 26, 2011

TRANSCRIPT
Transcriber's note: I have "cleaned up" some speech 
(stutters, "uh" and "um", etc.) in creating this copy. 
I have also left out the previews to the second segment 
of the show. If you believe I have incorrectly transcribed 
anything or have been dishonest, please email me at 
skepticarebear at gmail dot com with your corrections and 
concerns.

(clip, preview)

ANNOUNCER (V.O.)

Today on The Dr. Oz Show, all new, controversial medicine: 
why your doctor is afraid of alternative health. 

OZ (clip)

Why do you not want me to talk about these therapies on 
the show?

NOVELLA (clip)

It turns out they don't work.

OZ (clip)

I totally disagree.

ANNOUNCER (V.O.)

Should you be concerned?

NOVELLA (clip)

The public needs to get reasonable information, not just 
marketing hype. 

OZ (clip)

I just think it's very dismissive of you.

------------------------------------------

OZ

Welcome. Today I'm taking on a controversial issue in 
medicine that has everything to do with helping you take 
control of your health. There are a lot of doctors, 
including me, who are putting their reputations on the 
line because we're using alternative therapies in our 
traditional practices, and many doctors claim that these 
therapies are nothing more than "junk science" and may 
even be dangerous. Your doctor could be one of them. Why 
are they so afraid of alternative medicine, and should 
you be, too? 

OZ (V.O.)

Once found only on the fringes of health care, alternative 
medicine is now reaching its tipping point. Mainstream 
America has become so receptive to healing practices like 
acupuncture, meditation, herbs, and chiropractics, that 
almost forty percent of you turn to them to treat 
everything from stress and insomnia to chronic pain and 
even cancer symptoms. That's nearly thirty-five billion 
dollars out of your pockets every year. 

Here on The Dr. Oz Show, we've showcased alternative 
treatments--

OZ (clip) 

The noni fruit. Wanna put it on your radar.

OZ (V.O.)

--and the superstars of the alternative medicine movement. 

OZ (clips, several)

Dr. Christiane Northrup.
Dr. Joe Mercola.
Dr. Andrew Weil.
Deepak Chopra!

OZ (V.O.)

But when it comes to fully accepting the potential powers 
of alternative medicine, some in the medical establishment 
may be the biggest holdouts. Doctors question whether 
these treatments are proven to work, and even worse, are 
they dangerous? Time to time, even I've been taken to task 
by scientific peers for exploring new territory, saying 
I've gone to the Dark Side. You've shown you're not afraid 
to test the time-honored traditions of alternative 
medicine, so why is your doctor? 

OZ 

Joining me now is Mimi Guarneri, a cardiologist who also
practices alternative medicine at Scripps Hospitals, and
Dr. Steven Novella, a neurologist and assistant professor
at Yale University School of Medicine, who's an outspoken
critic of alternative medicine. Dr. Novella, let me start,
if I can, with you.

NOVELLA

Sure.

OZ

Why are there so many doctors out there, doctors of our
viewers, who don't like alternative therapies? Why do you
not want me to talk about these therapies on the show?

NOVELLA

Well, the problem we have with the notion of alternative
medicine or alternative therapies is that it's an
artificial category. It doesn't really mean anything. It
exists really to create a double standard. What we
think is there should be one science-based, common
sense standard to figure out what therapies work and
are safe, and not these artificial categories that are
used really to market things, in our opinion, that
essentially don't work.

OZ

Dr. Guarneri, you've heard Dr. Novella's arguments. Why do
you use it in your practice?

GUARNERI

As a cardiologist, I've been faced with what I can do to
prevent heart disease? So, because of my patients, I
reached out, and I said, "If you have pain, let's look for
another solution." Maybe that solution is acupuncture.
If you're stressed out, maybe your solution is prayer.
The rosary. Meditation. And certainly, I don't think
today we can call nutrition "alternative medicine" or call 
exercise "alternative medicine"--other things that I teach
my patients every day to prevent heart disease.

OZ

(to NOVELLA) Doctor, that's a pretty compelling argument. 

