don's report archive

by Donald B. Ardell, Ph. D.

Wellness in the Headlines
(Don's Report to the World)

Doctors have to make a living, like everyone else. Of course, we don't expect them to do unnecessary operations or involve themselves in enterprises that could conflict with their medical roles; but most of us realize that a bit of marketing and other business-boosting activities are fair initiatives. A medical practice IS a business -- the business owner/doctor has a right to do what it takes (legally) to prosper, while providing quality services. Yet, we expect a doctor to be ethical, to avoid conflicts of interest and to disclose information patients need for good decisions. More so than other merchants, doctors are expected to comport themselves in accordance with common decencies such as honesty, integrity, trustworthiness and all the rest.

All of which leads me to wonder about doctors selling "ephedra."

Ephedra is an unregulated stimulant. It was recently identified as a likely factor in the death of a professional ballplayer named Steve Bechler. Numerous controlled studies have led to concerns about the safety of supplements containing this substance. Thus, it seems paradoxical that doctors, of all people, would sell the product. Since 1993, 117 deaths have been linked to ephedra usage, along with 16,000 reports of other problems, including strokes, seizures, heatstroke, heart disorders and psychotic episodes. The Food and Drug Administration has banned ephedra/caffeine combinations in over-the-counter medicines. Since supplements are not classed as medicines, this ban does not apply to supplements for weight loss or other purposes. However, I question whether doctors practicing medicine should sell ANYTHING, other than their professional services. After all, patients are vulnerable and usually not in a position to make dispassionate, objective choices. When fearful of illnesses and the risks of one procedure or another, patients rely on their doctors' best advice more than, say, a potential buyer of a used car would rely on the salesperson trying to make the deal.

For this reason, it seems inappropriate for doctors to sell any products on the side, not just this potent stimulant. The head of the AMA ethical council was referenced in a recent New York Times article (March 31, 2003, "Bottom Line in Mind, Doctors Sell Ephedra" by Ford Fessenden) regarding doctor merchandising: "You can't exploit the patient for your own financial interest." Even more blunt was the head of the watchdog consumer group "Quackwatch," Dr. Stephen Barrett: "I tell people to avoid doctors who sell vitamins. It's a sign of bad judgment; you've made a wrong scientific judgment, in addition to which you're selling to a captive audience at a price that's inflated." Critics of doctor product sales cite studies that show higher use of products or services in which doctors have a financial interest. For this reason, most states follow federal law in forbidding doctors to refer patients to services in which they have an ownership interest, such as X-ray equipment. The same reasoning would apply to the practice of selling supplements, or books, tapes, cosmetics or anything else.

Yet, many doctors ARE profiting from pushing pills and other potions for weight loss, fitness, beauty, improved sex life and so on. The allure of an $18 billion annual supplement market seems too great to resist. They should try harder.

Why do they do it? Why would an otherwise honorable physician risk his/her professional honor on such a sleazy business? Let me count the reasons, besides loose ethics joined to hard times:

• Rising malpractice premiums and an attendant need to meet rising costs to show acceptable profits. For some doctor-vitamin pushers, more profit is attributed to product sales than practicing medicine, though the latter is vital to the success of the sales operation.
• Consumer demands -- people want this junk, and they will buy more of it from a trusted source than the usual non-credentialed hucksters.
• Lower managed care payments.
• Attractive profit incentives offered by companies that sell supplements.
• The added opportunities attendant upon much higher patient volumes -- and the temptations to offer goods responsive to patient desires for easy remedies (in other words, taking pills is more attractive to most patients than adopting and sustaining a vigorous exercise regimen.)
• The fact that some products do contribute to short-term weight losses. It is easy to appreciate that a doctor would want to see patients happy for a spell, even if he/she knew the desired outcome (weight loss) would be short-lived.

Sadly, the term "wellness" (which refers to a healthy lifestyle built around personal responsibility) is included in the brand names given to supplements, thereby associating the pills with good health.

The secretary of the federal Health and Human Services agency (Tommy G. Thompson) is seeking a ban on doctor product sales, in addition to label warnings on ephedra products. In response, some doctors who sell ephedra have lobbied to protect their side business. In doing so, I believe they put profit protection ahead of patient safety. Such sales are in the doctor's interest, but not the public interest.

My advice is the same as Dr. Barrett's of Quackwatch -- do NOT patronize doctors selling pills of any kind. My other piece of advice is, despite the presence of doctors with questionable ethics, always look on the bright side of life.

(Note: This essay will be filed in the archives in the MENTAL DOMAIN under the skill area of effective decisions. Additional articles related to this theme may be found there.)

(Ed. Note: Views expressed in this and other columns are those of the author and not necessarily those of the SeekWellness Editorial Board.)

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