I own an integrative health practice and resisted selling supplements at first, but my patients wanted it. I have a large Amish population that does not shop online. If I don't provide a safe option from a reputable company, they will either not comply or buy poor quality products. I also have a lot of patients (rural, conservative community) who do not like to shop online and pay in cash.
I do not upcharge for specialty labs. I tried this for awhile but it felt icky. I work very hard to keep costs contained so that it is more affordable, so product sales do offset that. No one is compelled to purchase from me, but some want that option. There is no perfect system, but my goal is to be fair to my patients, my staff, and myself.
Thank you, Krista, for giving another perspective and for making the point that in some cases, these decisions can be driven by the needs or desires of the patients. Given your patient population, I think what you describe sounds very fitting with the AMA guideline -"limit sales to products that serve the immediate and pressing needs of their patients." Thank you again for commenting.
Dec 10, 2023·edited Dec 10, 2023Liked by Courtney Snyder MD
I see your point and generally agree with the conflict of interest. Some of my friends and colleagues are "celebrity docs" and make a fortune online. Some even have their own product lines. Coaching companies and "masterminds" have shaped the functional medicine model. It goes something like this... write a book, develop a supplement line, launch a summit, build a platform, pump out content, and if you're lucky, you will make millions. Many of the online docs don't even see patients anymore. They are full-time marketers. The content produced is often written by copywriters (not doctors) and can be misleading or flat-out inaccurate.
This needs to be clarified for consumers struggling with health issues and needing proper guidance.
I have been practicing functional nutrition for seventeen years. I have never sold products or supplements in my office. I run specialty labs, and some offer practitioner discounts, which I extend to my clients. I recommend supplements, peptides, and other products and have always extended my professional discount. More recently, I signed up with Fullscript, and they allow a 35 percent discount to my clients, and I don't profit. It's much easier now that I don't have to place the order with five different companies on behalf of each client. That admin time was extensive and frustrating.
Many people come to me after spending over 30k and more in functional practices where testing and supplements are the primary income stream. Many of these patients are sick, tired, and toxic from the "treatments" that were supposed to correct functional imbalances found in testing by doctors who learned the protocols at education courses designed by supplement manufacturers! I have yet to meet many functional and integrative practitioners who understand functional medicine. That's the bigger problem if you ask me, and since you didn't, I'll stop here. I'm sure you don't want me to get started! 😉
LOL...please...get started! Thank you for commenting and adding to this. I have understood, but couldn't have laid it out as succinctly as you did, when you said - "It goes something like this... write a book, develop a supplement line, launch a summit, .......etc." I'm also glad you mentioned about extending discounts, which I do as well. I also share your experience with of hearing from people who have harmed physically, emotionally and financially. This past week, after hearing a couple more examples, I thought it was time to right something. Thank you, again.
I generally agree & glad you write about this. In places where I have received functional medicine care, there has been some MDs who market products. But some do not. The ones whom I have found most effective are usually not selling products and their services cost more. And there are one's who sell products but are also trying to work between insurances and keeping costs low. They don't make an unusual amount of profit and need to keep the lights on. That said, I think it is a mistake to take a narrow view or point the finger selectively when trying to understand the big picture. Eg., When meeting an allopathic doctor for f/u after testing, I received a Tx recommendation which I found odd for my profile. I declined and suggested a standard approach/Tx. The MD agreed & handed me his pre-printed report/recommendations he had in hand since the start of the OV. The notes on the report FIRST recommended the Tx I asked for and the THIRD Tx option listed was with the product he first recommended in office. THAT got my curiosity and I did some research. The MD was the CSO of the company who made the Tx he first recommended. While this Tx might have been a valid option for some patients, he did not disclose that to me, and, in this case, it was not a good option for me (other MDs would agree) as there was a longer term risk of complication. So is this just one MD pushing the limits? I don't think so. There are many MDs who do leadership/ committee work who have conflicts. There are industry reps on very important health policy/regulation/guideline committees. So I don't know what the answer is here. But to focus on something more simple as an MD selling vitamins as an add-on to the functional services they offer, is too narrowly focused. And it does not recognize that it provides possible record of compliance... as a pharmacy might. (It also means the product was screened by them and is trusted). I agree that the patient should not be put under influence or pressure of any sort. But I think, at most times, all is known to the patient with this functional care &, thus, might be considered "small fry" when looking at conflicts. It's their allopathic care that they don't know a lot about where there can be conflicts of many complicated types... be it their MD or the institution they are affiliated with. This doesn't mean there isn't a lot of good, ethical work done. But expert opinion or a committee or institutional locking of arms doesn't mean there isn't conflict. it just seems to depend on one's definition of "conflict" and what one wants to focus on IMHO. When healthcare is built on capitalism, all paths of care are affected.
