"Passive Greed": The Pharmacy Connection

Much of this book describes how the health-food industry uses misinformation to push its products. This chapter examines how pharmacists and so-called "ethical" manufacturers add to public confusion and share the loot. Our analysis is based on information from pharmacy-school educators plus twenty-years' worth of pharmacy journals and trade publications.

When we speak of the "health-food industry," we refer mostly to promoters who greatly exaggerate the value of nutrients or use blatant scare tactics associated with a basic rejection of scientific facts. Drug companies that promote "nutritional insurance" with more subtle scare tactics are equally guilty of profiteering, although most of their other activities are rooted in science. Some distinction should also be made between owner-operated and chain-operated drugstores. The latter are far more likely to be unprincipled in their vitamin promotions.

Supplement sales in drugstores have risen sharply in recent years. The 1993 total, according to a report in Drug Store News, was $880 million, with multivitamins as the leading category. Although a large percentage of supple­ments sold through pharmacies are unnecessary or irrationally formulated, pharmacists don't seem to mind selling them. Herbal, homeopathic, and aromatherapy products are also being sold through pharmacies.

The "Education" of Pharmacists

Pharmacy schools correctly teach their students that people who eat a balanced diet rarely need supplements. But after they graduate, pharmacists are seldom reminded of this fact. The subject of inappropriate vitamin use is rarely mentioned in their scientific journals, and their trade publications talk mainly about vitamin promotion. Moreover, most of the trade publications actually encourage pharmacists to utilize many of the sales techniques used by health-food retailers!

A 1978 article in Drug Topics, for example, told pharmacists how to exploit public interest in food supplements:

One way to stay ahead of consumer buying patterns is to keep tabs on what customers are reading—health food magazines, nutrition articles in women's magazines or any of the more popular paperback vitamin books.... By keeping track of what is happening in the health food store trade right now, you can get the jump on what might be happening in drugstore vitamin sales six months from now....

A trend that underscores the need for a complete vitamin line is the continuing segmentation of the market into target categories. First came special formulations for women containing iron; now there are special vitamins for men containing zinc (said to aid prostate prob­lems) . Today there are vitamins tailored for different age groups, stress formulas for the anxious, and energy compounds for the athletes— especially joggers. Just now appearing on the shelves are vitamins aimed specifically at strengthening the hair, and another new product advertises itself as a beauty formula.

"The vitamin business is not unlike the fashion industry," said one expert who was interviewed in the article. "What sells depends upon what is in vogue. The difference is that while manufacturers and designers set the styles in fashions, in vitamins it's the customers with the latest scientific findings in hand who determine sales trends." (To keep pharmacists abreast of these trends, trade publications have frequent articles about what sells well.) The marketing director of a private label manufacturer suggested that "the smart merchandiser is going to stock what people want." Another vitamin marketing specialist advised pharmacists to convey the idea that their drugstores had a "total" vitamin department so that the customer doesn't have to shop elsewhere. He also advised selling health-related paperbacks and magazines next to the vitamin section. (The ones that promote supplements, of course.)

William H. Lee, a pharmacist aligned with the health-food industry, has given similar advice:

Even if you do not carry health-related paperbacks as a rule, you must put in and sell health-related titles. They will be your best salesman. People will read about the use of various vitamins and minerals. You as a pharmacist may not be able to recommend a certain combination

for a certain condition. The law forbids you to do it. But if a person chooses to follow a path because he believes it will do him some good, then he has a right to buy and try what he wishes.

(Translation: You can't lie, so let the books lie for you.)

Lee has actively promoted the types of products sold in health-food stores by writing books, booklets, and articles in health-food magazines and newspa­pers. The biographical sketch in one of his booklets states he is a "master herbalist with a doctorate in nutrition" and "a consultant to the direct marketing industry on nutritional matters." His letterhead has further identified him as a nutritional consultant working by appointment.

