Stephen Holt, MD, LLD (Hon.) ChB., PhD, DNM, FRCP (C)
MRCP (UK), FACP, FACG, FACN, FACAM, OSJ
I am passionate about the future of natural healthcare. In addition, I defy anyone to argue against wellness promotion as the key health supporting strategy for the nation, but this area of medicine remains under explored and often frankly ignored. More than 70 cents of every healthcare dollar is spent on chronic disease management, where limited recovery often occurs. Disease prevention is one of the only tactics that will result in healthcare cost containment. Feeling well by total health management promotes happiness, quality of life and enhanced productivity in society. I revere the editor of Total Health Magazine, Lyle Hurd, who is a pioneer of the provision of credible information on natural health and who is brave enough to publish controversial opinions.
There is a greater self-reliance for healthcare consumers to self-diagnose and self-medicate with drugs and dietary supplements. These consumers seek what they perceive to be safer, simpler and gentler options for disease prevention and treatment, as a consequence of disenchantment with conventional healthcare systems. Unfortunately, some consumers choose medical options from a position of uninformed or misguided judgment.
Healthcare in the U.S. is in a crisis, for many reasons. This means that effective, low-cost medical interventions are required to make wellness portable in society. The most important, least expensive initiative to save healthcare costs is patient education. Education is therapy and it is necessary for informed patient decisions about healthcare matters. Education forms the basis of preventive medicine programs. This is my concept of “edutherapy”.
What is a Dietary Supplement?
Dietary supplements are not foods and they are not drugs, according to U.S. Federal Government Legislation. In simple terms, drugs are often synthetic chemicals with high cost, exclusive ownership, and significant adverse event profiles, of variable frequency. In contrast, dietary supplements can be sold with limited health claims about their beneficial effects on body structures and functions. Contrary to some uninformed opinions, dietary supplements are regulated in their sale by good manufacturing practices and conditions of sale laid down in government legislation in the form of Dietary Supplement Health and Education Act of 1994 (DSHEA).
Regulations that govern the sale of dietary supplements insist that they bear disclaimer statements on their labels including: “this product is not intended to diagnose, prevent or treat any disease” and “these statements have not been evaluated by the FDA.” This circumstance creates an enigma in modern medicine where many physicians and healthcare consumers use dietary supplements to treat and prevent disease. As clever and appropriate may be the actions of politicians and lawyers, it is not possible to legislate against a consumers self reliance to use supplements as treatments, in a democratic society.
A Futile Battle?
There is a battle that is brewing between or among the pharmaceutical industry, the dietary industry, the food industry, and agencies that regulate the sale of such items. On the one hand, the dietary supplement industry sometimes cries “foul” when it comes to government regulations, but, on the other hand, there is a small but discreet group of marketing predators who make false promises and illegal claims about dietary supplements. Let is be crystal clear, that the same circumstances apply to the pharmaceutical industry and the food industry, to a variable degree, as evidenced by sanctions taken against food or pharmaceutical companies for overstepping or magnifying claims of benefits for their products.
These circumstances are a “crying shame”. This conflict does not improve the health of the nation which is most dependent on public health education with credible information. Promoters of dietary supplements criticize physicians who respond to pharmaceutical representatives, but some of the same individuals respond to frank propaganda about dietary supplements from some marketing companies that may even engage in absurd or preposterous treatment claims. The media has been bombarded with commercials that promote non-existent “Natural Cures”.
There is a significant number of people in the U.S. who believe that conventional medicine is misguided or even sometimes evil (perhaps several million citizens). They are wrong. Conventional medicine is an evidence-based approach for the treatment of many acute or chronic diseases, but it should not be applied in an exclusive manner for disease management, without considering general management strategies (e.g. nutrition and positive lifestyle change).
We have been lost in a “sea of terms” where more than 100 words exist to describe non-conventional medical practice e.g. alternative medicine, traditional medicine, holistic medicine, integrative medicine… to name a few! There is no doubt that modern medicine has become eclectic and it must embrace non-allopathic (not drugs or surgery) healing strategies. It is hard for me to think of a drug that can actually “cure” a chronic disease, even though I am a trained clinical pharmacologist. Ultimately, the body heals itself. In brief, battles between conventional and alternative medicine are futile.
Lack of Education: Misguided Information?
The government has not done enough to educate consumers on medical treatments or initiatives that can be taken to prevent major public health problems, such as diabetes or osteoporosis. For example, the paucity of public education on the prevention of osteoporosis is dominated by television commercials that advertise drugs to treat osteoporosis. Other startling problems exist, such as the inappropriate purveyance of drugs for conditions such as simple sleep disorders that are often amenable to lifestyle change and nutritional support with dietary supplements.
While there are more than 20 million Americans with established diabetes mellitus, there are 70 million Americans who may be “brewing” diabetes or premature death as a consequence of the presence of the metabolic syndrome X. The answer to the diabetes epidemic is disease prevention. Diabetes prevention is not found currently in drugs or diabetic gadgets. The educated diabetic lives a longer and healthier life than the uneducated diabetic, according to several contemporary medical research studies, but up to two-thirds of all diabetics mismanage their own disease.
