Supplements for health

[painballer27]

Hi folks,

Has anyone looked into selling products/supplements for health, mental or otherwise? As we all know, there are numerous plants with medicinal properties (ashwagandha, curcumin, ginseng, rhodiola, saffron, etc.) It seems that as a physician, your endorsement for these beneficial products could carry more weight, and thus more people may try them and experience the benefits. Anyone do this or know anyone who does?

---

Members don't see this ad.

 

[birchswing]

your endorsement for these beneficial products could carry more weight, and thus more people may try them and experience the benefits.

It could also have the opposite effect in which they lose your trust in your other recommendations if they find the supplement recommendations to be spurious.

Anyone do this or know anyone who does?

Well, Doctor Oz is America's doctor, so in that sense, yes, I'd say that I know someone who does.

<Not a doctor or medical student>

Personally, I prefer dermatologists who don't do cosmetics (fewer and fewer of those) and treat disease--same with dentists. If you were recommending supplements with good evidence and knew a lot about them, it would give me a positive opinion. Selling a line of supplements that are doctor only (only because that's how the marketing works not because they are actually FDA approved products) would make me look elsewhere, but I'm just an N of 1 and I believe Pure Encapsulations does exactly that—sells only through doctors, or they did at some point. I see a big difference between selling and recommending.

 

[painballer27]

It could also have the opposite effect in which they lose your trust in your other recommendations if they find the supplement recommendations to be spurious.


Well, Doctor Oz is America's doctor, so in that sense, yes, I'd say that I know someone who does.

<Not a doctor or medical student>

Personally, I prefer dermatologists who don't do cosmetics (fewer and fewer of those) and treat disease--same with dentists. If you were recommending supplements with good evidence and knew a lot about them, it would give me a positive opinion. Selling a line of supplements that are doctor only (only because that's how the marketing works not because they are actually FDA approved products) would make me look elsewhere, but I'm just an N of 1 and I believe Pure Encapsulations does exactly that—sells only through doctors, or they did at some point. I see a big difference between selling and recommending.

Thank you for your non-medical opinion.

 

[WisNeuro]

Any psychiatrist hawking supplements would pretty quickly lose a lot of referral sources. And soon, they would be known as the psychiatrist who treats chronic Lyme's, chronic fatigue syndrome, fibromyalgia, etc. How many psychiatrists here want to fill their panel with patients who generally seek out unproven therapies for their non-specific, vague symptoms? In your experiences, how pleasant are these people to deal with?

 

[birchswing]

Thank you for your non-medical opinion.

It seems like you're looking for business advice more than medical. As a doctor you will have to interact with a patient at some point. Some might think you're a genius for whatever supplements you sell, some like me might be skeptical. But in terms of it being medical, you're talking about upending the doctor writes prescription, patient takes prescription to pharmacist route and doing direct to consumer sales of largely unregulated supplements. That seems like a business and not medical question. Supplements are mostly regulated like food. So if you asked about the wisdom of having a fruit stand within your psychiatric office where you sell fruit to patients versus telling them to eat a certain way, I think you can see the parallel to how it's a business question. I would be less skeptical of the fruit stand. The selling part is what interests me and seemingly what interests you. Why is the selling aspect so important? All these ingredients* are by definition GRAS if sold as supplements and can be sold anywhere without a doctor being involved. *I don't believe ashwagandha is GRAS and not sure of the legality of the supplements.

 

[Stagg737]

I would not sell supplements in my clinic. I'm a physician, not a pharmacy or a Walgreens. I rotated with physicians who did this and lost a lot of respect for them when I started asking them about the stuff they were peddling.

Some "natural" supplements have some evidence behind them and I educate my patients on those options when they ask about them including potential side effects, but beyond that I stick to EBM that I've been trained to prescribe.

 

[painballer27]

*I don't believe ashwagandha is GRAS and not sure of the legality of the supplements.

Are you trying to tell me it's illegal? Idk where you are but definitely legal in the US

 

[MacDonaldTriad]

You went to medical school so don't quack.

