Fair balance gives natural pills and supplements an advantage

The reality is that my job constantly challenges my sanity. Sometimes, I just want to scream.

Patient:  “Doc, I don’t want to put any poisons in my body!  Isn’t there a ‘natural’ remedy I can take?”

Doc: “No, I want you to take my poison!  I haven’t poisoned my quota of patients this month and need to reach my goal.”

Poisoning patients really isn’t good for business.  Why would a patient believe that FDA approved medications are poison?

Just watch any TV advertisement.  The FDA requires that all promotional pieces be balanced (the term is “fair balance”).  Balance means, if you say something good, you must say something bad.  So product “Y” protects you against stroke but can cause fatal bleeding.  The fact that bleeds occur in only 0.001% of patients is irrelevant; the only thing the audience hears is “fatal bleeding.”  So, having been scared out of taking a life saving “poison,” the patient has a massive stroke.

While your doc and pharmacist are handcuffed and gagged by fair balance, your local herbalist and vitamin purveyor (VitaHerb Central ) isn’t.  I’m jealous.  I recently walked into one of the VitaHerb Central stores (any national chain vitamin/herb store) and scoped out what they carried.   Instead of a trained and licensed pharmacist, a young man offers advice and sells you “natural” pills in a bottle.  He does not know the source of the material in the bottle.  He does not know how the “natural” medicine (yes, it’s a medicine) in the bottle is absorbed and processed.  He does not know if it is safe for your liver or kidneys.  He does not know if it will interact with anything else you are taking.

He tells you it is good for fatigue.  He tells you it will boost your immunity.  He does not know your medical history.  He has no idea that you have kidney disease and asthma.  You don’t know you have kidney disease and asthma either.  You don’t see a doctor because doctors use poison.  He can tell you anything because he is not gagged and handcuffed by the FDA nor by science and a code of ethics.  He’s just doing his job, hoping to finish college one day.

You start having problems breathing.  Finally, you see a doctor.  After a multitude of tests and introducing FDA approved “poisons” into your body, you finally admit that you are taking supplements.  The doc asks you to bring them in.  In the bottle is Echinacea (for your immune system) and a “respiratory rescue” herbal mix containing 15 “natural” cures, including licorice.  During your initial visit, you stated that you had ragweed allergies, problems with gluten, and licorice.  Case solved.  You’ve been poisoning yourself with “all natural” medications, dispensed by a clerk at a vitamin/herb store.  Echinacea is ragweed.

You trust the clerk while shunning my science.  If you are taking a pill, any pill, it is a medication.  It has potential side effects, interactions, and risks.  It is processed either by your liver or your kidneys and can be toxic if you have problems with renal or hepatic metabolism.  It is manufactured without government supervision.

Every bottle has the “Medical Miranda Rights” printed on it.  “These statements have not been approved by the FDA.  This product is not intended to diagnose, treat, cure or prevent any disease.”  My wife and I just spent five minutes looking for our magnifying glass so I could read the inscription on a bottle of cold prep a guest left at my house. The “Miranda” statement was positioned below the easily readable, miraculous claims section.

Despite the obvious fact that vitamin/herbals are manufactured pills unofficially claimed to treat a multitude of diseases and the fact that they are expensive, they outsell my “poisonous” medications.

Despite the fact that I have years of education and 28 years serving my community, the clerk at the vitamin/herbal store trumps my science.  The clerk at “VitaHerb Central” trumps the pharmacist.  He even trumps the FDA.

Yes, I must be crazy to come to the office every day.  If I was sane, I would go to work for VitaHerb Central, sell snake oil, and be revered.

Stewart Segal is a family physician who blogs at Livewellthy.org.

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  • Anonymous

    ” There is no such thing as a poison, there is only a poisonous dose.”

