A Question of Ethics or Ethical Questions?

You may have heard some fairly wild claims made by proponents of natural products. Even wilder claims, however, seem to be coming from the pharmaceutical industry. To find out more, you might want to start by asking your physician, but medical doctors usually have little or no training in natural remedies.

By way of background, I’ve been a physician (Board-certified internist) and researcher for almost 30 years. I do not take money from any pharmaceutical or natural products companies, and 100 percent of the royalties from my products go to charity. Although there’s nothing wrong with money, I simply find credibility to be more important to my role as a patient advocate.

Who Pays the Piper…

Almost everything that your physician learns about treating illness comes from the drug companies these days. Pharmaceutical corporations pay for almost all medical journals and conferences. Unfortunately, your doctor may not be aware that he or she is simply being indoctrinated with what Dr. Jerome P. Kassirer, distinguished professor of medicine at Tufts University and former editor of the New England Journal of Medicine, calls “marketing materials disguised as educational information.”

Recognizing that physicians are often unwittingly following drug company marketing instead of science, Kassirer has written: “In my view, relations between physicians and [the] industry have become scandalous. The profession’s response to the increasing involvement with industry has been feeble.” Drug companies may profit, and some physicians may be the recipients of free lunches, dinners, and gifts, but patients “are beginning to lose trust that their doctors’ advice is for their benefit rather than for their doctors’ benefit.” Pharmaceutical, biotech, and medical-device companies are increasingly striking “deals” with physicians.

A Question of Control

How did medicine go from being based on science to being predominantly money driven?

As far back as 1982, an article in Science noted “scientists who 10 years ago would have snubbed their academic noses at investor money now eagerly, legally seek it out.” A 2005 House of Commons Health Committee report notes that approximately 75 percent of clinical trials published in the Lancet, New England Journal of Medicine, and Journal of the American Medical Association (JAMA) were industry funded, with approximately two thirds of the studies being done at for-profit research companies instead of universities. This gives the drug companies enormous control over study design and data analysis.

Shockingly, as research data now often goes directly to the drug companies, many researchers do not even have access to the results from their own studies. In fact, in one case a researcher who complained publicly about not being able to get access to the data from his study was fired by his university–certainly a chilling commentary for most researchers.

A 2003 article in JAMA found that studies funded by drug companies were three to five times more likely to recommend a drug than studies funded by nonprofit groups, although the data supporting use of the drug was no stronger. The authors concluded that “trials funded by for-profit organizations may be more positive due to biased interpretation of test results.” Physicians–and patients–need to stop relying on drug-industry marketing that “summarizes” trial results in their favour, and read between the lines to see if the data in clinical trials actually supports the conclusions. (See alive’s article on biased research in our September issue).

Rigged Results?

More recently, the drug industry seems also to be focusing on attacking natural products by promoting false information about them in the media. A recent National Institutes of Health (NIH) study compared natural remedies for arthritis versus both placebo and a prescription drug. The study, published in the New England Journal of Medicine (February 23, 2006), showed natural remedies (glucosamine chloride and chondroitin) offered those with moderate to severe arthritis a markedly better reduction in pain than either placebo or prescription drug. For patients overall, the natural remedies gave a larger overall average decrease in pain than the medication. However, 66.5 percent of patients on natural remedies experienced at least a 20-percent decrease in pain, compared with 70 percent of those on Celebrex, so the study authors concluded that the natural remedies “did not reduce pain effectively in the overall group of patients—although natural remedies were more effective, overall, than the drug.

Their conclusion is not surprising; at least 11 of the study authors are on the payroll of pharmaceutical companies making pain medications. Given this misleading bias, it was not surprising to see The New York Times note that “no effect was found for glucosamine, chondroitin, or a combination of both.”

Unfortunately, a recent string of studies on natural remedies suggests that the study authors chose study designs guaranteed to fail. For example, a report on St. John’s wort for depression studied a population with severe depression, even though researchers were told specifically that the herb does not work for severe depression, only for mild to moderate depression. In this study the prescription drug being tested did not produce results either, and yet (again) the conclusions of the study authors were to recommend the drug, not the natural remedy.

The scientists picked by the NIH for a recent study on saw palmetto also set it up to fail by picking patients with severe prostate enlargement. However, with severe prostate enlargement, herbs–and often prescription drugs, as well–are ineffective. In patients with mild to moderate prostate enlargement, on the other hand, the herbs have been shown to work.

Ask The Experts

So how can the average consumer tell what really works? We have become more dependent on expert advice. You would not ask your car mechanic for tax advice, and it would be equally absurd to ask most physicians for advice about natural products. Fortunately, there are now four-year schools for naturopaths that train them as well as medical schools do physicians–but in how to use natural remedies. In addition, many chiropractors, nutritionists, and other natural health practitioners are also very well-trained.

Having been in practice for almost three decades, I have found that patients are most likely to get healthy by combining the best of natural and prescription therapies, when necessary. Effective natural treatments are available for most medical problems, but most physicians will only know about prescriptions and surgery.

When it comes to your own health, listen to your intuition and remember, caveat emptor—let the buyer beware.