Several weeks ago, my office phones and email were set ablaze. My contacts from the sleep and medical community began bombarding me with messages. "Did you hear about Dr. Oz?", "Can you believe he is getting sued over that?", "Heated up rice in a sock?" What was everyone talking about?
On April 17, 2012, Dr. Mehmet Oz, the popular host of "The Dr. Oz. Show" gave some unorthodox advice to his viewers struggling with their sleep. According to his website, Dr. Oz suggested that viewers with sleep problems fill their socks with uncooked rice, heat the rice in a microwave, and put the socks on before they go to sleep. "The heated rice footsie diverts blood to your feet due to the heat, which in turn cools your core, allowing you to get your Zzzs all through the night."
As a physician who has been involved with sleep for 20 years, I find this advice to be elementary and rather silly. It takes the very complicated science of sleep and distills it down to advice that sounds like it came from a 19th century barber/surgeon known for treating sleep maladies with bloodletting. It is insulting to my subspecialty, and in many ways, it is no different than me addressing a group of patients with various cardiac issues and telling them they can solve their problems with a bowl full of Cheerios.
However it does differ in one big way: there is real, evidence-based scientific literature to back up the Cheerios bowl. With little effort, I quickly found five articles supporting this treatment [1,2,3,4,5]. The research supporting "warm rice/sleep nice" is mostly a collection of weak, poorly powered studies that sleep researchers have known about for years but pay little attention to [6, 7, 8]. In fact, one study showed that the effect was not seen if the subject had preexisting insomnia. Why else would someone go to the trouble of warming their feet if they did not have a sleep problem? The most compelling study I'm aware of demonstrated a sound relationship between individuals who fell asleep quickly having warmer feet. It did not show that warming feet made a person fall asleep faster . In logical terms, just because a statement is true, does not make the converse of that statement true. It is well accepted that steroids can cause irritability and anger issues. Assuming that every angry person you encounter is jacked up on steroids would be an erroneous conclusion.
Unfortunately, a viewer with diabetic neuropathy followed this advice and severely burned his feet. Neuropathy is a neurological disorder that features nerve damage that often causes numbness. This is important because patients with neuropathy can often not feel processes that are damaging their feet. So when it was recently announced that this man, Frank Dietl, was suing Dr. Oz because the treatment left him with third degree burns, I had only one thought.
Leave Dr. Oz alone!
Regardless of my personal beliefs about Dr. Oz's attempts at curing America's sleep woes, he is clearly passionate about helping individuals lead a more healthy life through more educated health practices. What exactly is a viewer expecting when he tunes in to watch a highly accomplished cardiothoracic surgeon give out sleep advice? As a board certified sleep specialist and board certified neurologist, I don't find many individuals clamoring for my advice regarding how to handle issues related to high risk pregnancies.
While Dr. Oz may have set out to educate America about sleep, what he may end up doing is educating America about the frivolous lawsuits physicians live in constant fear of. Looking at the details of this case should make not only every doctor, but everyone in general selling a product or simply just trying to help take heed.
In this case, Frank Dietl, a 76-year-old man with diabetic neuropathy was tuned into Dr. Oz's show and tried his remedy for insomnia. Diabetic neuropathy is a painful, chronic condition that can cause significant discomfort and numbness in affected nerves, most typically in the feet. Patients with this condition need to take special care with their feet and are typically told by their primary care physicians and/or their endocrinologists/diabetes care specialists to do so. This often necessitates special shoes and frequent checks of their feet for wounds. Because of the numbness these patients have to deal with, even small cuts and abrasions can go undetected. Because neuropathy can also influence healing, small problems can become big problems in a hurry. It is not uncommon for patient suffering from neuropathy to have toes amputated for wounds a healthy individual would shrug off.
In this case, Dr. Oz was very clear to warn his viewers to not let the rice get too hot in the microwave. Did he warn viewers with diabetic neuropathy to be careful? Not specifically. Did he warn viewers with the countless other varieties of neuropathy to be careful and check their feet? No. Did he warn patients with rice allergies to be careful? No. Did he warn people who prefer metal socks to be careful about putting said socks in the microwave? No. Do I need to go on?
I am very sad this man injured his feet. I suspect Dr. Oz is too. Doctors, in general, just want to help. I do think there is responsibility here and it does not rest with Dr. Oz. It rests with a patient and the duty he has to be his own advocate. If he sees a Dr. Scholl's gel insert ad, he needs to know that the use of that insert could make his shoes too tight and lead to foot injury. I saw Joe Montana pitching some Sketchers Shape-Ups on TV. Is the greatest Super Bowl quarterback on the hook if a similar patient with diabetic neuropathy injures his feet with ill fitting footwear that promises a firmer gluteal region? I hope not. Finally, are the doctors that take care of this man adequately educating him about his feet and proper diabetic foot care practices? Given what I have read about this case, it is unclear.
Much will be made about television gurus when and if this trial ever comes to pass. Do I think the information being dispersed is particularly useful or grounded in good science? Not really. Despite that, the information is not harmful, and if it works for a few viewers, or many viewers, hooray! A pair of tube socks and a box of Uncle Ben's is a lot cheaper than a prescription and in many ways far more appropriate and safer for the masses than a sleeping pill prescription.
1. Andersson KE, Hellstrand P. Dietary oats and modulation of atherogenic pathways. Mol Nutr Food Res. 2012 Jul; 56(7):1003-13.
2. Harris KA, Kris-Etherton PM. Effects of whole grains on coronary heart disease risk. Curr Atheroscler Rep. 2010 Nov; 12(6):368-76.
3. Tighe P, Duthie G, Vaughan N, Brittenden J, Simpson WG, Duthie S, Mutch W, Wahle K, Horgan G, Thies F. Effect of increased consumption of whole-grain foods on blood pressure and other cardiovascular risk markers in healthy middle-aged persons: a randomized controlled trial. Am J Clin Nutr. 2010 Oct; 92(4):733-40.
4. Maki KC, Beiseigel JM, Jonnalagadda SS, Gugger CK, Reeves MS, Farmer MV, Kaden VN, Rains TM. Whole-grain ready-to-eat oat cereal, as part of a dietary program for weight loss, reduces low-density lipoprotein cholesterol in adults with overweight and obesity more than a dietary program including low-fiber control foods. J Am Diet Assoc. 2010 Feb; 110(2):205-14.
5. Davy BM, Davy KP, Ho RC, Beske SD, Davrath LR, Melby CL. High-fiber oat cereal compared with wheat cereal consumption favorably alters LDL-cholesterol subclass and particle numbers in middle-aged and older men. Am J Clin Nutr. 2002 Aug; 76(2):351-8.
6. Ebben MR, Spielman AJ. The effects of distal limb warming on sleep latency. Int J Behav Med. 2006;13(3):221-8.
7. Liao WC, Chiu MJ, Landis CA. A warm footbath before bedtime and sleep in older Taiwanese with sleep disturbance. Res Nurs Health. 2008 Oct;31(5):514-28.
8. Raymann RJ, Swaab DF, Van Someren EJ. Skin temperature and sleep-onset latency: changes with age and insomnia. Physiol Behav. 2007 Feb 28;90(2-3):257-66. Epub 2006 Oct 27.
9. Kräuchi K, Cajochen C, Werth E, Wirz-Justice A. Warm feet promote the rapid onset of sleep. Nature. 1999 Sep 2;401(6748):36-7.
Special thanks to Christine J. Jones for her research assistance.
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