Erik Goldman, Holistic Primary Care05.01.14
Clinical studies with negative outcomes are a fact of life in medical research. Sometimes the data just don’t show what we want or expect them to show. Ask anyone who works in research… or any of your friends who work in the pharmaceutical industry.
Yet, somehow negative studies about dietary supplements seem to trigger apoplectic responses from our industry.
As soon as a bummer finding emerges from the hallowed halls of academia, you can bet your inbox will be flooded with a predictable litany of industry responses: The methodology was flawed. The researchers were biased. Research techniques developed for pharma research are inappropriate for the study of nutrients or herbs. They used the wrong form. Or the wrong dose. Or wore the wrong color socks when they were doing their statistical calculations.
The cries of foul play become strident if the negative trial in question gets picked up and then dumbed down by mainstream media outlets.
To be sure, there are a lot of flawed study designs, especially when supplement trials are designed and executed by researchers with little background or training in nutrition. And it is absolutely true that most mainstream media coverage of nutritional studies—both positive and negative—borders on moronic.
I believe it is important for the more knowledgeable voices of our industry to step forward and point out methodological errors or provide context for new negative studies.
But my sense is that our industry’s reflexive responses to negative findings are coming less from a place of concern for scientific integrity and more from a deeply held insecurity about A) the true efficacy of our products, B) the scientific provability of this efficacy and C) the economic impact that a negative trial may have on a given product category.
Honestly, I think it’s the latter concern that’s the biggie.
Just as an endorsement from Dr. Oz can heat up sales not just of an individual supplement product but an entire product category, so too a negative study can be a major wet blanket—especially if the new findings make the 11 o’clock news.
The Dreaded Wet Blanket
According to the Global Organization for EPA an DHA Omega-3s (GOED), roughly 12 million consumers stopped buying omega-3 supplements since 2012, a downturn GOED attributed largely to two widely covered studies: a meta-analysis in 2012 questioning the long-established heart-health benefits of omega-3s, and the study last year suggesting a link between omega supplementation and risk of prostate cancer. GOED estimated that retail sales of omega-3 products dropped by 11% in the six months following the prostate study.
It is understandable that such extreme swings in consumer behavior caused a lot of sleepless nights for people in our industry. Studies suggesting any increase in cancer risk associated with a supplement seem to have the most damning and long-lasting impact on sales.
But is the issue really one of scientific method or more to do with consumer behavior?
Unbroken Confidence
The good news for players in the healthcare professional channel is that practitioners seem to be much less easily swayed by negative studies than consumers.
That may sound surprising—even counter-intuitive—but it appears to be the case based on data from Holistic Primary Care’s new 2014 healthcare practitioner survey.
From January to March of this year, we fielded responses from 549 primary care physicians (predominately conventionally trained MDs and DOs) and 94 nurses, who answered a 31-question survey on their attitudes toward and engagement with holistic modalities, dietary supplements and nutritional medicine.
Among the questions, we asked the following: “Over the last year, what net effect has the published research on nutrition, supplements & natural products had on your practice patterns?”
What we found was surprising: 51% of the cohort responded that they were MORE confident in recommending supplements, 45% responded there was no change in their confidence and only 5% said they were less confident in recommending supplement products to their patients.
When we looked at the MDs alone, we found a very similar pattern: 53% said they were more confident, 42% said there was no change in confidence and 5% said they were less confident.
The 90-plus nurses in the survey (mostly distributed between nurse practitioners, nurse midwives and registered nurses) showed less overall confidence in supplements. Still, 38% of the nurses said they were more confident in recommending supplements based on the net impact of research findings in 2013 and only 6% were less confident.
For the record, these practitioners while conventionally trained are more supplement-friendly than many people might assume. Nearly 80% said they are discussing supplements with patients at least once daily, and 91% said they do recommend some supplements in their practices.
These findings, which I first reported at the second annual Health Practitioner Marketing Forum in April, should come as welcome news, given that the practitioner responses came just a few months after the negative omega-3 report, as well as a spate of other negative supplement studies throughout the course of 2012-2013.
I was expecting the respondents to show a major loss of confidence in supplements based on all the negative press they’ve been receiving. It simply was not the case.
The numbers suggest that practitioner behavior is not as easily swayed by single studies and hyperbolic headlines as consumer behavior.
