The ethical shortcomings of selling supplements

A crunchy friend of mine on Facebook re-posted something from an even crunchier friend of hers who was shocked to find that many naturopaths sell supplements. Actually, she feels that selling them is okay; so is prescribing them. But selling what they prescribe apparently tips her ethics meter over into “unacceptable”.

As I read her screed against  the ND who conducted a cursory history and exam before checking off $750 worth of supplements on a pre-printed sheet (Visa, Mastercard, and Discover accepted, I’m sure) I felt my heart lift. Yes, I thought. Now you’re getting it. When she advocated hiring a naturopath who doesn’t do this, I found myself telling the screen, “Good luck with that.”

The poster was also, rightfully, concerned about “the heart of the practitioner.” She places great emphasis on intent. Question for her: what about the practitioner who really, truly feels that the only supplements good enough for her patients are the ones she is selling? You’d probably think she’d been hoodwinked by marketing, and you’d be right.

Here’s the thing, though: you yourself have been hoodwinked by the marketing of the entire “Natural Health” industry. Naturopathic medicine, energy healing, homeopathy, chiropractic, acupuncture, and all the rest are nothing but non-scientific hokum.

Some of it emerged before science had developed sufficient understanding of the human body. Others, like chiropractic, were actually invented in order to make money selling them to practitioners (who were understood to then turn around and use them to take money from patients.) There is no way to learn — and really understand — chemistry and then turn around and believe in homeopathy. Emerging consensus reveals that acupuncture is nothing more than an elaborate placebo.

Recognizing the ethical shortcomings inherent in the sales and marketing of supplements is the first step. The next is the painful understanding that those who sell “education” and “training” to become a “Natural Health care provider” are just as unethical, selling nonsense in lieu of science to people whose disappointments with “regular” (ie, real) medical care leave them vulnerable to the wish fulfillment that is “holistic” care. I’ve written about this before.

It’s important not to confuse the message and the messenger, or rather the material and the teacher. It’s possible, even likely, that the vast majority of natural health practitioners really believe that what they’re doing is legitimate; just like that Naturopath who really feels that her supplements are so much better than cheaper alternatives.

This friend of a friend goes on to give this advice:

Bottom line is this – if you are in the natural health field, or are planing a career in it – choose which side of the coin you want to be on – 1) patient care, consulting, advocating and teaching, or 2) retail, sales, product marketing. Both of these are perfectly fine when apart – it is the mixing of the two that causes my heart to sink.

The existence of the whole “natural health field” is what causes my heart to sink. I ache for those whose bad experiences with “conventional medicine” — that is to say, medicine — have caused them to look for alternatives. But for anyone looking for a career in the health field, make it a real health field, like nursing or medical school, EMR/paramedic/first responder training, or become a doula or lactation consultant. As for those already there, please take a long, hard look in the mirror, and think about what you are really selling.

Lucy Hornstein is a family physician who blogs at Musings of a Dinosaur, and is the author of Declarations of a Dinosaur: 10 Laws I’ve Learned as a Family Doctor.

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  • jpfenton

    My home state requires insurance companies to cover naturopathic medicine. Depressing.

  • Sara Stein MD

    Yes Lucy, you’re a dinosaur. Practicing medicine based on what you learned in training is a problem with a majority of physicians. A majority of Americans use some kind of supplement over the counter; therefore physicians have an obligation to understand and know how to recommend these supplements or treatments. My approach is to guide them specifically, keep them away from supplements that contain everything but the kitchen sink. Use a reputable store and a reputable company, but check the additives first. I sell a few supplements in my office because they’re too expensive elsewhere or too hard to find. And I do agree with you that hundreds of dollars of supplements is a racket.

    • Sara Stein MD

      So I assume that those of you who vote this down do not take Vitamin D3, omega-3 fish oil, melatonin, or any vitamins. Furthermore, you’ve never used zinc for a cold or echinacea and vitamin C to prevent one. You’ve never had chamomile tea for insomnia or to relax. Really, you should try them.

