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This post is meant as a ‘supplement’ to Orac’s 1/28/15 post on Respectful Insolence, Dr. Oz’s “green coffee bean extract” scammer guest must repay $9 million.

IMHO this is an excellent post! Orac does due journalistic diligence by sticking mainly to the facts, and offering speculation on motives etc. in either/or form that give the players proper benefit of the doubt — especially apt here because as a physician, Orac has limited knowledge of how the sausage of a TV talk show actually gets ground and stuffed into its casing.

However, as I’m in the ‘educated guess’ business and have a more ‘insider’ take on TV sausage-making, I’ll offer some even more critical hypotheses. Beyond that, and i hope more importantly, I’ll then follow these to some broader thoughts on the wider appeal of medi-woo in general. I’ve posted slightly condensed versions of the first three sections on RI as a ‘teaser’, so if you’ve read that you can skip down to The FTC without missing much. I have bracketed the deleted bits with bullets nevertheless.

Oz himself
Amiable empty scrubs who just shows up and reads whatever lines are given him on the cue cards, thus showing utter contempt for the Hippocratic Oath he took as an MD. Probably minimally involved in creation of any individual segment of his show. That’s what the producers get paid for — spending time on stuff so Oz doesn’t have to. Mehmet Oz is likely only minimally and passively involved in the construction of “Dr. Oz.” This is actually more disturbing than it would be if he was running the show and guiding it toward stuff he personally believed in, rather than just showing up and asking, ‘OK, what do we beard for today? Is the script in the teleprompter?’

• There are exceptions, of course, but if you ever get to see a TV ‘public affairs/talk’ thing being produced you’d most likely be shocked to discover that this is the standard routine – the staff does all the prep work, the ‘star’ shows up at the last minute, only dimly aware of what’s going on, gets a quick briefing from the senior producer, sits down — and sounds like an expert when the camera light goes on. That’s basically what makes them TV stars. They have the camera presence and such a thorough mastery of the schtick of being an on-camera authority, that with 5 minutes of prep they come off on screen as more knowledgable than any of us would after 5 months of prep. I’ve seen this on set a couple times (and not really in the ‘big time’ either) and it’s kind of surreal. •

“The Dr. Oz Show” producers
Undoubtedly complicit, with wink-wink, nudge-nudge plausible deniability. They have risen to a high level in an ultra-competitive dog-eat-dog business. There are at least 10 lower-level producers within shouting distance angling to move up the ladder, and if any production staff member at any level were actually gullible or incompetent in any way related to the show, the pack one rung down bring out their inner piranhas, and that’s that. The producers don’t have an inkling guests are selling what they’re promoting; they know guests are selling something. It’s not so much “don’t ask, don’t tell” as just such an obvious condition it doesn’t need to be discussed.

Where this would cross-the-line in TV biz terms would be if the Oz show or Oz himself were getting any kind of kick-back from the sales. Dr. Phil got himself in deep doo-doo by hawking his own supplements on his show. That’s excessive greed by TV standards. The standard quid pro quo is different.

• All non-premium-channel TV is produced in accordance with the bottom line of how TV shows make money: selling audiences to advertisers. Everything you see on a show is bait for some desirable demographic’s attention, placed there to build a higher Neilson rating in the next book, on which ad sales rates are based. Guests are booked because the producers think viewers want to see them; while seeing them they will continue watching rather than changing the channel; and after seeing them they will tune into the show again for more of the same. •

The quid pro quo is ratings for pitch time. The producers know:
1) Telegenic guests will be far more likely to come on the show if they have something to sell. Well, that’s probably an understatement. It’s more like telegenic guests only come on the show when they have something to sell.
2) Having something to sell gives the guests the motivation to be engaged and entertaining on air, making them good guests.
• If guests receive payment for appearances on talk show, it’s always guild minimum. •
Thus, the first question any booker for a talk show asks in seeking guests for upcoming segments is ‘who has something to sell?’ When do A-list guests show up on The Late Show, or The Tonight Show? When they have new movies, or albums, or tours to plug.

The recruitment of Lindsey Duncan:
Given the travails of Dr. Phil and others in the TV-supplement-feature thing, there does seem to be more nudge-nudge-wink-wink here than would be involved in booking guests on other shows and/or for other topics.
“I was hoping that Lindsey Duncan might be available to be our expert. Has he studied green coffee bean at all?”
Translation: Lindsey’s been a great guest before. The audience loves him and he pulls good numbers. Does he sell green coffee bean?
“Is there a GCBE brand or site that Lindsey recommends?”
Translation: Just making sure Lindsey knows he’ll get a chance to plug his product and site by name on the show
To get a bit farther out into not-implausible speculative possibilities, the producers could have done enough research into GCBE to know:
1) None of the folks currently involved in making GCBE would make good guests on the show, or were at least risky unknowns.
2) Duncan was not currently involved in making GCBE, but his company could gear up for it quickly.
Thus, PERHAPS “I was hoping that Lindsey Duncan might be available to be our expert. Has he studied green coffee bean at all? Is there a GCBE brand or site that Lindsey recommends?”
Translates as: If you guys want to start making GCBE, we’ll give you the primo slot as the go-to GCBE pluggers on “The Dr. Oz Show” because we think Lindsey is such an awesome guest.

