I just returned from the Institute for Functional Medicine’s (IFM) annual scientific symposium, where close to 900 physicians and other healthcare practitioners gathered to learn about nutrition-based, non-pharma approaches to preventing and treating cardiovascular disease.
 
In its size, energy and intellectual rigor, this year’s IFM conference represented a major step forward in the evolution of holistic medicine. The meeting could well be remembered as a milestone on the long, convoluted, uphill path to “The Tipping Point.”

IFM has been quietly emerging as the leading brain trust of the natural medicine movement, bringing together core principles of naturopathic and holistic philosophy with state-of-the-art molecular biology, neurophysiology and genomics. A heady mix indeed, and one that has been steadily attracting the attention and affection of a growing number of MDs, naturopaths, chiropractors, nurses and nutrition professionals worldwide.

In past years, IFM’s annual meetings would draw a crowd of 500-600, which is impressive enough. But this year the number took a substantial leap forward, exceeding 850, including upward of 80 doctors who had never had any prior contact with the organization, and a couple hundred who had never attended one of IFM’s conferences or training seminars.

The energy at the show was simply crackling. I’ve covered hundreds of conferences in my years as a medical journalist and few have had the palpable sense of imminent transformation that I felt at IFM. It was evident everywhere: in the rapt attention the 800+ doctors gave the lecturers; in the buzz in the exhibit hall, which at times looked like the Stock Exchange during a bull market; and in the genuine camaraderie and communication that flowed freely between attendees who represented a very wide range of professional disciplines and “camps.”
 
Evidence of a Major Shift

Throughout the three days, I heard words like “critical mass,” “hundredth monkey,” “convergence” and “tipping point” everywhere I turned. Over the course of the conference, IFM raised close to $200,000 in seed money to support a project to bring functional medicine training to medical schools all over the country.
 
The evidence of a major shift is certainly not confined only to IFM. A recent daylong seminar sponsored by Metagenics drew upward of 350 New York City clinicians, who gave up a beautiful sunny spring afternoon to hear Drs. Mark Hyman, Deanna Minnich and Bridget Briggs share their insights on preventing and treating diabetes. New York is traditionally a tough medical market, and the meeting didn’t even offer continuing medical education credits for MDs. Yet they turned out.
 
Supplement company reps who attended recent meetings of the American Academy of Anti-Aging Medicine (A4M) and the Age Management Medical Group (AMMG) tell me that attendance was high at both shows, and that physician interest is much stronger than in past years. Booth reps are telling me that the quality of questions they receive from physicians visiting their exhibits is more sophisticated than in past years.
 
Suddenly, it seems, a whole lot more doctors are getting interested in nutrition and natural medicine. To quote that old Buffalo Springfield song, “There’s something happening here…”
The surge of interest and excitement is not just confined to medical conferences and seminars. Many holistic clinics are experiencing robust growth, despite the down economy, as people seek modalities that fall outside the purview of “conventional” allopathic medicine.

Ben Kligler, MD, MPH, of the Continuum Center for Health & Healing at Beth Israel Medical Center in New York City, says his clinic cannot keep up with the public’s demand for access. “Continuum sees roughly 4000 patients per year, and we can’t see all the patients that want to come in,” he said at the American Herbal Products Association’s inaugural Botanical Congress in May.

“We’re expanding, taking over the entire third floor of our building,” said Dr. Kligler, a pioneer in the field of integrative medicine.
 
Recession Has Little Impact

The growth of integrative clinics like Continuum reflects broader public interest in natural medicine and natural products, as evidenced by continued robust sales of nutraceuticals, herbal medicines, homeopathics and healthy foods despite the hard economic times.
 
According to Loren Israelsen, executive director of the United Natural Products Alliance, a Utah-based industry trade group, total sales of dietary supplements and “nutraceuticals” represented $924 million for the state of Utah alone. In 2012, the figure will hit $7.2 billion. There’s been consistent growth every year for the past 20 years, to the tune of 11% per year. This growth has continued steadily since 2008 when the recession began.

According to Mark Blumenthal, founder and director of the Austin, TX-based American Botanical Council, sales of botanical medicines—one of the weaker segments of the supplement industry—still generated more than $379 million in the mass market and over $251 million in natural foods and specialty stores in 2011.
 
This does not include herbs sold as teas, which are classified as “foods” by industry bean counters. Herbs have shown growth rates of 4%-7% during the recession years. These data, from Symphony IRI, do not include sales through healthcare professionals, buying clubs like Sam’s Club or Costco, or convenience stores.
 
Speaking at UNPA’s conference, Mr. Blumenthal said recent findings from the Natural Marketing Institute (NMI), Harleysville, PA, show that roughly one in five consumers believe herbs represent important tools for maintaining health; and that 39% of all Baby Boomers and 41% of Gen-Xers are using herbs for health maintenance, prevention and—yes—treatment of diseases. Roughly 20% say they have increased their use of supplements since the economic downturn. (Full data that ABC has collected from both IRI,  SPINS and NBJ, will be published in the annual HerbalGram Herb Market Report, coming out in August in HerbalGram #95).
 
