Should I spend money on this? Helpful tips for evaluating that new remedy you ve been hearing about

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1 Michael K. Turner, MD, is a graduate of Stanford University and Harvard Medical School and is completing his training in Physical Medicine and Rehabilitation. He has particular interests in nutrition, Alternative Medicine, and fitness. He is blessed with a wonderful wife and baby daughter. He has a passion for helping people live a healthy life, to the glory of God. He created a website, to educate and empower patients and their families Should I spend money on this? Helpful tips for evaluating that new remedy you ve been hearing about Welcome! I pray that this article will be helpful to you. Being interested in nutrition and Alternative Medicine, I frequently find myself evaluating certain non-traditional therapies, herbs, or dietary supplements both for personal and professional use. The bottom line question is: Should I spend money on this? Should I tell my patients to do so? Providing a good answer to this question requires us to take a moment and think critically. We need to balance the desire to get the best possible care against the need to be a good steward of our time and money, and to be safe. What I would like to do is have us discuss some strategies for accomplishing this goal; some points to keep in mind that will help us think responsibly about managing our care. 1. What have I got to lose? (Realize your vulnerability) People with terminal diseases, or people in chronic pain, are vulnerable. What do I mean? I mean that their disease drives them to a point where they are willing to try anything to make the problem go away. This makes them vulnerable to unscrupulous people within the healthcare field who want to capitalize on this fact to sell a product. Sad, but true. Realize that your disease may place such a burden on you, or a loved one, that you have become vulnerable. Because of your position, you need to pause and take special care to think through decisions about therapy. An example: a good friend of our family was dying of prostate cancer. He heard a lot about places in Mexico that offered treatments not available here. The cost however, was about $10,000. He was on the verge of relocating when he thought better of it.

2 No matter how sick you are, you NEVER have nothing to lose. There is always the danger of 1) Ignoring or interfering with proven treatments, 2) lost time, 3) wasted money, or 4) compromised safety. Perhaps most devastating of all is the danger of false hope repeatedly raising your expectations that this next thing will be the elusive treatment that cures the problem. This can foster delusional thinking--it prevents you from focusing on the facts of your illness and making progress by dealing with it in a sober-minded way. Instead of focusing on reality, you are focused on a fruitless search for the gold at the end of the rainbow. In many cases, the best thing you can do is realize that there may be no cure and start to focus on how to live, despite the problem. False hope also causes repeated cycles of over-enthusiasm followed by despair not an emotionally healthy way to live! 2. No proof required (Realize the uncertainty) Everything changed in That was the year Congress passed the Dietary Supplement and Health Education Act. Since then we have seen an explosion in the availability of herbs and supplements. And lots of money has become involved more that $27 billion dollars a year. Why the explosive growth? Because that piece of legislation 1) classified herbs as dietary supplements, and 2) classified dietary supplements as foods, not drugs. The FDA requires that the makers of drugs 1) prove that the product is safe, 2) prove that it works, and 3) manufacture their product in a stringent manner that assures purity. But since these herbs and supplements are no longer considered drugs, the FDA no longer has oversight over them. Voila! Easier to market and sell. You need to realize that the makers of any herb or supplement 1) Do NOT have to register with the FDA. They are free from drug manufacturing standards regarding purity. 2) Do NOT have to prove that their product works. 3) Do NOT have to prove that their product is safe for consumption. 4) Do NOT have to report adverse effects to the government. What about our safety? If the FDA thinks something is unsafe, it must prove after the fact that it presents significant or unreasonable risk of injury. Even where overwhelming evidence of such injury exists, the F.D.A. lacks the staff and resources required to document its case in a court of law. Now, I m not trying to scare you. Many supplements are pure, safe, and do just what they re purported to do. But many do not. Just realize that when you buy Product X which claims to do A,B, and C, there may be very little product X in the bottle, there may be no evidence that product X does anything, and there is no guarantee that product X won t hurt you. 3. Who do you trust? Follow the money and be skeptical. Why is it important to find an honest mechanic? Because he tells you that you need an expensive part --and then offers to sell it to you. Same thing for healthcare. Be aware of the financial incentives involved.

