If vitamins don’t work, will industry-sponsored scientists tell us so?
Our consultation is nearly at an end when she asks, “So which vitamins are the best?”
“You don’t need vitamins”, I reply. “You are eating a variety of foods and getting some exercise, which is great.”
“But vitamins might cure my cancer.”
“I wish they could”, I say sympathetically, “but I think you understand that we can’t make your cancer go away although we can stabilise the symptoms.”
“But at least my immune system will be boosted and I will feel happier.”
“Vitamins won’t help if you don’t have a nutritional deficiency.”
She regards me dubiously. I also know that she has struggled to keep up with the mounting incidental costs of cancer therapy. Her husband has privately confessed using less insulin for his diabetes so that there is money left over for her growing stash of natural therapies. I told him plainly that she could relinquish them all and not know the difference.
“So you don’t think my vitamins work?”
“I just don’t think you need them.”
“Then”, she asks triumphantly, “why is a university so interested in them? They must do something!“
My heart sinks. Ever since the news broke that the vitamins giant Swisse was contributing $15m to “independent” research by Latrobe University into complementary medicine, I have been troubled by the ramifications for the broader community which, it must be said, is largely health illiterate. Every doctor I have spoken to is flummoxed that a prestigious university would put its credibility on the line over this matter. Now comes the news that professor Ken Harvey, a respected academic and government advisor on natural therapies, has resigned over the furore, citing a fundamental conflict of interest and foreseeing problems with research integrity.
In other words, he seems to be asking the question that plagues researchers and scientists across the globe: “How can I safeguard the independence of my work if I am being funded by the company who makes the product?” It is not inconceivable that one might feel conscious about biting the hand that feeds.
A related tricky question is, “if my research shows that complementary products, especially those made by Swisse, are no better, or even worse than placebo, how hard should I try to publish it?” It is a well-known fact that negative and inconclusive trials rarely make it to print while positive trials, however small the benefit, do. And then, another one: “who should write the paper resulting from trials?” It may come as news to the public that companies commonly employ professional writers to produce entire papers to which authors simply attach their name for a handsome payment and the promise of academic recognition.
Researchers do not deliberately set out to mislead the public; research is so poorly remunerated that one conducts it for the passion. Similarly, no doctor ever admits to being knowingly influenced by free post-it notes, pens or a lavish dinner. But it is naive to rely on a robust ethical compass alone to navigate one’s way through modern medicine, traditional or complementary – which is why around the world rules are being tightened on how doctors engage with big pharma, and why journal editors insist on greater accountability about source of funding, conflict of interest, and original authorship.
In this context, it is peculiar that a university would team up with a complementary medicine company to effectively promote its wares. While academia may pursue higher ideals like subjecting Swisse and similar products to “rigorous and independent, scientific assessment”, I can tell you that my patient is far from alone in her reductionist view. To patients like her, Swisse is immediately more credible because a recognised university has embraced it. To the medical and scientific community, the researchers’ work will seem tainted, regardless of the truth.
The $2bn annual sales of thousands of complementary therapies in Australia are part of a staggering $83bn in global sales. As an oncologist, I take it for granted that my patients are using them regardless of the meagre evidence.
In fact, there is evidence to support that some vitamins taken in high doses actually cause harm. And every oncologist has met a patient rendered debilitated and bankrupt by the fraudulent promises of some complementary therapy. Faced with carefully nuanced advice about the risks of chemotherapy and the emphatically upbeat world of the “natural therapy” patient freed of her ills, I am not surprised that my patients are amongst the last to let go of hope in a pill.
Of course, the problem is wider. Perfectly well people going about their lives devotedly pop a vitamin or two every day. Why wouldn’t you if you were surrounded by relentless marketing that promised to fix your mood, control the hunger pangs, detoxify your liver, protect your prostate and cleanse your bowel all at once?
Swisse is a significant player in the complementary medicines market. It has brand recognition and celebrity support so it doesn’t really need a humble university to cement its credentials. After all, it has more to lose if research confirms the findings of other reputable scientists that vitamins, super foods and natural therapies do not in themselves benefit the majority of takers. A marketing exercise, however, has different goals. Typically, such a company devotes significantly more to marketing than research and development. A relatively small promised injection of $15m has already bought Swisse the attention of a fickle audience – not bad.
Complementary medicines fall conveniently under the banner of “healthcare”, a problematic nomenclature for a start. It is neither practical nor desirable to dictate the plethora of healthcare choices people make, but we should all take notice when a public institution steps into the foray and seeks to influence our decisions. We must be sceptical, demand a more rigorous explanation, and importantly, seek an answer to the question as to whether this type of engagement is the best way to harness some of society’s brightest minds.