“Are you overweight or lack energy to get through the day and don't know why? Thousands of American families have relied on the medical wonder known as...”
Dr. Sylvester Andral Kilmer, M.D., had been heralded as a leading physician of our country, and devoted his 60-year practice to the study of diseases and their treatments. His impressive medical training was at some of the most respected medical schools, and he also studied under a pioneer of homeopathy, making him one of the earliest practitioners of integrative medicine.
According to biographers, Dr. Kilmer found that the ailments that afflict people in our modern age — digestive problems, obesity, water retention, kidney disease, bladder problems, bowel irregularity and liver problems — are the result of hidden chemical additives in modern methods of food processing and preserving, that strain the body. He developed medicines that promised to not only relieve, cure and restore all of these important organs to health, but also strengthen and stimulate them so that they would function optimally to process nutrition, cleanse the blood and rid the body of chemical and biological waste.
Treating nearly a million patients, his practice became so famous and popularly successful, he was able to build a laboratory and manufacturing plant in Binghamton, New York, for his prescription medicines. His remedy said to be the most proven, and developed after exhaustive research and experimentation, is a blend of 15 natural herbs from South Africa, North and South America, Europe, the Middle East, Tibet and North-west China. [Click on image for ingredients and what health problems each treats.]
Dr. Kilmer was, as you may know, born in 1840. His remedy, which exemplified patent medicine, is “Swamp Root Kidney, Liver and Bladder Cure.”
I say “is” because Swamp Root is still sold today, more than 120 years after it was first produced. Its distributor says it is “an approved medicine of the FDA and has received countless testimonials as to its effective benefit.” The Kilmer family business was well reputed and made many different medicines, including Ocean Weed Heart Remedy, Female Remedy, Indian Cough and Consumption Cure and Prompt Parilla Pills. Swamp Root, alone, made the family about a million dollars a year, according to Willis Sharpe Kilmer, Dr. Kilmer’s brother who graduated from Cornell University in 1880 and took over the business. When he died in 1940, his estate was estimated to be worth $10-15 million dollars.
Dr. Kilmer’s Guide to Health cautioned readers to “beware of fraud and imposters.” But, of course, it was these early patent medicines, which made extravagant claims to be able to cure just about everything and often targeted women and children, that epitomized the Latin phrase: caveat emptor — buyer beware.
Patent medicines came to be known as snake oil medicines — named after one that claimed to actually contain snake oil — and synonymous with quackery.
By the middle 19th century, patent medicines were a major industry in the United States, according to Hagley Museum and Library in Wilmington, Delaware. The patent medicine industry also pioneered many of today’s advertising and marketing techniques, according to the Smithsonian National Museum of American History. Consequently, slick snake oil salesmen, are also today’s popular term for charlatans.
But, as recognition of the importance of medical science grew, some doctors argued for legitimate treatments and against quackery and fraudulent advertising. Not surprisingly, they were met with fierce resistance from the manufacturers and their trade association, but also much of mainstream media, which had become dependent on the advertising revenue they received.
Finally, in an historic series by Samuel Hopkins Adams in Collier’s magazine in 1905-1906, some of the fraudulent and dangerous methods practiced by patent medicine makers were exposed. Eventually the science and increasing disclosures of the quackery reached the public, resulting in the passage of the Pure Food and Drug Act of 1906 and the Food, Drug and Cosmetic Act of 1938, which curbed the most fraudulent label claims. It resulted in the demise of most of these early 17th – 19th century patent medicines. A few of these early patent medicines are still around, although most have considerably toned down their claims.
Certainly, nothing like the pervasiveness of patent medicines of the mid-nineteenth century could ever happen again... could it?
Wellness and longevity
A supplement supplier referenced by the American Academy of Anti-Aging Medicine says:
For longevity, eliminate free radicals. Green and white tea helps renew your youthful energy and spirit, and combat the damaging effect of free radicals. Buy: NAC (N-Acetyl-L-Cysteine) — used by the liver to detoxify chemicals... Curcumin — antioxidant and anti-inflammatory... Vitamin E-400 w/Selenium — for heart disease, macular degeneration and PMS... Resveratrol Complex — for the cardiovascular and immune systems... Omega-6 — for diabetes, eczema, PMS, osteoporosis and rheumatoid arthritis... Triple X It Out Blend — kills infections, herpes and other skin diseases... Skin Serum — anti-inflammatory, anti-infectious, acne or any skin eruptions or rashes... Breathe Great Blend — to restore breathing due to asthma, emotions and infections... Wellness Paks — 35 nutrients, including 17 vitamins, 11 minerals and essential fatty acids Comfort Zone Blend — for anxiety attacks, depression, anger, irritability... Brain Memory — for loss of brain speed and acetylcholine... CLA (Conjugated Linoleic Acid) — for Weight loss, helps to reduce the size of fat cells... Slim Paks — prevent calories from fat and carbohydrates...
