“I can’t figure this out,” Senator Claire McCaskill prompted Mehmet Oz yesterday, from halfway across a capacious hearing room. Her tone implied that, at least to some degree, she had figured it out.
That was the reason her subcommittee summoned Oz to Washington.
“I get that you do a lot of good on your show. I understand that you give a lot of great information about health in a way that’s easily understandable. You’re very talented, you’re obviously very bright, and you’ve been trained in science-based medicine." Accolades piled up until a buckling of decorum was imminent.
"Now, here are three statements you made on your show."
McCaskill read Oz’s words from past segments of The Dr. Oz Show back to him with a clinical formality that underscored their absurdity:
“You may think magic is make-believe, but this little bean has scientists saying they’ve found the magic weight loss cure for every body type: It’s green coffee extract.”
“I've got the number-one miracle in a bottle to burn your fat: It's raspberry ketone.”
“Garcinia cambogia: It may be the simple solution you’ve been looking for to bust your body fat for good.”
McCaskill continued, as if reproaching a child. “I don't know why you need to say this stuff, because you know it's not true. Why—when you have this amazing megaphone and this amazing ability to communicate—would you cheapen your show by saying things like that?”
“If I could disagree about whether they work or not,” Oz contested, speaking quickly but betraying more diffidence than his face seems used to bearing, “and I'll move on to the issue of the words that I used.”
In the world of health-media broadcasting, the words one uses are a pretty central issue. At least Oz agreed to be a witness at the hearing, “Protecting Consumers from False and Deceptive Advertising of Weight-Loss Products,” saying that he is a “cheerleader for this process.” McCaskill noted that other media and advertising players declined to participate.
“Take green coffee bean extract,” Oz continued. (The hearing's cold open was actually a 2012 clip from The Dr. Oz Show in which Oz endorsed the extract’s powers effusively, saying, "When turned into a supplement, this miracle pill can burn fat fast for anyone who wants to lose weight. It’s very exciting, and it’s breaking news … The coffee bean, in its purest, raw form, may hold the secret to weight loss that you’ve been waiting for!")
“I'm not going to argue it would pass FDA muster if it were a drug seeking approval,” Oz said in a tone strikingly contrasted to his TV segment, “but, among the natural products out there, this is a product that has several clinical trials.”
McCaskill called him on that claim. “The only one I know is 16 people in India, paid for by the company that was, in fact, written up by somebody who was being paid by the company producing it.”
“I have five papers, plus a series of basic science papers on it as well,” Oz said, literally holding a stack of what appeared to be journal articles over his head. He also said that he never takes money for endorsements on the show.
“We could spend a lot of time arguing the merits of whether coffee bean extract is worth trying or not,” Oz said—downgrading his appraisal from miraculous to “worth trying”—before changing the subject away from the bean extract, toward the elusive nature of scientific truth. “Many of the things we argue that you do with regard to your diet are likewise criticizable. Should you be on a low-fat diet, a low-carb diet? I spent a good part of my career recommending that folks have a low-fat diet. We have come full circle and no longer recommend that. It wasn't working for our patients. It is remarkably complex, as you know, to figure out what works for a dietary program.”
Oz cited complexity and, in the next breath, a need for simplicity in health messages.
“Well then why would you say that something is a miracle in a bottle?” McCaskill asked.
“My job, I feel, on the show is to be a cheerleader for the audience,” Oz spoke quickly again, moving into platitudes but never appearing disingenuous. “When they don’t think they have hope, when they don't think they can make it happen, I look everywhere, including in alternative healing traditions, for any evidence that might be supportive to them. To get folks to realize there are different ways they could rethink their future. That their best years aren't behind them. They are in front of them. They actually can lose weight. I actually do personally believe in the items I talk about in the show. I passionately study them. I recognize oftentimes they don't have the scientific muster to present as fact, but nevertheless, I would give my audience the advice I give my family."
“The scientific community is almost monolithic against you in terms of the efficacy of those three products that you called miracles,” McCaskill said. “When you call a product a miracle, and it's something you can buy, and it's something that gives people false hope, I just don't understand why you need to go there.”
Dietary supplement companies can make outlandish claims in advertisements, and they are not regulated for safety until reports of harm get the attention of the Food and Drug Administration (FDA). Within that system, media messages are a turning point for whether a product is condoned or condemned. Oz, with his credible position as a professor at Columbia University and television show that reaches millions of viewers every day, occupies a critical place at the intersection of mainstream medicine and “alternative” weight-loss products. His power, yesterday’s Senate hearing made clear, will significantly influence the future of the diet-supplement industry.
"Snooki holds herself out as an expert in fitness," read a 2013 class-action federal lawsuit against the makers of diet pills called Zantrex.
At $40 per 14-day supply, Zantrex High Energy Fat Burner is a caffeine pill that claims on its site to confer “546 percent more weight loss than the leading ephedra-based diet pill.” Nicole Polizzi, Snooki, was temporarily the face of the pill after she publically lost weight in a short period of time. She is no longer in the ads, but the pill is still on the market.
Around the time of that lawsuit, you might also have walked into GNC and purchased something called geranium extract, a “natural” product promising an energy boost and weight loss, only to find that it contained an amphetamine derivative called dimethylamylamine (DMAA) and was linked to a couple deaths and more than 80 health complaints to the FDA, at which point, last year, the FDA sent letters to companies asking them to stop selling DMAA-containing products.
Unlike drugs, dietary supplements do not need approval for safety or effectiveness before they go to market. When safety issues arise, the FDA can investigate and take steps to remove a product. But in order for the FDA to ban a compound in a dietary supplement, it is required to undertake a series of lengthy scientific and legal actions. Under the Dietary Supplement Health and Education Act of 1994, proprietors themselves are responsible for evaluating the safety of their products before marketing them—but the FDA is underequipped to police adherence to that across the massive industry. (Senators Richard Blumenthal and Richard Durbin introduced the Dietary Supplement Labeling Act in August of 2013, which would require dietary supplement manufacturers to register their products with the FDA and disclose the known risks of any ingredients on their labels; the bill remains in committee.)
Fraudulent health claims in advertising are the domain of the Federal Trade Commission (FTC). Since the first FTC case against a weight-loss scam in 1927—when, as McCaskill noted during the hearing, the pages of True Romance magazine advertised that upon using a product, "excess fat is literally dissolved away, leaving the figure slim and properly rounded, giving the lithe grace to the body every man and woman desires"—the FTC has filed more than 250 cases challenging false and unproven weight loss claims. That’s an average of just a couple per year. Four settlements were announced in January, and a complaint was filed in federal court just last month against a seller of green coffee bean extract.