My first reaction to the news that Dr. Oz was nominated as head of the Centers for Medicare and Medicaid (CMS) was “he’ll probably do a pretty good job.”1
If you’ve been reading this newsletter for a while, you’ll know that I have a complicated view of the work I did for my old boss because of the way that the Dr. Oz Show represented science.2
But there’s a difference between making a commentary on the impact of the message a TV show had and suggesting that we know how the person who hosted that show will do in a wildly different role.
Most of the media commentary I see about Dr. Oz being nominated for CMS director has focused on the recommendations made on his show and his financial ties.3
I’ve read a lot of that commentary, and I don’t share many of the same reservations as a lot of the pieces that I’ve read.
Here are a few thoughts on Dr. Oz being considered for such a huge public health job.
Dr. Oz is really smart and insanely hardworking - he’s a serious person who will take the job seriously
Achieving success at the level that Mehmet Oz has is incredibly hard to do, and he has done it across domains and across industries.
Do you have any idea how hard it is to become Vice Chair of Surgery at Columbia University?4
There are huge numbers of brilliant, dedicated, and work-a-holic doctors who want to get to that sort of level - but simply can’t.
It’s not easy to achieve success and get promoted in academic medicine, and Columbia University isn’t exactly a cushy place to make it.
And the skills that you develop in academic medicine - taking care of patients, writing papers, sitting on committees, mentoring doctors in training - have basically zero overlap with being a TV star.
To learn how to do that from the bubble of academic medicine doesn’t just happen.
It requires work.
Mehmet Oz didn’t just show up on set and read from a teleprompter.
He worked insanely hard develop the skills as a TV host. He spent time late at night reading briefing notes, asking questions, and prepping to interview people across a million different domains.
He learned a ton about areas in medicine that he’d never needed to think about much before they became topics to discuss on his show.
The reason that I think he’d do a good job as CMS director is that he’s going to work his ass off to make it happen.
I’m sure a lot of people in prominent places don’t put in the work behind the scenes that it takes to success.
But Dr. Oz does put in the work.
He’s going to dive into the details, ask questions of smart people, and surround himself with a group of smart, serious, and hardworking people who are committed to the success of the organization.5
I think that people asking about specific conflicts of interest are missing the point - the problem is the audience
Anyone up for a public role will have their finances under a microscope and it’s worth scrutinizing everyone’s financial ties when they are going to be on the public payroll.
I’m not disagreeing with the need to hold public figures up to a high financial standard - and Dr. Oz is no exception.
The New York Times certainly raises the possibility of financial ties complicating his work in the CMS position.
And Dr. Andrea Love’s perspective at Immunologic that critiques Dr. Oz really focuses on the financial ties from the recommendations on the show.
But I think that the take that any specific recommendation was made based on financial incentives is probably wrong and, more importantly, misses the point.6
The problem here is way more meta - the viewers wanted that stuff.
Matt Yglesias has a smart take on the problems with the media, where he writes “the biggest problem in media is the audience.”
Arguably the biggest problem with the Dr. Oz Show wasn’t with the content on the show, it was with what the people watching the show did or didn’t want.
Do you think we didn’t cover exercise regularly because Mehmet Oz doesn’t believe in it?
We didn’t cover it because it didn’t rate.
The same issue extends to every other topic covered or not covered on the show.
When your audience is daytime TV viewers, your incentives on the margins are going to be to appeal to that group.
Sometimes people who are watching TV at 3pm on a weekday don’t want to eat their vegetables, either literally or metaphorically.
And so when the New York Times asks a question about “which Dr. Oz are we going to get at CMS?,” I think it’s way more likely you’re getting the former Vice Chair of Surgery at Columbia than the host of a successful daytime TV show.
CMS Director is a serious role, and I think you’re going to get a serious person in that role.
CMS Director is a thankless, difficult, and non-glamorous job
The American healthcare system is complex, chaotic, frustrating, slow-moving, and often incoherent. Do you think it sounds exciting to be a public health bureaucrat?
