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Your doctor as salesman

Last updated: April 2011

When the 20-year-old daughter of a physician friend developed infected tonsils last year, he took her to see one of his colleagues, an ear, nose, and throat specialist. The ENT prescribed antibiotics, not a surprising choice. But he also recommended that she take two nutritional supplements, one designed to "boost the immune system" and one of more ambiguous purposes. When my friend asked about the scientific evidence to support the recommendation, the doctor responded that he takes them himself and hadn't had a cold in five years. Even better, he was selling the pills right there in his office—$150 for a bottle of each.

A clear conflict

In the past, it was widely considered unthinkable for a physician to sell or even promote health products. But some doctors seeking extra income have turned to side businesses selling nutritional supplements, often out of their own offices. While it's not clear how many health-care professionals engage in this practice, a survey published in March 2010 by the Nutrition Business Journal, a trade publication, of 600 medical doctors, naturopathic physicians, chiropractors, nutritionists, and other practitioners revealed that 76 percent sell supplements in the office.

We don't know what percentage of the respondents were M.D.s, as opposed to alternative-care practitioners. But that remarkable figure does suggest that a significant number of mainstream medical professionals are now vying for a share of the $26.7 billion-a-year U.S. supplement market. Indeed, industry analysts predict that health-care practitioners could be among the fastest-growing sales channels for supplements over the next decade.

Selling supplements might yield a handsome profit for some doctors. But having a financial stake in promoting any health product to patients represents a serious conflict of interest. It subverts the responsibility of physicians to place their patients' interests before their own opportunity for financial gain. It also places undue pressure on the patient, especially if the pitch is aggressive. And it can erode trust in the doctor, as was the case with my friend.

For those reasons, the American Medical Association advises that physicians who distribute nonprescription health products provide them free or at their own cost. That removes the temptation of personal profit that can interfere with the physician's objective clinical judgment.

Dubious benefits

Such objectivity is especially important for supplements. Unlike prescription drugs, nutritional supplements don't have to be proved effective or safe before they go on the market. And their labels don't have to warn about side effects, even for products with serious hazards.

Several patients have told me recently that they, too, have felt compelled to buy products from various physicians. What should you do if a health-care practitioner tries to push a supplement, or any other product, on you during your office visit? Find another doctor.

Orly Avitzur, M.D.

Medical Adviser
   

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