  • James deMaine

    Thanks!   It’s always bugged me too.  I’m amazed at the number of supplements that are on the shelves at Costco, the big grocery stores, drug stores, as well as the “health food” stores.  It’s a huge largely unregulated industry.  Unfortunately some kids experimenting with drugs know the power of certain herbs.  Here’s a story from my blog:  http://www.endoflifeblog.com/2009/09/herbal-overdose.html

  • http://www.twitter.com/alicearobertson Alice Robertson

    Your point is well taken…but in an effort to be “fair” it would seem science is so confusing, corrupt, and coercive the average patient has lost faith in doctors because rarely do they keep up on all the clinical studies  (where 85% of them are financed by BigPharma).   There are worse case scenarios on both sides of the fence….patients can commit suicide with overdoses of just about anything natural or pharmaceutical…(MJ and poppies are natural….of course, we can order them online now via Tor….I believe a young woman tried to abort her baby with arnica and overdosed….there will always be sad cases on both sides of the debate).  

    Patients are skeptical of everything in medicine now….but we operate out of the “What if” syndrome…and it’s only pragmatic to view supplements are cheaper and more effective….in the big picture (again…obviously…both sides have warts….sometimes a patients receives so much diametrical advice after they leave your office…you go online and get more confused….but much of it is profit driven)..  Overall we self-treat with few problems….in the grand scheme of things pharmaceuticals keep us reliant on doctor visits and doctors….most want to avoid that.   

    There is a doctor near me who treats only naturally….she has patients from 39 states and doesn’t take insurance.   I don’t think everything she does is fine and dandy…but neither do I think that about the medical establishment….yet…I have to admit you are great at catastrophic care….well usually.   But the nominal….or mid-level care…..I think supplements are something doctors should educate themselves on…it’s the only true way to treat a public using the internet as a way to self-treat….because the patients are not likely to change.  And some are far better educated about supplements because…ta da…they watch Dr. Oz!:) 

    • http://www.facebook.com/brianpcurry Brian Curry

      Only pragmatic to view supplements are cheaper and more effective

      By what measure are supplements “more effective”? To the extent that many conditions tend to be self-limiting, I suppose you could argue that they resolve with supplementation, but otherwise I think you’ve lost the plot.

      See, doctors don’t have a problem with supplements per se. It is the fact that Big Supplement is in the pocket of lawmakers (like Orrin Hatch), tying the FDA’s hands and making it more difficult to ensure their safety and efficacy.

      As for Dr. Oz, well, the man’s a quack. Full-stop.

      • http://www.twitter.com/alicearobertson Alice Robertson

        LOL. Now that’s sacrilegious to say that about Dr. Oz. Ha! I like him…but rarely watch…but his show with the BigPharma PhD and the Harvard/watchdog author was very good. As you know Dr. Oz is a heart surgeon…he is pulling patients off statins…they simply don’t work for women…only work well for one in fifty men. Now who is being unfair? Doctors who will not keep up on research…scoff off supplement use…often rely on reps for research…..then say the supplement manufacturers have an unfair advantage….hmmm….my goal…and bottom-line is it’s unfair of a doctor not to keep up on research and give what works best for their patient…and that is often trial and error.

  • acueli

    As an acupuncturist in practice for 26 years, I quite agree with Dr, Segal’s concerns about the unprofessional levels of advice proferred at the mythical VitaHerb Central.  In Traditional Chinese Medicine, herbal medicine is a credentialled specialty.  Here in the USA, training in Chinese botanical medicine requires at least 6 semesters at the graduate level, extensive clinic supervision while in school, followed by a national board exam. 
    However, the good doctor has left himself open to be charged as a “drive-by debunker” with his inaccuate dig that “Echinacea is ragweed.”   Ragweed is Ambrosia artemisiifolia  http://www.ppws.vt.edu/scott/weed_id/ambel.htm  while the several echinacea species are simply not that.  I have not undertaken to research whether they are botanically related enough for there to be cross-reactivity.  Let me also note that echinacea preparations are mostly made from the roots and sometimes from the leaves.  Does Dr Segal have a reference that a person with a history of allergy to ragweed pollen will react to the root of echinacea?  You see, errors about alternative remedies by defenders of conventional medicine undermine the credibility of the critique.  It would have been enough for him to assign blame in that case history just to the licorice.