NAC (N-Acetyl-L-Cysteine) — used by the liver to detoxify chemicals...
Curcumin — antioxidant and anti-inflammatory...
Vitamin E-400 w/Selenium — for heart disease, macular degeneration and PMS...
Resveratrol Complex — for the cardiovascular and immune systems...
Omega-6 — for diabetes, eczema, PMS, osteoporosis and rheumatoid arthritis...
Triple X It Out Blend — kills infections, herpes and other skin diseases...
Skin Serum — anti-inflammatory, anti-infectious, acne or any skin eruptions or rashes...
Breathe Great Blend — to restore breathing due to asthma, emotions and infections...
Wellness Paks — 35 nutrients, including 17 vitamins, 11 minerals and essential fatty acids
Comfort Zone Blend — for anxiety attacks, depression, anger, irritability...
Brain Memory — for loss of brain speed and acetylcholine...
CLA (Conjugated Linoleic Acid) — for Weight loss, helps to reduce the size of fat cells...
Slim Paks — prevent calories from fat and carbohydrates...
[Regular JFS readers will recognize claims that have been disproven in major clinical trials and others that have no clinical trial evidence.]
The biggest source of growth is conventionally trained doctors, nurses and massage therapists. Supplements, alone, being sold by practitioners from their offices and websites, are growing 7.5% a year, topping $1.7 billion in 2006 and anticipated to exceed $2.5 billion this year, according to the Nutrition Business Journal’s 2007 report, “Complementary & Alternative Medicine and Practitioner Supplement Sales.” Mainstream doctors now account for nearly 20% of all supplement sales.
Supplement sales by doctors and nurses increased by 874% between 1997 and 2004, according to an article last week in Natural Products Insider by Dr. Grace L. Keenan, M.D. The anti-aging market is even bigger, growing by 9.5% a year and expected to top $70 billion a year by 2009, according to Business Communications Co., Inc. Doctors were told at the 2003 meeting of the American Academy of Anti-Aging Medicine (abbreviated A4M): “You can quadruple your revenue, especially if you add preventive medical screenings.”
With so many doctors adding anti-aging and lifestyle medicine to their practices and promoting antioxidants and other supplements, does that mean consumers can trust it all to be safe and proven?
In a hard-hitting article for MSNBC this week, writer Brian Alexander gave a behind-the-scenes glimpse of the anti-aging medical industry. The questions he raised weren’t popular with the industry, but can provide valuable insights for consumers. [Click on headline to read full article.]
For thousands of years, magicians, alchemists, even a few fringe medical practitioners have fueled an unbounded optimism that we can blunt the ravages of time, stay younger for longer, maybe even defeat death itself. Their pitches have usually hinged on some drug, food or device — everything from electricity to yogurt to surgically installing the gonads of animals into our own bodies — that will slow or reverse the aging process. Every decade or so, “anti-aging” promoters grasp onto news coming out of research labs and trumpet those developments as the answer we have all been awaiting...
[But] something new is happening in the world of anti-aging. Mainstream doctors who once wanted nothing to do with the naturopaths, osteopaths and others who first populated modern anti-aging, and whom they often considered glorified carnival barkers, are buying in, signing up for “certification” as anti-aging practitioners and offering patients the promise of youth and rejuvenation through such treatments as human growth hormone, testosterone, special diet and exercise regimens, antioxidants and hundreds of other supplements.
“It is mushrooming,” says Dr. Elliot Snyder, an emergency room physician based in Northern California who follows the movement closely by frequently attending anti-aging meetings and talking to friends in the field. He also uses some of its techniques himself. Besides exercising five days a week and following a strict low-fat diet that includes lots of fruits, vegetables and wild salmon but no white flour or red meat, he takes supplements ... about 50 pills per day.
The latest A4M conference, held this past December, was attended by some 2,000 business owners, anti-aging promoters and hundreds of doctors. The co-founder of the organization, Dr. Robert Goldman, says there are now 20,000 doctors who they’ve certified in anti-aging medicine. Alexander’s investigation found that A4M’s U.S. revenue from certification fees alone totaled $1.2 million in 2006.