NOVELLA

Well, I agree that nutrition and exercise are not
alternative. They've been part of science-based
medicine for decades. They've just been rebranded as
alternative to create this legitimacy for this whole
umbrella that now also includes a lot of things that don't
work or not based upon science or evidence. There's lots
of things that we do to prevent heart disease. We
recommend dietary changes, regular exercise, weight
control, using medication like aspirin or other blood
thinners when necessary. Preventive medicine is science-
based medicine. It's not alternative. 

OZ

Well, there's still many places where there's a ton of
push back. I hear it all the time. And I know that a lot
of the viewers also feel that their doctors aren't hearing
this message. And I gotta say, I don't just talk about
these things on the show. I use them in my practice. I use
them at home. You know, massage therapy, guided imagery. I
think it gives folks, my patients, me, a customized tool
that I can use that benefits me. So, I'm going to divide
this field of alternative medicine into three categories.
Let's have an open discussion--

NOVELLA

Sure.

OZ

--about what makes sense. There are three different ways
you can think about alternative care. There are things you
can put in your mouth; these are herbs, supplements, and
foods. Okay? There are things that are done to your body--
manual manipulation, we call it. Now I'm going to put in
massage. I'm going to include acupuncture in this
category, although some folks might not. Then there's the
mind-body connection, which we know is important, but the
question is, how do you bottle it? And that includes
meditation, breathing exercises, and the like. Are you
okay with that?

NOVELLA

Sure. Rough, but fair.

OZ

Rough, but fair. Okay. Just to organize all the debate.
So, let's start with the first of these therapies: things
you put in your mouth--

NOVELLA

Mm-hmm.

--supplements, vitamins, and the like. Now there's a study
that just came out from the National Center of Health
Statistics that says more than half of all Americans--
think about that--more than half of all of us are taking
some form of a dietary supplement. Here's what your doctor
has to say about this.

(clip, tag: "Clifford Bassett, MD, Allergist and Asthma
Specialist")

BASSETT (clip)

Natural supplements or herbs can be very powerful and
helpful. However, over the counter herbs and
supplements are not regulated by FDA, and as such,
there may be differences in potency, toxicity,
contamination, and it's important to understand, just
'cause it's natural doesn't make it the right treatment
for you. 

OZ

Dr. Novella, walk us through what you think are the
dangers of these supplements. 

NOVELLA

Well, within this category there's actually lots of
different things that I think are worth pointing out.
You mentioned herbs, and, again, I have no problem with
thinking of herbs as medicinals. In fact, they've been
used that way for thousands of years. What I have a
problem with is, again, rebranding them as "alternative"
and marketing them as "natural," and therefore arguing
that they don't need to have evidence that they're safe
and effective. And that's essentially what happened in
this country in 1994. You know, congress passed a law
saying, "You don't need evidence." It was a very, you
know, pro-industry, anti-consumer law, and now we have
lots of things like echinacea and ginkgo biloba, which
are multi-million, multi-billion dollar industries, but
when they actually get studied, and the NIH just put
billions of dollars down to researching things like
this--It turns out, they don't work. So, at the end of
the day, the public was sold products that the evidence
shows doesn't work, but it was marketed in a very slick
way.

OZ

Well, I'm gonna--I mean I totally disagree that these have
not been studied and some evidence been found to support
them. But I'm going to yield on one point, which I think
is important. And I think this is actually the underlying
argument that I read--

NOVELLA

Mm-hmm.

OZ

--in your blog. And I actually sense that the bigger
debate from physicians, (to audience) your doctors, is
that, they don't think you're telling them what your
doing. So you got two kinds of care going on: the care
that doctors are providing and the care you're giving
yourself. And there was a study done again, the National
Center for Complementary and Alternative Medicine, it
said that sixty-nine percent of people, you know, more
than two-thirds of people have tried alternative
medicine and not talked about it with their doctor.
Think about that. That's a big information gap. So, Dr.
Guarneri, let me turn to you for a second. Are you
concerned that there are so many of our viewers, so
many Americans, who are taking alternative approaches
into their own hands and are not talking to their
health care providers.

