Between one-half and three-quarters of all adults in the United States report taking dietary supplements. And while nearly half of consumers (48%) purchase their supplements from well-known retail outlets, according to a report published in 2011 by dietary supplement association the Council for Responsible Nutrition (CRN; Washington, DC), more than half of them (55%) point to their medical doctor or physician as being their number-one most-trusted source of reliable information on dietary supplements.
With so many consumers looking to their practitioners for guidance on supplements, it doesn’t require a huge leap of imagination to consider that practitioners are positioned to significantly influence the fortunes of the supplement industry by recommending—or not recommending—particular supplements to their patients, and even dispensing supplements themselves.
In fact, that is exactly what is happening, with more practitioners expected to recommend, and especially sell, supplements to patients in the near future. Erik Goldman, editor of Holistic Primary Care: News for Health & Healing, which sponsored the Health Practitioner Marketing Forum this past April, confirms: “There are a lot more practitioners using supplements, recommending supplements, and in some cases dispensing supplements in their offices” now than there were just a few years ago. Goldman recently surveyed U.S. practitioners about their practices and their use of what has been historically viewed as “alternative medicine” and found that an eye-popping 91% of the 643 respondents (who included primary-care physicians, nurses, naturopathic doctors, and others) are currently recommending supplements, nutraceuticals, or natural products to their patients. A full 95% of the MDs surveyed (mainly in general practice) are doing so. What’s more, 45% of respondents are considering dispensing supplements and natural products out of their offices directly to patients via dispensary or an online service.
This data all bodes very, very well for the supplement industry and those who produce the raw materials for it, despite some ongoing challenges—in particular, heavy competition from drugs and a still-evolving body of definitive science.
Building a Relationship
Primary-care physicians (particularly those caring for mothers and older female patients), nurses, and some specialists (mainly cardiologists, orthopedic doctors, and dermatologists) are recommending supplements and talking openly with patients about them, which reflects a “slow, steady paradigm shift” that is predicted to continue, according to Duffy MacKay, senior vice president, scientific and regulatory affairs, CRN. Indeed, 57% of cardiologists, 75% of dermatologists, and 73% of orthopedists reported actually taking supplements themselves, at least occasionally, in a 2011 study conducted by Ipsos Public Affairs for CRN and published in Nutrition Journal. That personal interest in wellness and prevention, particularly among practitioners who are part of the Baby Boomer generation, plays a part in the good relationship between them and industry, says David Foreman, RPH, ND, a retired pharmacist who created and maintains The Herbal Pharmacist blog. Holistic Primary Care editor Goldman agrees, adding that although most of these Baby Boom–era doctors were trained in a “very orthodox, traditional way,” culturally, nutrition science, supplementation, and prevention have been in play for much of their lifetimes. The Boomers tend to believe in proper nutrition for good health, as well as in certain medical conditions, such as food allergies or gluten sensitivity, that were dismissed as “way out of left field” the generation before, Goldman explains. “There are definitely a lot of mainstream doctors who don’t think there is anything radical or alternative about recommending a fish oil or a probiotic at this point,” he says.
Also playing a large and growing role in the generally positive relationship between practitioners and industry is the former’s interest in seeking out new revenue streams. Foreman, Goldman, and Douglas Laboratories’ Gene Adamski, whose company sells supplements to practitioners to sell to their own patients, all cite this factor.
“More and more practitioners are actively coming to us wanting to explore supplementation in their practices,” Adamski says. “The landscape is changing in terms of how practitioners are being reimbursed,” he explains, which has resulted in some dissatisfaction among private-practice owners who feel their net income is suffering. Simply put, health insurance reimbursement is decreasing, while medical office overhead is increasing.
“Private-practice doctors are at a crossroads,” Goldman states, “where they are saying, ‘Yes, I want to stay independent despite declining insurance-company reimbursement, in which case I may have to shift my practice model.’” These shifts, he says, can take the form of simply adding supplement sales and other new sources of revenue to the practice, or they can mean leaving insurance networks altogether in favor of going cash-pay only or adopting a concierge structure, in which patients pay a practitioner annually and subscribe to his or her services. Goldman’s survey reveals that 47%—nearly half—of practitioners surveyed are “considering making a major change to their practice model within the next two to three years,” while 53% are “actively seeking new revenue streams”—such as supplement sales.