An article this past December in My Long Life.com, profiled the president of A4M, Dr. Ronald Klatz, and its chairman of the board, Dr. Robert Goldman. They are bringing anti-aging medicine to medical professionals around the world, speaking at two recent events backed by the Chinese government, China Pharmaceutical Association and China Medical Association among other Chinese medical organizations: the World Anti-Aging Congress and China Pharma Exposition, and the China Health Industry Forum. “Chinese investors expect in next five years to build over 10,000 anti-aging hospitals, elite medical spas, Olympic-level sports medicine facilities, and anti-aging out-patient health check clinics,” the article revealed. A4M not only offers board certification for the medical specialty of Anti-Aging & Regenerative Medicine, it already oversees ongoing training of 60,000 doctors and surgeons on-site, and 500,000 healthcare professionals around the world through its international programs. A4M also accreditates anti-aging medical centers, hospital and medical spas through its new World Council on Clinical Accreditation. “China's over one billion consumers could well further accelerate this growth and become the new global powerhouse of anti-aging medicine,” it said.
A4M isn’t the only anti-aging medical association. A rival organization, Age Management Medicine Group, had more than 400 doctors at its last meeting. That meeting had been sponsored by the country’s largest healthy aging and longevity company, Cenegenics, which also certifies practitioners in “age-management medicine.” Its program for healthcare provider affiliates offers health assessments ($2,500) and anti-aging vitamin and supplement regimens ($300-$00/month) that includes growth hormones and low-glycemic diets. It is marketed to doctors as a way for them to secure their economic futures. According to its co-founder Rick Merner, it has more than 800 doctor affiliates.
One such affiliate, Cenegenics Atlanta, for example, says that anti-aging medicine or age-management medicine is the model of healthcare for the new millennium which focuses on optimizing health and preventing chronic diseases of aging. The benefits of its Cenegenics program are said to include decreased body fat, weight loss and avoidance of weight retain; youthful energy; better skin tone; increased libido; cholesterol control; improved memory and concentration; and stronger immune system. Its website says:
Since 1997, our world-class physicians have shifted medicine’s focus from disease to health. Their innovative, proactive approach helps Cenegenics’ patients stay healthy, vital, vigorous, mentally sharp and sexually active their entire lives. Cenegenics is the genesis of medicine’s next generation… well-proven, evidence-based medical science... 25% of our patients are doctors and their families. Cenegenics encourages you to live well longer... Bio-Identical Hormone Replacement is a foundation of Anti-Aging Medicine by Cenegenics and includes HGH or human growth hormone, testosterone and DHEA therapy for deficient adults... Cenegenics total health optimization is achieved through the synergy of the five Age Management Medicine or Anti Aging Medicine program elements including bio-identical hormone replacement, science based nutraceutical supplementation, low glycemic index diet, exercise and stress reduction.
Corporate Wellness Partners is another Cenegenics affiliate. It also offers a comprehensive health risk evaluation, this one sold to corporations for their employees and executives, that says it determines their real age, and provides a personal wellness plan with targeted diet and nutrition program and ongoing preventive health management said to slow or even reverse the aging process. It promises corporations its program will help contain their healthcare costs.
Long Life Sciences in Los Gatos, California, another Cenegenic’s affiliate, includes chiropractics and “neurofeedback therapy” for children and adults with ADHD; vitamins, herbs and nutraceutical; and hyperbaric oxygen that is said to not only enhance memory and physical performance, but proven beneficial for autism, asthma, allergies, brain injury, stroke, cerebral palsy, chronic fatigue and lyme disease.
Science or money?
Alexander’s article for MSNBC profiles one woman who complained of joint pain, insomnia and lack of energy, despite the fact that no doctor or standard testing had been able to find anything wrong. She now spends about $1,000/month on the anti-aging supplements and says it’s changed her life. Except, there is no such thing as an anti-aging specialty, according to the American Medical Association or the American Board of Medical Specialties. The anti-aging field’s emphasis on supplements continues even though there is little evidence that most do anything for most people. Alexander writes:
Goldman and his A4M co-founder, Dr. Ronald Klatz, have been accused by respected academics of being snake-oil salesmen. Cenegenics and A4M have both been labeled glorified hormone-pushers. Anti-aging advocates, on the other hand, argue that they are a persecuted minority of enlightened medical professionals who have the patients’ best interests at heart and that the AMA, the mainstream media and the government, especially the Food and Drug Administration, have conspired to keep the truth from the public. “Certain vested interests would not like to have anti-aging,” Klatz argues...