Thank you, for your comments on this.....I very much agree and hope someone else is writing about their experience with conflicts of interest in the allopathic world. As I haven't been part of that world for a number of years, I'm not in a place to write about it. Your comment is helpful, because it does sounds like you do have an understanding of these relationships in both functional and allopathic medicine - of the bigger picture. Given what I hear from many people that contact me (some who feel they have wasted tens of thousands of dollars on functional medicine), I wouldn't be able to say, ...", at most times, all is known to the patient with this functional care &, thus, might be considered "small fry" when looking at conflicts." That could be a really great poll question "How much is 'all known with this functional care?" Thank you, again.
Thank you for letting us know about the system. I knew there was money being made at the patients expense but you never think about if your holistic doctor has your back. Money is a huge motivator even for those who really are good intentioned. I also found others comments helpful. And what about allopathic doctors getting incentives from drug companies for writing prescriptions, doing procedures, and the like. This is also a conflict of interest. But it seems that allopathic doctors are always just prescribing, doing procedures, and surgeries. It’s the same. And maybe they think they deserve the extra money because of how long they studied to be a doctor and their medical school loans. And patients are getting evicted from their homes and can’t send their kids to college because their wages are getting garnished from medical bills.
You're welcome, Michele. I tend to think it has become such the norm that many doctors and practitioners aren't really thinking about it. As you can see from the comments, there are exceptions. I agree, there are conflicts of interest in other areas of medicine as well. Thanks for adding that. I didn't comment on allopathic medicine, because I'm no longer working in that world and don't have direct knowledge. Thank you for commenting on this.
I own an integrative health practice and resisted selling supplements at first, but my patients wanted it. I have a large Amish population that does not shop online. If I don't provide a safe option from a reputable company, they will either not comply or buy poor quality products. I also have a lot of patients (rural, conservative community) who do not like to shop online and pay in cash.
I do not upcharge for specialty labs. I tried this for awhile but it felt icky. I work very hard to keep costs contained so that it is more affordable, so product sales do offset that. No one is compelled to purchase from me, but some want that option. There is no perfect system, but my goal is to be fair to my patients, my staff, and myself.
Thank you, Krista, for giving another perspective and for making the point that in some cases, these decisions can be driven by the needs or desires of the patients. Given your patient population, I think what you describe sounds very fitting with the AMA guideline -"limit sales to products that serve the immediate and pressing needs of their patients." Thank you again for commenting.
I see your point and generally agree with the conflict of interest. Some of my friends and colleagues are "celebrity docs" and make a fortune online. Some even have their own product lines. Coaching companies and "masterminds" have shaped the functional medicine model. It goes something like this... write a book, develop a supplement line, launch a summit, build a platform, pump out content, and if you're lucky, you will make millions. Many of the online docs don't even see patients anymore. They are full-time marketers. The content produced is often written by copywriters (not doctors) and can be misleading or flat-out inaccurate.
This needs to be clarified for consumers struggling with health issues and needing proper guidance.
I have been practicing functional nutrition for seventeen years. I have never sold products or supplements in my office. I run specialty labs, and some offer practitioner discounts, which I extend to my clients. I recommend supplements, peptides, and other products and have always extended my professional discount. More recently, I signed up with Fullscript, and they allow a 35 percent discount to my clients, and I don't profit. It's much easier now that I don't have to place the order with five different companies on behalf of each client. That admin time was extensive and frustrating.