Duncan said, ““This is either a set up or manna from the heavens.” See, if he didn’t understand TV at all, he’d have just said ‘manna from the heavens’ and not even considered the Oz show was offering him a set-up. He might not have sure, but he might have read the signs to have a pretty good idea it was a set-up, and just felt it too openly gauche to phrase it that way.

The FTC

    Duncan did not disclose to the Dr. Oz Show producer his relationship to Pure Health. Over the ensuing months, Defendants continued to attempt to hide Duncan’s relationship to Pure Health from the Dr. Oz Show and the public.

Now that’s disingenuous. Either the FTC is gullible and incompetent to the point they don’t know how this game works, or they’re politically savvy enough to know that although the producers of The Dr. Oz Show should be on the hook to pay back the duped, that will never happen. Because even the senior producers of The Dr. Oz Show are relative paeans. The big bosses are Oprah Winfrey’s Harpo Productions and Sony Pictures Television. The FTC doesn’t have a hook they can get into Harpo and Sony, and their mandate is more directed at the scammers themselves than their TV shills.

Yeah, Hanlon’s razor cuts everywhere, and we could posit that the FTC’s representation of the Oz show as dupes falls as ‘never attribute to dereliction of duty that which is adequately explained by gullibility or incompetence.’ And I wouldn’t argue those qualities aren’t in evidence to some degree at the FTC. But, again, you don’t rise to the position of FTC enforcer with the power to go after Lindsey Duncan for $5mil if you’re gullible and incompetent in general. My guess: Duncan didn’t attempt to hide his relationship to Pure Health from the Dr. Oz Show. The show knew, and they knew without asking. And the FTC knows they knew. But the effort of proving that for an attempt to get at Harpo and Sony – which would be like shooting a beebee at Iron Man – would just be a waste of their time. So The Oz Show gets a pass.

Bottom line
Again, nothing I’ve suggested above is meant to critique Orac’s post in any way. From where Orac sits, going beyond what he wrote would be both irresponsible, and damaging to his credibility. I sit somewhere else, both knowing more about the TV biz and having far more freedom to speculate about what MIGHT be at work here (and these are indeed just hypotheses, not accusations). As such, I’ll venture to remove the “in essence” from the last paragraph of Orac’s post and state flatly: The Dr. Oz Show IS a marketing arm of the supplement industry.

But I do think the “why” matters, and it’s important to note the Oz/supplement relationship is conditional. I’m confident The Oz Show is offering free marketing services to the supplement industry in general and Duncan in particular because that draws more viewers than they can get with something else. Supplement use gets a big cultural boost and social reinforcement by being featured on the Oz show, but it wouldn’t be there in the first place without a sizable public interest. And IMHO, it would be short-sighted to imagine this as an interest in supplements per se, but rather what supplements promise, and a reflection of why that promise appeals to people.

Back to ‘reality TV’ producers as advertising agents for a sec, for some additional possibly disturbing notes. The career path for producers looking to move up the ladder will offer as many or more opportunities in different genres than in similar. Some of the Oz staff may be looking to be lifers at Harpo, and thus be ‘true believers’ in the sort of woo-magic supplements represent. But the next better open gig might be on ‘Judge Judy’ ‘Live with Kelly and Michael’ or ‘The View’.  So like most ad folks, the producers just have boxes to sell and don’t really care what’s in the box. A fair number of them probably know full well that supplements are BS, and Duncan is running a scam. But then, what TV advertising ISN’T a scam? It all promises more than the products can ever deliver. Caveat emptor. It’s the rules of the game. If the producers were going to lose sleep over it, they’d be in a different line of work.

Which is to say that advertisers/marketers/makers of the kinds of goods and services advertised on national TV are all about the box because consumer choice on those purchases is mainly about the promise on the box. GCBE is the supplement du jour, bit it’s disposable. For that matter supplements as a category are disposable. The market will always offer something that promises you’ll lose weight, feel healthier, be more more attractive — all for three easy payments, satisfaction guaranteed. If it’s not a supplement it’s a fad diet or an Ab-Roller, or a ‘toxin cleanse’… Even if all of those go down, they’ll come up with something else.