During the mid-1980s, Lee promoted supplements in a monthly nutrition column in American Druggist, which drew protests from scientifically oriented pharmacists. In correspondence with critics, Lee stated that he was "on the cutting edge of nutrition" and that his column was "intended to put pharmacists on an equal footing with health food stores when it comes to advice and sale of supplements." He also wrote that he is a graphologist, that his doctoral degree is in pharmacognosy from the University of Amsterdam, and that he had taken nutrition courses at New York University, the New School, Union University, and Donsbach University (see Chapter 6).

Lee's thirty-page booklet, "The Question & Answer Book of Vitamins... plus a Dictionary of Nutrition," was published in 1984 and distributed free to health-food stores by Earth's, of Valley Stream, New York, a company that sells supplement products through health-food stores and by mail. About half of the fifty answers in the booklet either contained significant errors or were misleading. Several months after a detailed critique and other pertinent infor­mation were sent to American Druggist, Lee's column stopped appearing.

In the early 1980s, Lee marketed a mail-order "Personal Computerized Nutrition Profile," which cost $24.95. Prospective buyers were told that their answers to 266 questions would indicate "the way your body communicates its nutritional adequacies or inadequacies, including mild, moderate or severe deficiencies, and the amount of supplemental nutrients to be included in your daily regimen." This test resembled Kurt Donsbach's "Nutrient Deficiency Test" and was just as invalid.

In 1982, Drug Store News carried a thirty-two-page insert called "Nutri­tion Centers: A how-to manual for setting up, maintaining, merchandising, servicing and getting rich (and maybe famous) from this hot new department." The booklet's apparent purpose was to suggest how pharmacies could compete with health-food stores "to capitalize on the fitness and nutrition trend sweeping the country." Its suggestions, "designed to give retailers a running jump," included: (1) luring clerks away from health-food stores, (2) attending the annual convention of the National Nutritional Foods Association (NNFA), and (3) not diagnosing or prescribing. Regarding the latter, the article stated:

What if acustomer complains of headaches and asks your health center manager "What should I take?" According to Bob Grenoble, executive director of NNFA, the answer must be worded very carefully: "You can explain what the product is traditionally used for. You can refer the customer to the shelf area where the product is. We also recommend that retailers refer customers to books and literature. There's a very fine line between prescribing and explaining."

To make things easy, the insert included suggestions about books, magazines, and booklets that the health-food industry uses to convey "authoritative knowledge."

A recent article in American Druggist contains additional advice about beating the competition:

To make sure your customers buy their vitamins from you and not from the mass merchandisers or specialty outlets like GNC, you must convince them that you know vitamins and that you have what they need at a price they expect.

How do you make sure that vitamin consumers will come to you and not the local warehouse club? One way is to reinforce the pharmacist's advisory role by conveying a level of awareness consum­ers won't find at supermarkets. You need to stay current. Important vitamin studies on antioxidants have emerged ... identifying health benefits linked to vitamin consumption.

While the Food & Drug Administration may not let manufacturers mention health benefits of their vitamins, they can't censor pharma­cists (at least, not yet). Consumers who missed the studies' results in Time, Newsweek, and TV news shows should learn from their pharma­cists what benefits might be gained from vitamins A or B, or calcium.

provide copies of vitamin-promoting articles from consumer magazines to give to customers. In-store merchandising material, the pharmacist said, should include language that says, "Ask your pharmacist for a recommenda­tion." In another article, the co-owner of Nat-rul Health Products (a pharmacist) advises laminating such articles and attaching them to the shelves or the counter where vitamins are displayed. This article concludes:

How should consumers determine whether they should take antioxi­dants or other vitamins? And how can they choose one antioxidant over another? By consulting with their pharmacists first. Counseling and sales opportunities don't come any easier.

Ask Your Pharmacist?

Many drug company ads suggest that consumers seek advice about vitamins from their doctor or their pharmacist. Curious about what pharmacists might say, Dr. Stephen Barrett designed a study to find out. The first phase was a visit to ten pharmacies in Allentown, Pennsylvania, by a young woman who complained of either tiredness or fatigue and asked whether a vitamin would help. Eight out of the ten pharmacists sold her vitamin products and one sold her a bottle of L-tryptophan (an amino acid).