Many people come to me after spending over 30k and more in functional practices where testing and supplements are the primary income stream. Many of these patients are sick, tired, and toxic from the "treatments" that were supposed to correct functional imbalances found in testing by doctors who learned the protocols at education courses designed by supplement manufacturers! I have yet to meet many functional and integrative practitioners who understand functional medicine. That's the bigger problem if you ask me, and since you didn't, I'll stop here. I'm sure you don't want me to get started! 😉
LOL...please...get started! Thank you for commenting and adding to this. I have understood, but couldn't have laid it out as succinctly as you did, when you said - "It goes something like this... write a book, develop a supplement line, launch a summit, .......etc." I'm also glad you mentioned about extending discounts, which I do as well. I also share your experience with of hearing from people who have harmed physically, emotionally and financially. This past week, after hearing a couple more examples, I thought it was time to right something. Thank you, again.
I generally agree & glad you write about this. In places where I have received functional medicine care, there has been some MDs who market products. But some do not. The ones whom I have found most effective are usually not selling products and their services cost more. And there are one's who sell products but are also trying to work between insurances and keeping costs low. They don't make an unusual amount of profit and need to keep the lights on. That said, I think it is a mistake to take a narrow view or point the finger selectively when trying to understand the big picture. Eg., When meeting an allopathic doctor for f/u after testing, I received a Tx recommendation which I found odd for my profile. I declined and suggested a standard approach/Tx. The MD agreed & handed me his pre-printed report/recommendations he had in hand since the start of the OV. The notes on the report FIRST recommended the Tx I asked for and the THIRD Tx option listed was with the product he first recommended in office. THAT got my curiosity and I did some research. The MD was the CSO of the company who made the Tx he first recommended. While this Tx might have been a valid option for some patients, he did not disclose that to me, and, in this case, it was not a good option for me (other MDs would agree) as there was a longer term risk of complication. So is this just one MD pushing the limits? I don't think so. There are many MDs who do leadership/ committee work who have conflicts. There are industry reps on very important health policy/regulation/guideline committees. So I don't know what the answer is here. But to focus on something more simple as an MD selling vitamins as an add-on to the functional services they offer, is too narrowly focused. And it does not recognize that it provides possible record of compliance... as a pharmacy might. (It also means the product was screened by them and is trusted). I agree that the patient should not be put under influence or pressure of any sort. But I think, at most times, all is known to the patient with this functional care &, thus, might be considered "small fry" when looking at conflicts. It's their allopathic care that they don't know a lot about where there can be conflicts of many complicated types... be it their MD or the institution they are affiliated with. This doesn't mean there isn't a lot of good, ethical work done. But expert opinion or a committee or institutional locking of arms doesn't mean there isn't conflict. it just seems to depend on one's definition of "conflict" and what one wants to focus on IMHO. When healthcare is built on capitalism, all paths of care are affected.
Thank you, for your comments on this.....I very much agree and hope someone else is writing about their experience with conflicts of interest in the allopathic world. As I haven't been part of that world for a number of years, I'm not in a place to write about it. Your comment is helpful, because it does sounds like you do have an understanding of these relationships in both functional and allopathic medicine - of the bigger picture. Given what I hear from many people that contact me (some who feel they have wasted tens of thousands of dollars on functional medicine), I wouldn't be able to say, ...", at most times, all is known to the patient with this functional care &, thus, might be considered "small fry" when looking at conflicts." That could be a really great poll question "How much is 'all known with this functional care?" Thank you, again.
Thank you for letting us know about the system. I knew there was money being made at the patients expense but you never think about if your holistic doctor has your back. Money is a huge motivator even for those who really are good intentioned. I also found others comments helpful. And what about allopathic doctors getting incentives from drug companies for writing prescriptions, doing procedures, and the like. This is also a conflict of interest. But it seems that allopathic doctors are always just prescribing, doing procedures, and surgeries. It’s the same. And maybe they think they deserve the extra money because of how long they studied to be a doctor and their medical school loans. And patients are getting evicted from their homes and can’t send their kids to college because their wages are getting garnished from medical bills.
You're welcome, Michele. I tend to think it has become such the norm that many doctors and practitioners aren't really thinking about it. As you can see from the comments, there are exceptions. I agree, there are conflicts of interest in other areas of medicine as well. Thanks for adding that. I didn't comment on allopathic medicine, because I'm no longer working in that world and don't have direct knowledge. Thank you for commenting on this.