Respectful Insolence

Thar’s gold in them thar “cures”

One of the favorite gambits that alternative medicine mavens like to use to defend their favorite remedies when a skeptic starts asking uncomfortably pointed and specific questions their scientific and evidentiary basis is to accuse said skeptic of being “in the pocket of big pharma.” Indeed, I’ve written before of the “pharma shill gambit,” where alties accuse skeptics of being nothing more than shills for the pharmaceutical industry (to which I always respond that it would be a dream come true to be paid for doing nothing more than posting skepticism about non-evidence-based medicine to a blog and Usenet but that unfortunately I’m just doing this as a hobby). There’s no doubt that big pharma makes a nice, juicy target, and no one claims the industry is without its problems. It’s also true that there’s a lot of money in pharma. But there’s also a lot of regulation and huge expenses. For example, between R & D costs, the costs of doing the clinical trials to demonstrate safety and efficacy, it costs around $800 million to bring just a single truly new drug (known as a “new molecular entity” or NME) to market, but can be about 60-70% less for a new drug in an established class of drugs (a.k.a. a “me-too” drug. Still, that’s righteous bucks (at least $250-300 million). By comparison, you’d think that the alternative medicine and supplement industry is a scrappy and poor underdog.

You’d only be half right. The alternative medicine industry may be smaller than big pharma right now, but it’s hardly poor. As fellow ScienceBlogger Abel Pharmboy, who happens to subscribe to the Wall Street Journal, including the Health Industry Edition, pointed out the other day, there’s big money in alternative medicine, quoting from the article about a Chinese company known as Tong Ren Chan (subscription only):

The brand is a household name in most of China, not unlike Tylenol in the U.S. Chinese medicine is traditionally sold by a specialist at a local shop that concocts mixtures of dried plants and animal products from wooden boxes behind the counter. One Tong Ren Tang store in Hong Kong sells everything from the thinly sliced horn of a young deer, which doctors say helps kidney problems, to an 85-year-old wild ginseng root that can be ground into a powder and used for heart failure — selling for 1.08 million Hong Kong dollars, or about US$138,700. There are dried larvae for asthma as well.

[…]

“The overall expenditure on drugs will increase tremendously in the long term,” says Gideon Lo, an analyst who follows Tong Ren Tang at DBS Vickers in Hong Kong. “Tong Ren Tang is the leader. … If you are bullish on the long term, you must buy the market leader.”

Ah, the altie says. That’s a Chinese company. In the U.S., big pharma still rules. Well, yes but perhaps not for that much longer. A while back, I blogged about an example here in the U.S., namely Airborne , the dubious herbal “cold preventer” that made its “discoverer,” a schoolteacher who dabbled in herbal remedies, fabulously wealthy:

For one thing, it makes for an excellent creation story. In the late 1990’s, Victoria Knight-McDowell, an elementary-school teacher in Spreckels, Calif., grew weary of picking up colds from her students and began “researching Chinese and holistic medicine and the use of herbs and vitamins to boost the immune system,” an official company history explains. She and her husband then decided to market her “natural formula of 17 ingredients” in 1997. They used the money her husband had made selling a television script. They handed out samples in malls and gradually got distribution in various stores. Kevin Costner became one of many celebrities to declare his confidence in the product. In 2000, Knight-McDowell gave up her teaching gig, and by 2004 annual sales hit $90 million. Along the way, Knight-McDowell appeared on “Dr. Phil,” and Airborne was discussed on “Live With Regis and Kelly” and other shows.

Pretty good bucks, I’d say. And, best of all, from Knight-McDowell’s perspective, there isn’t all that pesky regulation or those requirements to demonstrate safety and efficacy. Knowing a good opportunity when they see it, pharmaceutical companies are getting in on the action, paying big bucks to gobble up companies that make over-the counter medications, alternative remedies, and nutritional supplements:

GlaxoSmithKline has splashed out $566 million to buy US consumer healthcare firm CNS in a cash deal that expands its over-the-counter operations.

