Point-Of-Care Supplement Delivery With Drugs Proposed

Providing dietary supplements at the point of care would improve the public's health and more adequately ensure the products are being used correctly, according to Global Health Sciences Senior VP Alan Xenakis, MD/PhD.

Speaking at the American Association of Pharmaceutical Scientists Dietary Supplements Forum in Washington, D.C. June 29, Xenakis discussed significant changes he believes must take place in health care delivery.

Consumers need good information on supplements and believe the best source of health care information is their doctor, he stated. However, since most people do not believe their physician is knowledgeable when it comes to dietary supplements, they do not consult their doctor on how best to use the products, Xenakis added.

"For us to be able to manage consumer expectation in a doctor's office, we're going to have to bring fundamental change," Xenakis said. The solution he proposed is "to learn today how to manage care [for] the whole patient."

Xenakis proposed a model in which nurse practitioners working at a doctor's practice would be trained on the benefits of nutraceuticals and when to use them. While the primary care physician still would provide necessary medical advice, the nurse practitioner could answer any supplement- or nutrition-related questions posed by the patient.

The nurse practitioner would have access to the patient's chart and be allowed to write in it to "support [the patient's] health care, because that's what this is all about," Xenakis stated. Patients could then acquire any supplements they might need before leaving the office.

To be able to integrate allopathic medicine with nutraceutical treatments and achieve success, certain obstacles must be overcome, Xenakis continued. Besides securing a reliable source of supplements, health care professionals also must learn how to follow up on nutraceutical therapies, develop a protocol for history taking and exams as well as decide how best to "advertise" the new system to patients.

Past attempts to integrate allopathic and alternative medicine have failed, Xenakis maintained, because "taking a preferred provider doctor and a preferred provider preventive medicine or nontraditional doctor or health care provider and putting them in a separate bricks-and-mortar facility does not work."

Xenakis' model runs counter to American Medical Association voluntary guidelines passed at the organization's 1999 annual meeting that discourage doctors from selling supplements from their offices (¹ (Also see "AMA Discourages Physician Sale Of "Health-Related Products"" - Pink Sheet, 5 Jul, 1999.)).

Addressing this point, Xenakis maintained the guidelines are flawed, since the main priority for all physicians should be "that at the end of the day when that patient left [your] office, he or she was going to be healthier."

Providing nutraceuticals to patients does pose a dilemma, Xenakis admitted. Possible options physicians could adopt might include having "a whole formulary," contract manufacturing or providing supplements "there and then [and] have all the follow-up done by someone else," he proposed.

At two clinics in California, Xenakis "picked seven products that really worked at levels that really worked, private-labeled them...[and] coupled them with diagnostics. We're not diagnosing, we're not treating - we're [providing] information."

From this experience, he found "the average American...would pay up to $100 a month out of pocket if you could show that what you were giving them would make a difference," Xenakis asserted.

Providing patients with supplements at the point of care also could improve compliance, Xenakis stated, since "most of them take effect after about 30 to 60 days, [and] we already know in traditional medicine that [patient] compliance stinks."

Moreover, "somebody has to tell [supplement manufacturers] that they have to put enough of the active ingredient in to make a difference." Physicians would require stricter quality controls for the products they provide than retailers, and would be able to tell industry "that people are going to sell that product at that level and buy it."

Current manufacturers, including major drug companies, have been unable to offer quality supplements under the current system, Xenakis said. To illustrate the point, he mentioned the disappointing retail sales of Warner-Lambert's Quanterra line as well as Bayer's One-a-Day supplements.