Jeanne Lenzer: Donald Trump on Dr Oz—the greatest non-evidence based show on earth

jeanne_lenzerLate night comics will love Donald Trump’s latest act of showmanship: the neatly choreographed moment when he pulled out his “medical record” from his jacket pocket on The Dr Oz Show last night.

The show and this big reveal garnered plenty of headlines: now everyone knows that Mr Trump is overweight, verging on obese; that he thinks that waving his hands during his speeches is exercise; and that he asks his aides not to tell fast food servers that they are purchasing for Trump lest they doctor the food. And he takes low dose aspirin and a statin.

Let’s not forget the strange letter by Trump’s longtime doctor, the gastroenterologist Harold Bornstein, which the physician James Hamblin analysed in his article “The bizarre words of Donald Trump’s doctor.”

And let’s not leave out Dr Mehmet Oz himself, who has promoted any manner of nonsense, including “miracle” weight loss cures. (See also: Televised medical talk shows—what they recommend and the evidence to support their recommendations: a prospective observational study)

To elicit a history, Oz performed an abbreviated mockery of a standard review of systems live during the show.

Do you have any head and neck problems? No. Any hormone problems? No. Diverticulitis? No. And so on. No. No. No. Thankfully, Oz didn’t pull out a stethoscope or a latex glove.

Trump’s one page medical record was just a compilation of laboratory tests, many of which aren’t just of questionable value, they are actually rated “Don’t do it” by the United States Preventive Services Task Force (USPSTF) or the Choosing Wisely campaign.

Once again, the public was fed the notion that a slew of tests must be a good thing, a hedge against illness and death, something to desire because celebrities and wealthy people get them.

Let’s start with the annual exam for asymptomatic individuals, which Bornstein said Trump has every spring. Of course, it is tempting to think that we should do tests to ensure we have a fit presidential candidate. But can a bunch of lab tests and an annual tickle of the prostate gland provide that information? Not according to a 2012 Cochrane review or this overview, The Annual Screening Exam – What’s the Evidence?

What tests should we order for this 70-year-old man with no medical problems other than occasional hayfever, and who takes low dose aspirin and a statin, then? Here’s a summary of the evidence for the tests Trump had had:

  • Complete blood count and comprehensive chemistry profile—Choosing Wisely, against
  • Vitamin D—USPSTF, inconclusive
  • Testosterone—No recommendations found for routine testing even for initial evaluation of erectile dysfunction
  • C reactive protein: American Heart Association and Centers for Disease Control and Prevention both recommend against for routine evaluation of coronary heart disease
  • Protate specific antigen—USPSTF, against; Choosing Wisely, against
  • Chest radiograph—Choosing Wisely, against even for preoperative testing
  • Eectrocardiogram—USPSTF, against
  • Cardiac echo—No recommendations found for people without symptoms
  • Coronary calcium—USPSTF, against

What tests are generally recommended? Weight, blood pressure, and arguably a lipid profile, although for a man with no cardiac history and no risk factors, primary prevention is of questionable value.

Of course, some might say psychological screening would be most insightful.

Jeanne Lenzer, associate editor, The BMJ, USA

Competing interests: None declared. 

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