“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.
Because the problem is bigger than the FDA and FTC are able to police, self-regulatory bodies within the supplement industry, like the Council for Responsible Nutrition, represented at the hearing yesterday by CEO Steve Mister, play a part. But even Mister emphasized that more must be done to protect consumers, “who unrealistically yearn for a magic bullet.” Mister pointed both to increasing resources and enforcement by the FTC and FDA, and also called on the media and retailers to reject advertisers who are making illegal claims.
The FTC has ventured into consumer education with a list of “Gut Check” dietary claims that consumers should recognize and avoid—including warning signs like “causes substantial weight loss no matter what or how much the consumer eats” and “causes substantial weight loss by wearing a product on the body or rubbing it into the skin.” (As a general rule, if a dietary supplement is delivering an energy boost and weight loss, it’s most likely high-dose caffeine, thyroid hormone, or an amphetamine derivative.)
70 percent of Americans are obese or overweight, which costs the country $190 billion every year in related healthcare costs. A 2013 Gallup survey said that 50 percent of Americans want to lose weight, but only half that many report seriously putting effort into it. The market for simple solutions is massive, and its pervasiveness is costly in that it undermines legitimate weight-loss messages. It’s in the context of that type of public-health threat and consumer fraud that the senate subcommittee took Oz to task.
“I don't think this ought to be a referendum on the use of alternative medical therapies,” Oz said. “I have been criticized for having folks come on my show talking about the power of prayer. Again, as a practitioner, I can't prove that prayer helps people survive an illness.
“But it’s hard to buy prayer,” McCaskill said.
“Yes,” Oz smiled. “Prayer's free. That's a very good point. Thankfully, prayer's free.”
In defending green coffee bean extract, Oz said, “I say it all the time: I don't sell it, and these are not for long-term use. ... If you can lose a pound a week more than you would have lost doing the things you should be doing already—you can’t sprinkle it on kielbasa and expect it to work—but if that trial data is what's in your life and you get a few pounds off, it jump starts you and gives you confidence, and you follow the things we talk about every single day including those seven items, I think it makes sense.”
“Where I do think I made it more difficult for the FTC is in the intent to engage viewers,” Oz said, “I used flowery language. Language that was very passionate but ended up not being helpful, but incendiary. It provided fodder for unscrupulous advertisers. That clip you played is over two years old, and I have done hundreds of segments since then. We have specifically restricted our use of words.”
“I have not been talking about products in that way for two years,” Oz later reiterated. “And it has not changed at all what I’m seeing on the Internet. Frankly, it’s getting worse, so I completely heed your commentary. And I realize, to my colleagues at the FTC, that I have made their jobs more difficult.”
McCaskill refuted Oz's claim to have reformed, noting that just three weeks ago he said that a supplement product "literally flushes fat from your system. … Every time you cheat on your diet, I want you to grab one of these tiny, itty-bitty pills. This tiny tablet can push a lot of fat out of your belly.”
“It seems to me that if you said, every time you cheat on your diet, I want you to take a walk, that would eliminate the problem that is at the root of this hearing today. That your credibility is being threatened by a notion that we can take an itty-bitty pill to flush fat out of our systems. In January, you called forskolin ‘lightning in a bottle’ and ‘a miracle flower to fight fat.’”
“I know that you feel that you’re a victim,” McCaskill said, “but sometimes conduct invites being a victim. I think if you would be more careful, maybe you wouldn’t be victimized quite as frequently.”
“I know you know how much power you have,” McCaskill continued. “You are very powerful. With great power comes a great deal of responsibility. And I know you take it seriously, and I know you care about your audience and America’s health. You are being made an example of today because of the power you have in this space. We didn’t call this hearing to beat up on you. We called it to talk about a real crisis in consumer protection.”
“Your comments about the language are well heard,” Oz said. “I host a daytime TV show where I feel a need to bring passion to people’s lives about what they can do. … And I appreciate your kind words about the power I have. I’m in a position where I’m second-guessing every word I use on the show right now.”
“When I feel as a host of a show that I can’t use words that are flowery, that are exultatory, I feel like I’ve been disenfranchised,” Oz continued, “like my power has been taken away to get people. You don’t want to be on a pulpit talking about how passionate you are about life and thinking, well you know, if I use that word it’s going to be quoted back to me. And yes, the hundred words around it are all about doing other things right. So, I’m very respectful, I’ve heard the message, I’ve told my colleagues at the FTC, I get it.”
“Okay, good.” McCaskill paused. “No one’s telling you not to use passion. But passion in connection with the words ‘miracle pill’ is a recipe for disaster.”