Despite the New York Attorney General’s recent crusade against herbal products, and a tidal wave of negative media on supplements of all kinds that has followed, practitioner confidence in the value of supplements in clinical care has proven surprisingly resilient.

New data from Holistic Primary Care’s 2015 practitioner survey, based on responses from more than 650 clinicians, indicate that practitioners take most of the media reports—and even published clinical research—with a grain of salt.

The survey, fielded a few weeks after Attorney General Eric Schneiderman’s February offensive against store-brand botanicals from GNC, Target, Walmart and Walgreens, included the following question:

“Over the last year, what net effect has the published research and media coverage on nutrition, dietary supplements & natural products had on your practice patterns?”

Respondents were asked to pick one of three options: A) I’m more confident about using or recommending supplements in my practice; B) I’m less confident about using or recommending them; or C) The research and media coverage has not affected my confidence one way or the other.

One might expect a significant dip in practitioner confidence in light of the negative media maelstrom, and the AG’s assertion of fraud. That’s not what the numbers showed.

Only 6% of the respondents said they were less confident about using or recommending supplements in light of the previous year’s media coverage.

In contrast, 49% said the aggregate media coverage plus medical research left them feeling more confident in using supplements and natural products with patients. Forty-five percent said their confidence has not changed either way.

By way of background, half of all survey respondents were conventionally trained MDs or DOs. The majority considered their practice styles to be “holistic,” “functional medicine” or “mixed/integrative.” Ten percent self-identified as “conventional allopathic.”

Granted, this cohort was a fairly supplement-friendly crowd to begin with: the majority are engaged with holistic modalities and routinely recommend supplements and nutrition-based therapies as part of patient care; 53% dispense products in their offices.

Had we surveyed a cohort of hospital-based specialists or other dyed-in-the-wool conventional physicians, we might have seen a bigger confidence gap.

Core Confidence
Still, these findings should come as good news. The core customer base for practitioner-channel brands seems unfazed by the negative media, and the New York Times’ repeated assertions that herbal supplements—and by implication, all supplements—are not to be trusted.

Respondents’ written comments were telling of the mindset of many busy clinicians who are well-aware of the entrenched economic and political agendas underlying many scientific studies and regulatory initiatives—not just those regarding supplements, but in all areas of healthcare.

“I know the drug companies put out bogus or statistically inaccurate or poorly designed vitamin studies to scare the public into taking drugs,” wrote one MD.

A chiropractor noted that, “Most of the medical research and media coverage is not accurate for the brands I use. Sometimes I have to explain to patients why that coverage is slanted against natural remedies.”

“The media and research coverage is biased against non-pharma solutions. I don’t trust most of it unless I see the data myself, even then I go by results,” wrote one practitioner, echoing the inherently pragmatic nature of patient care. More than anything, medical people make clinical decisions based on what they see working in their practices.

In a way, it should not be surprising that confidence remained firm. After all, allopathic doctors don’t categorically lose faith in pharmaceuticals because of one—or even multiple—negative studies, FDA actions, or surge of adverse event reports. They might be more cautious with particular agents, but their inherent confidence in drugs as a basic toolset remains intact—even in the face of truly alarming problems like antibiotic overuse and prescription opioid addiction.

Arguably, that’s what’s happening here. Practitioners for whom supplements are a familiar and effective part of patient care are not likely to categorically dismiss them because of problems—real or imagined—with some specific ones.

Legislators and lay media reporters may like to paint with a broad brush. Clinicians tend to be more discerning.

The question is whether the spate of negative media, the allegations of fraud, and the AG’s regulatory demands will deter physicians not currently using supplements from considering them. That remains to be seen.

Likewise, outside the circles of clinicians already familiar and comfortable with supplements is a large cohort that tends to view all supplements skeptically, and the supplement industry as unregulated and inherently unruly.

A Question of Quality
The resilience in confidence apparent in this survey could also be a reflection of the fact that many respondents are using practitioner-grade products made by companies with longstanding relationships to the clinical community. So far, all the negative media and the AG’s regulatory actions have been focused on retail brands. Pro-channel brands—for the moment at least—seem to be a safe haven.

Taking to Facebook shortly after the New York story broke, Dr. Shilpa Saxena, a prominent functional medicine physician, wrote: “Integrative and Functional docs achieve some pretty miraculous patient outcomes with pharmaceutical grade, targeted dietary supplements, and botanicals. The products we use don’t fall into this category of shame. It’s a disservice that what we do use might be lumped in with this nonsense!”

Her comments echo the belief held by many holistic/integrative clinicians (and certainly promoted by the brands themselves) that the pro lines hold to much higher quality standards than retail brands. This may or may not be true, of course, but we’d all like to believe it.

While the HPC survey data may be reassuring on the question of confidence, it also shows clinicians have major questions about the adequacy of the current regulatory framework. Many, it seems, would like to see an overhaul.

The questionnaire asked: “How would you rate the ability of current regulations to ensure the quality and safety of supplements & natural products?”

Only 17% of respondents chose “Fully adequate and effective.” Nearly half (48%) selected, “Would be adequate if properly enforced,” while 35% said it was, “Totally inadequate and needs a major revision.”

Again, the comments were instructive. One clinician noted: “I don’t really feel any of these answers reflects my view; I feel there is some room for improvement since they are not regulated at all, but too much regulation could also be problematic.”

Given the ambivalence many clinicians feel toward the federal government in general, and toward the FDA specifically, it’s not surprising some question the motives behind the calls for increased regulation:

“Quality control needs to be implemented and enforced but not by the FDA, who have an anti-nutrition stance. Quality brands are being questioned along with the inferior brands. There is a big difference,” one respondent said.

Another wrote, “Current regulations do not ensure quality or safety. I am concerned about regulations for quality, however, I am concerned about the motives of the regulators and how decisions are made.”

In this question too, we saw a fair degree of confidence that practitioner-channel lines are of higher quality than retail-focused brands.

As one respondent put it, “They need to ban companies like GNC, Walmart, etc, from selling all of the crap. I only utilize professional formulations from reputable companies that manufacture pharmaceutical grade supplements.”

A lot of practitioners have serious questions about the way supplements are currently regulated, and some would like to see the framework changed. That said, they’re quite clear about the potential risks of over-regulation, and the punitive or restrictive intentions motivating many of the parties calling for increased oversight.

This raises an important point for industry leaders: how best to engage healthcare professionals as industry advocates at a time when hostile winds are blowing and allies in high office are growing thin?

It would be wise to consider this carefully. Practitioners in general—but especially those engaged in holistic practices—tend to be far more thoughtful and reflective about clinical science and about hidden agendas with regard to supplements and food products. They take a much more nuanced view on both patient care and on regulatory and economic issues. They are also powerful influencers of patient choices.

As cries for more regulation echo through legislative halls in a growing number of states, as well as in Washington, D.C., the reasoned voices of seasoned and experienced medical practitioners could be extremely important in safeguarding public health as well as free access to worthwhile natural products.

A comprehensive Executive Summary of findings from HPC’s 2015 survey of primary care practitioners, as well as five categories of medical specialists, will be available for purchase. For more information contact [email protected].

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Erik Goldman
Holistic Primary Care

Erik Goldman is co-founder and editor of Holistic Primary Care: News for Health & Healing, a quarterly medical publication reaching about 60,000 physicians and other heathcare professionals nationwide. He is also co-producer of The Practitioner Channel Forum, an annual executive level gathering focused on challenges and opportunities in the health practitioner channel. For more information: www.TPCForum.com.