Thursday, February 05, 2009

Big Nutra's direct-to-consumer scams

Feministing pulled a post about the "feminine" aspects of naturopathic medicine to post on the front page, and I am quite the skeptic of alternative medicine, but I was also annoyed at the "conventional medicine is patriarchal and for lame men who might as well spend all their money on useless, dangerous treatements and get sick and die while their doctor is being a jerk to them" vibe.

ericamatluck said:

Historically, women's voices have been excluded from medicine. Medical research has been conducted by men, for men. There was actually a time when hysterectomies were performed because women were considered "hysterical". Although we have seen progress with regard to women's involvement in medicine, the situation remains inadequate. Our understanding of pathology is based on how a condition presents in a man. This understanding is applied to women, ignoring the fact that we have a unique chemical and structural composition, and may respond differently to the same pathology.
This brings up real problems with medicine as it's been applied to caring for women, but is not any kind of argument for naturopathy as feminine, and therefore more-suited to female patients.

The comments erupted into a huge flamewar over "natural," "homeopathic," and "herbal" medicine, which seem to be used interchangeably. "Natural" is a marketing term that basically means nothing (see"all-natural" on the side of the bag of chips you're eating), and homeopathy is truly superstition-based and ridiculous. Homeopathy relies on an essential characteristic of a substance being imbued upon a diluent, even as the substance is diluted to minute, if even still present strengths.

Ever hear about the homeopath that drank a glass of water?

He died of an overdose.

I'm not really clear on the difference between "natural" and "herbal," but I'll bet a Venn diagram where the "herbal" circle was completely encompassed by the "natural" circle would represent that relationship. I've spent almost a solid year working to straighten out some medical problems, mostly with conventional doctors and pharmaceuticals. When things began, I really didn't have much capability to decide what I should do. I basically just did what doctors told me to do at first.

I've since warmed up a little to "alternative" medical practices, since hey, I don't mind taking a few vitamins or other substances that I know won't hurt me (ie valerian or hops or fish oil). I also usually run a search on pubmed with any new snake-oil-ish thing I'm considering trying.

Googling anything medical is almost always a disaster. If it's not on pubmed, it's someone trying to sell you something. I've learned that there are no bigger conspiracy theorists than people who have chronic, incurable diseases.

The thing I saw over and over again in the thread on Feministing that I thought was weird was all of the "pharma's corrupt, but try my $30 bottle of fish oil tablets" kind of stuff. You don't get the kind of exclusive manufacturing rights for a naturally-occurring substance, but people selling omega-everything are sure making themselves some money.

People are rightly suspicious of pharmaceutical direct-to-consumer advertising, but the same branding and appeals to emotions are applied to the overpriced supplement products. They don't make as much money as Pfizer, but they don't have the same liabilities either.

I don't think there's anything more consumer-friendly in the business of wringing the oil out of fish and putting it in little caplets, than there is in the business of creating novel compounds and testing them against diseases/symptoms, and then manufacturing and selling them.

With substances that aren't exclusively owned and manufactured by one entity, there's room for competition, which can open up the field to better-produced or plain better products. I bought a bottle of cheap fish-oil supplements, and the fish burps were in-freaking-tolerable.

This phenomenon has played out with generics of brand-name hits, and there are definite preferences for different generics. Generics aren't actually required to be precisely equivalent to brand-name drugs (they have to be within 80%, to my knowledge), so lots of people stick with their brand-name greatest hits drugs. I'm sure that competing in the supplement marketplace is a lot like competing amongst generics. You're all selling the same substance, but you need to make some kind of superficial distinction between yours and theirs. Make a supplement that is branded such that people feel good about buying it, and have an advantage such as convenience or user-modifiability. I've taken two generic forms of Ambien, and the first I took was a pill in an oblong shape that was easily broken in half so I could use a half-dose if I wanted. I preferred it to the one I currently have, that's tiny and unsplittable. They both do what they're supposed to do, but it's not efficacy on which I am basing my preference. I once had the birth control pills I was taking switch to a generic, and I switched back to the brand at my own expense(despite being made fun of by the pharmacist), because the generics really didn't feel right - I'd started a new type of pill when I was having really terrible menstrual cramps, and the new pill cleared that right up. They came back with the generic, and I'm not going to take birth control pills about which I feel iffy.
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