As a general category though, supplements have been around since the birth of advertising, and I doubt they’ll go away any time soon. They’re too easy to legitimate via the limited degree the masses understand legitimate medicine:

    Vitamins are good. The doctor prescribes them if I have deficiencies as shown in my blood work. Then surely more vitamins are better, or at least couldn’t hurt. When I have med issues, my doctor usually wants me to swallow some pills. Pills fix things, so supplement pills fix things. They’re on the shelf at Wal-Mart in the same aisle with the OTC meds my doctor prescribes for headaches, allergies, cold symptoms yada yada yada. A big pharmacy isn’t going to market a completely invalid category. But everybody knows the best stuff of anything isn’t at Wal-Mart. If you want the good stuff, you go to a specialty dealer and pay more. So, of course, there are premium products out there for the more discriminating in-the-know consumer, not mass advertised, and an expert like Dr. Oz is just the guy to point out The Best, and separate the wheat from the chaff.

The point being, none of this dynamic would work without the broad desire for an answer for the ‘problems’ supplements and other ‘health’ products promise to fix. And if we unpack that desire, I think we find two consistent things:
1) A belief in secular magic, bolstered by the mythos of modern science and technology being able to fix anything. A faith in the ingenuity of the plucky inventor/entrepreneur to defy all the conventional wisdom and produce a world-changing breakthrough. Because that’s what America does.
2) A frustration and disappointment with conventional medicine to deliver the ‘goods’ promised by advertising. This would mainly be the advertising for ‘legit’ OTC remedies, but on a wider plane all advertising in general, and on a narrower plane advertising for ‘legit’ medical services by ‘legit’ hospitals and clinics. You don’t see much of the later on TV, but I always have sports talk on the radio when I’m in the car, and I’d say the majority of ads are health related — a mix of sketchy-sounding supplements and cremes and what not, Lasik centers, hair restoration procedures, and heart/cancer/etc. clinics at major hospitals. All these ads have the same basic appeal: our magic is better than theirs.

This is the discursive soup American patients swim in every day. And on most of their visits to their PCPs, the message meets no contradiction. ‘Take these and it will go away.’ ‘It will go away by itself, but take these and you’ll feel a lot better while it runs it’s course.’ ‘It won’t ever really go away, but take these and it will barely bother you.’ But then there are exceptions, things for which the doctor has no good answer, or an answer that calls for way more action and/or way more discomfort than taking something, or even going in for an outpatient procedure: ‘You need to lose weight and eat better. You’ll have to start a serious exercise regime, overhaul your diet, and give up all that tasty junk food.’ ‘Sorry, no more booze.’ ‘You need chemo, so you’re going to feel as sick as a dog for a long time, and lose all your hair.’

    That’s not magic! Everyone has promised me magic! I want the magic! Sorry, doc. I know the magic is out there. It has to be. I’m off to hunt for it. I’ll be back for the scrip the next time the athletes foot rears up, or I need a refill on the metformin. See ya then!

The following is a response to the thread “A tale of two unnecessarily doomed aboriginal girls with leukemia‘ on Respectful Insolence. I have posted it here due to its length. If you wish to respond, please do so on RI. This post is incomplete. I post it now to address issues raised in the thread about my intent, and about Orac’s positions and character, as I feel these should not wait until I can complete the post with the full material about the cases of Makayla Sault and J. J.


ORAC, THE GOOD
Orac is not a liar. He is an honorable man. He has dedicated his life to doing his best to save people from a horrible disease. His hospital work alone would drain the energies of most human beings. Somehow Orac finds the time and energy to be a outspoken champion for the sick and vulnerable, and an enemy of the scum who prey on them on two well read blogs. Further, he is working with other scientists and doctors to create an organization – SfSBM – that hopefully can have real policy effect in cutting back on quackery. SfSBM has targeted its first political effort as opposing the licensing of naturopaths as primary care providers in Maryland. IMHO, naturopathy is by far the most dangerous form of quackery to the broad public health exactly because it has a possibility to acquire PCP status. The SfSBM initiative could not be more well chosen, and I am willing to do whatever I can to support it. I live in a trailer park on a fixed income. I don’t have money. I do (quite obviously) have time.

In terms of stopping Brian Clement, perhaps someone would argue Orac could do a bit more. I will not. It is absurd to fault him. Perhaps we all could do a bit more, eh?. Orac IS doing more than most of us. I’m with Orac. Don’t even think of throwing stones at him until you can show you’ve done more to stop Clement than he has. (Comment not just to the Col., but to all.) A useful suggestion is not a stone. If there’s been one in the thread, I’ve missed it (not sarcasm, I haven’t re-read all the posts).

‘TUDE
I disagree with Orac fairly often. Mostly these disagreements are about analysis, strategy, broader philosophical issues. Also, we seem to have very different thought processes. Orac appears not to like my web persona. He (a web persona, also) is sometimes rude and insulting to ‘sadmar’. He sometimes mis-characterizes what I have written. Or he simply fails to ‘get it.’ I sometimes write jagged replies when this happens. I am not angry at Orac when I write them. I am expressing my ideas theatrically. Before I went into media studies, I was trained as an actor, director, and playwright. I have done guerrilla theater satire at political rallies, and worked on multi-media projects with some modestly well-known professional comedians. I am not literal minded. I exaggerate. I perform.