Dr. Thomas Perls, a Boston University researcher who studies centenarians... [said] in my mind the whole anti-aging practice has so many problems of ethical and professional misconduct. These practices are selling medicines and substances at great profit with very little in the way of clinical studies to support what they are doing.”
According to Dr. Arnold Relman, professor emeritus of medicine and social medicine at Harvard Medical School, “the interest in anti-aging practice is mainly based on economic considerations” by physicians who are looking to boost income. These financial incentives are clearly evident among the anti-aging promotions to doctors.
“Get your piece of the $50 billion anti-aging marketplace!” trumpets a flyer distributed to doctors at A4M’s Las Vegas meeting. An article by Klatz and Goldman in "Medical Spas," a magazine that’s a member of A4M, encourages doctors to open their own medical spas and to have them certified under the World Council for Clinical Accreditation, another A4M organization, because “a single anti-aging patient is estimated to bring $4,000 to $20,000 in annual gross revenue.”
For doctors who begin anti-aging practices, it means easier work hours and workloads, patients who pay in cash, and freedom from insurance paperwork and bureaucracy. And, according to Alexander: “anti-aging doctors often sell lines of creams and supplements, such as vitamins, antioxidants and plant extracts, which claim to do everything from strengthening the immune system to boosting libido, directly out of their offices, sometimes with an enormous mark-up.” Preventive health screening of a large range of health indices involves regular tests and office visits for “another cash-only check up.” As Alexander wrote:
As some enthusiasts admit, anti-aging patients are essentially running a giant uncontrolled experiment on themselves — increasingly at the hands of doctors. Critics point out that the biggest concern about doctors getting involved is that many patients incorrectly assume that if their trusted physician is recommending hormones and supplements, these treatments must be safe and effective. The fact is, no drug, treatment or supplement has ever been shown to extend human lifespan...
These days, many anti-aging promoters, seeking to shed the flim-flam image, are ratcheting down the rhetoric. They have begun using terms like “age management” and “healthy aging” that imply realistic goals and give important, if commonsense, advice. Most anti-aging doctors tell patients what we already know: Exercise. Lose weight. Lower our blood pressure. Don’t smoke. “I do not see this as the basis for a new practice specialty,” argues Relman.
According to Dr. William T. Jarvis, Ph.D., president of the National Council Against Health Fraud: “Some techniques referred to as "alternative" may be appropriately used as part of the art of patient care. Relaxation techniques and massage are examples. But procedures linked to belief systems that reject science itself have no place in responsible medicine. Useless procedures don't add to the outcome, just to the overhead.”
While mainstream medicine may look askance at anti-aging, major healthcare centers have adopted these alternative modalities as part of integrative health programs and some of the most renowned clinics in the country offer executive health programs with health risk assessments that charge thousands of dollars for a day, said Alexander.
As Dr. Keenan wrote in Natural Products Insider, integrative medicine is exactly what is needed to remedy America’s healthcare and mainstream medicine is moving in this direction. “Nearly all of the nation’s medical schools now have coursework in Complementary and Alternative Medicine (CAM); most major medical centers have affiliated holistic health clinics,” she said, adding:
The Bravewell Collaborative, a philanthropy founded by Christy and John Mack of Morgan Stanley and Penny and Bill George of Medtronic, has funded clinical research, as well as health systems development at integrative medical centers across the nation.
Continuing medical education programs on nutrition and other aspects of natural medicine are blossoming. The growth of groups such as the Institute of Functional Medicine, American College for Advancement in Medicine ... the American Board of Holistic Medicine and the American Clinical Board of Nutrition, offering doctors formal certification in holistic disciplines. In an historic first, the American Holistic Medical Association and the American Association of Naturopathic Physicians are holding a joint annual meeting.
Even the conservative American Academy of Family Physicians, she said, is becoming more positively receptive to nutraceuticals and functional medicine. Many primary care doctors are fighting to survive, seeing their insurance reimbursements and incomes falling, and workloads and administrative paperwork increasing. The number of doctors taking bank loans to keep their practices afloat has hit an all-time high, as has the number of doctors defaulting, according to Dr. Keenan. So, leading nutraceutical channel and functional diagnostic testing fields are responding with “comprehensive turn-key programs designed to make it easier for physicians to incorporate nutrition-based medicine into their practices,” she said.
