Should Your Doctor's Office Be a Store?

Excerpted from
What Your Doctor Won't (or Can't) Tell You : The Failures of American Medicine -- and How to Avoid Becoming a Statistic
By Evan Levine, M.D.

It probably will not surprise you to learn that I am very suspicious of physicians who sell products from their office. Oncologists are permitted to sell drugs (in this case, chemotherapy) directly to the patient or the insurance company. With few exceptions, however, most medical practitioners cannot sell drugs and thus don't have yet another incentive to prescribe costly medications to you. So what can a doctor sell you in his office?

Vitamins, skin products, and weight-control formulas are the most common things. Since these are not prescription drugs, doctors are permitted to sell you their magic potions. Often, you pay double or triple the price for a simple vitamin manufactured in a huge lab that caters to the physician. Labels like "Doctor So-and-So's Health Vitamin" are produced by the company and slapped on bottles of vitamins that are shipped to the doctor. And that's not all. Not only are these supplements sold to you without any scientific proof of their effectiveness or safety, they may not even contain what the label says they do. That's because there are no FDA requirements for these manufacturers, whether these products are sold in your doctor's office, health food stores, or on television.

The companies that sell these products to your physician don't just drop the product off, either. They also supply marketing schemes, signs, and false scientific statements. Some even provide special payment plans for the doctor's patients.

Perhaps the biggest culprits in these schemes are the dermatologists. During your appointment, the physician or his nurse extols the virtues of products that he claims he has developed or sells exclusively for a company. It's hard to refuse to purchase a product from the person who is treating you and who tells you that this product will make you better. Your skin is blemished, maybe you are dating someone, and you are going to disagree with the doctor who wants to help you? So what's another $200 if it will make you look better? But what if these products could be purchased for a fraction of the cost at the local pharmacy? Or what if a better alternative medication is covered under your insurance plan? These doctors are not selling you a panacea; they are selling you a song and a dance. My mom was a victim of a similar scam perpetrated for years by a prominent New York dermatologist.

I know of a prominent surgeon on Long Island who is selling vitamins to women with breast cancer. I know this because a close friend, on whom he operated for breast cancer, was talked into purchasing these vitamins by the doctor himself. She felt pressured to purchase them after what she claimed was a very strong sell. "The vitamins were more potent and digestible than the ones you could buy in the store," he told her. So she purchased these vitamins for about $40 a bottle.

The night my friend called to tell me what happened, I asked her to read off the ingredients of the vitamins, and I was startled when she came across phytoestrogens. These are plant- (phyto-) derived estrogenlike hormones. There is no evidence that phytoestrogen supplementation in tablet form protects against breast cancer or is even safe. Furthermore (as explained in an article by Dr. J. Schwartz), concurrent use of high-dosage phytoestrogen supplements and tamoxifen in women with breast cancer should also be discouraged until further information is available, because of the potential for phytoestrogens to antagonize the desired antiestrogenic effects of tamoxifen.10 And my friend was prescribed tamoxifen by the same team of doctors who sold her these vitamins. Fearful of saying anything to the surgeon (she depended on him for her postoperative care), she just threw the $40 bottle into the trash.

According to the California Medical Association legal department (taken from the American Medical Association News, June 7, 1999), physicians can be held liable for recommending products as remedies for conditions they are not trained to treat. They can be found guilty of malpractice and possibly lose their licenses.

Because this thoroughly unprofessional practice has become endemic, the AMA ethics council issued a report in 1998 that strongly discouraged doctors from selling vitamins and other health-related, nonprescription products from their offices.