For nervousness, one pharmacist recommended B-complex "to help rebuild your nervous system." Another recommended Stresstabs because "what you burn up is your B and C vitamins if you're under a lot of stress." Another, asked about nervousness, said he didn't recommend vitamins or going to a doctor who might prescribe tranquilizers. But he sold the investigator stress vitamins when she mentioned that she sometimes feels tired. The pharmacist who recommended L-tryptophan tablets said, "I know they are good because people buy them all the time."

For tiredness, one pharmacist recommended a multivitamin with iron even though advising that "you're taking a needle in a haystack chance that it's iron causing the tiredness." A second recommended a stress formula, while a third recommended a multivitamin. Another recommended a stress formula with zinc, indicating that "zinc helps build body tissue." Another suggested Stresstabs as a "tonic" and said, "That's what they have for when you burn the candle at both ends."

To explore how pharmacists are taught to handle such situations, Barrett sent questionnaires to the deans of all seventy-two pharmacy schools in the United States. All but one of the fifty-one who responded said this situation is covered in such courses as pharmacy practice. Almost all thought that pharma­cists should attempt through questioning to identify possible causes of tiredness or nervousness and should ask whether a doctor had been consulted. More than half said that pharmacists should advise that vitamins are unlikely to help either condition. Yet not one of the pharmacists consulted in Allentown did any of these things.

Intrigued by these findings, Consumer Reports enlisted reporters to visit ten more stores in Missouri and ten in California. Nine of the twenty pharmacists recommended products and fewer than half recommended that a doctor be consulted. One who recommended a product said, "It might be a vitamin deficiency, particularly if you're not eating a balanced diet." When the reporter asked whether vitamins might help even if his diet were balanced, the pharmacist replied, "Yes. You might not be absorbing the food."

In the early 1980s, Edith Kalman, a registered dietitian, received inappropriate advice from three out of four pharmacists she consulted in New York City. When she complained of severe fatigue and expressed concern about anemia, one pharmacist guaranteed that Kalman would feel better within a week if she took a B-complex supplement plus a daily multivitamin. When she complained of fatigue and loss of stamina during long-distance runs, another pharmacist advised taking vitamins E, C, and B-complex. When Kalman asked for a recommendation for acne, the pharmacist said that vitamin A was a preventive and could "clear the blood of impurities." When Kalman com­plained that her gums bled heavily after brushing and asked whether the problem could be a vitamin deficiency, the pharmacist correctly insisted that she consult a physician or dentist.

In 1991, Kenneth Smith, a student at Kent State University, visited twenty-five pharmacies in Ohio and posed the same questions to pharmacists or retail clerks. In all but four instances he was advised to make a purchase. Two years later, Donna Mitchell, another KSU student, asked ten pharmacists whether a vitamin would help her feel less tired. Eight suggested that she buy a vitamin product.

A few years ago, two pharmacy school professors sent a questionnaire on supplement-related activities and "alternative methods" to one thousand phar­macists in the Detroit metropolitan area and received 197 responses. Among the 116 who identified their five most common reasons for recommending vita­mins or minerals, sixty-six (56 percent) listed fatigue and fifty-seven (49 percent) listed stress.

What do you think these findings mean?

Advertising Tactics

Health-food-industry propaganda is not the only reason why vitamin sales are booming. Advertising by so-called "ethical" manufacturers is also a big factor. Some of this advertising is done to persuade drugstores to stock their brands. Much of it, however, is done to persuade the public—and pharmacists themselves—that everyone should take supplements. When a manufacturer plans a major advertising campaign, it typically will be announced in trade publications so that druggists can stock up on the products promoted.

