The answer to the title question is increasingly becoming a resounding yes, as doctors-from complementary care practitioners like naturopaths and chiropractors to mainstream general practitioners-get involved in the burgeoning dietary supplement market. While the American Medical Association continues to frown on doctors selling supplements as part of their practice, in a stagnant nutraceuticals market, the health practitioner market has been one bright spot. A small but growing niche, the practitioner market has suppliers to the business optimistic about the future. According to Nutrition Business Journal, the practitioner market is a $535 million market (or $900 million at the consumer level).

In terms of issues, there has been a lot of "noise" about the connection between doctors, supplements and health-both at the government level and among actual practitioners-but in reality there's still only a small number of doctors actually selling dietary supplements to their patients. The numbers are growing, however, even among general practitioners, not just the alternative-minded doctors. Ethical questions remain, of course, as does the all important issue of insurance reimbursement, virtually nonexistent in today's market and showing little potential for the near future.

At a recent Town Hall meeting in New York City for the White House Commission on Complementary and Alternative Medicine, the point was made that neither side is open to the other; health practitioners are educated in Western medicine or alternative care, not both, and neither wants to work with the other. "The word 'complementary' should be taken literally,' "said one speaker and this is where the industry stands right now.

There's Strength In Growing Numbers

Overall, those involved in the business are encouraged about the health practitioner market opportunity. "I believe there's been a significant shift in the attitude of physicians," said Jan Bruce, CEO, Integrative Medicine, Newton, MA, a provider of science-based, clinically significant information on alternative medicine (see accompanying sidebar). "Four years ago, it was an attitude of 'don't ask, don't tell,'" she said. "Physicians were saying, 'we know our patients are self-medicating and we are losing control.' In the last year there has been a sea change in the industry and everyone is starting to look seriously at where these therapies can be helpful."

According to Kyle Bliffert, director of sales and marketing at Metabolic Maintenance, Sisters, OR, a manufacturer of supplements for the health practitioner market, "The physician supplement market is relatively healthy right now. There is continued new interest from all practitioners in dispensing supplements," he said. "There are really two type of M.D.'s at this time-'conventional' doctors that follow the pharmaceutical model and get their information from pharmaceutical reps and those that have 'stepped out of the mainstream' and are venturing more into the alternative field. These are the more progressive doctors and obviously the ones more open to supplying supplements to their patients. Most of these practitioners have had a personal experience that affected their opinion of conventional medicine and they have become disillusioned with the mainstream system." According to Mr. Bliffert, less than 25% of their business is made up of M.D.'s.

Growth in the segment is fueled by consumer demand, say suppliers. According to Jacqui McCartin, marketing director at Emerson Ecologics, Pepperell, MA, which also sells to the practitioner market, "There's a lot of news out there that's scary recently, particularly in the area of label claims, and this is one of the reasons the health practitioner market is booming. Consumers want to rely on a medical practitioner for advice on supplements because they believe doctors will only recommend supplements that they're comfortable with. Consumers rely on doctors because doctors do a lot of research."
Anne Ross, vice president, marketing at Integrative Therapeutics, Wilsonville, OR, a conglomerate of suppliers to the health practitioner market, also believes it's consumers that are driving the business. "MD's are our fastest growing customer group. Why? Patients are asking the questions and forcing the doctors to learn more about supplements."

Steven Miracle, chief operating officer of Access Health Alternatives, Orlando, FL, a complementary and alternative medicine (CAM) network, added, "What we're seeing is patients forcing the allopathic community to get involved in nutritional supplements. I think the trend is toward consumers wanting more information," he said. "The perception is that these supplements are higher quality. Doctors are picky about what they recommend to consumers."

Ms. Bruce said, "The era of 'don't get involved' has ended. Our experience is that physicians don't wake up one day and say, 'what can I do with vitamin E?' They may be treating a patient and feel like they need alternative options; that's when they start doing the research. It's very consumer and disease-driven."

Of course, there are ethical issues to be considered. The issue for medical doctors is not always whether or not they believe in supplements, but whether they want to take the next step and actually sell them from their offices. "We definitely meet with some resistance from doctors who will recommend supplements but aren't comfortable selling them," said Mr. Bliffert. "They feel that selling supplements may taint their image as a health advisor. But the momentum is headed more towards health practitioners being suppliers because patient compliance is much higher when the products come from a doctor," he said.