 

[Bartelby]

If you want to learn about supplements and recommend them when appropriate, that seems fine. If you sell the supplements it creates a built-in financial conflict of interest that will raise suspicion, especially when there are plenty of other places patients can buy them.

In addition, from a business perspective selling supplements to your own patients will not be very profitable unless you go totally nuts with it and start selling them thousands of dollars of supplements each month. Let's say you sell a $50 bottles of St. John's Wort, Ashwaganda, etc. to 100 patients per month. Is that income really worth it? You have to coordinate buying all of the supplements, trying to verify that they are actually what they claim to be (which is obviously problematic), and then selling them to your own patients before they expire. In order to make real money, you would need to push supplements infomerical-style onto a broad range of people, making claims such as improved intelligence or focus. There are plenty of people already running that scam, so while your MD might lend some credibility you are entering into a well-known field and pushing supplements blindly for profit (rather than carefully choosing supplements or alternative treatments in specific cases where they might be useful).

Overall, this doesn't seem at all like a path to riches if you want to do it in an ethically sound way.

 

[WisNeuro]

If you want to learn about supplements and recommend them when appropriate, that seems fine. If you sell the supplements it creates a built-in financial conflict of interest that will raise suspicion, especially when there are plenty of other places patients can buy them.

In addition, from a business perspective selling supplements to your own patients will not be very profitable unless you go totally nuts with it and start selling them thousands of dollars of supplements each month. Let's say you sell a $50 bottles of St. John's Wort, Ashwaganda, etc. to 100 patients per month. Is that income really worth it? You have to coordinate buying all of the supplements, trying to verify that they are actually what they claim to be (which is obviously problematic), and then selling them to your own patients before they expire. In order to make real money, you would need to push supplements infomerical-style onto a broad range of people, making claims such as improved intelligence or focus. There are plenty of people already running that scam, so while your MD might lend some credibility you are entering into a well-known field and pushing supplements blindly for profit (rather than carefully choosing supplements or alternative treatments in specific cases where they might be useful).

Overall, this doesn't seem at all like a path to riches if you want to do it in an ethically sound way.

I'd be curious what one's liability insurance would say if one called up and asked them about including this in their practice.

 

[painballer27]

I was thinking along the lines of online advertising etc. and marketing it to thousands of individuals. Like this guy:

Mercola.com - #1 Natural Health Website

A reliable source of health articles, optimal wellness products, medical news, and free natural newsletter from natural health expert Dr. Joseph Mercola.

www.mercola.com

 

[painballer27]

Idk what the profit margin on things like this are, but let's say $4. Get 10k people to buy a bottle a month. 480K. Thats like a whole extra job. And thats 10,000 people that get to experience the positive effects of these natural compounds.

 

[WisNeuro]

I was thinking along the lines of online advertising etc. and marketing it to thousands of individuals. Like this guy:

Mercola.com - #1 Natural Health Website

A reliable source of health articles, optimal wellness products, medical news, and free natural newsletter from natural health expert Dr. Joseph Mercola.

www.mercola.com

Umm, this guy is one of the biggest snake oil salesman to have ever existed. Sure, you could do this, you just have to decide what the price tag of your integrity as a physician is.

 

[erg923]

I recommend you travel the world and hock bags of vitamins at the locals from your yacht.

 

[Stagg737]

I was thinking along the lines of online advertising etc. and marketing it to thousands of individuals. Like this guy:

Mercola.com - #1 Natural Health Website

A reliable source of health articles, optimal wellness products, medical news, and free natural newsletter from natural health expert Dr. Joseph Mercola.

www.mercola.com

Mercola is an anti-vaxx scammer whose preachings generally have no basis in science. He's a blight on the DO degree second only to Larry Nassar. He's a lot worse than Dr. Oz and I'd strongly advise that anyone aspiring to follow him avoid a career in actual evidence-based medicine.

That's not saying that you can't sell supplements in a more ethical way. However, as Bartleby stated it's not likely to be significantly profitable and you can probably expect extra income in the range of a couple tens of thousands at the most. That's also only if you've got a patient population willing to commit to buying from you.

