Imagine an ideal healthcare world where the divisions between "conventional" and "alternative" practitioners were softened into a smooth continuum of care; a world in which practitioners and natural products retailers, rather than living in their own isolated universes, freely collaborated and exchanged referrals, keeping patients/customers best interests at the forefront.

In this healthcare utopia, physicians-even in the mainstream-would be on a first-name basis with their local supplement retailers, and would feel free and confident to refer patients seeking vitamins, herbs, and homeopathics to qualified, well-trained consultants in reputable stores who could provide supplements and information that the physicians are unable or unwilling to provide. Likewise, retailers would know which practitioners in their areas were open-minded about holistic approaches, and would refer customers who clearly need medical care and guidance to those professionals who could best help them.

This would obviously be good for both the practitioners and the retailers, but most important, it would be good for patients. Individuals seeking integrative healthcare-and data from many sources indicate that this is what a majority of Americans want-would know that their physicians are communicating with their supplement retailers and vice versa.

Collegial alliances between physicians and retailers go a long way toward ensuring that people end up with the most appropriate nutraceuticals and herbs for their healthcare needs, at the same time reducing the risk of adverse drug-supplement interactions, and ideally helping minimize the confusion faced by many supplement users.

The good news is that such bridge-building is occurring organically at the local level, as forward thinking physicians and conscientious retailers seek each other out and find they have much to gain in collaboration. Pioneering retail chains like Pharmaca Integrative Pharmacy and Elephant Pharmacy are exploring radical new visions of what natural products retailing can be, and they're blurring the generally rigid distinction between vitamin store and healthcare clinic.

A new generation of physicians is emerging from the nation's medical schools, nearly all of which have adopted some measure of coursework in "complementary and alternative medicine." This means that young, up-and-coming doctors will likely be far more open to the use of natural products and to collaboration with holistic practitioners than their predecessors may have been. The ranks of licensable NDs continue to increase each year. The steady growth of the practitioner channel in the natural products industry, estimated at roughly 10% per year for the last few years, also indicates that this vision of an integrative healthcare landscape is no mere pipedream.

But there's still a lot of work to do. On the whole, the retail world and the medical world-even the alternative medical world-remain parallel universes, isolated from one another by walls of professional pride, economic incentive and mutual suspicion. Some physicians shudder at the notion of minimally-educated "shop clerks practicing medicine without a license." They may see retailers as simply "product pushers" whose primary concern is boosting store profits.

Since there are no standards for the education of natural products retailers, who often do function as health counselors, physicians' fears are not entirely unrealistic. Some physicians may also secretly resent the fact that retailers may know far more than they do about nutrition science and botanical medicine.

Retailers, on the other hand, often view doctors as arrogant and closed-minded people too busy writing prescriptions to actually take the time to listen to their patients. Mainstream medicine's rigidity, turf protectionism, and strong ties to the pharmaceutical industry certainly feed this view. But retailers and nutraceutical advocates often fail to understand the extreme financial, medicolegal and time pressures with which physicians-even the holistic ones-must contend.

The natural products industry, since it spans both the practitioner and the retail/
consumer realms, is ideally suited to help build the bridges and lay a foundation for a more integrative healthcare system. It has everything to gain by doing so: bridge-building would generate business on both ends, leading to more appropriate and more effective supplement use, better clinical outcomes and ultimately, happier customers and renewed trust in the value of nutraceuticals.

For most of its history, the industry has largely treated the two worlds as entirely separate domains. One could say that parallel lines have been the rule. There were practitioner lines, and consumer lines, and seldom the twain would meet.

Practitioner-focused lines typically target chiropractors, naturopathic doctors, "anti-aging" specialists and holistic MDs with sophisticated condition-specific formulas, high-dose "therapeutic" nutraceuticals, or products containing ingredients that rightfully should be used under clinical guidance. Some companies have thriving businesses in private-labeling supplement products for physician practices.

Companies that play exclusively to the practitioner channel command far higher prices than those that play in the rough and tumble retailer channel where supplements are often priced as commodities. A "practitioner-only" formulation gives holistic practitioners a much-needed revenue stream, and gives their patients the convenience of one-stop shopping. There tends to be far stronger brand loyalty in the professional channel than in the retail channel, along with a much higher level of science, credibility and innovation. For companies willing to make the commitment, the rewards can be great.

Though the practitioner channel is clearly growing, it will likely remain a relatively small segment of the industry for the foreseeable future. Recognizing this, "professional channel" companies are quietly moving into the retail channel. They do so by either starting separate "consumer" lines under unique brand names, or by stocking their "pro-level" products behind the counter to be dispensed by qualified nutritionists, nurses, pharmacists or other professionals working in select health food stores and natural pharmacies.

On the other side of the once-great di-vide, many consumer-oriented retail lines have entered the practitioner channel with new lines and brand identities distinct from their retail lines. In some cases, these "pro" product lines feature higher-dose versions of the consumer products; in others, they are simply the same products in different bottles, often with higher prices.

I believe this convergence is a good sign, an indicator that the once unbridgeable gap between healthcare clinic and health food store is narrowing. But the trend definitely presents challenges for all parties involved, and the movement toward integration needs to be undertaken mindfully.

Practitioner brand managers seeking to capture a piece of the retail market need to understand the challenges this strategy can present for retailers. Sherry Walker, a certified nutritionist and supplement buyer for Whole Wheatery, a Lancaster, CA, retailer, said that in her experience the behind-the-register pro-level products have a difficult time competing with off-the-shelf consumer brands.

"Most supplement retailers don't have a health professional on staff, and can't afford to have one. Many don't have the luxury of 'behind-the-counter' retail space for products that would need to be dispensed by a professional." She added that the cool, clinical aesthetic of many pro-brand labels-the very sort of image that states "science" and "credibility" to doctors-often does not coo, "buy me," to the retail shopper.

A pro brand's move into the retail segment might not sit too well with loyal practitioners either, especially if the same product is available on the retail shelves at a lower price. Physicians who dispense supplements-the cornerstone market of the practitioner channel-may feel that they're being sold short by the very companies to which they'd committed years of business. Patients who can suddenly get the same product at a lower price from a retailer may start to suspect that their doctor has been taking advantage.

Likewise, consumer brands that enter the practitioner channel also need to be careful. According to Ms. Walker, "One product with two different labels, one for professionals, the other for retailers, is confusing to customers." Dual branding can be particularly tricky when a physician who does not sell supplements sends a patient to a retailer with a request for the pro-channel brand name. On one hand, this is exactly the sort of physician behavior we'd all like to see-a clear referral for a specific branded product. But the dual branding leaves the retailer in the position of having to explain to the customer that the store sells the consumer version. "Many times, a customer wants exactly what the doctor ordered and not the same thing with a different label," said Ms. Walker.

Like many other aspects of the natural medicine movement, greater integration between practitioners and retailers is being driven by the consumers themselves, and the strongest, most beneficial models will emerge when all parties involved actually listen to what people really want.

"Ever since the Women's Health Init-iative study (showing increased cancer incidence from hormone replacement therapy) was halted, we've had more doctors than ever sending their female patients to us," said Ms. Walker. "This has been a tremendous opportunity for us as retailers to build bridges between women, their doctors and their stores."

Industry leaders can play a key role in harmonizing the relationships between retailers and health professionals. I believe a bright future awaits those who venture into this crossroad with careful cognizance of existing market dynamics, far-reaching vision and most important, sensitivity to the needs and sensibilities of consumers, practitioners and retailers. NW