Effectiveness, and the Case of Dr. Oz
Dr. Oz became famous on Oprah, then developed his own TV show. Millions of people who seek health and medical information hang on his every word. But can we believe him?
A group of doctors publicly called for Columbia University to fire Dr. Oz. Their accusations?
“Dr. Oz has repeatedly shown disdain for science and for evidence-based medicine … he has manifested an egregious lack of integrity by promoting quack treatments and cures in the interest of personal financial gain.”
The controversy focuses attention on evidence-based practices. So, what do we mean by evidence? What constitutes credible information that a treatment works or that a specific behavior promotes good health?
Evidenced-Based vs. Best Practice
In human services, the meaning of the term, evidence-based practice, has achieved some consensus, at least in a general sense. Most people would agree that, to meet the standard of evidence-based, a treatment, service, or policy must have multiple rigorous studies which support it. Rigorous usually means either some form of experimental design or at least a very strong comparative effectiveness study. Comparative means that information exists to show that people who received a service achieved an outcome to a higher degree than people who did not receive that service. The Substance Abuse and Mental Health Services Administration, for example, has established criteria, as have some other organizations.
Oftentimes, the fact that a practice has appeared in a scientific journal becomes accepted as proof of adequate strength to demonstrate effectiveness. However, in the field of medicine, many practices with early promise of effectiveness, as reported in credible medical journals, actually turn out not to work during later years of testing.
We can’t let a similar-sounding term, best practice, confuse us. It sees a variety of uses, one of which unfortunately constitutes a bad use: as a synonym for evidence-based practice, but without any evidence! Sometimes, a so-called best practice is a new service approach that seemed to produce positive outcomes in one situation, perhaps only for a limited period of time, and now it attracts other providers to incorporate it into their operations.
However, no sound research has demonstrated the effectiveness of that new approach. If an approach appears promising, evaluation researchers can work in unison with practitioners to determine its effectiveness by creating a sound base of evidence.
So, what should we do?
- We should move forward with a combination of hope and humility, using the best information available to make informed choices about what services to deliver. Strong evidence of effectiveness means that a specific service, delivered as intended, will produce positive outcomes for many or most of those who receive it. Keep in mind, though, that nothing’s perfect. If we go with the evidence, we maximize the chances of taking the best possible action using our current state of knowledge, even though we will not produce our desired outcomes 100 percent of the time.
- Let’s remember that science is just science. It never reaches the final “truth”; it always searches to discover more. New evidence inexorably supplants current evidence, sometimes changing the way we think and act. In addition, our environment changes; our communities change. Science strives to keep up and provide the best answers at any given point in time, acknowledging for example, that actions by individuals and government that worked effectively to produce strong communities in 1915 might not work in 2015.
- The fact that science has imperfections and we may never achieve absolute certainty should not compel us to ignore the best evidence and put all of our trust in self-proclaimed experts and authorities. From blood-letting during the Middle Ages to quack remedies of today, many “experts” have had no basis for the approaches they use to treat the illnesses of individuals and the social problems of communities.
Effective service delivery requires blending the latest evidence, the wisdom of practitioners, and the preferences (cultural, personal, etc.) of an individual or group who receives a service. Over time, we continually refine our knowledge and competence so that human service practitioners, policy makers and others can shape services, programs, and policies optimally to meet the needs of our ever changing communities.
What does this all mean for Dr. Oz? Dr. Oz speaks as one, fallible physician; hopefully, he uses research evidence wisely. The conflict of interest that his accusers charge might, or might not, exist. But I’m willing to let others fuss over the fate of him and other celebrities, while we work on improving the future of our communities!