Minnesota-based CNS manufactures Breathe Right nasal strips and FiberChoice dietary fibre supplements and GSK is paying $37.50 per share, which represents a premium of 31% over the US firm’s stock price at close of business on October 6.

The deal is expected to close by early 2007 and GSK said it will be neutral to earnings next year, and accretive from 2008.CNS had sales of $118.5 million for its last financial year, which was up18% over the previous 12-month period, and the vast majority of that (86%) came from revenues generated in the USA.

Breathe Right is sold in 27 countries and FiberChoice is marketed solely in the USA, but John Clarke, president of GSK Consumer Healthcare, said “this outstanding business provides a great global growth opportunity.”

Meanwhile hundreds of companies sell herbs, nutritional supplements, and Chinese medicine. With this, it shouldn’t be surprising that some alternative medicine companies are starting to engage in the same sorts of dubious promotional tactics and price-gouging that big pharma is rightly castigated for indulging in, including promoting conflicts of interest in doctors:

Federal Parliamentary Secretary for Health Christopher Pyne announced the planned investigation yesterday after complaints about a lack of legal guidelines for the sale of complementary medicines by doctors.

Sunshine Coast general practitioner Scott Masters told The Australian he knew of a doctor practising nutritional medicine who had confessed to buying $10,000 worth of vitamin E at the start of each year and then selling it on to patients for a total of $100,000.

“That’s not a bad mark-up,” Dr Masters said. “This is entirely legal, although there are major ethical concerns about conflict of interest.”

Dr Masters said his practice received an increasing amount of material from the promoters of supplements.

“I can sell all these products directly to patients at a mark-up I consider reasonable,” he said.

The danger of doctors having financial interests in a product was that they might fail to prescribe a medicine that actually treated their patients’ complaints.

Dr Masters said the community was right to be concerned about pharmaceutical companies attempting to influence doctors to prescribe particular drugs.

But too little attention was focused on the way in which producers of complementary medicines sought to influence doctors.

Mr Pyne said the ACCC was reviewing the code of conduct of the pharmaceutical industry after claims of inducements being offered to doctors.

“I have inquired as to whether they have a similar code of conduct for the complementary medicines sector and they do not,” Mr Pyne said.

As EoR put it, commenting on the above story:

Critics complain doctors receive inducements to promote pharmaceuticals, but these are of paltry value due to self-regulation by Medicines Australia. Viagra’s self-raising calculator is cute, but a $10 gift ceiling usually makes for a marginally decent biro or mildly embarrassing brolly.

On the other hand, Big Altie’s dispensers are enjoying their hayday. I heard a back-of-the-stables rumour of substantial inducements offered to a GP (afflicted with an altie-friendly diploma) to endorse and sell neuraceutical products. He refused.

The worry about doctors receiving kickbacks to sell alternative medicines has led to an ACCC investigation, “with a view to the ACCC recommending a code of conduct similar to that applying to pharmaceuticals”. This would block bribes to doctors – now how about to so-called “health professionals”?

My point here is not to defend big pharma or the conflicts of interest that come about because pharmaceutical companies are prone to giving inducements to doctors to prescribe their product. My point is to echo Abel in pointing out that there’s a lot of money in alternative medicine and nutritional supplements, and the industry is growing. As the industry grows, it naturally starts to behave not unlike the way big pharma behaves, whose excesses have led to a backlash and increasing numbers of hospitals and doctors refusing to accept gifts of other than nominal value from drug reps. Moreover, alternative medicine companies do not have to deal with anything near the regulatory hurdles that traditional pharmaceutical companies do (you know, pesky little requirements that the drug be safe and effective and stuff like that). As these companies become more profitable, it is not unlikely that many of them will be purchased by pharmaceutical companies and become part of big pharma themselves.

