In a message dated 1/15/1 3:32:11 AM, [log in to unmask] writes:

<< There is frequently a high profit margin in selling herbal and vitamin
supplements in many practices. >>

You are certainly correct, Denise, that there is an ethical dilemna here.
Also, often, the HCP's are not that knowledgeable about the products they
sell, unless they are herbalists, naturopaths, etc.

<<Is there any less bias in recommending these  supplements to their patients
where the benefit of recommending these  products is clearly in the financial
interest of the prescriber. >>

This is, of course, a chicken and egg issue. Many times, the reason that
practitioners sell products is b/c they believe these are superior products
and they know that their patients will not have easy access to them in the
retail market. OTOH, once a good profit is being made from the product, the
reason for promoting that particualr brand naturally becomes suspect. Even
so, holistic practitioners tend to use the very products they sell, so they ar
e able to evaluate the products in a way that a cardiologist, for example, is
not going to evaluate the drugs her patients use, unless she has a medical
need for them. I, personally, would rather have my naturopath mix a tincture
for my sick child right in her office than have to go out and buy the herbs
if they are ones I do not have. I would also rather buy the supplements from
her directly if the price is comparable to another source, since I am already
there. Many times, I have referred mothers to holistic practitioners, for
whom these are new ideas. I know they would be much less likely to try the
herbs, etc, if they then had to go to a health food store to buy the
products, since it can be very confusing. And, in the long run, it is much,
much cheaper to buy a tincture from the doctor, since you do not then have to
buy a full bottle of each of 4 or 5 herbs and mix it yourself. So, it is
certainly a complex issue.

<<In comparison any bias towards prescribing a particular antibiotic or
antihypertensive is not financially rewarding to the prescriber unless of
course it is sold in his office which is not commonly the case anymore." >>

This may be true, in one aspect, but financial rewards do come from free
seminars, etc. Also, many doctors do own interest in facilites that do
expensive testing--wouldn't there be a conflict there? Another way to look at
it, though, may be that HCP's are being used by the drug companies. The HCP's
are often relying on the reps to "keep them up to date", and so take their
info from those reps about usefullness of certain drugs. I had a client whose
dh was a drug rep. We were discussing hazards of AIM and lack of info about
those hazards coming from peds and he said something like, "I know that
doctors get most of their info about drugs from people like me. They believe
what we tell them about the drugs and they don't have the time to research
any further. We are their primary source of info." He told me that he,
himself, based on his line of work, would never assume an HCP knew the side
effects of drugs they prescribed and would always do the research himself.
    What I tend to trust is information that teaches me how to care for my
own family. I have learned enough about herbs and homeopathy, etc, both from
my own research *and* from the doctors I have used, that I rarely need their
help anymore. I have certainly found that this teaching (including about
nutrition) is far more a part of holistic practices than it is allopathic
practices. This is very similar to breastfeeding vs AF. When a mom bf's, she
learns far more about caring for her own children, both physically and
emotionally than when she AF's.  And when she bf's, she is practicing
preventative health care, vs AF, which is creating a need for all of those
drugs the doctors are learning about from the same companies that make the
AIM. And while the need for holistic health care may also be driven by the
poor health of our AF population, the companies that make the herbs and
supplements are certainly not driving that need, nor are you likely to find
any holistic practitioner who would promote AF either obviousely or passively
(with web banners, etc).
    I would imagine that as holistic medicine becomes even more popular,
these issues will become bigger and they will face the same ethical choices
that other HCP's now face.

Jennifer Tow, IBCLC, CT, USA

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