Selling online essentially means you're recommending these treatments to people without seeing or evaluating them, which is opening yourself up to a lot of liability that your malpractice almost certainly won't cover. You have no way of knowing who will buy those supplements and who could inappropriately use them or have avoidable side effects. It contradicts everything we do as physicians.

 

[whopper]

I don't know why anyone here would want to sell supplements that can be bought in any store. I strongly endorse we inform our patients about supplements and OTCs that could help but why should we sell them ourselves? You're not going to beat Amazon's price.

The mention of Oz is exactly why I brought him up in the Lieberman thread I mentioned months ago. You have someone hawking quack products for years and Columbia is okay with this likely cause they're getting in some of that money but Lieberman says something stupid (not the worst thing I've ever heard, not even very offensive, but stupid yes), and he's taken out as chair? WTF. Why did that matter? Same institution, similar positions, one offense ongoing with a clear profit motive that is unethical on several levels and the other person saying something stupid that's mildly offensive, the latter guy loses his position. Go figure.

Oz, they didn't even get rid of him. He's given the emeritus title which is only given to top professors as a show of respect, so that banter of "they got rid of him" is misinformed or disingenuous. Emeritus is only given to professors that still have involvement with the department and were considered best of the best but are retired or semi-retired such as a former department chair or literally one of the best in the field that the department still wants to be attached to them. "Getting rid of him" when he's given a very rare honor-you don't know academic titles.

 

[birchswing]

Are you trying to tell me it's illegal? Idk where you are but definitely legal in the US

I didn't try to tell you anything other than what I said. ("I don't believe ashwagandha is GRAS and not sure of the legality of the supplements.")

If it's not GRAS, I would imagine it's still an extremely low priority for the FDA. They can't even manage their high priorities that well.

It may be a bit like NAC in supplement form, which was on the bubble of being taken off the market and now, as of just this month, isn't despite not being GRAS:

https://www.fda.gov/media/157784/download

In short, the FDA says the product is not "kosher" for use in supplements but they're not going to enforce the policy because it's been in use for a long time.

So, I am unsure of the legality of ashwagandha. It's not in the GRAS database—I just checked under several different names.

I doubt the FDA is sure of the legality of it either. And I doubt they care.

Wasn't really germane to my overall point that a doctor who does direct-to-patient sales will have a certain type of clientele and might do well, but that they would probably turn away a lot of people as well. There is a risk-benefit to entering that type of industry.

Can you tell me what you base your statement that it's "definitely legal" in the US on?

I would say it's murky. I also don't think anyone really cares whether it's legal or not, but I am just curious about your certainty on it.

 

[splik]

Oz, they didn't even get rid of him. He's given the emeritus title which is only given to top professors as a show of respect, so that banter of "they got rid of him" is misinformed or disingenuous. Emeritus is only given to professors that still have involvement with the department and were considered best of the best but are retired or semi-retired such as a former department chair or literally one of the best in the field that the department still wants to be attached to them. "Getting rid of him" when he's given a very rare honor-you don't know academic titles.

At Columbia and many universities, emeritus status is given to pretty much all professors (depending on academic series) upon retirement. Certainly not a rare honor. Nowadays it is more synonymous with "retired" than being a special honor.

 

[painballer27]

Can you tell me what you base your statement that it's "definitely legal" in the US on?

Sure, its on the shelves at major stores like Walmart, Walgreens, etc. Generally things that are illegal aren't kept on those shelves.

 

[painballer27]

Alright, I've gathered from this thread that physicians selling supplements is generally a bad idea. Thanks guys

I strongly endorse we inform our patients about supplements and OTCs that could help but why should we sell them ourselves?

Just out of curiosity, what particular supplements and OTCs do you inform patients about?

 

[clausewitz2]

At Columbia and many universities, emeritus status is given to pretty much all professors (depending on academic series) upon retirement. Certainly not a rare honor. Nowadays it is more synonymous with "retired" than being a special honor.

And denying him that status, and thus making an especial enemy out of a maybe-could-be-soon US Senator-to-be, also seems like a bad call strategically on the university's part.

 

[VA Hopeful Dr]

Alright, I've gathered from this thread that physicians selling supplements is generally a bad idea. Thanks guys


Just out of curiosity, what particular supplements and OTCs do you inform patients about?