Hoffmann-La Roche, Inc., which produces most of the bulk nutrients repackaged by other vitamin manufacturers, advertises heavily to physicians, pharmacists, and the general public. Roche's Vitamin Nutrition Information Service distributes reports that quote scientific literature but are heavily biased toward vitamin supplementation—exaggerating the need and minimizing the risks by omitting adverse facts. Roche also generates press coverage by sponsoring scientific meetings.

During the early 1980s, Roche engaged in blatant scare tactics to stimulate vitamin sales. Two ads questioned whether people were getting enough vitamin E but failed to mention that in the United States, no case of vitamin E deficiency based on faulty diet had ever been reported. Another ad asked "How much vitamin C gets lost on the way to the table?" and (falsely) suggested that food processing places people at risk of dietary deficiency. Roche's campaign to plug biotin included a brochure entitled, "Is BIOTIN missing in your vitamin supplement?" The brochure described biotin's importance for good health and what happened when biotin deficiency was induced in laboratory animals. The brochure failed to note that biotin is made by bacteria within the human intestine and that deficiency does not occur in humans on a dietary basis (unless they gorge themselves on raw eggs); thus there is no reason whatsoever for people to worry about not getting enough biotin in food. Advertising to doctors spotlighted "vitamin underachieves" and described how Roche was telling the public (dishonestly) about the risk of deficiency. And a booklet for children ages thirteen to seventeen stressed the importance of getting enough nutrients and warned that "many people are not getting the full amount."

In 1983, Roche ran a series of ads with the theme "Don't Take Chances, Take A Supplement" (see Chapter 3). According to an article in Drug Store News, the main thrust of this campaign was directed at pharmacists who— Roche assumed—would relay the information to customers. The article also noted that Roche planned a training program "so that pharmacists will more readily engage in nutrition counseling."

Roche's more recent ads have been more subtle and include all or most of the following themes: (1) nutrient or nutrient group X does such-and-such in the body; (2) X is abundant in such-and-such foods, (3) some people don't get enough of X, (4) while not substitutes for eating a variety of foods, supplements can be an important addition to your diet, and (5) research is under way to determine whether supplementation with X can protect against cancer (or another disease). Some ads don't mention supplementation and merely advise eating foods rich in antioxidant nutrients. Do you think these ads are intended to encourage dietary improvement or to stimulate supplement sales?

In the early 1980s, Hudson Pharmaceutical Corporation advertised to pharmacists that it was "committed to helping you sell more vitamins [and] to bringing pre-sold customers into your store." Stores that carried its products were provided with free "educational" materials (see Chapter 3) and offered "in-store vitamin sales training for your people to help them sell vitamins more knowledgeably." In 1980, in an interview in Drug Topics, company president Ed Samek said that "health-food stores and supermarkets have stolen a great many customers from drugstores, and now is the time for drugstores to take that business back." At that time, Hudson was using radio commercials geared toward "seasonal trends" in vitamin sales. In January and February 1980, vitamins were suggested to counter the supposed effects of stress. Fun and fitness were featured in March and April. May and June used a "natural" theme, and September related vitamins to going back to school.

In 1981, Hudson began "Nutra-Phone," a daily "educational" message on nutrition and health that could be heard by dialing a telephone number in New York City. Not surprisingly, many of its messages used scare tactics to promote the sale of unnecessary supplements. Research associates of the American Council on Science and Health (ACSH) studied the contents of thirty-four taped messages related to nutrition and found significant errors or omissions in about half of them. They also objected to the fact that many of the tapes ended with a message to take supplements "for extra protection." In a report to Samek ACSH's Kathleen Meister stated:

"Extra protection" implies that taking more than the recommended amounts of vitamins will provide an extra benefit. There is no good evidence of this, and the suggestion is harmful, since it may lead people to take dangerously large amounts of supplements.

It is clear... that your tapes are designed to serve [your] interests as sellers of supplements, and not... the interests of the public. Your tapes are a form of advertising, not a consumer education service. We are disturbed that they have been presented to the public as an educational device, rather than an advertising device.