Doctors and nurses are used to seeing and hearing negative trials (there are plenty of negative or inconclusive pharma studies). They take them with a grain of salt, put them in broader scientific context, and tend to take a more measured view in either direction.
There’s an inherent conservatism in medical thinking, a general unwillingness to make sudden changes in practice patterns. Doctors and nurses are less likely to jump on a product’s bandwagon based on one or two positive studies; but it seems they are also less likely to abandon useful products based on one or two negative trials.
We did not drill down and ask specific questions about confidence in particular supplement categories (there’s a limit to how many questions participants will reasonably answer). Suffice it to say that the top most-recommended supplement brand and the second most commonly dispensed brand among this cohort of practitioners is an omega-3 brand (to find out which, and to learn lots more about the practitioner segment, watch for our 2014 Survey Report coming soon).
In short, if consumers have become skittish about omegas since last year, it seems that practitioner confidence is holding fast. If doctors and nurses did lose any confidence in omegas, they certainly have not generalized that to a loss of confidence in supplements and nutraceuticals.
Yes, we have heard that following the prostate study, some medical directors at some medical centers and hospital networks banned omega-3 products from hospital formularies or issued policies forbidding practitioners to recommend them. That’s not terribly surprising; clinicians in institutional settings tend to be much less friendly toward supplements in general, and given our nation’s taste for medical litigation, hospitals are extremely risk-averse.
Our survey respondents are, by and large, solo and small-group practitioners. They’re your typical family physicians, general internists and nurse practitioners out there in the trenches of American healthcare.
For them, last year’s blizzard of negativity did not cause a crisis in confidence. Just the opposite, it would seem.
It may be that negative studies, paradoxically, reinforce rather than destroy confidence. Perhaps to a clinically trained mind, anything that always comes out looking good begins to look too-good-to-be-true. Perhaps an occasional negative or inconclusive finding makes a product or product category look real enough to be believed.
Erik Goldman is co-founder and editor of Holistic Primary Care: News for Health & Healing, a quarterly medical publication reaching about 60,000 physicians and other healthcare professionals nationwide. He is also co-producer, with Greg Stephens of Windrose Partners, of the Health Practitioner Marketing Forum, an executive level summit focused on challenges and opportunities in the health practitioner channel. The 2014 Forum was recently held in Long Beach, CA, and plans are in development for 2015; details will be announced soon. Visit www.HPMForum.com for more information.
Yet, somehow negative studies about dietary supplements seem to trigger apoplectic responses from our industry.
As soon as a bummer finding emerges from the hallowed halls of academia, you can bet your inbox will be flooded with a predictable litany of industry responses: The methodology was flawed. The researchers were biased. Research techniques developed for pharma research are inappropriate for the study of nutrients or herbs. They used the wrong form. Or the wrong dose. Or wore the wrong color socks when they were doing their statistical calculations.
The cries of foul play become strident if the negative trial in question gets picked up and then dumbed down by mainstream media outlets.
To be sure, there are a lot of flawed study designs, especially when supplement trials are designed and executed by researchers with little background or training in nutrition. And it is absolutely true that most mainstream media coverage of nutritional studies—both positive and negative—borders on moronic.
I believe it is important for the more knowledgeable voices of our industry to step forward and point out methodological errors or provide context for new negative studies.
But my sense is that our industry’s reflexive responses to negative findings are coming less from a place of concern for scientific integrity and more from a deeply held insecurity about A) the true efficacy of our products, B) the scientific provability of this efficacy and C) the economic impact that a negative trial may have on a given product category.
Honestly, I think it’s the latter concern that’s the biggie.
Just as an endorsement from Dr. Oz can heat up sales not just of an individual supplement product but an entire product category, so too a negative study can be a major wet blanket—especially if the new findings make the 11 o’clock news.
The Dreaded Wet Blanket
According to the Global Organization for EPA an DHA Omega-3s (GOED), roughly 12 million consumers stopped buying omega-3 supplements since 2012, a downturn GOED attributed largely to two widely covered studies: a meta-analysis in 2012 questioning the long-established heart-health benefits of omega-3s, and the study last year suggesting a link between omega supplementation and risk of prostate cancer. GOED estimated that retail sales of omega-3 products dropped by 11% in the six months following the prostate study.
It is understandable that such extreme swings in consumer behavior caused a lot of sleepless nights for people in our industry. Studies suggesting any increase in cancer risk associated with a supplement seem to have the most damning and long-lasting impact on sales.