The ones with evidence that shows they actually help. So like motrin and Caltrate?

 

[painballer27]

The ones with evidence that shows they actually help. So like motrin and Caltrate?

What about Omega-3 supplements? Is there evidence for those?

Efficacy of omega-3 PUFAs in depression: A meta-analysis - PMC

We conducted this meta-analysis of double-blind randomized placebo-controlled trials to estimate the efficacy of omega-3 polyunsaturated fatty acids (PUFAs), especially docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), in the improvement ...

www.ncbi.nlm.nih.gov

 

[painballer27]

Curcumin for depression: a meta-analysis - PubMed

Curcumin is the principal curcuminoid found in turmeric (<i>Curcuma longa</i>), a spice frequently used in Asian countries. Given its anti-inflammatory and antioxidant properties, it has been hypothesized that curcumin might be effective in treating symptoms of a variety of neuropsychiatric...

pubmed.ncbi.nlm.nih.gov

Effects of ginseng on stress-related depression, anxiety, and the hypothalamic–pituitary–adrenal axis - PMC

Ginseng effectively regulates the immune response and the hormonal changes due to stress, thus maintaining homeostasis. In addition to suppressing the occurrence of psychological diseases such as anxiety and depression, ginseng also prevents ...

www.ncbi.nlm.nih.gov

Adaptogenic and Anxiolytic Effects of Ashwagandha Root Extract in Healthy Adults: A Double-blind, Randomized, Placebo-controlled Clinical Study - PMC

Background Stress, anxiety and impeded sleep are a frequent feature of life in modern societies. Across socio-economic strata, stress, anxiety and ineffective sleep detract from healthful living and serve as precursors of various ailments. The use ...

www.ncbi.nlm.nih.gov

 

[TheRightMedication]

I have considered a proprietary line of bottled water - Dr. Rightmed's Tonic.

If you drink it, AND either engage in a weight training regimen OR adhere to a Mediterranean diet, I can guarantee there's good evidence that it can treat depression.

 

[TheRightMedication]

I will also release a homeopathic version, but will save on costs by not bothering to re-label the bottles.

 

[whopper]

At Columbia and many universities, emeritus status is given to pretty much all professors (depending on academic series) upon retirement. Certainly not a rare honor. Nowadays it is more synonymous with "retired" than being a special honor.

And denying him that status, and thus making an especial enemy out of a maybe-could-be-soon US Senator-to-be, also seems like a bad call strategically on the university's part.

Splik-thanks for the clarification. Also true Clauswitz.

But the bottom line is Columbia knew what Oz was doing was wrong, and on several levels, for years and let him get away with it. Several of his colleagues petitioned that he be removed. I strongly suspect they were complicit and looked the other way cause they were likely getting a double-digit payout from his quack products.

Also clarifying something I wrote above that echoes what was already said. I strongly endorse we educate our patients on OTC supplements but only if they have evidence they can safely and effectively work.

 

[smalltownpsych]

If this guy is really trying to be a doctor, I just don’t know what to say. For some reason I find it kind of funny how he keeps trying to come up with alll these get rich schemes. Reminds me of characters in multiple tv shows. I think Ed Cranston from the Honeymooners was one of the originals. These are usually blue collar types or young wannabe entrepreneurs, it adds a whole other element of humor to have someone who is on a path of almost assured exceptional financial success scheming this way. Now that I think about it, I seem to recall a resident like this in one or two of the ER seasons or maybe I’m thinking of another medical drama.

 

[Liquid8]

I’m a bit unclear as to the direction of the OP. It’s one thing to publicly endorse a product and accept a sponsorship, it’s another to actually sell the stuff yourself – to do something like that at a scale where it’s profitable you’re going to need some business nous, knowledge of distribution chains or warehouse operations and enough capital to start things off.