What all of this means is that it’s nothing more than a massive fallacy to imply that alternative medicine sellers are somehow above the commerce of it all, that they are untainted by financial concerns. They aren’t, and are probably becoming less so. Arguments over the efficacy (or lack thereof) of any treatment or drug should be confined to the scientific evidence.

Comments

  1. #1 Just another Gelfing
    October 11, 2006

    You mean this guy isn’t just doing this for the benefit of mankind?

    btw, seriously, separated at birth?
    Barry
    and Garry

  2. #2 Tina
    October 11, 2006

    In Australia (I’m sure like the US and UK) we spend millions of dollars a year on vitamins (sorry, don’t have acutal figures, but it is a lot of money). It’s unbelievable what people will buy. There was a scandal where the vitamins of one particular company were being contaminated, but this didn’t put much of a dint in people’s faith (and reliance) on vitamins. And then there’s the myth going around that ‘our fruits and vegetables don’t have the vitamins in them they used to’.

    I’ll stick with apples for now.

  3. #3 Nat
    October 11, 2006

    How about the pesky little requirement that the label on the bottle actually match the contents of the same bottle.

    The setting up of treatment trials for altie suppliments have resulted in reports that the listed ingredients are completely missing or are at substantially higher or lower doses than the claimed dose.

    No quality control, no safety, no effectiveness.

    Suppliment companies are not only regulated at a lower standard than pharmaceutical companies they seem to be held at a lower standard than standard food distribution which does at least have to supply the advertised weight of goods.

  4. #4 Joe
    October 12, 2006

    Nat,

    Not only do the amounts of ingredients vary from label specifications; many producers find it expedient to add real drugs to their products in order to make them work. Of course, safety (if there were any) goes right out the window. Viagra shows up in “herbal” remedies, steroids are in “homeopathic” asthma drugs, the list goes on …

  5. #5 Inquisitive Raven
    October 12, 2006

    The setting up of treatment trials for altie suppliments have resulted in reports that the listed ingredients are completely missing or are at substantially higher or lower doses than the claimed dose.

    No quality control, no safety, no effectiveness.

    Funny, Consumer Reports (who does their own testing) has been saying that for years.

  6. #6 James
    October 13, 2006

    And yet somehow the alties keep convincing people that there is a conspiracy by “Big Pharma” to repress them. The first law of politics is to always accuse your opponent of posessing your faults.

  7. #7 shano
    October 16, 2006

    To be fair, the recent news about big pharma drugs being pulled from the market because they make people sick should be a part of this discussion. Or the recent studies that a popular drug for Alzheimers is no better than a placebo. Who is making all the money, really?
    Big pharma has the ability to run its own tests on the drugs it wants to market! wow, talk about a sweet deal. How about some independent testing before drugs hit the market?

    So, a pox on both houses…..alternative, mainstream-both have big problems. Deception on both sides. I have used both alternative medicine and mainstream medicine to stay healthy. And I have a great doctor who is informed on both. This is the way of the future for progressive doctors.

    I would not go to a doctor who did not think that lifestyle, nutrition and stress are factors in preventing sickness. If a little ginsing gives you a boost, what is the harm? Taking big pharma drugs indescriminately, however, can cause great harm. For example, the widespread problems caused by overuse of antibiotics.

  8. #8 Orac
    October 16, 2006

    So, a pox on both houses…..alternative, mainstream-both have big problems. Deception on both sides.

    At least big pharma has to show some evidence of efficacy and safety before it can sell a drug. (Whether the testing is adequate or not is a topic upon which reasonable people can disagree.) In marked contrast, alt-med and supplement manufacturers are under no such regulatory obligation. Why do you think drug companies are moving into the supplement and alt-med business? It’s profitable and has much less regulatory hassle.

