Having spent many evenings and weekends working in a retail pharmacy with a thriving vitamin and supplement aisle, I’m no longer surprised at the purchasing habits of consumers. The setting gave me not only the opportunity to learn about the latest supplement fads, but also to speak with consumers that place great faith in these products. A recent paper suggests 25% of CAM users account for 75% of all expenditures on CAM. And that’s consistent with what I saw in the pharmacy. Some consumers spend hundreds per month on supplements, so the belief that these products are beneficial must be very strong. So I like to ask about reasons for use. Many attribute their current health status to supplements, and usually tell me that their supplements are for preventing disease, optimizing health, or “boosting” the immune system. And while I’m encouraged to see these consumers take an active interest in maximizing their own health, I’m often puzzled by the decision-making that’s occurring. In some cases, beliefs about health, medicine, or the effectiveness of their supplements are misguided, or flat-out wrong. They’re getting expensive urine and positive feelings, but there’s little evidence to suggest the supplementing is having any objective benefits. More surprisingly, some consumers take products for which there is no medical indication at all – it’s intended as “primary prevention” of a medical condition they believe they can avoid through supplement use. Afraid of macular degeneration? Take lutein. Or worried about Alzheimer’s? Grab some ginkgo biloba. No matter your anxiety, there’s a supplement marketed for your. One supplement with enduring popularity is magnesium. It cures cancer. And depression. Throw away your inhalers, because it cures asthma too. Read enough online, and you’ll conclude that magnesium is quite possibly the prevention and the cure to all disease. (more…)
Archive for Herbs & Supplements
One of the points I’ve tried to emphasize through my contributions to Science-Based Medicine is that every treatment decision requires an evaluation of risks and benefits. No treatment is without some sort of risk. And a decision to decline treatment has its own risks. One of the challenges that I confront regularly as a pharmacist is helping patients understand a medication’s expected long-term benefits against the risks and side effects of treatment. This dialogue is most challenging with symptomless conditions like high blood pressure, where patients face the prospect of immediate side effects against the potential for long-term benefit. One’s willingness to accept side effects is influenced, in part, by and understanding of, and belief in, the overall goals of therapy. Side effects from blood-pressure medications can be unpleasant. But weighed against the reduced risk of catastrophic events like strokes, drug therapy may be more acceptable. Willingness to accept these tradeoffs varies dramatically by disease, and are strongly influenced by patient-specific factors. In general, the more serious the illness, the greater the willingness to accept the risks of treatment.
As I’ve described before, consumers may have completely different risk perspectives when it comes to drug therapies and (so-called) complementary and alternative medicine (CAM). For some, there is a clear delineation between the two: drugs are artificial, harsh, and dangerous. Supplements, herbs and anything deemed “alternative”, however, are natural, safe, and effective. When we talk about drugs, we use scientific terms – discussing the probability of effectiveness or harm, and describing both. With CAM, no tentativeness or balance may be used. Specific treatment claims may not be backed up by any supporting evidence at all. On several occasions patients with serious medical conditions have told me that they are refusing all drug treatments, describing them as ineffective or too toxic. Many are attracted to the the simple promises of CAM, instead. Now I’m not arguing that drug treatment is always necessary for ever illness. For some conditions where lifestyle changes can obviate the need for drug treatments, declining treatment this may be a reasonable approach – it’s a kick in the pants to improve one’s lifestyle. Saying “no” may also be reasonable where the benefits from treatment are expected to be modest, yet the adverse effects from treatments are substantial. These scenarios are not uncommon in the palliative care setting. But in some circumstances, there’s a clear medical requirement for drug treatment – yet treatment is declined. This approach is particularly frustrating in situations where patients face very serious illnesses that are potentially curable. This week is the World Cancer Congress in Montreal and on Monday there were calls for patients to beware of fake cancer cures, ranging from laetrile, to coffee enemas, to juicing, and mistletoe. What are the consequences of using alternative treatments, instead of science-based care, for cancer? There are several studies and a recent publication that can help answer that question. (more…)
Dr. Andrew Weil has teamed with Innate Response Formulas to develop a series of seminars and a line of products for “seasonally appropriate integrative strategies.” Seasonal Therapeutics is a system for adjusting diet supplement recommendations according to the season of the year. To kick off the program, a one-day seminar was presented by Weil’s colleague Tierona Low Dog in Boston on August 25, 2012. It was approved for 8 CEU credits for DCs and NDs through the University of Bridgeport, a school that has ties to Sun Myung Moon’s Unification Church and offers degrees in naturopathy, chiropractic, and acupuncture. It cost $129 to attend the seminar, but participants were given a product credit of $129 so they could apply their newfound knowledge by buying Innate products.