      • Lucy Hornstein

        Actually, it was just your first comment I agree with. The second is bullshit, and proof that you’re the one practicing on incomplete and/or inaccurate literature.

        • Sara Stein MD

          Sad comment Lucy. Try getting your patients up to a Vitamin D level of 50 and keeping them there for their own health. Give them some Coenzyme Q10 so they dont have crippling myalgias from statins. Give them high grade 3-omegas when they are depressed. Check their B12 levels and their MMA’s to see if they actually metabolize B12 after you’ve given them metformin and omeprazole. Hardly incomplete or inaccurate literature on my part.

      • EE Smith

        Of course I take echinacea and vitamin C to prevent colds, and zinc to cure them when that fails. Peer-reviewed science-based medicine is pretty over-rated. I also wear a necklace of garlic to ward off bubonic plague, and on the advice of President Mbeki and his fine izinyanga
        I use beetroot extract for AIDS. I’m just glad I don’t have asthma, as I don’t really fancy the idea of snorting ground-up freeze-dried geckos, but.

        • Molly_Rn

          Echinacea has proven to be worthless by real scientific testing. The problem with the so called alternative medicine (there really is only one medicine and that is western based on science medicine) is that it is based on bull $hit. There are no real scientific studies just antidotal crap. So many things just take care of themselves so people say I was cured when it is a short lived disease or problem. Why are you all so afraid of real science? Why would you rather be duped by these con men? Don’t you see the money the take from you for nothing?

          • sphenoid

            Are you trying to say that people aren’t researching nutraceuticals? Funny, I see “real” scientific studies down on them all the time.

          • Molly_Rn

            Yes,there aren’t real scientific studies done on them they are by their con men.
            When a real research study finds that Echinacea doesn’t do anything useful,
            there is a hue and cry from those who make money selling it that it isn’t
            accurate. This has become a religion.

    • Lucy Hornstein

      With this, I agree.

  • EE Smith

    When my son had an earache this last winter, a friend who’s become something of an alt-health evangelist was on my case to take him to her chiropractor, who also apparently deals in all manner of supplements (my friend has an entire cupboard in her kitchen dedicated to bottles and boxes of “natural” pills, powders and potions she’s been “prescribed” for herself and her children). I got the whole spiel on how “allopathic practioners” weren’t interested in actually healing their patients, that they have a vested monetary interest in keeping them sick, bla bla bla. Apparently chiropractic techniques plus supplements can completely cure children of earache but pediatricians don’t want word of this to get around because it’ll do them out of business. (!)

    This is a basically sensible and well-educated woman not otherwise given to weirdness and woo. Where does this even come from?

    • Kristy Sokoloski

      Wow. I have heard some of this same type thing happening with regard to treatment of Diabetes too, and same with people who have other types of illnesses.

    • Mandy

      Just read some of the comments on this very blog platform, such as one recently published in reaction to the post “It’s time to put the vaccine-autism link behind us”. One commenter heavily insinuates that pediatricians push vaccines because vaccines cause autism, and autistic patients are money spinners for them. People are turning against the medical community, and leaving an opening for charlatans and hacks.

      • Guest

        I just find it hard to believe that medical professionals cannot recognize that some herbals or supplements might be beneficial as they have been used in Eastern cultures for thousands of years. Also can no one believe that people who take supplements or practice holistic medicine are not vaccine hating cuckoos that eschew Western medicine? I like to believe we practice a nice balance of both in our home – and I am a specialist in private practice!

  • louise40

    And of course you know all about natural supplements, naturopathic medicine, energy healing, homeopathy, chiropractic, acupuncture? You’ve spent many years studying them, right?

    • Guest

      Snort. Of course not, though the author is certainly arrogant enough to believe she’s an expert on dispelling them!

      • another guest

        I am not an expert in astrology but I am confident that the daily horoscopes in the newspaper are hokum.

