Hi. I'm Art Caplan from the Division of Medical Ethics at the NYU Langone Medical Center in New York City. What do you do when your patient says, "Hey doc. I'm using a supplement," or if he is taking some vitamins or something that comes out of a health food store? Do you say that that's great, or ignore it? Might you even say that you sell it in your office? There are many doctors who are starting to get involved in the sale of supplements or vitamins right out of their offices as a way to make additional money.
To me, it's unethical. It's also unethical to the American Medical Association, the Canadian Medical Association, and many other groups who say that you can't be selling things like that out of your own office. We all know that it would be wrong to set up a pharmacy and then prescribe. Why is it any better to say, "Hey, I have things you could buy down the street in a store, but you can buy them from me," if those things don't work?
That's probably the biggest problem with pushing supplements on television, as many prominent doctors do, or selling them in your office as a way to supplement your income. The evidence that people need vitamins in the United States is nonexistent. People who have a balanced diet or have as much food around as we do don't really need to take multivitamins.
If you look at the supplement world, it's unregulated and uncontrolled. Most of the claims that have been assessed turn out to be false in terms of giving you more resistance to the flu, improving your eye health, or the many other claims that the supplement industry is notorious for. Whether it's bee pollen, echinacea, or whatever it is that is being pushed and promoted, there isn't much evidence that it works.
We also sin. Even at the best of hospitals or cancer centers, I've increasingly noticed that aromatherapy, manipulation, or other things are part of the package that is offered as a way to pull patients from cancer program A to come get their cancer care at hospital B. I don't think we're doing ourselves any favors when we say that we stand for evidence, we stand for science, and we stand for proof, if even in some of our fanciest hospitals and cancer centers, you can see the supplement business hard at work.
I think it's wrong. I think it ought not be given in the doctor's office. What we should be saying is that if patients want to use vitamins or supplements, here is what is known and proven. Unless your patients have a vitamin deficiency or you think they may not be getting everything that they need through their diet, the right thing to do is to point them toward the literature and say that a lot of this stuff doesn't work. The right thing isn't to point them to the back of your office and say, "I can sell that to you, too."
I'm Art Caplan at the Division of Medical Ethics at the NYU Langone Medical Center. Thanks for watching.
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Cite this: Is It Right for Doctors to Sell Nutritional Supplements? - Medscape - Apr 22, 2014.