When I was a starving grad student subsisting on $565 a month, the high point of my year was attending the annual meeting of the doctors and researchers who treat and study diabetes. When we weren’t sitting through hours of research talks (or giving one of these talks, ourselves), we roamed the display hall, where representatives from the companies that made diabetes drugs stood behind lavish displays, plying us with coffee mugs, pens resembling hypodermics, sticky note pads, rubber food models, rubber duckies, and other goodies, all decorated with the company names and logos. As you can imagine, treating type 2 diabetes (the kind of diabetes that usually occurs in adults, largely due to obesity and lack of exercise) is hugely profitable for drug companies because it is so prevalent and its prevalence is skyrocketing!

But the joys of hauling home those bags full of fun loot were nothing compared to the thrills of the after-hours parties: each drug company tried to outdo the others with their lavish spreads of chilled seafood, barbeque, Asian appetizers, and desserts, with free-flowing alcohol to wash it all down! If I felt the smallest pangs of guilt about being able to partake in these freebies, those feelings were allayed, knowing that my research advisers and all the other MDs who specialized in treating diabetes got free trips and other big benefits from these same companies, as incentives for prescribing their drugs!

But no more! No more trips, big dinners, or little toys. The days of health care providers being bribed by Big Pharma to pedal their products are long past, thanks to…MEDICAL ETHICS! These days, docs get nothing in return for prescribing you a particular medication, except the satisfaction of trying to help you get better.

So I was shocked when I first visited a chiropractor for a chronically bad back a few years ago and was told I needed various dietary supplements (vitamins, minerals, and herbs), all of which, amazingly, were being sold right in his office at an astronomically high profit margin. Never mind that the chiropractor knew less about nutrition than my Intro Nutrition students do after the first week of class, and that no dietary supplements had ever been shown to help relieve back pain. Never mind that the chiropractor, knowing I evaluate nutrition evidence for a living, never asked me about the evidence underlying any of these supplements. And never mind that it is completely against medical ethics for a practitioner to be selling the very products he or she is telling patients they need, especially at a profit! Even at the height of drug company bribery of MDs, doctors never sold drugs in their offices!

I soon ran into more chiropractors who were “pushing” dietary supplements and other questionable therapies, not only to treat back pain but to treat things like fatigue, difficulty losing weight, underactive thyroid, diabetes, and a painful, dangerous effect of diabetes called diabetic neuropathy.

Although it is true that an underactive thyroid can cause fatigue, feeling cold, hair loss, and difficulty losing weight, the vast majority of people who undergo thyroid function testing in legitimate lab tests performed by legitimate endocrinologists (i.e. medical doctors who treat conditions that involve hormones) for symptoms like these, have completely normal thyroid function. However some unscrupulous medical doctors will prescribe thyroid hormones for such patients, even though increasing your thyroid function above normal levels is very dangerous. And now, a growing number of chiropractors (who, it must be remembered, aren’t allowed to prescribe medications) have begun convincing patients who complain of the same kinds of vague symptoms— fatigue, difficulty losing weight, coldness— that they need an array of costly lab tests and a boatload of even more costly, and unproven, over-the-counter dietary supplements.

Questionable thyroid underactivity isn’t the only condition some chiropractors are now trying to capitalize on. Two of the other more noteworthy targets are a non-existent condition they’ve named “adrenal fatigue” and the very real Type 2 diabetes. Effective diabetes treatment requires careful adherence to a low-carb diet, usually weight loss, and exercise, and if exercise and diet don’t work (or aren’t practiced), medications are prescribed. One of the especially painful and dangerous results of poorly managed diabetes is diabetic neuropathy (literally, nerve damage); it worsens with time if diabetes is not treated correctly, and in its advanced state, can lead to amputation of limbs and blindness. The nerve degeneration that leads to diabetic neuropathy is irreversible: The only way to prevent or slow the condition is good nutrition and exercise and, usually, medication to control the diabetes. And the pain often does not respond to standard pain medications, so it’s a tempting target for practitioners peddling questionable therapies.

Some chiropractors have pressured their state governments to be allowed to prescribe medications, but so far, they have been unsuccessful, and I believe it is with good reason: They don’t learn enough basic science, physiology (in a nutshell, how your body really works), clinical medicine, or pharmacology (how drugs work) in chiropractor school to diagnose illnesses or prescribe the right medications. So they have adopted the stance that mainstream (prescription) medications are useless at best and dangerous at worst. Instead, they have taken to convincing their patients that their bodies are deficient in various, often obscure vitamins, minerals, enzymes, hormones, and other biological substances, all of which can be sold over the counter (in the chiropractors’ own offices) with no evidence of any real medical condition and usually with no evidence that the supplements could address the patient’s symptoms. There is so much wrong here, it’s hard to know where to begin.