In October 1986, Consumer Reports took issue with the American Association of Retired Persons, which operates the largest nonprofit mail-service pharmacy in the world. (Its gross sales are over $200 million per year.) To promote Activitamins, AARP's Pharmacy Service catalog had claimed: "A vigorous lifestyle puts extra demand on your body. So if you play golf or tennis or swim, walk, jog or bike, you should know about our formula." Calling this claim "bunkum," Consumer Reports also criticized AARP for selling bee pollen, royal jelly, bone meal, several amino acids, kelp, alfalfa, rutin, and biotin "despite lack of any scientific evidence that using such substances as supple­ments serves any nutritional need."

After Dr. Barrett filed a complaint with the National Advertising Division of the Council of Better Business Bureaus, AARP announced that it would stop publishing the misleading claims for Activitamins, but it continued to sell them as well as the other items criticized by Consumer Reports. In 1987, AARP Pharmacy Service appointed a nutrition advisory board to offer advice and consumer messages about vitamin, mineral, and supplement products. Follow­ing the board's appointment, products with potentially toxic doses of vitamin A were reformulated, misleading claims were stopped, and most dubious products were withdrawn from the pharmacy service's catalog. However, some of the consumer messages in the catalog have been written in double-talk that encouraged inappropriate use of supplements.

Lederle, the leading promoter of misinformation on stress supplements (see Chapter 3), is now misleading the public about antioxidants. Its recent ads for Protegra state:

Alert your customers to the importance of antioxidant nutrients.

•  Free radicals, normal byproducts of cellular metabolism, can attack cells and damage them.

•  Antioxidants help neutralize free radicals and stop them from damaging cells.

•  Antioxidant nutrients are found primarily in fruits, vegetables, nuts and grains.

•  2 to 4 servings of fruit and 3 to 5 servings of vegetables per day are recommended to maintain good health.

•  However, studies show that only 1 out of 10 Americans actually eats enough of the right foods to meet these recommendations.

•  PROTEGRA is specially balanced to supplement dietary antioxi­dant nutrient intake.

•  PROTEGRA can be taken by itself or with a multiple vitamin.

Although most of these statements are true, the ad as a whole is misleading. Protegra contains megadoses of vitamins E and C plus moderate amounts of five other nutrients. It is not necessary to eat five or more portions of fruits and vegetables each day to ingest an adequate supply of antioxidant nutrients. More important, as we note in Chapter 8, it has not been proven that megadoses of vitamin E or C are beneficial. A recent Roche ad in Drug Topics headed "Antioxidant Vitamin Protection.. .Why you should make it your business" provided essentially the same message.

In-Store Promotion

A recent survey by Hearst Business Publishing Research found that 109 (49.5 percent) of 220 druggists said that they offered their customers literature about vitamins. Most literature we have seen includes a table of vitamin functions and symptoms of deficiency.

The table of "vitamins" posted by Drug Emporium includes choline, inositol, para-aminobenzoic acid (PABA), and "P" (bioflavonoids), none of which are vitamins for humans. One column of the table is a ridiculous list of "Factors Working Against Vitamins" that includes sugar as "working against" niacin, thiamin, and choline, and stress as "working against" B-complex vitamins, riboflavin, folic acid, and vitamin C. Accompanying the table is a list of "Robber Barons" that supposedly increase vitamin needs. One such item is "the stress of living."

The "CVS Quick Reference Guide To Vitamins And Minerals," a flyer distributed in the vitamin section of CVS drugstores, includes a table of functions and food sources of vitamins plus lists of other nutrients with which they supposedly are "more effective." The accompanying text states:

You know how important vitamins and minerals are. But did you know that factors such as pollution, stress, and physical activity can rob your body of the nutrients it needs to maintain good health?

Sometimes abalanced diet just isn't enough, and supplements are necessary.

This handy guide will help you evaluate your situation___You'll

simply find general information about what various vitamins and minerals do, where they can be found in nature, how they can get depleted from your body and how you can make them more effective.

