Photo: Steven Depolo
Last night’s Four Corners exposé of Big Vitamins marketing their supplementary pills via community pharmacists would have had doctors throughout the nation nodding their heads.
We only have to walk past a pharmacy shopfront to see how rife the problem is. Clearly most pharmacist-owners see it as a profitable—some would argue, a critical—part of their business plan.
As for pharmacist-employees, most are presumably resigned to selling these supplements by the kilo, and some would perhaps believe the industry’s own hype that ‘pick me up’ vitamins really do pick people up. Even well people, with clean livers.
The issue is not so much the selling of products in a free market, but the dubious veneer of scientific credibility, beginning with exaggerated or false advertising claims and ending with a highly trained, trusted professional. As a pharmacist said on the show, “If they’re after complementary medicines, then I’m happy to provide them”.
After such media reports featuring sceptical doctors, inevitably some commenters retort by questioning why they pick on pharmacists, when the medical profession itself is so influenced by Big Pharma. Something about sinners casting the first stone.
And, you know what? They have a point. So, let’s lob a few stones in every direction, even if a wall of my own glass house cracks.
Take the Four Corners quote about how promotional budgets inevitably trump research budgets: “You get a much more profitable return on investment from putting fifty million dollars into celebrity marketing.”
This is unarguably true if you’re selling vitamins, but a parallel model operates in medicine. Who is the equivalent of a celebrity in the doctors’ world? The medical expert.
A few days before the Four Corners report, another, less vaunted, ABC News story ran about the marketing of new blood-thinning medicines.
Thanks to the obligatory reporting of total Australian pharmaceutical budgets spent on doctors back in 2015 (an obligation since scrapped), the ABC revealed that in just six months, $2.6 million was spent on doctors to market the new anticoagulants.
The “celebrities” in this case were haematologists and other medical specialists who were judged to be what pharma calls “key opinion leaders”. Some $185,000 was spent flying 25 of them to Vienna, and $86,000 paid for six to go to Canada.
They came back home to run sponsored journal clubs in hospitals, speak to thousands of GPs at dinners, and give interviews to the media to promote how ‘old hat’ it is for GPs to prescribe plain old warfarin.
As with selling vitamins, the celebrity endorsement played its part in a huge upsurge of sales.
The new anticoagulants jumped right to the top tiers of PBS spending and will sit there until the excitement wears off, the patent wears off, non-sponsored research catches up, and it’s time for the celebrities to move on to the next big thing.
So, I don’t see it as a question as to whether pharmacists or doctors should claim ‘casting’ rights on the first stone. Both professions should be encouraged to critique the influences of marketing.
This post was first published in Medical Observer, Feb 2017
drjustincoleman 
Good on you Dr Coleman,
It is good to hear from someone who calls it as it is. I am a Naturopath who was (more than) a little concerned by the ABC’s unbalanced and highly misinformed attack on complementary medicines. Perhaps my concern though was from a slightly different angle.Whilst I understand where the pharmacists are coming from an economic point of view in selling the huge variety of complementary medicines, I see it much more from the point of view that they (and their high school casuals) are giving advice on products that they have no training in without any form of consultation to ascertain what the customers state of health is to begin with. Given that most of these OTC products are highly dubious and most are in forms that are not absorb-able it was very one sided of the ABC to not discuss the need for correct prescribing of these medicines so that we don’t just end up with “expensive urine.” As a naturopath I rarely recommend OTC products as most of the time the dosages are too low to correct any deficiencies. The medicines and supplements I prescribe are practitioner only products that come from a couple of reputable companies that spend a lot of time and money on research and trials to back up their products. Unlike with the pharmaceutical industry we Naturopaths and Nutritionists and Herbalists don’t get kickbacks or overseas conferences from these suppliers but we are happy to recommend them because of the trust they have built up. Lets hope the ABC starts employing journalists that are there to give a balanced view on a topic . We can always find people who are one sided to attack something and give them most of the air time. The ABC should be doing a better job with taxpayers funds.
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Hi Lena, I agree with you that important perspectives were overlooked. However it is important to acknowledge that a lot of naturopaths make money from selling practitioner supplements. While it might not seem like a lot for some ($4 here and there), other successful practitioners that do sell a lot of supplements or own businesses do get kickbacks – a night at a hotel for attending a sponsors conference etc. This is a conflict of interest just as it is a conflict of interest for a pharmacist to exist in a retail setting or an optometrist selling glasses. The same ethical considerations apply to us as naturopaths and it is important to be transparent about these issues.
If I were you I wouldn’t have blind faith in supplement companies and their education seminars… you have to do your own research. That doesn’t mean calling the companies and asking them it means looking at the evidence. When you do this you don’t find much evidence to go on unfortunately – however complementary medicines have considerably less funding for research. Practitioner only products do this so they can make higher level claims than they are allowed to on a label directly to the practitioner.
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Couldn’t have put it clearer myself Lena. Shame on you Four Corners for such shoddy research and misrepresentation of a poorly funded and misunderstood industry. As a Nutritionist, I’m really hoping people will stop self medicating and listening to on-the-floor advice from sales persons and start employing us in order to stop wasting their hard earned cash on ineffective products.
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Deborah Cooper, I don’t understand your comment on shaming 4 corners. They have just exposed those companies who have crap research and are manufacturig pills which have little or no value to the average person looking for relief.
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Lena do you sell any products directly from your practice. and if so how does this make
you morally better than “big pharma”
and Deborah Nutritionalist is a fairly vague qualification in Australia .
And the CAMS industry is hardly poorly funded.$50 million on one campaign by Swisse is hardly loose change.
Specifically what was misrepresented
and what was poorly researched.
Perhaps the part where Radik Salis Father announces that he is working on a cure for cancer
“we can get rid of the cancer cells when they have been detected in a way where there are no primary cancer cells to be seen by a scanning technique” I did leave a bit off the beginning of the quote ,but this is just more word salad it is meaningless drivel, and this is the guy that does their research.
Does any any one remember Pan pharmaceuticals a CAMs company that nearly killed people.
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Hi Paul, lack of funding in complementary medicine research does need to be acknowledged in discussions. $50 million might seem like a lot to you or me however considering the overall spending on health and medical research in Australia is $5.9 billion annually this is actually is small change. NHMRC contributes $850million annually, ARC $85million annually (although I think they have withdrawn this?) to health and medical research – https://industry.gov.au/innovation/reportsandstudies/Documents/2015-16ScienceResearchAndInnovationBudgetTables.pdf – since the year 2000 NHMRC has given $86million to CM research however if you work this out as a percentage of their overall budget for that time frame it works out to about 0.1% of spending and most of that is given to medical doctors (https://www.ncbi.nlm.nih.gov/pubmed/24280483 ) and independent funding for research for CM is decreasing over the last 7 years or so (http://linkinghub.elsevier.com/retrieve/pii/S2212958816300465?via=sd – let me know if you want the article). Additionally to this their are other issues!
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Thanks Dr Coleman for the acknowledgement that complementary medicine is the canary in the coal mine.
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