  • http://twitter.com/livewellthy Stewart Segal

    There are many definitions of “natural”.  According to Merriam-Webster, one of the definitions of “nature” is, “existing in or produced by nature: not artificial”.  Alice writes, “There is a doctor near me who treats only naturally”.  I assume that means she uses herbal medications, derived from nature.  “Natural” would mean she uses the actual roots and leaves in their unprocessed state.  If she uses pills and potions derived from nature, then they are no more natural than my pills and potions.
    If it sold in a bottle or a box, it is NOT “natural”; it is “artificial” and manufactured.   I am a trained skeptic (http://livewellthy.org/2011/03/14/skepticism.aspx).  My professors taught me to question everything and seek knowledge.  The accusation that your doctor’s care is any less “natural” than an herbalist is a result of the highly successful marketing of neutraceuticals in this country.
    The accusation that doctors do not keep up with the latest research is an overgeneralization meant to discredit your doctor’s opinion.  As a board certified family physician, I am required to take continuing education courses yearly and prove my proficiency every 7 years by taking a day long, recertification exam.

  • http://twitter.com/livewellthy Stewart Segal

    Acueli, I stand corrected.  You are correct. Echinacea is not truly a “ragweed.”  However, in my area of the country, the purple cone flower grows wild and flourishes and is indistinguishable as from ragweed as a source of allergies.  The midwest prairie is a major source of allergens and the purple cone flower, while beautiful, is problematic. 

  • http://www.facebook.com/people/Steven-Reznick/100000549195050 Steven Reznick

    The American College of Physicians publishes a wonderful book on Alternative and Complimentary Medicine. It evaluates the research done on vitamins, minerals , supplements, herbs and alternative health systems and rates it much like it rates the studies which eventually appear in Evidence Based Guidelines. The National Institute of Health has a division of Alternative and Complimentary Medicine which states a philosophy of ” if it works its not alternative.”  That means that the data was well researched and is reproducible by other researchers. 
    The NIH website on this subject is a wonderful resource for use and discussion with patients.
    There are different cultural and regional philosophies of medicine as well that have served their patients well for years. The University of California San Francisco along with a a major University in China offer a two year long course on Oriental Medicine that requires six months of comprehensive pre study before taking 3months of courses in San Francisco and then 6 months in China. There are clearly areas of medicine that western medicine will benefit from examining and incorporating into our system. The level of training and education of these practitioners will be significantly higher than clerks at the health food store and they will be welcome members of the profession who provide an invaluable educational and treatment resource.

    • http://www.twitter.com/alicearobertson Alice Robertson

      I really appreciate these suggestions…and, yet, I am skeptical….anything from the government of even the AMA, etc. just seems to flush studies that show differently from their own agenda.  I firmly believe ALL the cards should be on the table….let me be responsible…in truth, I am growing tired of the government protecting me and making subjective decisions claiming they are protecting society…and, sadly, I see that in doctors to.  But I will give a kudos to some of my daughter’s doctors at Cleveland Clinic…one gave me a great answer on immunizations…he and his wife are research doctors so they come down from the Ivory Tower sometimes:)….he said isn’t against not immunizing…he is against “ignorance”.  That sums it up doesn’t it….so patients remaining willfully ignorant is just as wrong as doctors who remain so…and, sadly, that is not the exception on both sides of this aisle.

      That said, I am going to look into your book suggestions and put on my thinking cap and read:)  The NIH is very interesting….the work of Francis Collins sorta captivates me.  He has brought truth and integrity to the job.  If you haven’t read some of his writings or debates with Christopher Hitchens I recommend them.  They are working together on Hitchen’s cancer treatment.  I love bad, brilliant boy Hitchens to:)

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