        There is science-based medicine and then there is “alternative” “healthcare”. Anyone with even a basic background in real medicine understands that “alternative” “medicine” such as homeopathy is based on superstition, not science.

        • Guest

          Oh I see. I guess that explains that explains what happened with thalidomide and vioxx, right? Those came out of science based medicine – I guess those should have been considered alternative therapies.

  • Guest

    Once there is rigorous science behind a “natural” or “alternative” medicine, we don’t have to call it “natural” or “alternative” medicine. It’s just medicine.

    A single 12-year-old Iranian study involving 36 subjects (passionflower v. oxazepam, the only one I clicked on) would probably not be enough to convince real doctors to ditch the science-based medicine in its favor when prescribing. Additionally, most American psychiatrists do not go around blithely “handing out benzodiazepenes” like lollies these days anyway.

    • Sara Stein MD

      Sorry guest, I am a psychiatrist and we do go blithely handing out prescriptions that are potentially harmful. Al Killian is right, it’s just not all benzos.

  • Dave

    I’ve come up with a litmus test when talking to people about the Naturo-chemical industry. Which do you think is better for you: 1) a 500mg tablet of synthetic ascorbic acid manufactured by a giant pharmaceutical company in a lab, or 2) an all-natural extract of vitamin C from organically grown rose hips? Anyone who stayed awake in high school chemistry knows they’re the same thing, but apparently most people nod off sometime around the ideal gas law.

    My issue with herbals has never been one of efficacy. Even if it’s just a placebo effect, if someone wants to shell out $8 for a capsule of grass shavings and ends up feeling better, I’m glad it worked and I wish it worked as well for me! No, my issue is that that, if herbals are truly effective, then they are chemicals just like those made by big pharma and accompanied by a comparable retinue of side effects and long term complications. They can’t be both effective and free of side effects, but this is exactly how they are marketed.

    Naturopaths seem to diagnose every patient with one of those broad disorders affecting myriad systems that could manifest in countless ways. Candida seems to be a favorite. Same goes for wheat sensitivity, lyme disease, hypo/hyperthyroid, “parasites”, “leaky gut’, etc. Most of these are actual conditions you can google (and probably find an ebook cure for $19.99), and all could have 100+ presentations.

    Years ago, a friend of mine had been feeling fatigued for awhile, had a persistent cough, hoarseness, and a number of general symptoms. He went to his GP who examined him and did tests but found nothing, so on another friend’s rec he tried a naturopath. This person was extremely personable, listened well, and diagnosed him with a systemic candida and parasite infection. His Rx was a gluten/suger-free diet and ~$1,000 in herbal supplements. A couple months later he felt markedly better and to this day attributes it to his treatments. He even refers friends to his naturopath when they too have similar nonspecific symptoms and what do you know, he’s accurately diagnosed candida and parasite infections in each friend who followed up with his ND.

    I’m reminded of this from Bernay’s Golden Rules of Surgery: “If your work is painstaking and you take interest in it, your practice must grow because nature has wisely arranged matters so that of one hundred patients who call upon a physician about ninety-five would recover even if left without treatment of any kind.” Works just as well for non-physicians!

    • Al Kilian

      The point you are trying to make with the synthetic vitamin c vs organically grown rose hips is true to an extent, but also reflects the western medical fallacy that the benefits of an herb or natural supplement can be explained solely on one vitamin, mineral phytonutrient etc…

      Why the Vitamin C amount in rose hips vs ascorbic acid may be the same the end result/how it impacts the body may be different.

      For example pretty much any study will show that acute caffeine consumption will hamper insulin sensitivity. Yet studies on habitual high intake coffee drinkers tend to show improved insulin sensitivity.

      Vitamin E being another one. In foods like wheat germ, nuts etc it is shown to have great health effects and prevent cancer in those with the highest vitamin e intake from foods. The vitamin e family has actual 8 subgroups of tocotrienols and tocophenols. So then we do studies and find out the aplha-tocophenol is the most powerful one that “has all the benefits” and synthetically make just 1 of the 8 nutrients in the Vitamin E family. The results: the highly publicized study about Vitamin E increasing the risk of lung cancer.

