Why celebrity doctors bug me
And why they should bug you too
I’ve been getting questions recently about a certain doctor and his most recent book.
It doesn’t really matter who this doctor is or, for that matter, what his book is about. The specifics change every few years. The doctor is photogenic and usually male. He is smart and has an impeccable academic pedigree. The book is about a solution to a problem for which traditional medicine has little to offer. It might be about preventing cancer or maintaining cognitive function or achieving shocking longevity. Sometimes the books inform the reader about a problem he or she didn’t know exist – systemic fungal infection, vascular inflammation, or oxidative stress – and proposes a solution.
In addition to being associated with talented publicists, these celebrity doctors have a lot in common. They possess actual scientific knowledge and are experts in extrapolation. They recount hypotheses and the preliminary studies, usually run in vitro, that test them. If they share clinical data, they come from small studies with surrogate endpoints. Never is there actual evidence that people live longer, maintain their cognitive prowess, or develop cancer less frequently.
An author might take a relationship between telomere length and aging; combine that with an observation that a mouse diet rich in anthocyanins slows telomere shortening; and produce a treatise on an anti-aging diet of black elderberry and blood orange smoothies.[i]
These doctors become the bane of this practicing doctor. Mention one of their names and I will begin quietly grinding my teeth. Never has New Yorker cartoon better captured my internal dialogue.
Why does the work of these doctors aggravate me? I have absolutely no distaste for patients educating themselves. I practice in an age of patient empowerment and knowledge that would have been inconceivable decades ago. I relish working collaboratively with informed patients. I also love the challenge of debunking the bizarre suggestions that people occasionally bring from an aunt, a friend, a Google search, or their uncle the retired doctor in Colorado.
I think my aggravation comes a recognition that good medical advice is specific and personal. The day-to-day practice of medicine is about caring for a series of individuals. While physicians fill their days providing sound advice to their patients, there are, by comparison, remarkably few recommendations that they can make to the population as whole.[ii] Everyone should exercise and wear seatbelts, nobody should smoke or drink excessively, and everyone should receive childhood vaccines. Not only are these types of recommendations limited in number, they are also neither interesting nor innovative. They would certainly not make for an interesting book, podcast, YouTube channel, or television show.
Anybody who tries to counter this fact to become rich or famous peddling medical advice to the masses must, in my mind, be somewhat of a charlatan.
Once we get beyond basic recommendations it becomes difficult to give health advice to large populations. Any doctor who has ever been interviewed by the lay press realizes this immediately. After every recommendation you utter, a wave of caveats floods your brain.
I was once interviewed for a magazine piece. The question was a good one, simple and interesting to a large readership. “When you have a headache, is it better to treat it or just tough it out?” If a patient asked this question, it would be easy to answer. I would know the severity and type of headache in question. I would know if the headache required further evaluation. I would know my patient’s likelihood of experiencing side effects of analgesics because I would know if she drinks, has kidney disease, or gastritis? I would also know the patient’s values. Is this a patient who willingly uses medications or one who prides herself in her stoicism?
Trying to make a more general recommendation, the doctor speaking publicly faces an uncomfortable choice. He might choose to give a concise answer that will satisfy the interviewer and interest the reader, but will certainly be wrong for a large number of patients. Or he might choose to give a long-winded answer filled with exceptions, cautions, and seemingly extraneous details—an answer that is more accurate but likely to confuse (and bore) the audience.
Now imagine that the doctor’s choice is influenced not only by his desire to impart information, but also by the desire to sell books and maintain a lucrative media presence.
I think this is why I, as someone responsible for the care of individuals and dedicated to practicing from a firm evidence-base, am so often frustrated by celebrity doctors who ply their trade to “the masses.” Even the best media outlets, those with thoughtful writers and producers, who research their subjects in depth, avoiding disease-mongering and sensationalism, often present information that seems illogical and inappropriate when restated by a smart, well-read, and medically literate patient to a doctor in the office.
The other reason that “celebrity doctors” cause me such irritation is that no doctor likes to be second-guessed. I think, who is this person giving advice to my patient? These are not only second opinions I did not seek, but often opinions on issues that I didn’t even know existed. I didn’t know my patient was troubled by waning libido? I’m embarrassed that my patient feels the need to seek information from those I see as charlatans. Are my recommendations and accessibility not good enough?
Is there a role for the public physician? When physicians serve as public experts, we must first make all efforts to get the boring but crucial information out to a broad audience: bicycle helmets, safe sex, exercise programs, and gun locks are not terribly interesting subjects, but they do lend themselves to broad recommendations. When discussions enter the realm of less broadly applicable recommendations, we must admit this limitation. We must carefully define to whom we are speaking and make it clear that recommendations made to large groups often do not apply to individuals. It takes creativity to accomplish this while keeping the information engaging, but to do so is to everyone’s benefit. We must also routinely defer to the doctor who is really caring for the patient. This needs to be done in a more genuine fashion than the typically advertised admonition to “talk to your doctor about…”
Caring for a single patient is difficult. Caring for an audience, while entertaining them, is impossible. Good medicine is often boring. Scientific advances and speculation about the future of medical care can be exciting. When doctors seek wide audiences, they need to remember that their highest responsibility is to individual patients.
“I shall work with my profession to improve the quality of medical care and to improve the public health, but I shall not let any lesser public or professional consideration interfere with my primary commitment to provide the best and most appropriate care available to each of my patients.”[iii]
[i] This actually sounds pretty good.
[ii] This comment obviously excepts the transformative interventions of public health.
[iii] Bulger, R. A dialogue with Hippocrates and Griff T. Ross, M.D. In Bulger R, ed. In Search of the Modern Hippocrates. Iowa City: University of Iowa City Press; 1987:253.
(A related version of this essay was previously published here. I was reminded of the earlier piece when I began to write this one. It was a pleasure to edit out some of the parts forced on me by the journal’s editors.)