Not quite. The flyer contains at least seven scare statements that are false or misleading. The most blatant are that "smoking in general can cause a vitamin C insufficiency" and that "over-exerting or not getting quite enough exercise" can "deplete your body's natural resources."

The Issue of Homeopathy

In 1992, the British Pharmaceutical Conference backed the promotion and sale of homeopathic remedies by pharmacies. This took place when a large majority of pharmacists who attended a debate rejected a motion to cease involvement in such activities. The motion's sponsor, Brian Harrop, said that since homeopathy had no scientific basis, pharmacists who condoned the sales of homeopathic remedies were not living up to their reputation as "experts" on medicines and were collectively guilty of hypocrisy.

One pharmacist who favored the motion said that medical doctors and other professionals would not sell or prescribe a medicine they did not believe worked. One pharmacist who opposed the motion said it would result in other motions, casting doubt on other products, and soon the shelves in pharmacies would be depleted of stock. Pharmacists might not be able to sell vitamins, slimming preparations, or diabetic foods. It was hypocritical to attack homeopathy while turning a blind eye to other products that may not have a proven effect. Another pharmacist reported that when she sold a homeopathic product, she informed the buyer that she did not endorse it on a scientific basis. This approach, she said, provided a way out for pharmacists who were unhappy selling homeopathic products.

As far as we know, no similar debate has taken place in the United States. Most pharmacy educators ignore the topic, and professional organizations and their journals do likewise. Trade publications, on the other hand, provide a steady stream of promotional articles and ads. Among the 197 Detroit-area pharmacists who responded to the vitamin/alternative survey, 27.4 percent said homeopathy was "useful," 18.3 percent judged it "useless," and 54.3 percent "didn't know." The researchers thought that if more questionnaires had been returned, the percentage of unfavorable answers would have been higher. Regardless, most pharmacists appear to know very little about homeopathy.

Meanwhile, homeopathic products are being promoted vigorously through

ads and articles in pharmacy trade publications. The most outrageous of these promotions is a sixteen-page supplement to U.S. Pharmacist, a magazine that normally is quite scientific. The program was supported by a grant from a homeopathic manufacturer and is approved for continuing education credit by the University of Wisconsin School of Pharmacy. The material covers the history and theories of homeopathy, "prescribing basic homeopathic rem­edies," and "the need to become involved in homeopathy." The course material concludes: "The pharmacist who has knowledge of allopathic as well as natural medicine will provide the ultimate in pharmaceutical care."

An insert from Nature's Way Products, Inc., in Drug Store News for the Pharmacist, states: "It is predictable that American consumers today are more receptive than ever to alternatives such as homeopathic medicines given the high cost, limitations and dangers associated with conventional medicines." Sunsource Health Products, Inc., of Kilei, Hawaii, recently announced a multimedia campaign that would create "an incredible 300 million impressions weekly throughout the entire year." The campaign will include ads in health and fitness magazines, sixty-second radio ads on more than two thousand stations, and TV ads during "Wheel of Fortune," "The Price is Right," and the talk shows hosted by Phil Donahue, Maury Povich, and Sally Jesse Raphael. An article in the same publication described how a pharmacist in New York City saw homeopathic medicines as "a niche he could capitalize on." The article noted that the store used more than thirty feet of shelf space for homeopathic products and that a manufacturer's representative made regularly scheduled visits to the pharmacy to consult with patients and recommend products.

Ethical Questions

Almost all drugstores carry a large assortment of vitamin products, including many "natural" ones. While most chain stores promote them vigorously, most individually owned ones do not. Some pharmacies use deceptive tactics (like placing vitamin C products among cold remedies or vitamin A with eye-care products), while others display their vitamins inconspicuously.

Profiting from vitamins is not difficult. ADrug Store News survey of 455 heads of households found that 70 percent believed that vitamins and mineral supplements could help prevent illness and disease. The conditions that they thought supplements could help protect against were common colds (67 percent of those surveyed), anxiety (37 percent), heart disease (32 percent), cancer (29 percent), and insomnia (21 percent).