But is the issue really one of scientific method or more to do with consumer behavior?
Unbroken Confidence
The good news for players in the healthcare professional channel is that practitioners seem to be much less easily swayed by negative studies than consumers.
That may sound surprising—even counter-intuitive—but it appears to be the case based on data from Holistic Primary Care’s new 2014 healthcare practitioner survey.
From January to March of this year, we fielded responses from 549 primary care physicians (predominately conventionally trained MDs and DOs) and 94 nurses, who answered a 31-question survey on their attitudes toward and engagement with holistic modalities, dietary supplements and nutritional medicine.
Among the questions, we asked the following: “Over the last year, what net effect has the published research on nutrition, supplements & natural products had on your practice patterns?”
What we found was surprising: 51% of the cohort responded that they were MORE confident in recommending supplements, 45% responded there was no change in their confidence and only 5% said they were less confident in recommending supplement products to their patients.
When we looked at the MDs alone, we found a very similar pattern: 53% said they were more confident, 42% said there was no change in confidence and 5% said they were less confident.
The 90-plus nurses in the survey (mostly distributed between nurse practitioners, nurse midwives and registered nurses) showed less overall confidence in supplements. Still, 38% of the nurses said they were more confident in recommending supplements based on the net impact of research findings in 2013 and only 6% were less confident.
For the record, these practitioners while conventionally trained are more supplement-friendly than many people might assume. Nearly 80% said they are discussing supplements with patients at least once daily, and 91% said they do recommend some supplements in their practices.
These findings, which I first reported at the second annual Health Practitioner Marketing Forum in April, should come as welcome news, given that the practitioner responses came just a few months after the negative omega-3 report, as well as a spate of other negative supplement studies throughout the course of 2012-2013.
I was expecting the respondents to show a major loss of confidence in supplements based on all the negative press they’ve been receiving. It simply was not the case.
The numbers suggest that practitioner behavior is not as easily swayed by single studies and hyperbolic headlines as consumer behavior.
Doctors and nurses are used to seeing and hearing negative trials (there are plenty of negative or inconclusive pharma studies). They take them with a grain of salt, put them in broader scientific context, and tend to take a more measured view in either direction.
There’s an inherent conservatism in medical thinking, a general unwillingness to make sudden changes in practice patterns. Doctors and nurses are less likely to jump on a product’s bandwagon based on one or two positive studies; but it seems they are also less likely to abandon useful products based on one or two negative trials.
We did not drill down and ask specific questions about confidence in particular supplement categories (there’s a limit to how many questions participants will reasonably answer). Suffice it to say that the top most-recommended supplement brand and the second most commonly dispensed brand among this cohort of practitioners is an omega-3 brand (to find out which, and to learn lots more about the practitioner segment, watch for our 2014 Survey Report coming soon).
In short, if consumers have become skittish about omegas since last year, it seems that practitioner confidence is holding fast. If doctors and nurses did lose any confidence in omegas, they certainly have not generalized that to a loss of confidence in supplements and nutraceuticals.
Yes, we have heard that following the prostate study, some medical directors at some medical centers and hospital networks banned omega-3 products from hospital formularies or issued policies forbidding practitioners to recommend them. That’s not terribly surprising; clinicians in institutional settings tend to be much less friendly toward supplements in general, and given our nation’s taste for medical litigation, hospitals are extremely risk-averse.
Our survey respondents are, by and large, solo and small-group practitioners. They’re your typical family physicians, general internists and nurse practitioners out there in the trenches of American healthcare.
For them, last year’s blizzard of negativity did not cause a crisis in confidence. Just the opposite, it would seem.
It may be that negative studies, paradoxically, reinforce rather than destroy confidence. Perhaps to a clinically trained mind, anything that always comes out looking good begins to look too-good-to-be-true. Perhaps an occasional negative or inconclusive finding makes a product or product category look real enough to be believed.
Erik Goldman is co-founder and editor of Holistic Primary Care: News for Health & Healing, a quarterly medical publication reaching about 60,000 physicians and other healthcare professionals nationwide. He is also co-producer, with Greg Stephens of Windrose Partners, of the Health Practitioner Marketing Forum, an executive level summit focused on challenges and opportunities in the health practitioner channel. The 2014 Forum was recently held in Long Beach, CA, and plans are in development for 2015; details will be announced soon. Visit www.HPMForum.com for more information.
