Supplements Under Attack
As I went to access the July 5, 2011, Journal of the American Medical Association anti-supplement editorial online, I had to first wait for the drug advertisement to time out. Perhaps there is a message here…
The article does raise some valid points, such as the need for the natural products industry to better prevent contamination, ensure potency, and stop inappropriate advertising claims. Perhaps most revealing, however, is the explicitly stated concern that “…many users will almost certainly forgo conventional medical treatment…” I think the continuing anti-supplement sentiment is often due to real concern that patients are not getting the treatment they need, but also fear that natural health products could obviate the need for conventional drugs. However, underlying this perspective is an unrecognized context of publication bias that consistently provides readers of conventional medicine journals with anti-natural-medicine articles.
Kemper and Hood published an interesting study (Does Pharmaceutical Advertising Affect Journal Publication About Dietary Supplements? BMC Complement Altern Med. 2008 Apr 9;8:11) documenting an association between pharmaceutical advertising and bias against natural-health products. They studied one year of issues from 11 major medical journals and looked for a correlation between the number of drug advertisements and articles about dietary supplements (DS). They found that the more pharmaceutical ads in a journal, the fewer articles were published on DS—and, if an article was published, it was more likely to be negative. Further, they found that the percentage of major articles concluding that DS were unsafe was 4 percent in journals with the fewest drug ads and 67 percent among those with the most drug ads.
Interestingly, they also looked at some complementary and alternative medicine (CAM) journals. They found no studies showing lack of safety of DS and that only 10 percent of the articles on DS in CAM publications did not show efficacy. I wonder if this was another example of publication bias, where a positive study was not accepted by the mainstream medical journals, but a study reporting adverse events or lack of efficacy was more likely to be accepted.
Let me be clear—I am not anti conventional medicine—it is often lifesaving, and some conditions progress beyond the ability of the body to heal by itself. However, I am against a healthcare system comprising ONLY conventional medicine. Conventional medicine has real limitations. It produces a high level of adverse events and is so costly it is bankrupting the US (the biggest driver of the growth in federal spending is now healthcare). And I am not blind to the problems in natural medicine—most manufacturers work diligently to provide us with high-quality products, but some do not—and too many who provide healthcare and product guidance are not adequately trained. Nonetheless, we need a system which responsibly and effectively integrates the best of conventional and natural medicine.
Antagonistic rhetoric—on either side—does not help.
Joseph Pizzorno, ND, is editor in chief of Integrative Medicine: A Clinician’s Journal; president emeritus at Bastyr University; president of SaluGeneticists Inc.; and a writer, speaker, and researcher in the area of science-based natural