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?
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!