    As for “independent testing,” that’s a nice idea in the abstract, but when you get to the nitty-gritty of it, such testing can never be truly independent unless someone else pays for it. Where do you think the money is going to come from? The government? And, given how expensive it is to do the testing already required, do you really think either the government or the pharmaceutical companies will be willing to spend a lot more to do even bigger clinical trials, at the expense of slowing down the arrival of useful new drugs to take even longer than it already does?

  9. #9 anonimouse
    October 16, 2006

    I would not go to a doctor who did not think that lifestyle, nutrition and stress are factors in preventing sickness. If a little ginsing gives you a boost, what is the harm? Taking big pharma drugs indescriminately, however, can cause great harm. For example, the widespread problems caused by overuse of antibiotics.

    Hey genius, find me a doctor who does NOT think that lifestyle, nutrition and stress play a role in health. I’ve never met one, and I’m in a position to know quite a few more than you’ve ever been exposed to. That is the classic woo straw man – that doctors don’t care about lifestyle factors – which has zero basis in reality.

  10. #10 shano
    October 16, 2006

    My point seems to have been lost. That sometimes alternative medicine can be a solution to a problem that cannot be solved by convetional medicine. Sometime conventional medice is the best choice. And I wish insurance covered them both.

    Chronic pain is one example. A surgeon is not going to tell you that reducing the stress in your life, losing weight and taking Qi Gong sessions can help with back pain. He may just want to sign you up for a session under the knife first.

    Dont get me wrong, if I need a surgeon I will go to a good one!

    If a doctor is pushing drugs for big pharma, he is much less likely to say you need to improve your choices in lifestyle. He is just going to write you a prescription, pretty simple.

    It is up to the individual to investigate, after all, no one is going to be more interested in your health than you are.

    As far as who should do the testing, maybe a combination of private and public money to pay independent studies. BTW, who is going to pay to regulate the herbal market? The consumer. I know the compainies that sell great and reliable herbal products, after all, something like golden seal has a distinctive flavor and nose, like coffee. I see it as something like the spice market, there are different grades and potentency that determine the price.

    If the natural medicine does nothing else, it may give you a micro-nutrient that you need or a mineral your body needs. Doctors dont have all the answers for something as complex as nutrition. They dont even know if the official list of nutrients is all we need for good health. To say nothing about enzymes, etc. It is really complex! The useless pharma drug you take may actually harm you, though.

    Regulation will only make herbal medicine more expensive. Yea, there are alot of rip-offs, but there are great companies, too. Individual should do some research on their own and support products that work for them. And let the buyer beware.

  11. #11 james
    October 17, 2006

    You appear to be suffering from a bit of double standards there shano. On the one hand you call for more rigorous testing of conventional (i.e. proper) medicine while defending the clear legal bias in favour of alternative (i.e. illusory) medicine on the basis that it would make it more expensive (as if it didn’t do the same for conventional drugs). What in your opinion justifies making the testing for alternative medicine less restrictive than for conventional medicine?

    If you think “natural” remedies are safer, that is simply not true. Many of the “chemicals” in commercial drugs are chemically identical to those found in herbs. The primary difference is that drugs are purer and carefully dosage controlled. Given that there are many substances (such as foxglove) that are medicinal in the right dose and a swift death in the wrong dose, this makes drugs safer than herbs.

    The reason for the difference in regulation over conventional and alternative medicines is simple politics, which I assure you is much more corrupt than business, even “Big Pharma”.

  12. #12 Bronze Dog
    October 17, 2006

    My point seems to have been lost. That sometimes alternative medicine can be a solution to a problem…

    Evidence, please.

    Chronic pain is one example. A surgeon is not going to tell you that reducing the stress in your life, losing weight and taking Qi Gong sessions can help with back pain. He may just want to sign you up for a session under the knife first.

    I have a feeling you’ve never met a surgeon in your entire life.

    No idea what Qi Gong is, but you might want to prove its efficacy.

    If a doctor is pushing drugs for big pharma, he is much less likely to say you need to improve your choices in lifestyle. He is just going to write you a prescription, pretty simple.