In a video, Dr. Weil acknowledges that the best nutrition is obtained through diet but says it is essential to take supplements as insurance against gaps in the diet. He recommends Innate Response products because they are formulated with whole foods and contain accessory compounds that have health benefits. They are claimed to be “food, not chemicals” and “potent healing solutions.” They describe their seminars as “research based programs.”
A series of seminar programs will address seasonal issues:
- Autumn: Season of Harvest: focuses on liver and GI
- Winter: Season of Reflection: focuses on immune and mood
- Spring: Season of Renewal: focuses on purification and allergy
- Summer: Season of Vitality: focuses on cardio and joint health. (more…)
A customer strolled up to the counter one night when I was working in a retail pharmacy:
“My doctor says I have prediabetes. I don’t want to take any drugs. Do you have something natural I can use to cut my blood sugar?”
I looked at him in the eye, and pointed at his sizeable midsection. “Sir, if you’re at risk for diabetes, and you don’t want to take medication, the single best thing you can do for yourself is lose some weight.”
He grinned and asked, “Great – what supplement can I take to help me?”
This type of discussion occurs all the time. A patient has been assessed by their physician, and informed that they have a medical problem of some sort. The patient, reluctant to accept the physician’s evaluation, heads to the pharmacy for a second opinion. In some cases, the patient may question the physician’s advice: “All my physician wants to do is prescribe drugs.” Yet there’s a disconnect when it comes to strategies for management. More often than not, non-drug approaches are rejected out-of-hand (probably because the sample I speak with have already made the decision to buy something). And in those that are leery of medical management, there’s often a willingness to consider anything that’s available without a prescription – particularly if it’s perceived as “natural.” Natural products are gentle, safe, and effective, while medicine is thought of as unnatural, harsh, and potentially dangerous. This is the naturalistic fallacy, nothing more. Purveyors of supplements leverage the naturalistic fallacy into the marketing strategy of choice for almost all supplements and “alternative” medicines. And it leads to bad health care decisions. (more…)
I have nothing against berries. I, in fact, enjoy many kinds of berries in my diet. My favorite fruit, the banana, is actually a berry (botanically speaking). I am disturbed, however, at the extent to which various kinds of berries are being sold as the latest superfood cure-all.
Dr. Oz, for example, has been pushing the lingonberry (a relative of the cranberry and blueberry) as “a new superfruit for longevity.” An attached article on his site states:
“Today, scientists are showing its value in both human and animal studies that are proving to have positive results.”
Curiously, there are no links or references to these studies.
Polyphenols and Antioxidants
We are still in the midst of the “antioxidant craze” – if you read the justification for just about any so-called “superfood” or longevity supplement you are sure to read about antioxidants. I have already covered antioxidants, but briefly: Cell metabolism in part creates oxygen free radicals which are molecules that steal electrons from other molecules, causing a cascade of reactions that can damage proteins and other chemicals in the body. Anti-oxidants are chemicals that can stop free radicals and limit the damage. They therefore decrease “oxidative stress” on cells. So far it sounds like anti-oxidants are therefore a good thing and we should be gobbling up as much as we can. However – free radicals and anti-oxidants exist in cells in a homeostasis. Free radicals are used by the immune system, for example, to fight invading organisms. They are also important signaling molecules, triggering other cell-protective mechanisms.
ASEA is a diet supplement described as a “life-changing” health aid that can benefit everyone.
“ASEA is trillions of stable, perfectly balanced Redox Signaling Molecules suspended in a pristine saline solution—the same molecules that exist in the cells of the human body. Redox signaling is a function that is central to all life. Signaling molecules are created within every cell in the body. After the age of 12, our cells make fewer and fewer of these molecules. ASEA is the world’s only source for replenishing them.”
- Promotes enhanced immune function
- Supports the vital activity of cellular communication
- Provides superior “support” to athletes
- Boosts efficiency of the body’s own antioxidants by 500%
- Protects against free radical damage
ASEA doesn’t (can’t legally) claim to be effective for any disease, but since a number of diseases are related to immune function, free radical damage, etc., it’s only natural to assume that ASEA would benefit a host of conditions. The claims are deliberately vague, and there is the usual disclaimer that it has not been evaluated by the FDA and is not intended to treat or prevent any disease; but testimonials and innuendo suggest all kinds of specific benefits ranging from better sleep to cancer.
What’s in this miracle product? The ingredients are listed on the label: water and salt.
The Summer Olympics are coming up, which means that, in addition to world-class athletic performance, the public will be exposed to a variety of sports-related pseudoscience. This is not unique to the Olympics, of course. The world of sports competition is rife with pseudoscience, false claims, dubious products, superstitions, and magical charms. The most egregious example of this recently has been the energy bracelet scam — multiple companies have and are marketing little bits of rubber, plastic, or metal that you wear on your wrist and they claim (based on parlor tricks rather than evidence) will improve athletic performance. They give classically pseudoscientific explanations for the alleged effect, such as negative ions or energy frequencies. In fact the new icon of the entanglement of sports with pseudoscience is the Power Balance Stadium.
