Conflicts of Interest

Last week I made some comments about the claims made in the new book by Suzanne Somers.

As expected, I had a good many people who said, “About time somebody said something,” and a few others who just felt that her publisher should have arranged for more fact checking.

To the people who agreed with me, thank you.

To those who did not, I respect your various positions, and I think that we have to look at this problem in a bit more detail.

By “this problem,” it is not simply about whether Suzanne needs to have some facts checked. I think that there is a very real problem with someone who has no medical training giving medical advice.

The more so if that person or persons is unable to undertake a critical review of published research.

This is much the same as the monstrous comments made by Tom Cruise earlier this year. He abused his position to make comments that made no sense. I saw several people who were weeping and distressed by what he had said. Many were saying things along the lines of “These medicines have saved my life, how can he say something so terrible?”

This is similar to the recent problem with Kevin Trudeau, who has made a great deal of money out of peddling highly questionable advice. He can do so in the United States because of the First Amendment. Nobody would want to change a constitutional right, but I get very worried about people saying anything that they want about health, and if anyone gets harmed, they say that it’s not their fault.

Some don’t even seem to have the wit to understand that their recommendations may cause harm. Harm that can come not just from commission – taking something harmful or being given a harmful treatment – but also of omission: not getting a treatment with proven efficacy. Trudeau claims that he is fighting on behalf of the American public. In which case, why has he not contributed the entire proceeds from the sales of his books to an independent central fund to educate the public about health?

I certainly do not think that people with an MD, DO or ND have all the answers: none of us does. But when we are talking about people’s health, I think that we all have to be extremely careful about dishing out advice.

I am also very aware that there are millions of people – mainly, but not exclusively women – who have severe problems with hormonal imbalances, and that they have not always been well-served by the medical professions. Giving unsubstantiated advice to people who are suffering is so unfair.

A number of people who are known for their work in hormone replacement have published an open letter that they have written to Suzanne Somers’ publisher, Crown House, expressing their dismay over some of the claims in her book. The signatories include Christiane Northrup and Diana Schwarzbein. Neither of whom would be called pillars of the establishment.

The Endocrine Society has just published a position paper about bioidentical hormones that I would urge you to read if you want further clarification about the whole issue of hormone replacement.

The front cover of the magazine Life Extension gleefully proclaims “Suzanne Somers Versus the Medical Establishment.” Life Extension is a fine looking glossy publication that looks like a peer reviewed Journal. It seems, though, to be a medium for disseminating information about supplements. Some of the articles are really quite good, but there is always the subtext that they are written in order to promote products.

The Journal uses a familiar tactic in some of these magazines that are selling products. This tactic is that they are letting you in on A Secret. A secret that is being kept from you by those terrible doctors or, shock horror, pharmaceutical companies that are trying to keep you sick. I’ve worked with countless pharmaceutical companies, and I’m well known for speaking my mind. But I have to tell you that in every company that I’ve worked with on five continents, the vast majority of the people involved have had a genuine concern for human welfare. Yes, they have a business to run, but pretty much all the people that I’ve known in the industry have been in that particular industry because it meshes with their own life goals of helping humanity. And as I pointed out a moment ago, the open letter to the publishers was not penned by pharmaceutical company lackeys.

Is Suzanne Somers making money out of her claims? Well, of course she is. She is using her celebrity and her extravagant claims to sell books. I’m quite sure that far fewer people would be interested in reading her material ff she just stuck to the facts.

That in itself presents some important ethical issues. Clearly, if she stuck to the data and gave a clear account of the pros and cons of what she is suggesting, she’s not likely to sell so many books.

As a spin off, she is also getting large numbers of people to visit her website, where they may buy products that may not contain bioidentical hormones, but ARE touted as being “anti-aging.” In other words the products on sale make some of the same claims that are associated with the hormones. This is a well-known marketing tactic. She claims to have one million people in her database, though we have not been able to confirm those numbers.

People all over the Internet are trying to find out if she is receiving any payments for endorsing products. I know that because several have contacted me. Of course she can do any kind of business deals that she wants, but there are ever-evolving rules about conflict of interest. Some new rules have just been proposed in the medical literature, and it would be excellent if the same standards were applied in all publications, whether print, online, in infomercials, interviews or any other kinds of medium of communication.

An important article on conflict of interest and full disclosure has just been published in the American Journal of Psychiatry.

Most major scientific journals now require that authors fully disclose ALL sources of funding. There are also strong, and I believe welcome moves to ensure that when patients receive medications, that they are fully informed if the prescriber has any relationships with drug companies. I have seen some people suggest that there should be a complete separation of pharmaceutical industry and the medical professions. A moment’s thought shows that would not be an answer to anything. If we can do this in conventional medicine, why not in every area of healthcare?

(As I’ve said before, my own list of disclosures is available to anyone who wants them, and they get updated every time that I do any work for which I get compensated. And not just me, any members of our staff. We are determined to remain squeaky clean.)

So what to do about the people who make wild claims about health, without disclosing their conflicts of interest?

Since we’ve just been through an election we’ve all seen how the squeaky wheel gets the grease!

People who say things loudly and repeatedly and appear to be saying something novel, do get attention. There’s no question about it, and there’s a good reason: Our brains are hard wired to notice and respond to loud noises and novelty. But when we are dealing with outrageous medical claims, the soft whispers of good data will ultimately drown the foghorns of dogma and opinion, however loudly they are blasted from the rooftops.

Some of the claim makers retire behind the fig leaf of saying, “Well there isn’t any data but if there were any, it would prove what I’m saying.”

Believe it or not, I’ve had that said to me on several occasions by several different people.

All of whom managed to keep a straight face…