I hate to get into a hassle with doctors, especially those who acknowledge the value of good nutrition in the prevention of cancer and heart disease. I think we're all on the same team.
But my June 5 column, suggesting that physicians ought not to be selling nutritional supplements to their patients, stimulated positive and negative responses that demand a reply.
So I'd like to clarify two points:
1. Doctors selling to patients create a difficult situation.
Dr. Peter Dans, a physician specialist in medical ethics at the Johns Hopkins School of Medicine, says that physicians' sales to patients are usually inappropriate, because the power in the relationship is uneven. Both the doctor and the patient expect the patient to trust and follow the doctor's advice.
The Code of Ethics of the American Medical Association agrees:
"A physician should not be influenced in the prescribing of drugs, devices, or appliances by a direct or indirect financial interest in a pharmaceutical firm or other supplier. Whether the firm is a manufacturer, distributor, wholesaler or repackager of the products is immaterial.
"Physicians may dispense drugs within their office practices provided there is no resulting exploitation of patients."
Such advice acknowledges that scrupulous and unscrupulous doctors exist side by side, that otherwise ethical doctors might get trapped in a conflict of interest, and that patients don't always have the power to just say no.
One patient said he felt foolish rejecting his doctor's advice to buy almost $100 a month's worth of "nutritionals," requiring a monthly follow-up visit (to buy his next month's supply). When the patient complained, the doctor invited him to become a salesperson and get the supplements wholesale. In this arrangement, the doctor would now profit from sales made by the patient.
Dr. Dans pointed out that in such a situation, a doctor's needs (to help the patient and make sales) become "agglomerated" -- mixed in a jumbled heap -- and the doctor may not do the right thing, or he may not recommend a better thing.
Which brings me to my second point.
2. Eating more fruits and vegetables and grains is cutting-edge advice for improving health and preventing disease. Added to an enormous body of knowledge about the health-protective effects of anti-oxidants is information on newly discovered, disease-fighting phytochemicals. These naturally occurring functional elements are so widespread in plant foods that the only way to get them all is by eating more produce. And this is the better message.
One doctor's public comment that eating right is important but nobody has time, simply begs the issue. If eating right is the better thing (and that's clear to anyone keeping up with the research), doctors should put the bulk of their time, effort and influence into encouraging patients to eat better. (How about a veggie check-up during the monthly vitamin sale?)
The Harvard Health Letter notes that "at least 200 epidemiologic studies from around the world have found a link between a plant-rich diet and a lower risk for many types of tumors (cancers)," then quotes other researchers:
* Cheryl Rock, nutrition and cancer expert at the University of Michigan: "Simply put, the best advice is to eat real food instead of relying on supplements. If you just take supplements, you simply don't get all of the compounds in food we're still learning about. Right now, only nature knows best."
* Clare Hasler, director of the Functional Foods for Health Program of the University of Illinois: "I don't condone emphasizing one or even several functional components. Phytochemicals and other dietary substances no doubt work in concert to fight cancer and other diseases."
* John D. Potter, cancer epidemiologist at Seattle's Fred Hutchinson Cancer Research Center: "We're discovering a plethora of bioactive substances in plant foods. Vegetables and fruits contain the anti-carcinogenic cocktail to which we are adapted. We abandon it at our own peril."
No time? Who among us doesn't have time to implement the most important health message of all? How long does it take to drink a glass of juice in the morning, order a salad with lunch, or munch ready-pack veggies as a TV snack? Frozen veggies abound and can be added to any meal in just minutes -- about the same amount of time it takes to write a check for your monthly supplements.
Colleen Pierre, a registered dietitian, is the nutrition consultant at the Union Memorial Sports Medicine Center and Vanderhorst & Associates in Baltimore.