Jarrod Shapiro, DPM Practice Perfect Editor Assistant Professor Dept. of Podiatric Medicine Surgery & Biomechanics College of Podiatric Medicine Western University of Health Sciences St. Pomona, CA

Thanks for the Press, Not!

The other day one of my partners showed me a video from the Dr Oz show, originally aired October 30, 2013 called The Surgery You Should Say “No” To.

This famous physician, Mehmet Oz, MD, this former Columbia P&S thoracic surgeon, educator to the masses, started the show with a segment on the horrible experience that The People’s Court judge Marilyn Milian had with a bunion surgery. It was an irresponsible general indictment of bunion surgery replete with poor advice for patients. Apparently, eight weeks prior to filming, Judge Milian had undergone a revisional bunionectomy. They repeatedly commented about how painful the procedure was, no doubt scaring anyone watching from considering the only true way to resolve a bunion. Granted, this procedure may be painful (especially revisional surgery), but we have many ways to make the procedure more comfortable and a more positive experience. Besides, many surgeries, both elective and nonelective, may be painful, but they are necessary. For all surgery, we often endure short-term discomfort in order to effect long term pain relief. Dr Oz, though, failed to consider this in order to attack bunion surgery as a bugaboo.

During the discussion, Dr Oz stated there are three causes of bunions:

1. High heels with narrow toe box.
2. Family history (AKA heredity)
3. Arthritis

I can live with the first two explanations (though I am of the camp that believes this is a hereditary problem worsened by inappropriate shoes), but the third, arthritis, makes no sense. Dr Oz states arthritis causes one to walk differently which “throws the bone off.” I’ve never seen a patient with primary osteoarthritis alone causing an increased intermetatarsal angle and deviated joint. This is a complete misunderstanding of the process of osteoarthritis, which is caused by joint malalignment or direct trauma leading to inflammatory changes and degeneration, NOT the other way around.

Dr Oz, expert bunion surgeon – NOT – then goes on to explain surgical options using a giant foot. Typical to television, he pulls out a giant saw, and he and Judge Milian put on a ridiculous display, sawing off a portion of the first metatarsal head. This is their “demonstration” of bunion surgery, completely ignoring the now more common osteotomy procedures. It was sensationalist, tabloid journalism, way below any acceptable standard. That’s the level this Ivy League trained heart surgeon has sunk to.

More than eight minutes into the segment, they finally had Crystal Holmes, DPM come on to provide expertise. I don’t agree with everything Dr Holmes said, but she presented a professional, knowledgeable image that represented podiatry well. Of course, she was on for about two minutes and was never given an opportunity to address the prior comments about bunion surgery.

During an earlier video, Dr Oz provided recommendations for ways viewers can prevent bunions. He called them “bunion busters”. Very creative:

1. Avoid heels higher than one inch.
2. Use bunion splints.
3. Take aspirin or ibuprofen to reduce pain and swelling.
4. Visit the doctor.

It was especially painful when he said, “You can visit the podiatrist or the surgeon.” Yes, podiatrist OR surgeon. What a piece of....misinformation. In reality, options 1-3 were not preventative at all but rather palliative. You can’t prevent bunions with the use of splints and aspirin. Only option #4, seeing the podiatrist, has a chance of “busting” or curing the bunion – via surgery.

The best cure, he said, is prevention. What’s the best cure for irresponsible doctors who think they can effectively communicate complex medical issues by providing misleading information?

On August 5, 2010, a different TV show, The Doctors, also discussed bunions. I give them kudos for having a podiatrist on the show, Ali Sadrieh, DPM, to provide some expertise, rather than Dr Oz’s version where he does the explaining. As I watched this segment, I thought Dr Sadrieh did a nice job explaining the surgery, until he started talking about the Mini-Tightrope^® procedure for bunion correction.

I became concerned when he said the Mini-Tightrope^® was a new alternative to fusion – a true statement, though misleading. I gather the “fusion” procedure was a Lapidus bunionectomy (never clarified on the show). However, the viewing public doesn’t know what “fusion” actually refers to, making Dr Sadrieh’s explanation misleading. Of course I would want the Tightrope procedure instead of a scary fusion since it looks so easy! Or so I might think if I was a layperson that knows nothing about the foot.

We were then privileged to witness this procedure on one of his patients, filmed in typical television hyperbolic fashion. Afterward, they showed the before and after clinical images, a few weeks postop, which looked good. They then showed the pre- and postoperative radiographic images, and here it all fell apart for me. The after X-ray showed that Dr Sadrieh had performed a head procedure in addition to the Tightrope! This part had not been mentioned during the lead up to the surgery or during the surgery, and was glossed over during the postop discussion.

Personally, I won’t use the Mini-Tightrope^® for my bunionectomies (I’ve had to revise several that had been done previously). However, I don’t fault Dr Sadrieh for his choice of procedures, and he did have a good result. Additionally, he successfully portrayed surgery as a potentially positive experience, something we as a profession have had trouble accomplishing.

The fault of misinformation really lies with three sources. First, the television media “educates” in five minute sound and video bites, using anecdote instead of legitimate research. The most hyperbolic, loud, and shiny message is what’s heard. Second, the fault lies with the general public for buying into this type of media manipulation and misinformation.

Third, the greatest fault lies with us in the podiatric profession. We have allowed people like Dr Oz to hijack our message, distorting it for his own purposes. We have allowed someone with absolutely no authority to teach the public about something over which we have significant authority. It’s also our fault that our research into so many pathological issues of the lower extremity is itself faulty and of poor quality, diminishing our claimed authority and opening the door to unproven comments.

I congratulate Drs Holmes and Sadrieh for succeeding where so many of us have failed. At least they got on television to keep the discussion from running into the absolutely absurd. It’s just a shame that hyperbolic, misinforming, irresponsible, fame-grubbers like Dr Oz have the ear of the public. Thanks for the press, Dr Oz.

Best wishes,

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
jarrod@podiatry.com

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