Then it usually becomes a full time job in itself, so in a sense much different from the core business of what we know to be medicine. However, if you can put the right people in the right places, grow it to the point where it’s self-sustainable and cream the profits each year – then you’re obviously golden. But getting to that point is difficult, and many small businesses end in failure

On the health side, if we exclude the snake oil salesman the closest thing I can think of where there is a good being sold in addition to the service is an optometrist practice. Once diagnosed they order the lenses and there is usually a 100% profit margin on glasses frames. While I’ve pftem heard people dismiss podiatrists as shills for orthotics and doctors for big pharma, I’ve never heard anyone complain about an optometrist having a conflict of interest in that regard.

 

[VA Hopeful Dr]

I’m a bit unclear as to the direction of the OP. It’s one thing to publicly endorse a product and accept a sponsorship, it’s another to actually sell the stuff yourself – to do something like that at a scale where it’s profitable you’re going to need some business nous, knowledge of distribution chains or warehouse operations and enough capital to start things off.

Then it usually becomes a full time job in itself, so in a sense much different from the core business of what we know to be medicine. However, if you can put the right people in the right places, grow it to the point where it’s self-sustainable and cream the profits each year – then you’re obviously golden. But getting to that point is difficult, and many small businesses end in failure

On the health side, if we exclude the snake oil salesman the closest thing I can think of where there is a good being sold in addition to the service is an optometrist practice. Once diagnosed they order the lenses and there is usually a 100% profit margin on glasses frames. While I’ve pftem heard people dismiss podiatrists as shills for orthotics and doctors for big pharma, I’ve never heard anyone complain about an optometrist having a conflict of interest in that regard.

Because you put on the glasses and see better instantly. The same glasses that can last for years if you're careful.

Very little we do fixes things as quickly and obviously as glasses.

 

[Liquid8]

Because you put on the glasses and see better instantly. The same glasses that can last for years if you're careful.

Very little we do fixes things as quickly and obviously as glasses.

To play devils advocate, I'm sure there are some patients who would take the same view on alprazolam or stimulants.

I think what it comes down to more in examples like optometry is simply convenience. They write the lens prescription and send off your choice of frames to their lab, and it comes back in a complete piece. The same applies to dentists and oral surgeons who take impressions and organise various prostheses which dental technicians then engineer. It doesn't make sense to send the patient off to a third party as they have to come back for further testing/installing etc.

With medications, in most countries those who prescribe do not also dispense. For the same reason that the homeopath who sells their clients expensive coloured water is seen as questionable, it would also apply to doctors selling the drugs they prescribe. Logically this also extends to any other supplements if we supplied them.

 

[VA Hopeful Dr]

To play devils advocate, I'm sure there are some patients who would take the same view on alprazolam or stimulants.

I think what it comes down to more in examples like optometry is simply convenience. They write the lens prescription and send off your choice of frames to their lab, and it comes back in a complete piece. The same applies to dentists and oral surgeons who take impressions and organise various prostheses which dental technicians then engineer. It doesn't make sense to send the patient off to a third party as they have to come back for further testing/installing etc.

With medications, in most countries those who prescribe do not also dispense. For the same reason that the homeopath who sells their clients expensive coloured water is seen as questionable, it would also apply to doctors selling the drugs they prescribe. Logically this also extends to any other supplements if we supplied them.

I used to dispense my own medications (noncontrolled only for many obvious reasons). I'd still get pushback for most things that were over say $15 per prescription.

 

[painballer27]

someone who is on a path of almost assured exceptional financial success

Some of the numbers thrown around here for employed jobs are hardly exceptional... If you're Making 270k with student loans and living in even a moderate cost of living area, you're barely getting by

 

[WisNeuro]

Some of the numbers thrown around here for employed jobs are hardly exceptional... If you're Making 270k with student loans and living in even a moderate cost of living area, you're barely getting by

If you're barely getting by on 270k, even with average loans, in a moderate CoL area, you are absolutely terrible with finances.

 

[GoSpursGo]

I'm going to lock this thread since the question has more or less been answered. Bottom line, you're a physician and you can decide what you do or do not believe can help your patients. Use high quality medical literature to decide--for one example, @painballer27 , I would basically never trust an article published in Cureus.

Please don't call for members to be banned publicly. If there is a post that you believe violates the TOS, please report so we can review. If something is not against the TOS but you just don't want to see that content, you can always put users on ignore.