Caught in the middle

Drug Store News, July 20, 1998 by Rob Eder

With point-of-sale scanners documenting the steadily rising tide of the natural care business on a daily basis, chain pharmacy executives are moving quickly to shore up their business in vitamins and mineral supplements, herbals, natural products such as melatonin and DHEA, and combined formulations aimed at such specific segments as women, men, people fighting colds or stress, and so forth.

On the one hand, many barometers show positive readings: Fueled by genuine consumer demand, food/drug/mass retail sales for vitamins and dietary supplements increased 28 percent from May 1997 to May 1998, to a total of $2.8 billion, making it the fastest-growing major category in the health-and-beauty care department. The average purchase in the category has increased by $1 over the past 18 months, to $7.05. And, joining a host of specialists in various segments of the vitamin and supplement business, some of the largest OTC companies are now weighing in with new herbal lines, including American Home Products, Bayer Consumer, Warner Lambert, Upsher-Smith and others.

On the other hand, a number of important voices in the healthcare community are calling out for caution, with a minority going so far as to ask for the products to be pulled off retail shelves. They speak of the absence of Food and Drug Administration regulation, insufficient information regarding efficacy, long-term health effects and interactions, and a lack of standardization.

As this rather intense debate continues to unfold, chain pharmacy is caught in the middle, with headquarters personnel sometimes at odds with their chains' own pharmacists. With a clear answer rot likely to emerge soon, chain executives and their pharmacists must sort through at least as many different opinions as there are colors, hues and tints in the rainbow.

Erring on the side of caution

Opposition to the natural care category generally stems from some level of doubt-with some more doubtful than others-of the proper role, if any, of dietary supplements in American health care.

"Although OTC drugs are generally effective, nearly all pharmacies still carry irrational supplements, and many stock dubious herbal and homeopathic products as well," said Stephen Barrett, M.D., who further asserts that "chain drug stores are more likely to do so than individually owned stores."

In terms of natural care cynics and self-styled nutrition business debunkers, perhaps none have been more active than Barrett, who also serves as medical editor of Prometheus Books and consulting editor of the Nutrition Forum, a bimonthly newsletter devoted to exposing "fads, fallacies and quackery" in nutrition. In addition, Barrett is a board member of the National Council Against Health Fraud, a scientific advisor to the American Council on Science and Health, and a former recipient of the FDA Commissioner's Special Citation Award for Public Service in fighting nutrition quackery. And as for the business of putting the pharmacist on point? Barrett's opinion is biased, and he does not mince words. "Pharmacy schools appear to teach the facts needed to advise people that 'nutrition insurance' is rarely needed, that 'stress' supplements are a scam, and that doses above the RDAs are seldom appropriate," Barrett continued. "Yet pharmacists throughout America seem content to sell supplements to people who don't need them. Their professional journals rarely contain articles criticizing the fraud involved, and their trade publications carry articles urging pharmacists to compete with health food retailers by using similar propaganda techniques."

Barrett is not alone in his thinking.

"Just walk into your pharmacy; it's out of control," said former FDA commissioner Dr. David Kessler in a recent article. "Efficacy is now defined by what sells off the shelves. The [FDA] is powerless."

Dubbed by some on the opposite end of the natural care debate as the "Darth Vader" of the nutritional supplement industry, Kessler has been perhaps the most outspoken, and certainly the most visible, opponent to the dietary supplement business. Certainly, his efforts to restrict the sale of dietary supplements and bar manufacturers from making health claims about their products have been welldocumented both before and after his stint as FDA commissioner from 1990 to 1997.

Kessler attended a full-day media event hosted by Good Housekeeping; the purpose of the half-day symposium was to share some of the research compiled for the magazine's April cover story, 'If It's on the Shelf, It's Safe ... Right?" as well as to share the perspectives of some of the article's key sources.

In his presentation, Kessler charged that many pharmacists have lost touch with their traditional roles as healthcare professionals, and so, have grown indifferent to what Kessler perceives to be potentially dangerous products being sold in the natural care sets adjacent to many pharmacy counters. "Maybe because they're no longer in charge of the store--just behind the counter--anything in front of the counter goes," Kessler said.