Beyond the yellow brick road: More on Dr. Oz and resveratrol

A couple of weeks ago I posted a piece titled “A view from the emerald city” (meaning evergreen Seattle, of course) about Dr. Mehmet Oz’s endorsement of resveratrol supplements. During one of his appearances on Oprah, he spoke favorably about resveratrol, the substance from red wine that has such impressive anti-aging properties. Since reports about resveratrol’s ability to extend lifespan in certain organisms, and its possible anti-cancer, ant-diabetes, and anti-Alzheimer’s potential, it has been widely touted. In a couple of short years it went from a substance few had heard of (and couldn’t pronounce if they had) to the latest miracle cure available from literally hundreds of internet sites. Dr. Oz is featured as a prominent endorser for some, even giving the impression that the product is his own creation.
But there are a couple of problems. First, despite the promise of resveratrol as an anti-aging remedy, it has not been proven in people. More to the point here is that it turns out that Dr. Oz has nothing to do with any of these companies. He may wish he had if anything is eventually proven about their effectiveness, but my hunch is that it will be synthetically derived pharmaceuticals based on the molecular structure of resveratrol that will prove to be the real deal. There are some uses that make sense, such as in skin care, where it can be applied directly instead of depending on absorption through the digestive tract, but in general the resveratrol supplement market has all the trappings of the snake oil salesmen that used to roam the west preying on the naïve. So kudos to Oz for staying above the fray (or behind the curtain) and remember he doesn’t really offer anything that you don’t already have: common sense about diet and exercise for the heart, and the courage and wisdom to make the right choices.

Is the FDA’s oversight of tobacco a good idea?

The newly enacted law giving the Food and Drug Administration the authority to regulate tobacco has generated a lot of strong opinion. On the one hand, nicotine is a pharmacologically active substance and highly addictive, so it is hard to refute the logic that it should be regulated; and clearly there can be no dispute as to the enormous toll that tobacco use has taken in terms of life and health. Others see it as big government meddling in matters of personal choice, pointing out that our health and well-being is ultimately our own responsibility. I see it as naïve political posturing.
Here’s why: In the words of one of the senators who advocated for the law, the new authority will be used to immediately require larger warning labels, so that smokers will have to pause and reconsider before lighting up. The problem is that warning labels don’t work; it’s not like the ones that are there now are invisible. Smokers see them now just as they will when the warnings are larger. So what is really going on in the minds of people who consume a product labeled as likely to be deadly when used as intended? Understanding that is the key to understanding the decision to smoke, and to effective public health measures.
There is some information on this thanks to a technology called functional MRI (magnetic resonance imaging), or fMRI. This captures what is going on in the brain in real time. Martin Lindstrom, in his book Buyology: Truth and Lies About Why We Buy reports using fMRI to study the issue of warning labels and other factors related to decision-making. (The field of study is called “neuromarketing.”) Lindstrom was able to definitively show that warning labels have no effect on smoking cravings. This was true even if the subjects answered in an interview that the labels were a deterrent.
There are a number of potential reasons for this, but the point is that the science is way ahead of the policy-making process here, as with so many other topics. Requiring calories and fat content to be displayed on restaurant and fast-food menus seems equally unlikely to stem the tide of obesity, or admonishments on liquor bottles to prevent drunk driving.

Awake augmentation? Sleep on it before you decide.

Wouldn't it be great if, instead of having to decide before surgery what breast implant size you want, or having to leave it up to your surgeon, you could just be awake during surgery and have some input? That what some surgeons (notice I didn't say plastic surgeons) are doing. They use only local anesthesia so the patient is awake, and then a temporary expander is inserted which can be adjusted to preview what different sizes would look like. The patient gets to sit up and even have some friends or family weigh in. Sound like a good idea?
I can think of a lot of reasons why it isn't, and not very many why it is. Patients do like to have a say as to size, which is a good thing; in fact I insist that they make the final choice, with guidance as to what the limitations of their anatomy are. We have them try on implants at least two different times before deciding. But ultimately there is no way to make the process perfect, because what looks right at one point may not be later. There is a very typical sequence that goes something like this: Right after surgery, there is swelling and the implants haven't settled, so patients may feel they are too large; then after a few weeks, everything looks fantastic and they are proud of what a great decision they made about size; and after 6 months to a year, we might hear "I am happy with them, but if I had to do it all over again i would have gone a little larger." So a decision made during surgery really has no advantage in the long run.
But there are other problems. For one, doing an augmentation under local really won't work very well with implants under the muscle, which is how most of them are done and for good reason. so if the awake approach isn't limited to carefully selected patients, there will be a lot of fake looking results and unhappy patients. another is the question of sterile technique; having the patient sit up and look in a mirror may compromise the rules of sterility that are critically important whan placing an implant of any type. I could go on, but you get the idea.
Most telling is that the technique is being adopted by doctors with little training in plastic surgery. After nearly 20 years and thousands of breast implant patients, I can tell you that it is a lot more difficult to do consistently well than someone just embarking on breast augmentation can appreciate. So sleep in it, for a long time, before making a decision to do the wide awake augmentation.

O Suzanne

I almost hesitate to post this one, because I don't want anyone to think that I am down on Oprah, but the "crazy talk" cover story on Newsweek really hit the mark on some of the wacky things her misinformed guests have spouted over the years. Case in point is Suzanne Somers, who apparently has never seen a supplement pill she doesn't like. According to the article, whenever she drinks wine she detoxifies with high doses of vitamin C. This is exactly backwards! Wine polyphenols are much more potent antioxidants than vitamin C or any other vitamin, and vitamin megatherapy has been debunked in every major study that has looked at it. Typical of this way of thinking, the hard science is dismissed as a conspiracy between the pharmaceutical industry and miseducated doctors, as if she would be in a position to know. As a dedicated and honest physician, I can't begin to tell you how insulting and naive that is.
By the way, what ever happened to the thighmaster? One thing Suzanne Somers did get right was the importance of regular exercise. Time to start exercising some good judgment about supplements.