3 How is your healthcare practitioner (whether doctor, chiropractor, masseuse, Reiki practitioner, or whatever) getting paid? If you keep coming back, does he make more money? Is he offering to sell you things that he profits from? This does not necessarily mean that the treatment offered is invalid, but it should make you suspicious enough not to accept everything at face value. Not to be sound self-serving, but in this regard your doctor may be your best ally. Like many doctors, I am on a fixed salary, and like all doctors, I do not make money from the medicines I prescribe. This gives me freedom from financial conflict of interest. Unfortunately, this is not true for most healthcare interactions. Thus, discernment is required. 4. THEY don t want you to know about this. (Ignore conspiracy theories) Conspiracy theories seem to be all the rage these days. In some cases they are simply harmless and silly, but in healthcare they can be downright dangerous. You need to ignore them. Ignore any product that is introduced as some secret that they don t want you to know about. This is the easiest way to hype a product that has little merit. Theories abound about drug companies, the FDA, the medical establishment and others who collaborate to cover up helpful health breakthroughs. These are lies. Now, there is a kernel of truth in the idea that drug companies or government agencies have vested interests that do not always align with those of the individual consumer. However, like most effective lies, this one takes a little truth and then distorts and magnifies it. The danger is twofold: you may be duped into some treatment that is wasteful or harmful AND you begin to lose trust in legitimate sources. 5. Does it work? Demand SCIENTIFIC EVIDENCE before spending your money or subjecting your body. One hundred years ago people who were sick drank mercury. They were also cut in order to drain their blood. Why? Because the medical establishment thought this was helpful. Why don t we do these things today? Because science has proven that they are not helpful. Is this an improvement? I certainly think so. But what if we didn t know this? What if your doctor, today in 2006, continued to make money by selling you mercury, or by having you come in for weekly blood-letting? That would be a shame, a tragedy. It would represent bondage to a false idea. This is the beauty of rationality, and by extension, the scientific method. It is a gift of God. It reflects one of the ways we are made in His image. It helps us discover truth in our world. In so doing, we are set free from bondage to false ideas that are, at minimum, a waste of time and money, and at worst, downright harmful. What about a person who charges $60 an hour to adjust your energy? Or someone who sells you expensive formulations of colloidal silver? Or Noni juice? Is this helpful? Or does this represent bondage to false ideas? Only time, and scientific inquiry, will tell. Be patient and allow time for scientific evidence. Don t be in a rush to spend hundreds, or thousands, of dollars on some health treatment for which

4 there is no good evidence -- any more than you would spend that much money on some funnylooking kitchen gadget without any explanation or evidence that it would actually help you get work done! 6. Does it work? Understand the different LEVELS OF EVIDENCE. Not all evidence is created equal. Of course, we intuitively know this. In a court of law, there s a big difference between someone saying, He had a motive to do it, versus I saw him do it, versus showing a fingerprint from the crime scene. Different levels of evidence carry different amounts of weight and represent different levels of certainty. The same is true for healthcare. A brief example is as follows: Weakest: Testimonials. I used product X and I lost weight. You don t even know if you can trust the person. Weak: A good theory. Product X is known to help cells break down fat; thus, it should help you lose weight. A fine mechanism, but does it ACTUALLY help people lose weight? Middle: Personal experience. You tried product X and you lost weight. But guess what? You can t completely trust this, either. What about the placebo effect? (certain people will lose weight even if given an empty pill). What about your diet or stress levels did those change recently? Maybe you were drinking more coffee which causes you to urinate more and lose water weight. Or maybe your hormones fluctuated and caused weight loss? Ultimately, you can t completely trust yourself because you never know what would have happened had you NOT tried the product. This is why we need observations of large numbers of people to discern the truth. In other words, why we need science. Better: Numbers from animal experiments. ( Product X produces weight loss in animals. ) Or surveys of people who lost weight. ( Of all the people who lost 20 lbs or more, most of them were using Product X ) Best: Numbers from human experiments which that demonstrate a difference. We gave product X to two identical groups of people and those who took it lost Z amount of weight. Who cares about all this? Because many therapies, herbs,and supplements are based on levels of evidence that are weaker. Thus, there is more uncertainty as to whether they are actually helpful. They may work; they may not. But we will never know for sure until science proves it. Spending your hard-earned money may be helpful or a complete waste. The longer you wait, the more certainty you will have. 7. Stick with reputable companies As I mentioned earlier, because of deregulation there is no requirement that herbs or supplements are pure, safe, or effective. The quickest answer to this dilemma is to stick with companies that have a long track record of excellence. I will go on record and mention these as the most reputable brands I m aware of: Twinlab, Nature s Way, Solgar, Puritan Pride, Shaklee, Country Life, Nature Made, EAS.

5 There are others, but these are many of the major players. (FYI: I have no financial interest in any of these) What about supplements from the store brand, like GNC? In my experience these are lower quality. Why? Because the retailer gets bulk production with cheap ingredients to offer the best price possible, thus taking market share away from competitors. For a simple product like vitamin E, or Vitamin C this doesn t matter. But for something more complex, like glucosamine or an herb, I would stick with a brand name. 8. Know your resources These are the best resources on the internet regarding herbs and supplements. -- Is it pure? (not all parts of this site are free -- Is it safe? -- Does it work? 1) Free access to Natural Standard, the authoritative database. 2) Also click here for free access to Health Notes, another of the most comprehensive summaries on the web. Summary Points 1. Our freedom is a double-edged sword. We have ease of access to many treatments, but also, tremendous amounts of money being wasted, and sometimes harm being done. 2. The difference between drugs and herbs or supplements. Herbs and supplements are unique in that the makers DO NOT have to 1) prove that they work, 2) prove that they are safe, 3) prove that they are pure, or 4) report adverse events in those who take them. 3. Don t jump on every bandwagon! Understand that most herbs/supplements are based on preliminary levels of research. Further research may show that it works or not. Spending your hard-earned money may be helpful or a complete waste. The longer you wait, the more certainty you will have.