On the other hand, practitioners who do not own their own practices but instead belong to large hospital or clinic networks are generally not free to seek additional revenue streams or even to make supplement recommendations that haven’t been explicitly sanctioned by the hospital leadership, so the connection to industry among that group is less solid and much slower-growing.
Another population that is increasingly likely to recommend nutritional supplements to patients, however, is nursing professionals. Nurses and nurse practitioners “spend a lot of time with their patients, and they spend a lot of time on counseling on lifestyle and diet,” CRN’s MacKay explains. The Herbal Pharmacist’s Foreman agrees with MacKay on this point, adding that the majority of nursing professionals are women, and, nationwide, women purchase and consume more nutritional supplements than men do.
Just which supplements practitioners are recommending and even selling to patients most is clear-cut; consensus emerged among all those interviewed for this article. Probiotics, minerals (such as iron and calcium), essential fatty acids (such as omega-3s), and letter vitamins (such as D) lead the pack, followed by multivitamins, specialty supplements (such as coenzyme Q10, recommended mostly by cardiologists, and SAM-e and chromium), and supplemental fiber. Cranberry extract is recommended quite freely and confidently by those in family practice, CRN’s MacKay adds, and he expects an uptick in practitioner recommendations of iodine supplementation to pregnant patients, based on findings laid out in a position paper published this summer by the Academy of Pediatrics about the element’s potential effect on a fetus’s cognitive development.
Recommendations and sales of vitamin D, which has enjoyed enormous name recognition and popularity in recent years, might soon “plateau,” MacKay says, based on a recent U.S. Preventative Services Task Force recommendation that physicians discontinue widespread vitamin D screening. The task force “believes doctors should use a little more judgment to determine who is at risk for deficiency,” MacKay explains, “and that only those individuals should be tested. So if clinicians respond to that, then we’ll see a little less testing, but it will stabilize similarly to how calcium has stabilized: popular forever, necessary, important. But I don’t think we will see that continued upward growth and interest.”
Trailing farther behind the widely recognized and relatively well-regarded big-name supplements are enzymes (though this category is growing), so-called medicinal foods, homeopathics, and medicinal mushrooms.
The health reasons for which practitioners are currently most likely to recommend supplements to patients, according to Douglas Laboratories’ Adamski, include cardiovascular support, autoimmune support, weight loss, stress relief, vitamin deficiency based on blood work, hormone support, inflammation, and general wellness. On the horizon, he adds, will be recommendations for products geared toward women’s hormones and adrenal fatigue, and The Herbal Pharmacist’s Foreman predicts increasing interest in products for blood sugar and antiaging support.
The How-To of Dispensing and Selling Supplements
In Goldman’s survey, about two-thirds of practitioners are seeking new revenue streams for their practices; of these, half are considering dispensing supplements as a way of generating more revenue. The two major methods by which practitioners dispense and sell are 1) by contracting with a supplement manufacturer that operates a practitioner-only sales channel, such as Douglas Laboratories, and 2) by joining and using an online platform, such as PureRxO and Natural Partners, which allows practitioners to order various products and brands from one virtual location or to set up individual websites and maintain virtual stock for patients.
For in-office dispensing, Adamski says, depending on the practitioner’s specialty, if any, and how integrative his or her practice is, a practitioner might carry and stock anywhere from 10 to 100 different products. “We have smaller accounts that order from us twice per year,” he explains, “and larger accounts ordering product every day.” Once a practitioner has contracted with Douglas Laboratories, Adamski says, the company offers “patient-fulfillment programs for which the patient can call Douglas directly, or go online.” In that model, product is shipped directly to the patient on behalf of the practitioner, and the practitioner gets a cut of the sale.
For the online arrangement, the Web platform makes various supplement brands and products available, and in some cases (as with PureRxO) the practitioner sets up his or her own website on that platform. The practitioner specifies which products are “stocked” on his or her site, and patients can shop there. The practitioner takes a percentage of sales.