Slip Sliding Away: Bill Benda, MD on the Integrative Practice-Natural Products Industry Relationship
Written by John Weeks
Slip Sliding Away: Bill Benda, MD on the Integrative Practitioner-Natural Products Industry Relationship
Summary: Bill
Benda, MD uses the fresh face of a naturopathic medical student,
working a conference booth as a nutraceutical company representative,
to launch a reflection on the slippery slope of product and practice
relationships. In this column, originally written for Integrative Medicine: A Clinician's Journal,
Benda suggests educators and for the industry need to step up to avoid the patterns of the past.
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Integrator advisor Bill Benda, MD is also an associate editor of Integrative Medicine: A Clinician's Journal (IMCJ). Aware of the Integrator dialogue about the optimal integrative practitioner-natural products relationship, Benda focused on the subject for his regular column for IMCJ.
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Slip-Sliding Away
Bill Benda, MD, Associate
Editor Integrative Medicine: A Clinician's Journal
“'Is academic medicine
really for sale?' goes the inside joke. 'No, the present owners are quite happy
with it.'
Bill Benda, MD
"I was wandering through the labyrinth of vendors at the
American Association of Naturopathic Physicians’ annual convention this past
August when I happened upon a familiar face beaming from behind one of the
booths. It was one of our Bastyr Universitystudents, helping pay for her
medical education by promoting nutraceutical products for a prominent company.
Although it’s always nice to be acknowledged by one of our untainted youth, at
that particular moment I experienced a quiet sinking feeling somewhere within
my allopathically imprinted heart. A student. Selling products. Something was just
not quite right here.
“'Is academic medicine
really for sale?' goes the inside joke.
"'No, the present owners are quite happy
with it.'"
- Bill Benda, MD
"It was only later that I flashed back to my own younger
years as an emergency medicine resident, training in a county hospital by day
and moonlighting in a private ER by night, writing reams of prescriptions for
medications I believed would be the salvation of my suffering patients. In
those long-ago times, the pharmaceutical industry was still a cultural icon,
battling bacteria and wiping the scourge of epidemic disease from the face of
our planet. Intrepid researchers scoured distant jungles in search of the next
miracle plant from which to distill another tincture of life-saving tonic.
Rigorously controlled studies were thoughtfully published in prominent journals
whose editorial board was as pure of moral intent as it was of scientific
heart. We could believe these
guardians of truth. This was science,
by God, and science bowed before no mere commercial enterprise.
"But 2 decades is an eternity in this modern world, and Big
Pharma has gone from hero to goat, tripped up by free-market pressures that
inevitably collide with human values in the pursuit of fiscal prosperity.
Clinical research, once the proprietary realm of academic medicine, is now
churned out by industry-funded private companies that often 'forget' to include
negative findings and adverse effects in their final draft. Even
more intriguing, or horrendous, depending upon one’s point of view, is that not
only pharmaceutical companies have been quietly co-opting research—advertising
agencies themselves have been funding clinical trials for their clients and
creating companies to ghostwrite the resulting articles, eliminating any
remnant of scientific peer review altogether. To repeat: 'Is academic medicine really for
sale? No, the present owners are quite happy with it.'
"What happened to Vioxx can happen to valerian,
and
academia and advertising
agencies alike must remain
cognizant of the fall from
public grace that always
accompanies unbridled
commercialism disguised
as
science."
- Benda
"And what does the above have to do with a young naturopathic
medical student handing out information at a vendor booth? 'Those who do not
learn from history,' counseled philosopher George Santayana, 'are doomed to
repeat it.' Today our botanical and supplement companies are the
champions of the integrative medicine movement, funding such worthy endeavors
as educational conferences and academic debate, as well as this very journal [IMCJ]. I
personally have spent time with some of the industry leaders and can vouch for
their moral sincerity as well as honest pleasure in facilitating a less-toxic
approach to life’s maladies. But success can be such a slippery slope, and we
must be oh-so careful as sales soar and stocks split, and the world of herbs
and minerals usurps the pharmaceutical-industrial complex that currently rules
our healthcare system. What happened to Vioxx can happen to valerian, and
academia and advertising agencies alike must remain cognizant of the fall from
public grace that always accompanies unbridled commercialism disguised as
science.
"So should our idealistic student be protected from the
potentially seductive charms of complimentary and alternative capitalism? The
realpolitik answer is, 'No.' Our future clinicians will be prescribing these
products as part of their living wage and must engage the business of medicine
with as much integrity as they bring to each patient visit. But let us do
things a bit differently this time around. Let our medical colleges begin to
teach appropriate and ethical boundaries when interfacing with the business of
healthcare. Let the nutraceutical industry itself recognize the siren song that
shipwrecked its pharmaceutical predecessor, and consciously plot a different
course. Medicine and money may never be comfortable bedfellows, but if they
allow for their differences, they could develop a very fine platonic
relationship."
Comment: I was taught that Karl Marx' hung an addendum on the Santayana line which Benda quotes. Santayana said that "those who do not
learn from history are doomed to
repeat it." I am told Marx responded with: Yes, and the first time is a tragedy, the second a farce.