Health & beauty
GPs and nutritional supplements
Introduction
Should doctors be able to sell patients expensive dietary supplements and pocket the profits? We say no.
When you go to see your GP, you expect to get an informed diagnosis of your state of health. What you might not expect is for the doctor to offer you pricey and unproven nutritional supplements that are sold through a multi-level marketing scheme. But this is exactly what happened to "Peter's" relative.
Commission-based healthcare
Last year, Peter got in touch with us about Dr Rochelle Wilson. Dr Wilson practices in the beach-side settlement of Paekakariki, about 40 minutes north of Wellington. Peter told us Dr Wilson had recommended supplements sold through a scheme that would cost his relative $1500 to join plus an ongoing $100 a month to buy the pills.
We were sufficiently concerned by what we heard to investigate further. Unfortunately, we found this wasn't an isolated case. This writer went to see Dr Wilson and was offered a similar deal.
Dr Wilson and Mannatech
Dr Wilson is a registered medical practitioner. She also sells nutritional supplements manufactured by a Texas-based company called Mannatech. You won't find Mannatech products in shops. Its supplements are sold mainly by multi-level marketing.
The people selling Mannatech products are called associates. They earn money by keeping a percentage of the price of each product they sell. But the most effective way they can increase their income is to sign up others to sell the supplements. Not only do they earn bonuses for every person signed up, but they also earn commission on any product that the new associates sell.
The appointment
After Peter contacted us, I made an appointment to see Dr Wilson, presenting with general symptoms of feeling tired and unwell. Dr Wilson carried out a routine exam and sent me off for blood tests. About a week later, I phoned to get the results. Dr Wilson told me the test results were fine and our story may have ended here. However, she then went on to recommend nutritional supplements.
Dr Wilson did first tell me she was recommending the supplements in her role as an associate of a nutraceutical company rather than as a GP. But we think that letting doctors do this at all is problematic. In our view, it's reasonable for patients to assume from the doctor-patient relationship that the advice they receive from their doctor is based on that doctor's medical expertise.
The Mannatech pitch
During our phone conversation (see Commission-based healthcare), Dr Wilson didn't mention the specific name of the supplements. Instead, she invited me to a presentation later that month at Wellington's Duxton Hotel where a "Dr Fouts" would be speaking.
Dr Fouts, whose credentials include a doctor of chiropractic degree, turned out to be a Mannatech enthusiast from the US and the event consisted of a lengthy presentation by him on the benefits of the company's products.
The Mannatech line is that everyone needs to take supplements because our diets are deficient in essential plant-based "glyconutrients". Mannatech's products claim to provide these nutrients which it says "support your immune system, protect against free radicals [and] slow down the process that causes premature aging".
The company has previously come to the attention of regulatory authorities in the US. In July 2007, the Texas Attorney General, Greg Abbott, filed a law suit against Mannatech alleging the company had aggressively marketed supplements to unwitting purchasers "aided by an army of multi-level sellers and their fictitious claims".
Under a settlement reached in February 2009, the company agreed to pay $4 million in restitution to Texas customers and agreed not to advertise or otherwise claim its dietary supplements can cure, treat, mitigate or prevent disease. The company's founder and largest shareholder, Sam Caster, must pay a $1 million civil penalty and is prevented from serving as an officer, director or employee of Mannatech for five years.
Mannatech tactics
Mannatech has come to our attention twice before. In 2003, we warned that misleading health claims made by company salespeople risked breaching the Fair Trading Act. The Ministry of Health also cautioned the company (in writing) that salespeople faced prosecution under the Medicines Act for claiming the pills could cure or treat cancer.
In 2005 we reported on Mannatech Manna-Bears, sugar-coated gummi-bears containing powdered fruits and vegetables. Designed for children, they're marketed as "every parent's answer to the continuing challenge of getting kids to eat the right foods in the quantities growing bodies need". According to the US Food and Drug Administration, these types of products have minimal nutritional value.
The company also sells skincare and weight-loss products.
New Zealand sales of Mannatech products in 2007 were worth US$6.9 million.
The cost
Mannatech products aren't cheap. A 60-capsule bottle of the company's main supplement - a month's supply if you follow the recommended dose - costs around $70. Other products are more expensive. However, you can buy the supplements at a discounted price if you sign up as an associate. Dr Wilson suggested this is what I could do.
