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.

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 University students, 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."