Holistic wellness and supplements in medical education
Dr. Keenan is a clinical assistant professor at Georgetown University’s Department of Medicine, which started its own CAM program at its School of Medicine with a $1.7 million NIH grant in 2001. Its program is especially far-reaching, according to a press release, integrating CAM throughout its curriculum. “This program really is about training a new kind of physician,” said Aviad Haramati, Ph.D., professor of physiology and biophysics, and the principal investigator of this project. “We're introducing a new paradigm of medical education that integrates CAM philosophies into conventional approaches to healthcare.”
Since 2005, Georgetown has also offered a masters of alternative medicine. This curriculum includes herbal medicine, nutritional supplements, homeopathy, acupuncture, naturopathy, mind-body techniques, and manipulative techniques.
Dr. Keenan is also chairing the first conference, “Heal Thy Practice: Transforming Primary Care,” for this fall (at $895 a head). Its programs will present business development and practice strategies for doctors looking to add alternative modalities into their practices. This conference is being given by Holistic Primary Care News, a 4-year old company that publishes “scientifically sound information on natural medicine and holistic healthcare,” said to reach 100,000 doctors nationwide. Its editorial and design team also offers to create science-based monographs, continuing education modules, and other marketing collateral for advertisers to help build their brand, while educating and informing their target market about the benefits of their products.
Sponsors. The publication is sponsored by NewMark, which supplies nutritional and herbal supplements specifically to healthcare professionals. It says: “Our integrative paradigm -Life Sustaining Life- honors the healing energy and intelligence of nutrients and phytochemicals from whole foods and whole herbs scientifically grown, extracted, and formulated for optimum benefit.”
Another sponsor is SpectraCell, a laboratory that services healthcare providers by doing “functional intracellular analysis” of patients’ nutritional status — unlike traditional serum, hair and urine tests — and promises to evaluate how a patient’s “individual cells respond to specific nutrient environments.” It says: “By measuring the functionality of specific vitamins, minerals and antioxidants in a client's own cells, personal differences in age, genetics, health, prescription drug usage, absorption rate or other factors are taken into consideration, opening a true ‘window on intracellular function.’”
Another sponsor is Sedona Labs which supplies probiotics, enzymes and colostrum specifically to healthcare providers.
In other words, this source of supplement information for medical primary care professionals is a marketing publication, not a peer-reviewed medical journal. The publisher is Meg Sinclair, whose online bio says:
Meg Sinclair developed an interest in holistic health care at an early age, under the influence of her mother, a home economics teacher with a strong interest in natural foods and nutrition. In the early 1970's, Meg moved from Michigan to the San Francisco Bay area where she began a serious study of aikido, energy awareness, and meditation. While in San Francisco, she became familiar with acupuncture and Chinese herbal medicine, making them part of her personal approach to health maintenance. She obtained her bachelor's degree in piano and composition from Mills College, Oakland, CA...
The editor and co-founder of Holistic Primary Care News, Erick Goldman, is a journalist who wrote a recent article in Nutraceuticals World promoting their upcoming conference. He described “what’s going on in the trenches of healthcare,” highlighting the last annual scientific meeting of the American Academy of Family Physicians, the organization representing more than 95,000 board certified family physicians, most primary care doctors. The situation in the profession is more than dire, he said, and one theme prevailed at this year’s meeting: “family medicine is struggling for its very survival.”
Since general practitioners don’t do a lot of procedures, high-tech diagnostic imaging and acute care interventions for very sick people, they don’t get much insurance reimbursement. “Primary care has always been the low end of the medical money hierarchy, and it just keeps getting lower,” he wrote. “[T]hey're actively looking for a way out of the morass their chosen profession has become. They're burnt out, bruised up and beaten down, and they don't want to spend the rest of their productive lives slaving away.”
But, he said, there is “one very clear and bright ray of hope: a newfound openness to nutrition and natural healthcare.” As he noted:
[S]omething is clearly shifting in the attitudes of mainstream family physicians. Whether it is simply a reflection of their economic desperation, a desire to please their alternative-minded patients, or a genuine interest in what natural medicine has to offer, I believe it is a very positive and encouraging signal for the nutraceuticals industry.
The public trusts that today’s promotion of preventive health and wellness programs, nutraceuticals, and ‘healthy’ dietary interventions to help them attain optimal wellness and live longer that are coming from mainstream medical professionals and reputable clinics is sound. When those trusts are broken by modalities that are unsupported by scientific evidence, it can be helpful to look at possible conflicts of interests or try to understand the reasons for the disconnect. History teaches us the importance of caveat emptor.
Do doctors and nurses, increasingly trained in “other ways of knowing,” really believe in these supplements and anti-aging modalities, or do they understand the scientific process and know what they’re selling, but do it anyway? Neither answer is very reassuring.