Guess Who’s Into Alternative Medicine Now?

Timothy B. McCall, M.D.

The other day I got a shipment of drugs in the mail unbidden. This isn't unusual. As a physician, I receive dozens of unsolicited, glossy medical journals, offers of free continuing medical education courses and drug samples--all courtesy of the marketing arm of the pharmaceutical industry. But this package was different.

The white box contained samples of two herbal supplements, gingko biloba for "mental sharpness" and saw palmetto for "prostate health," that the drug manufacturer Warner-Lambert plans to start selling. Printed in large letters on the box is the question: “What happens when a leading pharmaceutical company brings out a brand of herbal extracts?” Indeed.

One thing that seems to have already happened is a change in the marketing of herbs to doctors. In 10 years of practice, I’ve received plenty of packages of conventional pharmaceuticals but never an herbal remedy, megavitamin or other dietary supplement. Other favorite marketing techniques of the industry can’t be far behind including visits to doctors from promotional reprentatives, invitations to educational seminars and the latest tool: direct-to-consumer advertising? Perhaps the television will soon be instructing us to ask your doctor about goldenseal.

The material from Warner-Lambert promises that it will bring “its scientific standards to herbal medicine." Perhaps by this they will manufacture pills that actually contain what the bottle says they will. This has been a real problem for much of the dietary supplement industry since most regulatory controls were lifted after passage of the 1994 Dietary Supplement Health and Education Act.

If drug companies do actually produce higher-quality and more consistent supplements, that would be in everyone’s interest, though without regulatory oversight, they would be no more required to than any other manufacturer.

First, we might expect an improvement in the purity and consistency of the samples though without governmental regulation, this is far from guaranteed. The pharmaceutical companies certainly have the ability to manufacturer standardized and unadulterated products, something that can't be said of many manufacturers of dietary supplements. Under the 1994 Dietary Supplement Health and Education Act, most regulatory controls were removed from the supplement industry. As a result, there is nothing that guarantees that what's listed on the label will actually be found in the bottle.

But with the rapidly growing dietary supplement business now topping $3.6 billion in sales annually in the U.S. and with studies in mainstream medical publications like the Journal of the American Medical Association and the British Medical Journal documenting the efficacy of herbs like St. John's Wort for mild to moderate depression and saw palmetto for benign enlargement of the prostate, major drug companies have decided the time is right. They probably figure that a good-sized chunk of a booming market is better than none at all.

From the consumer's point of view, the entry of major pharmaceutical companies into the world of alternative medicine may be a mixed blessing.

The drug industry is unsurpassed in its ability to manufacturer standardized and unadulterated products, something that can't be said of many manufacturers of dietary supplements. Under the 1994 Dietary Supplement Health and Education Act, most regulatory controls were removed from the supplement industry. As a result, there is nothing that guarantees that what's listed on the label will actually be found in the bottle.

Lab analyses have found, for example, that some preparations of ginseng contained none. Some herbal supplements have also been documented to be contaminated with heavy metals or to include conventional pharmaceuticals not listed on the label. This lack of manufacturing standardization and purity has been one factor in many physicians’ shying away from recommending dietary supplements.

Better supplement manufacturers have responded by offering "standardized" preparations in which they certify the ingredients. An investigative report by the Los Angeles Times, however, found that various standardized preparations of St. John's Wort contained as little as 20 percent and as much as 140 percent of the amount claimed on the bottle.

The competition from drug companies would probably force traditional manufacturers of dietary supplements to improve their production standards. More reliable products can only add to the growing legitimacy of herbal remedies among both physicians and the public. The pharmaceutical industry has also proven its ability to market its products with incredible effectiveness to physicians which should increase their knowledge and acceptance of herbal medicines.

We can also expect to see drug companies extensively employ direct-to-consumer advertising as they attempt to build brand identification and loyalty among the public. Such advertising undoubtedly leads to increases in both appropriate and inappropriate use of promoted products. And if the drug industry’s track record on pricing is any guide, we can expect costs to soar.

More traditional manufacturers of dietary supplements do have some advantages over large drug companies. They know the field, understand their customers and have extensive contacts among alternative healers and in health food stores--a major locus of supplement sales. You've got to wonder how long these advantages will persist, however, once major drug companies start throwing millions of dollars at the alternative market. Most small herbal manufacturers won’t be able to compete in the expensive world of direct-to-consumer advertising. And if drug companies can wine and dine doctors to increase market share, who says they won't be able to do the same for supplement buyers from health food stores and large pharmacy chains?

In fact, there is every reason to believe that major drug companies will come to dominate the world of dietary supplements. But it's still relatively early in the game and there is a learning curve. Among the ingredients listed on the package of Warner Lambert's gingko biloba is artificial color. That's not going to go over too well with the natural health crowd.

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