Though it does seem like we are reaching a tipping point, particularly among healthcare practitioners, the transformation process is still in its earliest stages, and there’s a long way to go before nutritional products, botanical medicines and the like become cornerstones of standard medical practice.
 
IFM’s robust plans aside, medical education remains conservative, and many physicians are still hesitant to bring supplements, herbs and other forms of natural medicine into their practices. “Mainstream medicine is still on this cusp,” Dr. Kligler said. “Concerns over ‘standard of practice’ are a major source of inhibition. We are prisoners of ‘standards of care.’”

That said, physicians who dismiss or ignore natural medicine do so at their own risk. “Our patients are doing all of this stuff already. Why do we want it to be a separate stream, an ‘other’ that we either ignore or discourage? If 40-plus percent of your patients are doing something, doesn’t it behoove you to know about it? Patients these days expect their doctors to know about herbs and supplements,” Dr. Kligler said.

Dealing with Double-Standards

As a medical educator and practicing clinician, Dr. Kligler has years of experience mediating between the worlds of “alternative” and conventional medicine. He described what could only be called a double-standard that underlies much of conventional medical thinking.

“If you prescribe an NSAID and the patient has a GI bleed, that’s a known and expected side effect, so as a doctor you are supported by the ‘standard of care’ because most doctors prescribe NSAIDs, despite this risk,” Dr. Kligler said. “If you recommend an herb, and there is an adverse effect, will you be supported by standards of care?”

A certain degree of conservatism and skepticism toward herbs and supplements makes good sense, but it needs to be even-handed and it needs to leave room for patient preferences.
In his own practice, Dr. Kligler says he considers four things when advising patients about herbs and supplements: Are they safe? Are they affordable? Are they what the patient wants? Is there any evidence of efficacy?

“I really consider who is the patient, and what does he or she want to do. All things being equal, this ends up being the decider,” Dr. Kligler said. If there’s no strong evidence one way or the other, or the evidence is equivocal, he says he usually opts for trying the herb or supplement, so long as he is convinced of the safety.

Public preference for botanicals, nutraceuticals and food-based therapies is not going away anytime soon, and it has not been tempered by the recession. The medical community needs to do a better job of meeting patients’ demands.

Dr. Kligler said that many doctors’ worst fears—that they will be sued or confronted with disciplinary actions if they talk about herbs or other supplements—may be unfounded. “There are not a lot of cases of doctors getting sued for discussing or recommending herbs,” Dr. Kligler said. “In fact, you might encounter liability by not talking about them.”

Useful Guidelines

Dr. Kligler’s key considerations can serve as useful guidelines for companies developing products for the practitioner channel. In considering your product positioning, you must earn clinicians’ confidence not only in the safety and efficacy of your products, but also in their ability to meet real health needs, and provide patients with real economic value.
 
Remember that when encouraging practitioners to recommend or dispense your products, you are essentially asking for a very high level of trust and confidence. Ultimately, it is that clinician who must sit face to face, eye to eye and heart to heart with his or her patient.
 
These are indeed exciting and fast-moving times in the practitioner channel, with great opportunity for science-based nutraceuticals. Discussions we had at SupplySide Marketplace indicate that many branded ingredient companies are considering plays in the practitioner space; the same holds for finished product companies that have up ‘til now played largely on the direct-to-consumer side.
 
The practitioner channel presents many unique challenges, and given all the turbulence in healthcare these days, a successful play will require thorough understanding of the clinical landscape.

To this end, my company, Holistic Primary Care, is teaming up with fellow Nutraceuticals World columnist Greg Stephens and his Windrose Partners, to produce the inaugural “Healthcare Practitioner Marketing Forum” (HPMF), a 3-day executive retreat, April 3-5, 2013, at the Hotel Maya in Long Beach, CA.
 
The Forum will offer opportunities to learn from nationally recognized experts and real-world examples of successful practitioner channel companies. Key topics include: Building your brand by building trust; communicating efficacy and safety; assessing practitioner channel opportunities; strategies for market entry and brand development; understanding different practitioner segments; effective outreach at medical conferences; navigating claims and other regulations; and adapting the pharma and medical food industry playbook for nutra industry metrics.

You’ll have a chance to hear from practitioners themselves, and network with potential channel partners. Stay tuned!

Erik Goldman is the editor of Holistic Primary Care-News for Health & Healing, a quarterly medical news publication covering the field of holistic health care for an audience of roughly 65,000 primary care physicians. He is also co-founder of “Heal Thy Practice: Transforming Primary Care,” an annual conference focused on business models for integrative health care practices. The next Heal Thy Practice will be in Long Beach, CA, Nov. 9-11, 2011. He is currently collaborating with Greg Stephens & Windrose Partners to develop the first Health Practitioner Marketing Forum, an educational gathering on opportunities and challenges in the health care practitioner channel. For more information contact Erik at: 212 406-8957 or Erik@holisticprimarycare.net