If you had tens of millions of dollars in the bank and were as well connected as Dr. Oz, there’s almost no chance you’d want to work as CMS Director.
You aren’t judged for your work in that role by ratings or some other superficial metric.
It’s a really hard job that promises to be almost thankless.
So I admire the fact that Mehmet Oz wants to do a job like this after all he’s done before, especially because he doesn’t have experience working for this type of a health organization.
When I first interviewed with him for a job at his show, I asked Oz why he would give up so much success in medicine to take a chance working in the TV world.
He answered the question by drawing me a picture that looked sort of like this, to describe his need to take on big new challenges:
The point was that people who want to impact the world in big ways can’t do the same thing forever, otherwise you become stagnant and stop growing.
That sort of mindset explains why someone would take a gigantic career risk by leaving a rocketship of a career in the world of academic medicine and then take a similar risk by leaving a job hosting a successful daytime TV institution to run in a contested Senate primary.
And that mindset is also why I’m optimistic about Dr. Oz in this role.
The message in this newsletter isn’t positive or negative - it’s a perspective with my rationale
I’ve already written about my feelings on the show in a lot of depth - if you’re looking for a commentary on Dr. Oz, his show, or my work there, read one of my other pieces to see my defense and my critique.
This newsletter is meant to add something different to the discussion.
I’m proud of some of the messages I contributed to on the show but really disappointed (maybe even ashamed) in my role promoting others.
And I’ve come to believe that when you have a public platform, you should be judged based on what you say on that platform rather than who you are behind the scenes, because the platform is what influences people and what most of them hear.
But even though I don’t feel great about the end result of some of the work that I did (and continue to harbor misgivings about the overall impact of the Dr. Oz Show), it doesn’t mean that I view it all - or view the man himself - in black and white.
People are complicated.
And so I think I would sum up my perspective here by saying that even though I disagree with some of the decisions that Dr. Oz has made about how to use his public platform, I still admire how hard he works and how much success he has achieved.7
I’ll be rooting hard for Mehmet Oz to have success as CMS Director.
There’s a ton I don’t know about what Oz’s perspective is on the many issues a CMS director needs to have opinions on, but I do feel confident that he’s going to dive into the details and work really hard in the role.
And me saying that isn’t dismissing the critiques that I’ve read. But it is hopefully providing a slightly different perspective on a person being considered for a really important job.
When news broke that he was being nominated for that position, I was seeing patients with my phone in my pocket. My phone vibrated so many times with texts from people in my life that I thought something had happened to my family and actually looked at my phone in the middle of a patient visit (which I really try hard not to do).
The New York Times article has a number of framings that I would consider inaccurate. They describe his opposition to Covid vaccine mandates and giving the Covid vaccine to all ages and demographic groups as fringe opinions, but they aren’t. Those are pretty mainstream controversies for most of the people who really know this data well. The article also suggests that Oz has a concerning relationship with Pharma because of his role in inventing the Mitra-clip device. But they don’t mention how revolutionary that device has been, and that being a part of inventing it saves lives and prevents hospitalizations for really sick heart failure patients.
And the corollary: do you have any idea how tough it is to maintain success in daytime TV for more than a decade? How many people can figure out how to get to the top of two hyper-competitive industries and stay there? Underestimate the intelligence and savvy it takes to do that at your own risk.
The team at the Dr. Oz Show was really smart. The TV producers I worked with there were true professionals. They just played in a different playground that doctors do. Like many really smart and successful people in non-medical industries, they weren’t always that health literate. But they were the top of their field - there’s a reason that show won so many Emmy awards. You’re fooling yourself if you think Dr. Oz is going to bring TV producers to work in a bureacracy like CMS. He’s going to hire smart and experienced people to help him succeed.
Many of the “solutions” on the show were pitched by producers working 80 hours a week to find a supplement that had a bit of supporting evidence to fit into the segment that they were working on. I can’t remember anything ever being forced on us to specifically validate as a recommendation.
I know that some people are reading this and hoping for a takedown piece. That’s not the point of this newsletter. I’m trying to provide context and insight with some nuance.