This is Orac’s blog. He can ban me. He doesn’t. He lets me post. I can leave if I want to. I don’t. I’d guess at least 95% of the time, Orac and I want the same things in terms of changes in the real world regarding medicine and pseudo-science. We have our arguments about how best to achieve those goals. That is all. If anyone finds that not a legitimate topic for discussion here, feel free to lobby Orac to urge a change in policy. He makes the rule, here. If he decides to rule that out, so be it.


THE COURT DECISION
I have written before, and I repeat:  while understandable in some respects under the specifics of the case and under the applicable law, Judge Edward Gethin’s ruling sets a disastrous precedent that must be overturned by court appeal or (preferably) legislative action. If the Canadian Parliament is sitting on their hands now, that is moral bankruptcy.

‘OLD BLOODS’
Orac’s question to Colonel Tom is spot on. Makayla Sault is dead. It is EVERYONE’s responsibility to attempt to spare J. J.  from the same fate. It is EVERYONE’s responsibility to keep vctims away from Brain Clement. It is especially incumbent on the Six Nations and New Credit communities to prevent Clement from preying on their children.  Like Orac, I would hate to learn that no old blood warriors are stepping up for J. J. and all the future possible Makaylas.

I will go further, I believe every warrior of every blood age should not only be standing between Clement and their communities, I believe THEY should tell J. J.’s Mom that if she doesn’t get that kid’s butt in chemo right now, she out of the band and off the rez. They want autonomy. They deserve autonomy. So they should act like it, and do something autonomous to save the dying kid from her loony-tunes Mother who is lying through her teeth about wheatgrass being Native medicine.

Additionally, it the responsibility of the First Nations communities in Canada and the Native American communities in the U.S. within shouting distance of Ontario to put pressure on the Six Nations to find a way, any way, to get J. J. back into the hospital. (I will exempt from this responsibility the deeply impoverished Ojibwe and Lakota of Northern Minnesota and the Dakotas, as they have more than enough problems of their won to deal with).

And it is the responsibility of every First Nations communities in Canada to come together and work for a political solution that can prevent any future Makaylas or J.J.s while still protecting their children from forced apprehension and relocation by Canadian authorities. Yes, indigenous peoples engage in politics. At the moment, their politics stink. The answer is not for them to abdicate to Canada. The answer is for them to take the political bull by the horns and do the right thing for their own people.

SUBTEXT?
Orac wrote:
Whenever I hear some of these arguments I seriously start to wonder whether the real subtext behind this is that if the price for asserting the independence of the First Nations against the Canadian government in this issue is unnecessary and preventable deaths of two aboriginal girls at the hands of a white quack from Florida who isn’t even using traditional aboriginal medicine, then that’s a price the girls’ elders are willing to pay.
I shall assume Orac meant to include in “willing” ‘the girls elders are justified in paying’. I can only speak to my own subtext. The life of Makayla Sault was not a price. She was a human being, not a commodity. No one had justification to sacrifice her life for any cause. Adult human beings having chosen to pay the price of their lives for independence and autonomy for centuries, and they will continue to do so. Makayla Sault was 11. That is not a choice 11 year olds get to make for themselves, and no one else gets to make for them.

To any extent that Makayla life was used as a pawn in a political chess match, that would be abhorent beyond words. I have searched the web for every document I can find about this case, and on the basis of that information, I have concluded that the tribal politics of the First Nations bands were not immediate highly significant factors in Makayla’s death. J.J.’s case is another matter. My concerns about the role of the tribes are questions of fact. Of evidence.

Here in the U.S. we have had cases where parents have been allowed to let their minor children die by refusing to have them undergo proper medical treatment. If Makayla had been an American citizen and not a member of any recognized tribe, her parent’s fundamentalist beliefs would have doomed her in many jurisdictions. Here Jerry Coyne has it absolutely right IMHO:
The problem exists in the U.S. as well. According to the National District Attorney Association, 38 of our 50 states have religious exemptions for child abuse, and five have exemptions for manslaughter or murder. If you kill or injure your child by withholding medical care on religious grounds, it’s difficult to prosecute you. And even when prosecutions of religious parents occur, judges and juries are reluctant to convict, or they impose only light sentences. This is part of the unconscionable and unwarranted respect for faith that permeates our nation, and it’s caused the death of thousands of children.
If anyone can provide me with additional factual material to clearly establish that something beyond this was at work in Makayla’s death, I shall reconsider my position.

I shall elaborate on the factual issues, and add my comments on Andrew Koster of the Brant CAS, America’s role in this tragedy, and whatever else comes up in a subsequent post.