Diabetes prevention involves the management of metabolic syndrome X which is the variable combination of being overweight, having high blood pressure or cholesterol all linked by underlying resistance to the hormone insulin. These constellations of problems that are found in syndrome X are not easily managed by drug or surgical treatments. If they were, you could “bet your bottom dollar” that the drug industry would have let the nation know with their highly effective “loudspeakers”.
Researchers have shown that integrative medical strategies, involving positive lifestyle change are the key to the baseline management of syndrome X. If my statements are matter of fact, than one must ask “why is metabolic syndrome X infrequently diagnosed, often mismanaged, despite its rampant presence? The answer rests in the absence of a quick fix and the unwillingness of U.S. healthcare to engage in simple natural and gentle first-line options to change lifestyle, nutrition and behavior away from this tragic disorder. In fact, I have proposed repeatedly that metabolic syndrome X is the number one public health initiative in industrialized health communities, “the penny has not dropped”. There are many nutritional factors used in dietary supplements that can help impact disordered body structures and functions that occur in the metabolic syndrome X.
The TV “Gospel”
It seems like a significant proportion of the American public consider television programming about dietary supplements to be gospel. The public do not seem to understand that these media promotions for drug, food, or dietary supplement products are paid advertising which sometimes may involve gross misrepresentation. There has been a massive, inappropriate, public response to extended thirty minute television commercials on cable channels which offer false promise to individuals with serious disease. I consider this to be despicable behavior in our healthcare crisis. It is akin to looting. Marketing predators prey on the desperate and afflicted, even using illegal treatment claims for dietary supplements, such as “stand-alone weight loss” claims.
Sell a Drug: Sell a Supplement: Sell a False Promise?
The pharmaceutical industry has done a great deal to enhance medical treatment but their financial model is to sell drugs. Fortune 500, pharmaceutical companies provide more funding for research in many medical schools than the U.S. government and their desire is to sell drugs. I repeat this statement because much medical education of both physicians and their patients comes from pharmaceutical companies, again to sell drugs. The U.S. has the most medicated citizens in the world, but our ratings on general health in comparison with many other nations, are quite poor. I object to TV commercials for drugs that start by disqualifying first-line, natural options for well-being while they promote “pill popping”. One massive campaign to lower the nation’s blood cholesterol involves the promotion of drug use by initial statements that diet and exercise did not work… therefore my doctor prescribed drug X.
The U.S. nation receives a constant reminder that more than 100,000 deaths per year are attributable to drug side effects or medical mistakes. However, not all dietary supplements are safe for everyone and because something is “natural”, it does not mean that it is necessarily safe. Retailers must accept responsibility for educating consumers about dietary supplement usage and this activity must be regarded as a contribution to public health. For more than thirty years, the medical profession has understood the use of simple painkillers, such as aspirin and non-steroidal anti-inflammatory drugs (NSAID) as a major public health problem.
These NSAID are the commonest reason for adverse event reporting of all drugs to the Food and Drug Administration. These drugs are the commonest cause of life threatening, bleeding from the gastrointestinal tract and they are a common cause of liver and kidney impairment. Furthermore, several of these drugs may be associated with increased risks of heart attack and stroke. It is no wonder that many people with painful disorders, such as simple arthritis (osteoarthritis) seek natural anti-inflammatory alternatives. Of course, the evidence base for the use of drugs for “treatment” exceeds that for supplements and this circumstance is likely to continue because dietary supplements cannot be readily patented to form the basis of an exclusive, high profit commercial venture.
Furthermore, mature females are educated about osteoporosis by focusing upon drug prescriptions for this disease when the real issue is to prevent osteoporosis by diet and positive lifestyle change in young women, or even children. The reader can now see how imperfect some segments of commercial healthcare really are. The solution is for the individual to take control by educating themselves on healthcare initiatives by reading credible information.
At the risk of becoming unpopular in the supplement industry, I am not supportive of trade organizations in the dietary supplement industry who respond mainly to advertising dollars rather than credible education of retailers and consumers. Many publications in natural healthcare contain misleading information and even treatment recommendations made by sales and marketing staff, rather than healthcare experts. Clearly, a new broom must sweep clean if the dietary supplement industry is to remain intact. I am grateful.
I do not expect that my words are music to the ears of the dietary supplement or the pharmaceutical industry. Neither group lives in a perfect world. I am passionate about the role of natural medicine in the promotion of health, well being, and longevity, but only credible and valued sources of information should be used to purvey dietary supplements. The informed consumer of dietary supplements is asking increasingly the question: “Who Formulated the Supplements You Take?” It is an indictment of healthcare initiatives, if dietary supplements are formulated without the input of individuals with biomedical training who can concentrate on the safety and effectiveness of natural products. In brief, my passion is impacted by imbalanced opinions and failure of people to be able to readily distinguish facts from fairy tales, especially when it comes to natural health initiatives.