PZ brings to my attention this article in Newsweek which sums up Oprah's views on health, and one sadly must come to the conclusion that Oprah is a crank. Based on our definition of crankery, one of the critical aspects is the incompetence of an individual in judging sources of information. How else can you describe her dismissal of legitimate medical opinion for the pseudoscience of celebrities like Suzanne Somers or Jenny McCarthy?

That was apparently good enough for Oprah. "Many people write Suzanne off as a quackadoo," she said. "But she just might be a pioneer." Oprah acknowledged that Somers's claims "have been met with relentless criticism" from doctors. Several times during the show she gave physicians an opportunity to dispute what Somers was saying. But it wasn't quite a fair fight. The doctors who raised these concerns were seated down in the audience and had to wait to be called on. Somers sat onstage next to Oprah, who defended her from attack. "Suzanne swears by bioidenticals and refuses to keep quiet. She'll take on anyone, including any doctor who questions her."

That would be a lot of doctors. Outside Oprah's world, there isn't a raging debate about replacing hormones. Somers "is simply repackaging the old, discredited idea that menopause is some kind of hormone-deficiency disease, and that restoring them will bring back youth," says Dr. Nanette Santoro, director of reproductive endocrinology at Albert Einstein College of Medicine. Older women aren't missing hormones. They just don't need as much once they get past their childbearing years. Unless a woman has significant discomfort from hot flashes--and most women don't--there is little reason to prescribe them. Most women never use them. Hormone therapy can increase a woman's risk of heart attacks, strokes, blood clots and cancer. And despite Somers's claim that her specially made, non-FDA-approved bioidenticals are "natural" and safer, they are actually synthetic, just like conventional hormones and FDA-approved bioidenticals from pharmacies--and there are no conclusive clinical studies showing they are less risky. That's why endocrinologists advise that women take the smallest dose that alleviates symptoms, and use them only as long as they're needed.
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This is where things get tricky. Because the truth is, some of what Oprah promotes isn't good, and a lot of the advice her guests dispense on the show is just bad. The Suzanne Somers episode wasn't an oddball occurrence. This kind of thing happens again and again on Oprah. Some of the many experts who cross her stage offer interesting and useful information (props to you, Dr. Oz). Others gush nonsense. Oprah, who holds up her guests as prophets, can't seem to tell the difference. She has the power to summon the most learned authorities on any subject; who would refuse her? Instead, all too often Oprah winds up putting herself and her trusting audience in the hands of celebrity authors and pop-science artists pitching wonder cures and miracle treatments that are questionable or flat-out wrong, and sometimes dangerous.
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But back on the Oprah show, McCarthy's charges went virtually unchallenged. Oprah praised McCarthy's bravery and plugged her book, but did not invite a physician or scientist to explain to her audience the many studies that contradict the vaccines-autism link. Instead, Oprah read a brief statement from the Centers for Disease Control saying there was no science to prove a connection and that the government was continuing to study the problem. But McCarthy got the last word. "My science is named Evan, and he's at home. That's my science." Oprah might say that McCarthy was just sharing her first-person story and that Oprah wasn't endorsing her point of view. But by the end of the show, the take-away message for any mother with young kids was pretty clear: be afraid.

What's worse is that while seeking advice from quacks who promote this wishful thinking, at the same time she reinforces that most fundamental aspect of medical woo. When you are sick it isn't because human bodies are fragile, or they wear out, or are attacked by bacteria and viruses, instead it's your fault. Sickness isn't an accident. It's your failure. You failed to take supplements, or you failed to protect yourself, or you are weak-minded, or you failed spiritually. Of course there are things that we can do to protect ourselves and stay healthy, I wouldn't suggest some form of health fatalism. But medical quackery takes a healthy attitude of self-protection to an extreme of self-flagellation. It promotes the idea that there is always a way of staying healthy, (take this vitamin!) when in reality sickness and death comes to us all no matter how hard we wish it were otherwise. This wishful thinking and self-doubt is, of course, what is exploited to sell quack remedies.

Oprah fails her audience, not only in her incompetence in judging medical expertise, but also for complicity in this most insidious aspect of quackery, that of blaming the victim.

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