Blog | Wednesday, March 27, 2013

Do probiotics work? Marketing mania tramples science

My kids know that I enjoy a spirited argument. During the days when the dinner table was our public forum, I tried hard to offer a responsible voice of dissent on the issues before us. I admit now that the view I espoused was not always my own, but one that I felt merited inclusion in the discussion. I still do this with them and to others in my life who are willing to succumb to probing of the mind. I willingly subject my own mind to the same process.

Because I am a gastroenterologist, folks assume that I have special expertise in nutrition. I should, but I don't. Perhaps, medical education has evolved since I was in medical training, but in my day, a soft subject like nutrition was bypassed. I am hopeful that I can remedy this knowledge vacuum in the years ahead.

These days, nutrition is part of the burgeoning tsunami of wellness medicine, a discipline that races beyond known science as it seeps into the marketplace.

Several times a week, I am queried on my view of probiotics, which are bacteria that confer health benefits on the human who ingests them. If you were to survey the public, I suspect that a majority would express that probiotics promote health and are effective in treating or preventing various maladies.

These products are included in the billion dollar enterprise of alternative medicine that is not subjected to any Food and Drug Administration (FDA) oversight. Their claims are very difficult to study and there is no standardization in the industry of what constitutes probiotic treatment. This is a different universe that conventional drugs inhabit. These medicines, prescribed by physicians, are subjected to rigorous oversight by the FDA and must demonstrate safety and efficacy. Alternative product purveyors, free from these constraints, can appeal to our New Age beliefs with promises that are seductive but unproven. They promise better health but don't have to prove anything.

If you were in the business of selling medicine, would you choose to spend gazillions dollars and several years praying your drug gets through the FDA, or promote a probiotic that a public is ready to swallow on faith? If you're stuck on this question, then consider my alternative blog MDWhistleblower for Dummies for remediation.

Do probiotics treat or prevent disease? Are these companies overpromising? Clearly, the marketing claims are a light year or two beyond verifiable and supportive science.

I know that many of us want probiotics to be the panacea for what ails us. I know that wellness and preventive medicine have become a religion for many of us. I suggest that we need some old-fashioned wisdom to restrain New Age converts.

Don't misunderstand me. I'm not dissing Alternative Medicine acolytes. Does their stuff really work or is belief of efficacy sufficient? Why aren't these companies utilizing the scientific method to determine if their potions are just placebos? Kick this issue around your own dinner table and make sure that dissent is on the menu.

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.