      This post is long enough, but another example would be looking into the MTHFR genetic mutation and how natural folate (B9) is entirely different from the folic acid (B9) that is frequently added to processed grain products or found in cheap multivitamins.

    • Al Kilian

      One more easy to digest example. Say one has anemia and it has been diagnosed to be a lack of iron and not the other causes. Is 10 mg of heme iron (from meat, although there is one heme-iron supplement available) the same as 10 mg from non-heme ferrous supplements. If you answer yes, you fail that litmus test. Off the top of my head the absorption difference is something like 40% vs 10%.

  • Obinna Akunna

    Wow, what are an ignorant piece. Herbs and supplements DO WORK. They have been used for centuries and so are well tested….Quite unlike those “here today, fda removed tomorrow” blockbuster drugs that your ilk are so quick to prescribe. No wonder our healthcare system is broke.

  • Obinna Akunna

    And if people seem to be healed by naturopaths, maybe it is because they actually spend more than 15 mins listening to their symptoms and are not rushing them out just to see the next patient.

    • Kristy Sokoloski

      Just because they may spend more than 15 minutes listening to the patient’s symptoms and not rushing them out just to see the next patient does not necessarily mean that the treatments they recommend are safe. Please explain to me and everyone that will be reading the article and the comments that follow it why insurance companies do not cover Naturopathic doctors for the most part (one of the commenters above said their insurance does because of State law)?
      Some people think that using strictly alternative treatments are much safer than using conventional medicine. I do not agree with this, because just like there are safety concerns with regard to conventional medicine the same is said for alternative medicine. There are people out there with certain medical conditions that can’t have anything alternative at any time because it might make them sicker.

      • Obinna Akunna

        1) Natural supplements are safe. We have centuries of data on them unlike conventional drugs.

        2) Insurance companies most likely do not cover natural supplements or naturapathic way of healing because they have not figured out a good way to make money on them. Forget all you read in brochures, insurance companies are not in it for your well being.

        3) Alternative medicine can be misused but so can conventional medicine. Haven’t you heard of folks misdiagnosed for years by conventional medicine?

        • Kristy Sokoloski

          1. No, not all natural supplements are safe. This is especially the case for those with certain medical conditions.

          2. The same can be said for the companies that make natural supplements or those that claim the naturopathic way of healing is the only way to go, and that if you go with conventional medical care you are doing yourself more harm than good.

          3. Correct about that alternative medicine can be used, and it goes back to what I said before and tying in with #1 in this comment alternative medicine can be dangerous for some people. Moreso than conventional medicine even though yes it has its own problems. In turn my question to you is have you not heard of misdiagnosis in Natural Medicine too, or as someone suggested overdiagnosis of things like Candida? It has happened there too.

          When done right the two ways of treatment can be a good thing for the person depending on their overall medical history. And for those that want to read the data because they like studies would you please post the links to the research that is done? Also, please include any that were posted in conventional medicine journals (because yes some alternative treatments have been studied by conventional medicine organizations).

      • Guest

        Kristy, surely you do not believe that western medicine has all the answers! Plus, read many of the exposes (sorry, can’t type in the accented e) out there about the American health care system. There is loads of cash to be made by interventions and treatments (and many of the indications for these are marginally appropriate at best).

        Why don’t insurance companies cover naturopaths? Why didn’t they cover my child’s medication? Why didn’t they cover the full hospital bill after my surgery? Why didn’t they cover my child’s cochlear implant on the R when they covered the one on the L? Insurance companies do not operate ethically 99.99999% of the time; the lack of coverage of naturopaths should not impugn the field.

        Most people out there find a nice balance between allopathic medicine and holistic medicine. Very few are extremes either way.