    Are you telling me that my doctor is working for the cereal manufacturers? ‘Cuz he wrote a prescription for Fiber One cereal once before.

    It is up to the individual to investigate, after all, no one is going to be more interested in your health than you are.

    So far, all “alternative” “medicine” has turned out to be quackery in my investigations. No one in the industry is interested in proving efficacy. Just cherrypicking testimonials.

    BTW, who is going to pay to regulate the herbal market? The consumer.

    Despite the fact that consumers typically aren’t qualified to make determinations. Most don’t know what a double-blind control study is.

    I know the compainies that sell great and reliable herbal products, after all, something like golden seal has a distinctive flavor and nose, like coffee. I see it as something like the spice market, there are different grades and potentency that determine the price.

    And yet, the herbs are never consistent in quality. Some vary between double or nothing of the active ingredient. They also have a habit of carrying dangerous secondary ingredients. Why take a near-random chemical cocktail when you can get the reliability of pharmaceuticals that isolate the active ingredient and carefully measure the dose?

    If the natural medicine does nothing else, it may give you a micro-nutrient that you need or a mineral your body needs. Doctors dont have all the answers for something as complex as nutrition. They dont even know if the official list of nutrients is all we need for good health. To say nothing about enzymes, etc. It is really complex! The useless pharma drug you take may actually harm you, though.

    99% of what you hear about nutrition is bunk. A balanced diet is what doctors recommend. The reason Big Altie keeps selling people on “nutrition” is that vitamin and mineral suppliments are nearly unregulated. The FDA approval on those amounts “not poison to most people.”

    Big Pharma isn’t useless. They have evidence of efficacy. They’re also regulated: When someone gets harmed as a result of a drug, we know all about it. When Big Altie harms someone, it’s either unrecorded or sweeped under the carpet. That needs to change.

    Regulation will only make herbal medicine more expensive. Yea, there are alot of rip-offs, but there are great companies, too. Individual should do some research on their own and support products that work for them. And let the buyer beware.

    Herbal medicine is mostly inflated as it is now. Personally, I think there should be consumer protection. I think frauds should be punished.

    If there’s no regulation, and herbal companies are allowed to get away with doing people harm via disclaimers, how can the consumers tell? 99+% of herbs are bunk, anyway. The ones that work have been, and will always be purified by pharmaceutical companies to carefully guarantee dosage of active ingredient. I’d rather not permit sloppiness for the sake of profit margin.

  13. #13 anonimouse
    October 17, 2006

    shano,

    If you want to convince me you’re not using straw men to make your point, stop with nonsense like this:

    Chronic pain is one example. A surgeon is not going to tell you that reducing the stress in your life, losing weight and taking Qi Gong sessions can help with back pain. He may just want to sign you up for a session under the knife first.

    No, he won’t. Surgery for back pain is usually a last resort kind of measure. I know this not only from personal experience, but because most back pain IS treated with conservative measures. You might want to prove Qi Gong actually works before suggesting that doctors recommend it as a first-line treatment, but the reality is that back pain – with few exceptions – is NOT something commonly referred for surgery.

    If a doctor is pushing drugs for big pharma, he is much less likely to say you need to improve your choices in lifestyle. He is just going to write you a prescription, pretty simple.

    Prove that doctors are “pusing drugs” for big pharma, and then we’ll talk.

    I know the compainies that sell great and reliable herbal products, after all, something like golden seal has a distinctive flavor and nose, like coffee. I see it as something like the spice market, there are different grades and potentency that determine the price.

    So in other words, the herbal remedies don’t need regulation, but pharma drugs need more.

    I could go on, but the reality, shano, is that you’re an altie fraud trying to pose as someone who has respect for conventional medicine. I’ve seen far too much of this in my life to be fooled, and you’re not even that good at it, so you might as well quit while you’re behind.

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