Many fans of Complementary and Alternative Medicine (CAM) see the American Medical Association (AMA) as an evil organization. Medical Doctors can voluntarily be members of the AMA, and now less than half of them are. AMA policies, however, do have an influence on the medical profession, especially where medical ethics are concerned. I am not saying that I’m a fan of all AMA policies and politics; I am not aware of them all. However, a huge issue for my business is supplement companies which actively disallow internet sales and/or insist on a Minimum Advertised Price (MAP or Vertical Price Fixing). Let’s review statements and reasoning on both sides of this fence and see if the grass is greener on one.
AMA Council on Ethical and Judicial Affairs (CEJA) Policy Statement On In-Office Sales
The 1999 CEJA Report on Sales of Health-Related Products from Physician’s Offices shows that this issue has been deeply considered in the medical world. Well, not the CAM world, as my acupuncture school didn’t mention these issues at all, and I suspect naturopathic and chiropractic education also ignore the conflict-of-interest issue. Here are some highlights from that report (emphasis in the text is mine):
CEJA Report 1 – A-99
Sale of Health-Related Products from Physicians’ Offices
At the 1998 Interim Meeting, the House of Delegates adopted Resolution 7, introduced by the Oregon Delegation, which asked that the American Medical Association “develop ethical guidelines that will discriminate between the legitimate provision of medically necessary goods and services in physicians’ offices and physicians’ marketing activities that exploit the patient-physician trust.”
… Continue reading
Reading FDA warning letters and recall notices is highly recommended for anyone in the supplement or herb business. It can be discouraging for anyone who wants to legally introduce new dietary supplements to the market. This is partly because the laws and requirements are so complex, and partly because so many products currently on the market are clearly illegal and escape enforcement.
I’ve written several posts about Aconite (called Fu Zi in Chinese) in Traditional Chinese Herbal Medicine. Aconite is a powerful and toxic plant with some poorly understood narcotic alkaloids. The earliest Chinese herbals recognized that it could easily kill, and documented its use in China as poison on arrowheads. They also found that if it was prepared properly (mainly by boiling for a long time) and given in small enough doses, it had dramatic effects on some disease states. While it is used in tiny amounts in a few fairly common formulas, some modern practitioners, inspired by the 1800s Szechuan Fire School and a new Classical Chinese Medicine movement, are currently recommending Aconite in larger doses for a wider variety of patients.
Hong Kong researchers have found that Aconite prescribed by TCM practitioners is responsible for more adverse reactions requiring hospitalization than all other Chinese herbs combined. There is no antidote for Aconite poisoning; supportive care is given with hope that the body can process the toxins and survive.
Given this reality, if Aconite is given to a modern patient at the very minimum the patient deserves informed consent which includes being made aware of the cardiac symptoms of an adverse reaction. I have personally never called for banning of Aconite, but I see fewer and fewer instances where it seems reasonable or safe to recommend it. At one point I was so libertarian that I felt heroin and cocaine should be legal and freely available. I’m no longer that extreme. It is unrealistic to expect most people to sort through claims, promotions, research, facts, and deceptive advertising before deciding to try something which could result in death or permanent disability. There is a role for consumer protection beyond what occurs in a free market discourse. Unfortunate as it may be, the FDA is the first line for consumer protection against fraudulent and dangerous drugs and supplements in the USA.
As I was surfing the FDA warning letter databases for TCM-related matters, this letter popped up from the year 2000:
I’m back from a fabulous Hawaiian vacation. It’s great that Aloha has several nuanced meanings, including hello and goodbye.
The ancient Taoists talked of the Islands of the Immortals in the Eastern Sea (they called them Peng Lai). Hawaii is a pretty close match. No snakes! There were no mammals until humans introduced them. The effort to combat stowaway rats by introducing the mongoose didn’t go so well, either (rats are nocturnal, the mongoose is diurnal, never the twain shall meet). After a very busy December, it was great to take a break. I highly recommend a Hawaiian vacation, especially if you live where it is cold and snowy for months.
My break gave me time to contemplate my path: my business, blog, projects, personal health… To be honest, I even considered taking down this blog to focus more on making money. I would really like to pay off my student loans and spend more time in Hawaii. Writing about Traditional Chinese Medicine (TCM) and Complementary and Alternative Medicine (CAM) from a critical and consumer-protection perspective has taken much time but hasn’t increased my income at all. Probably the opposite has occurred. The thing is, I am not doing this for the money. I was very clear with myself when I chose the TCM/Taoism path 20 years ago that it was not about making money. At the time, I felt I was on a spiritual path to help people with natural medicine, help the planet through increasing humanity’s respect for nature, and grow as an individual by learning and practicing what I called “Taoist arts and sciences.”
