Consumer Health Digest #14-20

Your Weekly Update of News and Reviews
June 1, 2014

Consumer Health Digest is a free weekly e-mail newsletter edited by Stephen Barrett, M.D., with help from William M. London, Ed.D., M.P.H. It summarizes scientific reports; legislative developments; enforcement actions; news reports; Web site evaluations; recommended and nonrecommended books; and other information relevant to consumer protection and consumer decision-making.

Drug ingredients found in many products marketed as "dietary supplements." The U.S. Food and Drug Administration has issued a series of public warnings that undisclosed prescription drug ingredients have been found in many dietary supplements marketed for weight loss and sexual enhancement. Noting that this is a growing problem, the agency has responded with public notices, warning letters, and recall requests and has set up indexes of actions taken. Currently, the Tainted Weight Loss Products index identifies about 90 products and the Tainted Sexual Enhancement Products index identifies about 70, but the FDA warns that these represent only a "small fraction" of tainted products being marketed. The FDA has received many reports of serious harm from product users.

Pharmacists urged to shun "integrative medicine." Scott Gavura, BScPhm, MBA, RPh, has written a blog lamenting the development of "integrative" pharmacies that offer homeopathic products and dietary supplements and herbs claimed to "boost the immune system," "detoxify the body," or "cleanse" you of Candida. [Gavura S. Beware the integrative pharmacy. Science-Based Medicine Blog, May 22, 2014] He notes:

Integrative medicine purports to take a "best of both worlds" approach, mixing science-based treatments with a variety of unconventional treatments. The fundamental challenge with integrative medicine is that "integrative" products and services don't have scientific evidence to support them: if they did, they'd simply be called "medicine." Instead of evidence, promoters of integrative medicine rely on other standards—many are grounded in belief systems, such as the idea of "vitalism." While ideas like vitalism are long-discarded from science-based medicine, they live on in the philosophies of practices like homeopathy, naturopathy, and chiropractic. And the retail part of the pharmacy profession sees an opportunity.

I'm seeing the retail component of the profession deciding between one of two paths: One path will involve retail pharmacists, supported by pharmacy regulators, taking greater responsibility for their own profession and professional standards. . . . On this path, professional ethics trump retail pressures, and the practice of retail pharmacy changes to a new equilibrium, where products and services offered are focused on optimizing health, based on the best scientific evidence. . . .

The alternative path for pharmacy is . . . . the "anything for a buck" model, otherwise known as the "integrative" pharmacy. In this model, the retail practice of pharmacy becomes a loss-leader to get customers into stores, and there is a growing disconnect between the practice of dispensing and selling prescription drugs, and the rest of a pharmacy's offerings. The pharmacy is a retailer first, and abandons any scientific standards or justification for products and services offered. Customers may be pleased, but they won't be well-served. Pharmacists and pharmacies may profit in the short-term, but this self-sabotage will effectively and ultimately ostracize the retail pharmacy from science-based medicine.

Personally, I see only one path that is tenable. First, the profession needs to stop embarrassing itself, and get the most egregious quackery, like homeopathy, out of the pharmacy. Second, it needs to stop confusing and misleading customers into the sloppy (and potentially dangerous) thinking that underlies "integrative" care. Finally, it needs to recommit to putting the patient at the center of its practice. . . . As a pharmacist I want retail pharmacy to thrive—but in a framework that is grounded in the best science and the best medical care. "Integrative" pharmacy isn't that path.

"CAM" practitioners seeking primary care status. The Academic Consortium for Complementary and Alternative Health Care (ACCAHC) has published an 85-page report which asserts that chiropractors, naturopaths, acupuncturists, and direct-entry midwives are qualified and can relieve a looming shortage of primary-care medical providers. [Goldstein MS, Weeks W. Meeting the Nation's Primary Care Needs: Current and Prospective Roles of Doctors of Chiropractic and Naturopathic Medicine, Practitioners of Acupuncture and Oriental Medicine, and Direct-Entry Midwives. Academic Consortium for Complementary and Alternative Health Care, Dec 2013] In 1996, the Institute of Medicine defined primary care as "the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community." [IOM Committee on the Future of Primary Care. Primary Care: America's Health in a New Era. Washington, D.C., 1996, National Academy Press] None of the four groups could ever legitimately qualify under this definition because they cannot adequately address the large majority of health needs, because they (a) have a narrow scope of practice, (b) lack the ability to prescribe drugs, (c) lack sufficient training to deal with most health problems, and/or (d) base their work on unscientific concepts. But the ACCAHC report suggests how they can represent themselves to policy-makers to seek primary-care status.

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This page was posted on June 2, 2014.