To become an associate, I was told there would be an initial "investment" of $1500. Once I'd paid this, I would be able to get products at the cheaper rate. The way Mannatech's system works, Dr Wilson stood to gain a bonus for bringing me on board, as well as a commission on any products I bought in the future. Dr Wilson explained that I could also earn money in this way by signing up my friends and relatives.
Dr Wilson says she takes Mannatech supplements herself. Evidently, she genuinely believes they work and she's entitled to that opinion. That's not our concern. What we do take issue with is doctors using their contact with patients to sell products in which they have a financial interest. In our view, this practice risks compromising the doctor-patient relationship.
Ethical questions
Putting aside questions about the veracity of Mannatech's products and its sales techniques (see The Mannatech pitch), what are the ethics of doctors selling products directly to patients?
The New Zealand Medical Association's (NZMA) code of ethics doesn't prohibit the practice. But there are provisos. Dr John Adams, chair of the Association's ethics committee, says doctors must be open and honest about any financial interest they have in a product and provide patients with scientific evidence on its efficacy. The NZMA represents specialists, GPs, doctors-in-training, and medical students. Membership is voluntary but the Association's code of ethics sets out principles of behaviour applicable to all doctors.
Ethics code
The New Zealand Medical Association's code of ethics states: "Doctors should not allow their standing as medical practitioners to be used inappropriately in the endorsement of commercial products. When doctors are acting as agents for, or have a financial or other interest in, commercial organisations or products, their interest should be declared. If endorsing a product, doctors should use only the proper chemical name for drugs, vaccines and specific ingredients, rather than the trade or commercial name. Any endorsement should be based on specific independent scientific evidence, and that evidence should be clearly outlined."
The Medical Council of New Zealand, the regulatory body responsible for doctors' conduct and competence, also provides guidance on the professional standards expected of doctors. Its publication, 'Good medical practice', states doctors must be upfront in any financial dealings with patients. This includes declaring a financial interest before taking part in any discussions with the patient about buying the product.
Complaints
Are the existing provisions sufficient? We're aware of two complaints involving GPs selling products to patients that have come before the Health and Disability Commissioner. In both cases, the Commissioner found the doctors exceeded the boundaries of proper practice and their conduct breached the Code of Health and Disability Services Consumers' Rights.
One case involved a GP who sold Nutriway products (nutritional supplements marketed by Amway). In her decision in 2006, the Acting Health and Disability Commissioner Tania Thomas said she had serious concerns about the potential conflict of interest raised by the doctor's involvement in Nutriway. Commenting on the case later, Commissioner Ron Paterson concluded: "situations where doctors seek to peddle products to patients are undesirable, and can expect to be carefully scrutinised by regulatory bodies and courts."
The second case, determined by the Commissioner in 1998, involved a GP selling nutritional supplements to a patient to the tune of around $200 a month. The patient bought the supplements unaware the product was part of a multi-level marketing scheme and only discovered this by chance some time later. The Commissioner found the GP exploited the patient by failing to disclose the fact he received a commission on each sale of the product. The Commissioner also found the GP breached the patient's right to be fully informed.
Conflict of interest
We strongly support the Commissioner's view that there's the potential for a serious conflict of interest when doctors sell products in which they have a financial stake.
While we're not asserting Dr Wilson breached the Code of Health and Disability Services Consumers' Rights or any other ethical or professional code, in our opinion it's an unsatisfactory state of affairs that the ethical rules of the medical profession don't prohibit this practice absolutely.
As the professional body for doctors, we think the Medical Association needs to look at strengthening its code of ethics. We think doctors should be prohibited from selling products to patients if the doctor has a direct financial interest in those products.
Our view
- The doctor-patient relationship is one based on trust. Patients rely on their doctor for expert advice about their healthcare.
- When doctors promote particular products in which they have a financial interest, they risk compromising the trust that their patients place in them.
- The New Zealand Medical Association's code of ethics should be strengthened to make it clear such practice is unacceptable.
More information
- Health and Disability Commissioner: www.hdc.org.nz
- Medical Council of New Zealand: www.mcnz.org.nz
- New Zealand Medical Association: www.nzma.org.nz
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Report by Jessica Wilson.