These chiropractors have been greatly helped, I’ve learned, by what is now an entire industry devoted to teaching chiropractors about diseases (many of which are not recognized by evidence-based, mainstream medicine) for which they can order expensive diagnostic tests from shady but legitimate-sounding labs. Because almost none of the tests and none of the supplements are covered by insurance, patients need to pay out-of-pocket. This industry even has adopted names that make what they are doing sound like legitimate medicine: “functional medicine,” and “functional endocrinology.” An impressive number of hormonal conditions, such as hypo- and hyperthyroidism, diabetes, and several disorders of the adrenal glands, are well understood and treatable with medications, lifestyle changes, and rarely (e.g., in the case of overactive thyroid) with surgery. In contrast, “functional” endocrinology tries to push the notion that mainstream doctors fail to look for the true causes of patients’ symptoms and just treat the symptoms themselves …with prescription drugs, of course…while these functional endocrinology heroes supposedly get to the bottom of their patients’ symptoms, find the real causes, and treat them with supposedly natural, harmless dietary supplements. Nothing could be further from reality!

Because back pain, which is the traditional purview of chiropractors, is so difficult to treat successfully, I suspect folks who visit chiropractors are often already disappointed in the mainstream health care system and especially disillusioned by mainstream medicines. These folks are easily convinced that medicines don’t work and in fact are dangerous and that what they need are natural-sounding dietary supplements, especially obscure supplements they’re not likely ever to have heard of.

You may have seen full-page ads in your local newspapers inviting patients with diabetes or neuropathy to call and register for free dinners to learn about miraculous new cures. My husband even received a hand-addressed invitation in the mail to attend a dinner for people with nerve damage (although he doesn’t even have diabetes). The ads and invitations say nothing about the treatment, and if you phone the numbers provided, the folks who answer the calls ask for extensive amounts of personal information while divulging nothing about the treatments.

A little digging on the internet revealed that the “treatments” for diabetes combine strict weight loss diets, exercise, and copious amounts of dietary supplements containing proprietary (secret) ingredients. No dietary supplements have demonstrated conclusive evidence of benefit for diabetes in any published scientific studies. The “treatment” for neuropathy combines nutrition and supplements with treatments involving electrical stimulation, whole body vibration, and light therapy. NONE of these “treatments” has shown any evidence of benefit for treating neuropathy in actual published scientific research, and they are not covered by insurance. It turns out this “miracle cure” was devised by a Colorado chiropractor who has been under indictment for medical fraud; the model has since been adopted by a number of Southern California chiropractors, one of whom “claims” to be a nutritional biochemistry researcher but hasn’t been published by any reputable medical journals. Instead he has “self-published” books on curing thyroid underactivity, fatigue, and various brain disorders through dietary supplements! The chiropractor who issued the invite my husband received has been fined for misleading advertising by the CA Board of Chiropractors!

A recent Medscape article reviewed studies that asked whether dietary supplements have any benefit for treating diabetic neuropathy. Medscape is one of the most reputable sources of medical information on the internet. The article found no convincing evidence that any dietary supplement can treat diabetic neuropathy; in fact the only studies that showed any benefit were in laboratory animals, which are almost never directly applicable to humans. The treatment regimens being touted by chiropractors, if they have any benefit at all, do so because they incorporate weight loss and exercise, not because of the costly mystery supplements the chiropractors are pushing to their patients.

These “functional endocrinology” practitioners who are touting obscure vitamins, minerals, enzymes, hormones, and other chemicals for conditions like diabetes are having people part with their hard-earned money needlessly, encouraging them to ingest useless (at best) and potentially dangerous (at worst) substances, and delaying them from obtaining legitimate treatments. Those who claim to have treatments for refractory conditions like diabetic neuropathy are also doling out false hopes of a cure for a condition that has no proven remedies, and they should have their activities curtailed.

So if your health care provider is pushing supplements? If he claims his are purer than the ones in retail stores, ask to see if the labels indicate they’ve been USP certified or Consumer Labs tested, either or both of which would test purity. Supplements whose purity has been certified by one of these independent testing labs are easy to find in stores. And if your provider insists his supplements are so unique that no one else sells them, it’s because no need for them has ever been established. So run away!!!

But, meanwhile, if any of you have any of those old hypodermic pens or fun rubber food models you’re not using, I’ll be happy to take them off your hands!