If asked point blank, most pharmacists will admit that few of their

customers need supplements and that megadoses of vitamins should be taken only under medical supervision. Why, then, do they stock and sell them willingly? Many pharmacists claim that if they try to discourage vitamin purchases, most customers will get angry and shop elsewhere. Do you think this is true? (Would these pharmacists be willing to post signs stating: "You don't need supplements, but if you've been talked into them, we'll be happy to sell them to you."?) Or do you think the bottom line is money? According to an article in Drug Topics, "the vitamin category is one of the drugstore's top money-makers. For the space it requires, nothing equals the vitamin section for fast turnover (typically 5-7 times a year) and large profits." Drug Store News states: "Vitamins are a valuable trip generator for drug stores. Respondents [to a survey] said they buy vitamins about once a month and spend an average of $80 a year." Other reports have noted that even though prescription drugs are more costly, the profit per transaction is often higher on supplement products.

Do you think that pharmacists—whom the public believes have expert knowledge of the products they sell—should take advantage of customers who are confused by health-food-industry propaganda? We believe that pharmacists have as much of an ethical duty to discourage inappropriate use of vitamin and mineral supplements as physicians do to advise against unnecessary surgery or medical care. Do you know of any pharmacists who do so?

Merlin Nelson, Pharm.D., M.D., while working as an assistant professor of pharmacy practice at Wayne State University School of Pharmacy, wrote a hard-hitting article called "Promotion and Selling of Unnecessary Food Supplements: Quackery or Ethical Pharmacy Practice?" In the October 1988 issue of American Pharmacy, he stated:

Why do pharmacists continue to promote and sell food supplements to healthy individuals who do not need them? I have concluded that the most common reason is greed. Advertising creates a demand that the pharmacist can supply and make a profit. . . . Pharmacists are apparently more interested in a sale than in the patient's welfare.

Some pharmacists may be influenced by misleading advertising as much as consumers are. Some pharmacists may "believe" in certain supplements because of personal experience or testimonial evidence from friends, colleagues, or patients, while others promote "nutrition insurance." .. .

Suggesting vitamins and minerals for such nonspecific symptoms as stress, tiredness, and nervousness is outright fraud. The most common response I have heard to this statement is, "Well, if they think it will help them, it just might." We have an ethical responsibility to tell the truth. The placebo response can be elicited with reassurance without the use of tablets, capsules, syrups, or any other... nostrum.

Nelson believes that pharmacists who advise patients not to waste money on vitamins might generate respect rather than antagonism. His article noted: "Patients are impressed when a pharmacist discourages the purchase of an unneeded item and dispenses sound advice. Patients feel personally helped by such unselfish behavior and often respond with long-term loyalty."

Has any pharmacist, pharmacy school professor, or professional pharma­ceutical organization ever made a sustained effort to warn the American public that food supplements are promoted fraudulently? Is there a conspiracy of silence? Is there any reason why the pharmaceutical profession should not make a determined effort to protect Americans from being misled by major pharma­ceutical manufacturers, as well as by the health-food industry? Are educators silent about supplements because drug companies donate money to their schools and research projects? Are trade-publication editors merely mouth­pieces for their advertisers? Can't pharmacies exist without selling products to people who don't need them?

And what about homeopathic products? Why aren't pharmacy students being taught that they don't work? Why aren' t pharmacy-school educators and journal editors attacking them as frauds? Why does a profession based on science tolerate the sale of homeopathic products through drugstores?

The American Pharmaceutical Association (APhA), which is the largest professional organization of pharmacists, sets standards, promotes professional education, publishes American Pharmacist and other scientific publications, and provides information to members as well as to the public. In 1988, the association adopted a policy advocating programs that "address the public health implications of the misuse and/or abuse" of nutritional supplements. The policy also encouraged pharmacists "to provide health education regarding unsubstantiated and/or misleading health claims" for supplements.