Deep down I am still influenced by Taoist and Zen philosophy, but have become increasingly skeptical of groups, belief systems, and teachers claiming to be Taoist or Zen. I don’t really want to be seen as a “Taoist” or “Zennist.” The principles of observing nature, not being attached to ideas, beliefs, or things, and not resisting change are still core to my internal attitude. However, I identify these principles more with science and logic than a religion which seeks to avoid reincarnation or attain immortality.
My dear Uncle, a Montana libertarian who has been involved in law and politics for decades, sent me this note today. I wrote a response and thought to share it with my blog readers, as it touches on many of the sensitive issues surrounding freedom, science, and the herbal medicine business. Even though I doubt he needs anonymity, I made it so.
I am attaching a copy of a solicitation I received from the Center for Inquiry
with which they are attempting to have me donate to them. As stated in this solicitation, it is on their agenda to “demand that homeopathic (treatments) go through the same rigorous scientific and medical scrutiny that all other FDA approved medicines go through.”I believe having all new treatments submit to
the FDA monopoly would be horrible. It is nice to know who our enemies are.
Your Uncle Continue reading
It’s very common for an acupuncturist who prescribes Chinese herbal medicines to have an in-house pharmacy and sell herbs directly to patients. Most herbalists don’t see a problem with this, and in general neither do I. A nurse first raised the question in my mind that it could be a conflict of interest. My Master’s Degree in Acupuncture and Oriental Medicine from the Oregon College of Oriental Medicine did not cover this area of medical ethics and patient’s rights.
My intention in designing AncientWay.com’s online herbal pharmacy 12 years ago was to be a reliable source for responsible adults to buy good quality Chinese herbs. My customers range from acupuncture patients, martial artists, self-taught Chinese herb students, to other healthcare professionals. I’ve never thought of my business model as unfairly ‘stealing’ business from other acupuncturists. I used to price my herbs at ‘normal’ retail price plus actual shipping. I began to hear from customers that they were saving considerable money ordering from me, even after shipping. When I learned what their acupuncturist was charging for the same product, my jaw dropped.
A small group of acupuncturists charges 3-5 times normal retail price to their patients (who also pay a consultation fee). These greedy people pressure herbal supplement manufacturers to have strict prescription-only policies, even though these products are only legal as dietary supplements. Then these practitioners to refuse to give prescriptions to their patients, forcing them to buy in-house at excessively inflated prices. The manufacturers (particularly Golden Flower Chinese Herbs, though many other “professional lines” of supplements have this business model) tolerated (and thus encouraged) this behavior. In my opinion, it is completely profit-motivated, as practitioners who make more money selling a product line with artificial scarcity prescribe more of that product line. This unethical behavior is part of what motivated me to become a consumer-protection advocate in my industry.
Nothing has made me love my modern dentists more than seeing this scene in rural China. I took this picture at the appropriately named Sha Ping market just north of Dali in the Yun Nan province. It takes planes, trains, and a long, bumpy bus ride to get there, or at least it did in 1998 when I went.
I continue my investigation of how two Portland acupuncturist instructors I knew while getting my Master’s degree at the Oregon College of Oriental Medicine caused Beverly Hames to have kidney failure and require dialysis, a kidney transplant and multiple surgeries in order to survive. It has taken me a while to get this far, and the implications keep getting more disturbing. I first learned about the involvement of my teacher Mitch Stargrove and well-known author/teacher/manufacturer Subhuti Dharmananda while reading journalist Dan Hurley’s book, _Natural Causes: Death, Lies, and Politics in America’s Vitamin and Herbal Supplement Industry_. I like to read books that challenge my mind and make me think, but I wasn’t expecting to see people I studied with in there!
While chewing on this issue and considering whether to write about it or not, I was dismayed to see a small movement in the Chinese herbal medicine world adamantly promoting the use of banned herbs containing Aristolochic Acid, the chemical now confirmed beyond doubt in causing severe irreversible kidney damage and vastly increased upper urinary tract cancer risk. On the heels of that, a huge study from Taiwan was published showing that an incredibly large number of citizens have still been taking Chinese herbal medicines containing Aristolochic Acid and have a corresponding world-record level of kidney and bladder cancers, connected beyond doubt. Continue reading