Insurance Reimbursement: A Pipe Dream?

The feeling is that getting supplements reimbursed by insurance companies and/or HMO's would of course go a long way towards boosting the growth of this industry segment, but no one is holding their breath. "There's none that works right now," said Mr. Miracle. "We are seeing in the literature that some insurance companies are interested, but they are mainly offering a discount on products right now. We have also established a program for employers as a supplement to their healthcare program and we've had a lot of interest, but this will be a long time in coming." He continued, "The trend toward nutritional supplements is major and will continue, though. As the science behind efficacy becomes stronger, we will see more reimbursement, but this is a ways off."

"The pharmaceutical lobby is way too connected with our current healthcare system for insurance reimbursement of supplements to happen anytime soon," said Mr. Bliffert. Despite the lack of reimbursement, he said, the industry is seeing a surge of interest. "You won't see sales quadruple in one year, but this will continue to be a double-digit growth segment," he said. There are insurance companies that are covering certain alternative therapies, he said, "and as we see more of that, we will see more openness to the idea of doctor-supplied supplements."

Ms. Ross added, "The business will 'take off' with or without reimbursement but eventually HMO's will look at this and realize that covering these products would be beneficial to their customers as well as their bottom line. Preventive healthcare is always a cost savings."

Centers Making It Happen

There are some organizations out there that are making the complementary care model work. One of the most prominent is The Continuum Center for Health & Healing at Beth Israel Medical Center, which opened last summer in New York, NY. A totally philanthropically funded center that is the result of more than two years of planning, the center is built on the history of groundwork done by the hospital in many different disciplines and has a three-pronged approach to wellness, which includes patient care, education and research. According to Barbara Glickstein, director, clinical services and community outreach, "Our goal is to bring together clinician leaders in the field, the well versed mavericks in particular disciplines. We are working to apply a base of knowledge about complementary care options."

Right now there is no real reimbursement at the Center, although two physicians on staff have a limited practice that is reimbursed by a few managed care companies, said Ms. Glickstein. Some of the patients that come to the center are going out of network and getting reimbursement and are fighting with their healthcare providers on the issue. "However, we need more of that," said Mary Beth Augustine, integrative medicine nutritionist at the Center. "Many of our patients can afford to pay for their services out of pocket. I tell them to send in the paperwork anyway, along with a letter about the benefits of complementary care. If we as consumers aren't demanding this type of coverage-from legislators, health policymakers and insurance companies-it is not going to happen. We need to vocal about this."

The center includes a strong nutrition component and Ms. Augustine reports that she mostly sees patients with digestive disorders, fatigue syndrome or cancer. "We are trying to reaffirm the importance of whole foods. People have gotten so caught up in vitamins and supplements and so concerned with eliminating foods-high fat, high cholesterol, etc.-that they forget that foods can maximize the effects of supplements. They can work together." Ms. Augustine does recommend supplements to patients on a case-to-case basis. Currently the center does not sell vitamins but she reports this is something that is being heavily investigated at the moment.

Another up and coming center is Access Health Alternatives, which bills itself as a healthcare company rather than a nutritional products company. "Our approach is to integrate provider offices into the nutritional world to access patients from a nutritional perspective," said Mr. Miracle. Access has been around since late 1996 and was founded by a chiropractor, thus giving it a healthcare provider background. It recently acquired a majority interest in Access Health Care, an affiliated company in the business of providing complementary and alternative medicine centers. It is the largest chiropractic group in Florida and serves over 150,000 insureds.

The company formulates its own line of nutritional supplements under the HealthMax label. Currently the company has 13 product offerings, with 30 more set to launch within the next 12 months. Mr. Miracle talked about the products. "We concentrate on products designed from a body system standpoint rather than a disease state," he explained. "We are looking to support body function."

The key to Access' strategy, however, is its training program for practitioners. "We want to partner with practitioners to give them the training they need to fully integrate nutrition into their practices. We teach doctors how to evaluate patients and how to implement nutritional approaches to care."

Access will also sell direct to consumers from an 800 number and a website, but it always provides the option of seeing a practitioner as well. Currently the company is well established in the Orlando area and has about 100-150 providers across the country.

NW