GUARNERI

Absolutely. And the biggest issue, of course, with the
natural supplements industry is, are you mixing these
supplements with your pharmaceutical medications? Are
you mixing ginkgo biloba with your aspirin and Plavix
and increasing your risk of bleeding? This is the kind
of information I need to know as a physician. 

OZ

Right.

GUARNERI

Especially if someone's going to surgery. 

OZ

So I wanna address Dr. Novella's point head on, because he
said--claimed--

NOVELLA

Yeah.

OZ

--that there was very little evidence to support many of
these therapies, the St John's Wort, the ginkgo bilobas--

NOVELLA

Mm-hmm.

OZ

--that we're talking about. There's a website that's
available to all of you right now, and we're going to
link to it on doctoroz.com. It's a clearing house for
alternative medicine. It's called Natural Standard. We
use it a lot. Our medical unit that does all the
research for the shows uses it a lot. It's a great
resource of information on supplements. The chief editor
and cofounder of National Standard, Dr. Catherine
Ulbricht, is here with us today. Dr. Ulbricht, please
help us, 'cause you spend your life trying to study
exactly what Dr. Novella is complaining about: the
presence or absence of information about supplements.
What's out there? Is it true there really aren't any
good studies about these supplements and herbs?

ULBRICHT

Not any more. If you asked me that ten years ago, I might
have said, "The jury's still out," but, as a clearing house
of information, Natural Standard has gathered the world's
literature, and with the research explosion and the
billions of dollars of funding in this area, the quality
and the volume of high-quality, clinical data has
skyrocketed. 

OZ

Okay, let's move to the second area of alternative
medicine: body manipulation, specifically acupuncture.
Let's check in with your doctor again.

(clip, tag: "Audrey Halpern, MD, Neurologist and Headache
Specialist")

HALPERN (clip)

In general, acupuncture and massage and other body
therapies like that can be  helpful. The problem with
some of these therapies is that they can be time
consuming and costly. One of the biggest problems is
that they haven't been studied well enough.

OZ

So, Dr. Guarneri, you have acupuncturists who work with
you at Scripps--people who're actually going to you for
cardiac catheterization, life-threatening problems, and
you're using acupuncturists on them. Why is that?

GUARNERI

When a number of years ago, after I would put a stent in,
I would send all my patients to cardiac rehab. You have
heart disease. We need to get you exercising and doing
all the things that (to NOVELLA) we both believe in.

NOVELLA

Right.

GUARNERI

And my patients would come back and say, "Hey Dr. G, my
tendonitis is keeping me from exercising." "My elbow
hurts." "My back spasm hurts." So I said, "I need a
treatment for my patients, for their pain, that is not 
pharmaceutical." So, I went right to the NIH consensus
statement, and I said, "I'm picking acupuncture, because
acupuncture relieves inflamation, decreases muscle spasm,
and if I can do that with my patients along with physical
therapy and stretching and so on"--First do no harm.
That's the hippocratic oath.  

OZ

Dr. Novella.

NOVELLA

Well, you know--

OZ

(interrupting) D-d-d-dut. Just--

NOVELLA

Go ahead.

OZ

There are a lot of doctors of our viewers who are very
much against these types of treatments. Acupuncture's just
a classic example of it. Just explain to me why it's such a
big deal if patients are using it.

NOVELLA

Well, again, my job is to advise my patients based upon my
understanding of the scientific evidence, and you know,
again, what makes sense, and I spend a lot of time reading
the acupuncture literature. I've written a lot about it,
and the evidence overwhelmingly shows that acupuncture, in
fact, doesn't work. If it worked, I would have no problem
using it. I think it's this ritual surrounding a positive,
therapeutic interaction; a comforting, caring person;
you're relaxing for a half an hour or an hour. There.
That's where the effect is. There's no effect to actually
sticking a needle through the skin. There's some risk to
doing it. It's small, but it's there. If you do a risk
versus benefit analysis, which is standard in medicine,
you say, "Well, there's risk to sticking the needles, but
it doesn't seem to help." So why aren't they just poking
people with toothpicks?

OZ

There are billions of people around the world who use
acupuncture as the foundation of their health care. It's
the basis of ancient Chinese medicine. I just think it's
very dismissive of you to say, because we couldn't take
this idea that exists with a different mindset and
squeeze it into the way we think about it in the West,
that it can't be possibly effective. 