Though well intended, this action did not address the problems we discuss in this chapter. For one thing, the policy background document states: "The one-a-day type of vitamin product that more than 40% of the public takes as a 'legitimate food supplement' is not the problem." More important, the policy fails to criticize the advertising or selling of products that are useless or irrationally formulated.

The Tenth Edition of APhA's Handbook of Nonprescription Drugs contains a chapter titled "Nutritional Products." The chapter correctly states:

In most cases, the typical American diet does not need supplementa­tion. Nutrition experts agree that foods, not supplements, are the preferred source of vitamins and minerals and that most individuals can easily meet their requirements by eating a balanced diet.

Pharmacists and their customers have millions of conversations per year about dietary supplements and related products.  Can you imagine what would happen to quackery in American if pharmacists discouraged inappropriate purchases of these products?  Do you think that will ever happen?

Thirty Ways to Spot Quacks and Pushers

{topic headings listed by jk}

1.  When talking about nutrients, they tell only part of the story.

2.  They claim that most Americans are poorly nourished

3.  They recommend “nutrition insurance for everyone.

4.  They say that if you eat badly, you’ll be ok as long as you take supplements

5.  They say that most diseases are due to faulty diet and can be treated with nutritional methods.

6.  The allege that modern processing methods and storage remove all nutritive value from our food.

7.  They claim that diet is a major factor in behavior

8.  They claim that fluoridation is dangerous

9.  They claim that soil depletion and the use of pesticides and chemical fertilizers result in food that is less safe and less nourishing

10. They claim you are in danger of being poisoned by ordinary food additives and preservatives

11.  They charge that the recommended dietary allowance have been set to too low.

12.  They claim that under stress, and in certain diseases, your need for nutrients is increased.

13.  They recommend “supplements” and “health food” for everyone.

14.  They oppose pasteurization of milk

15.  They recommend a wide variety of substances similar to those found in your body.

16.  They claim that “natural” vitamins are better than “synthetic” ones.

17.  They suggest that a questionnaire can be used to indicate whether you need dietary supplements

18.  They say it is easy to lose weight

19.  They promise quick, dramatic, miraculous results.

20.  They routinely sell vitamins and other “dietary supplements: as part of their practice.

21.  They use disclaimers couched in pseudomedical jargon.

22.  They use anecdotes and testimonials to support their claims.

23.  They claim that sugar is a deadly poison.

24.  They offer phony vitamins.

23.  They display credentials not recognized by responsible scientists or educators.

26.  They offer to determine your body’s nutritional state with a laboratory test or a questionnaire.

27.  They claim they are being persecuted by orthodox medicine and that their work is being suppressed because it’s controversial.

28.  They warn you not to trust your doctor.

29.  They sue to intimidate their critics.

30.  They encourage patients to lend political support to their treatment methods.

  Conclusion:

Vitamin pushers and food quacks benefit only themselves.  Their victims are not only milked financially (for billions of dollars each year), but may also suffer serious harm from vitamin overdose and from seduction away from proper medical care. 

            There is nutritional deficiency in this country, but it is found primarily among the poor, … [Being poor they are the least likely to turn to supplements.]  The best way to get vitamins and minerals is in the packages provided by nature:  foods that are part of a balanced and varied diet.

            One reason why quackery is so difficult to spot is that most people who spread nutrition misinformation are quite sincere in their beliefs.  For them nutrition is not a science but a religion—with quacks as their gurus (35)

The quacks are not just the true believers but also major corporations and the media which mindlessly repeat their deliberate deceptions.  The voice of balanced science is barely heard.

The idea that some is good therefore more is better is without scientific substantiation.  However, too much has been shown—such as with vitamins A & B6 to be harmful.  The claim of optimal levels not met by RDAs is without scientific substantiation.  The vitamin pushers tread upon the ignorance of who the RDAs have been determined.  Is excess oil good for your car engine?