  • Guest

    Wow, this article is pure crap. Dismissing naturopathy and saying people turn to herbal and holistic treatments only after having had a bad experience with conventional medicine is completely ignorant. There are millions of educated, conscientious people that balance holistic therapies with allopathic therapies and are *GASP* doing just fine. Don’t believe that holistic medicine can cure all? That’s fine, but acknowledge that conventional or western medicine can’t either.

  • jpfenton

    Thank you, EE! That made my day!

  • euonymous

    Some of what you say seems true to me, but you’ve lost all credibility when you attack chiropractic and acupuncture. It would appear you have never experienced the sort of pain which these two practices alleviate. You might want to do a bit more research. The AMA endorses chiropractic these days and even the evil-but-profitable health insurance companies cover some acupuncture treatments.

    • Guest

      I’m a private practice allopathic physician. We take garlic and glucosamine supplements in this house. We also take multivitamins (GASP, the horror). My husband takes singulair for his allergies. My husband and I have both had acupuncture in the past and had positive experiences.

      For whatever reason these people posting here don’t seem to understand you can have a balance of allopathic and homeopathic medicine in your life and be ok (and possibly even in better health than those who completely eschew “naturopathic” medicine!)

  • Molly_Rn

    Excellent post about the truths about the business of hucksters like chiropractic, supplements and naturopaths. What a racket!

  • Molly_Rn

    Love it! Watch the youtube video for the cure for someone with more money than sense. LOL

  • querywoman

    I just hate it when somebody starts hucking supplements. I have a friend who takes all kinds of supplements and vitamins, and she’s full of advice.
    However, I use some natural healing techniques. Even a spoonful of yogurt with active cultures straightens out my tummy. I use essential oils. Lavender and tea tree oils are great for yeast, in moderation, diluted in another oil. Eucalyptus oil clears the sinuses.
    My endocrinologist has me taking the once-a-week high power Vitamin D pill, based on testing and my autoimmune skin disease.
    I put pure olive oil on skin, with my dermatologist’s approval! No fragrance or additives there!
    The friend who lives on oral supplements also uses lotions with all kinds of additives and every fragranced laundry product in existent. I recently gave her a homemade ointment: sunflower oil, beeswax, and touch of borax to emulsify it, make it blend together on mild heat. She was surprised that it had no fragrance. I’d rather rub a drop of essential oil in it at time of use. She was pleasant surprised at the new clean feeling of the ointment.
    I do not rule out some oral supplementation. The difference with prescription meds is that they have been specially formulated, refined, and tested to predict results.
    I had a diabetic brother who just wouldn’t take prescribed meds! He thought he was treating his blood sugar with echinacea. After he lost the first foot, I always aid to myself there is no way I will ever use echinacea, for anything!
    Some people don’t want to use any prescription medicines. To that, I always respond that opium and alcohol are the oldest drugs! And that prescription drugs have been tested and regulated to predict results!
    Helen of Troy was some kind of healer, and mixed some poppy potion in “The Iliad.”

  • Steven Reznick

    The National Institute of Health had a division of Alternative and Complimentary Medicine. Their original motto paraphrased was that if it worked and was reproducible it was not alternative. The American College of Physicians publishes a guide to alternative and complimentary medicine that is a great resource for traditionally trained medical personnel to use as a reference along with the NIH website. Evidence Based Medicine lists chiropractic manipulation for simple low back pain as one of the most effective treatments.
    I think that as physicians we need to learn what works and what doesn’t. We need to learn what chemically interacts with what and teach our patients about this so that they do not inadvertently harm themselves. We need to take the best of what works in other treatment systems and discuss it with our patients and agree to help them with their research on a topic if they ask for input.
    Snakeoil for profit should be branded as rubbish but clearly there is much to be learned from medicine practiced in the Orient and elsewhere. Of more recent concern is the talk that supplements on our shelves, no longer reviewed for safety by the FDA , are contaminated with large amounts of heavy metals and toxic additives. I recently attended a lecture by a nephrologist at the U of Miami who pointed out the contaminants in products from India and portions of Asia

  • Noni

    That’s hilarious