NOVELLA

But I wasn't dismissive. I said I carefully reviewed the
literature and the research, and I didn't say it couldn't
possibly work. I said, when you look at it, it doesn't
work. So I don't buy the argument that, because it's
somehow ancient wisdom, or used by a lot of people--that's
the argument from popularity--that it works, therefore.
You know, people were doing blood letting for thousands of
years, and that was the standard of care. We don't think
that anyone thinks that blood letting is a good way to go
these days. 

OZ

Right, but there's two reasons you might not be able to
show that it doesn't work, and one of them is you don't
understand it enough to study it the way it has to be
studied. And there are many examples of that, where we
have struggled to understand things that we now know to
be true, but we couldn't put our arms around them and
couldn't study them--

NOVELLA

Mm-hmm.

OZ

--in an insightful way, we flail. Let me turn now to the
third alternative medicine problem that we're talking about
today. It's the mind-body therapy area. This is a big one.
Things like meditation, which I talk about on this show all
the time. There are numerous studies showing that
meditation can lower your blood pressure, anxiety levels,
aids in recovery from serious diseases. Here's what your
doctor has to say about that. 

(clip, tag: "Mark Melrose, DO, Emergency Medicine
Physician")

MELROSE (clip) 

Mind-body treatments, we might not understand how they
work, and I don't think that they should be used
exclusively, because there's a whole range of
conventional medicine which we know is helpful and useful.

OZ

Dr. Guarneri, I know you use this in your patients as
well. (to NOVELLA) Do you take issue with this because
you think it's too "soft and fuzzy" or do you think it's
just unproven and worthless?  

NOVELLA

Well, neither of those. I think that things like
meditation--What is it really? Again, as a scientist, we
need to carefully define what we're talking about. What
is meditation? Well, we know it's relaxation, and we
know that relaxation reduces stress, reduces blood
pressure, but my problem is when you wrap it in this
mystical sounding language, and then you say, "Well,
because relaxation helps lower your blood pressure,
maybe it will also cure your cancer," that's where I
have a problem: when you make that leap to real, physical
diseases that, where there's no evidence and no real
plausible mechanism. I'm fine using it as stress
reduction. Just don't wrap it in, you know, mysticism
that makes it sound like it's something it isn't. 

OZ

But here's where the big disconnect that we have--

NOVELLA

Yeah.

OZ

--is on this point. Because, I think when people begin to
study their bodies, and you call it mysticism, which,
again, I think is a bit dismissive of the process, it's
people intuitively understanding what's happening in their
body and getting to examine it. And you know what? Maybe
we can harvest our immune cells so they can kill cancers.
Neither you nor I know that. That's darn hard to study. So
my advice to everybody is, customize therapy for yourself.
Figure out what makes sense for you. Do drugs and surgery
work? Yeah. They often work pretty well, and they have side
effects as you acknowledge, and we all talk about them all
the time. But the difference for me is, a bow and arrow
approach, a stealth approach to hitting exactly what you
wanna get that works in you versus the ballistic missile
approach that we have so often become comfortable with.
Now, there have been lots of other findings from the
National Institutes of Health. They've been very positive,
I think, in regard to alternative medicine, and the
majority of schools in this nation now are offering
programs to teach students so that we're more
understanding. Because you know what I think the big
problem is? You know why people aren't talking to their
doctors? Because they don't think their doctors know
anything about it.

NOVELLA

Mm-hmm.

OZ

(to audience) Is that close to on-target, folks? Right?
So, if I can give you my take: alternative medicine, I
think, is at the grassroots level. And because of that,
nobody owns it. Now, that stated--

NOVELLA

Mm-hmm?

OZ

--I think we got our homework to do. But I think
alternative medicine empowers us, and that's the big
message for all of ya, but only if you know more about
it, and it if does work for ya, trust me, do not let
anybody take it away from you. Dr. Novella, thank you very
much. 

NOVELLA

Thank you.

OZ

Dr. Guarneri, I appreciate you so much. Dr. Ulbricht,
we're gonna be back with you in a second.

END SEGMENT
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