Occasionally the scientific community takes notice of such claims and bothers to review them. Also, in the internet age, the information is actually available to the public (rather than buried in an obscure journal). A recent joint investigation by BBC Panorama and the British Medical Journal (BMJ) recently found a shocking (to them) lack of evidence for many claims made to market performance-enhancing products. The BBC reports:
A team at Oxford University examined 431 claims in 104 sport product adverts and found a “worrying” lack of high-quality research, calling for better studies to help inform consumers.
High quality studies would be nice, but the article fails to ask the question — who is going to fund those studies? What incentive do manufacturers have in proving their products don’t work?
While much of CAM is ridiculous or implausible, herbal remedies are an exception. Plants produce pharmacologically active substances; in fact, the science of pharmacology grew out of herbalism. Some herbal remedies have not been scientifically tested, but others have been tested and are clearly effective. Nevertheless, these are seldom if ever the best choice for treatment.
One natural remedy stands out. Red yeast rice has been tested and has been shown to lower cholesterol as well as a statin drug. That’s hardly surprising when you realize that it contains the exact same ingredient as the pharmaceutical drug lovastatin.
Only it doesn’t any more.
I contribute biweekly to Science-Based Medicine and could easily devote every post to writing about weight loss supplements, and never run out of topics. As soon as one quick fix falls out of favour, another inevitably replaces it. Some wax and wane in popularity. And pharmacies don’t help the situation. I cringe every time I walk down the aisle where weight loss products and kits are located. Detox? Hoodia? The “fat blaster”? Here are pharmacists, well educated and perfectly positioned to provide good advice to consumers, but standing behind a wall of boxes with ridiculous weight loss promises. Yet pharmacists tell me that these products are not only sought out by customers, but they actually sell well. It’s a lost opportunity to provide good advice, and consumers pay the price.
Perhaps because consumers associate these products with pharmacies, I get regular questions about weight loss programs. I end up developing some degree of familiarity with many of them, if only to be able to credibly redirect away from some of the more harmful plans and approaches. It’s that philosophy that I used recently when I was asked about how to best to manage a “plateau” on the HCG diet. I’d never dispensed human chorionic gonadotropin (HCG) before, but knew of its use for the treatment of infertility, where it promotes egg release. But weight loss? I couldn’t think of a mechanism for how HCG could promote weight loss. So I did some digging, and found a long, rich vein of pseudoscience that dates back decades. (more…)
Note: This article originally appeared in Skeptical Inquirer, 28(1), 48-50 & 55, January/February 2004. I’m recycling it now because I have been at The Amazing Meeting in Las Vegas instead of home at my computer writing new posts. It’s still timely: despite multiple debunkings and FTC actions, vitamin O is still for sale. Amazon has it for $4.80 an ounce. I’m no Mark Crislip; but I like to think this article borders on the Crislipian. Enjoy!
Oxygen is not just in the air; it’s on the shelves. It has been discovered by alternative medicine and is being sold in various forms in the health supplement marketplace. Back when I was an intern, we used to joke that there were four basic rules of medicine: (1) Air goes in and out. (2) Blood goes round and round. (3) Oxygen is good. (4) Bleeding always stops.
Alternative medicine has latched on to rule number three and won’t let go. The rationale, apparently, is that oxygen is required to support life; therefore more oxygen should make you more healthy. It’s not clear how this relates to alternative medicine’s advice on anti-oxidants, but that’s irrelevant. OXYGEN IS GOOD, so we should put it in our soft drinks and breathe it at oxygen bars. Take an oxygen tank home with you — you might feel better. The oxygen vendor might feel better, too. Dr Andrew Weil, the renowned health guru, tells patients with chronic fatigue to ask their doctors to prescribe oxygen for a home trial. Sure, why not? The money it costs will literally vanish “into thin air,” but who cares? OXYGEN IS GOOD.
Ignore the fact that you could find out whether you need oxygen by testing your blood oxygen saturation with that little-clip-thingy-they-stick-on-your-finger-in-the-emergency-room (aka pulse oximeter). Who cares if your blood is fully saturated with oxygen already? OXYGEN IS GOOD. If your oxygen saturation is a little less than 100 percent, there is no evidence that raising it will help with anything. If it is a lot less, and you do need oxygen, any competent doctor should be able to figure that out. But try an oxygen tank anyway: OXYGEN IS GOOD. Is this starting to sound like a mantra? It should. This is religious belief I am talking about, not science. (more…)