An old joke about research compares it to a man looking for his lost keys under a streetlight. When a policeman asks if that is where he lost them, the man replies, “No, but the light is better here.” The point is that what we learn from research depends on where we choose to look. Critics of natural therapies often argue that these approaches are not scientific or well researched, but this perception may partly reflect a bias in where research attention is directed. Much of the medical literature has historically favored drug-based therapies, which can limit attention to non-drug or natural approaches.
Evidence of this bias was reported in a study conducted at Wake Forest University School of Medicine and published in BMC Complementary and Alternative Medicine (April 9, 2008). The researchers reviewed articles from 11 major medical journals over a one-year period and compared the amount of pharmaceutical advertising in each journal with how dietary supplements and natural healthcare were covered. Journals with the highest levels of pharmaceutical advertising were the least likely to publish articles on dietary supplements, and when supplements were discussed, the tone was more often negative. Journals with less drug advertising were more likely to feature neutral or favorable coverage of non-drug therapies.
This influence has coincided with major growth in prescription drug use and spending. According to the National Institute for Health Care Management Foundation, prescription drug spending rose every year between 1995 and 2000, with a 20% increase between 1999 and 2000 alone, reaching $132 billion. By 2005, prescription drug sales had climbed to $251.8 billion. Data reported in the New England Journal of Medicine (February 14, 2002; 346:498–505, 524–531) showed that in 2001, about 80% of Americans took at least one medication in any given week, roughly half used a prescription drug, and about 7% took five or more prescription medications weekly. During this same period, spending on direct-to-consumer drug advertising increased sharply, rising from $791 million in 1996 to $2.5 billion per year by 2000.
Healthcare is often viewed as a purely altruistic and scientific endeavor, and for many practitioners it is. At the same time, it is also a business, and financial incentives can shape priorities. This helps explain why approaches to conditions such as heart disease often emphasize cholesterol-lowering drugs, while giving far less attention to non-patentable substances such as coenzyme Q10, enzymes, gamma tocopherol, carnitine, or resveratrol. Statins and other drugs are highly profitable; most natural substances are not. It has been estimated that more than 100,000 people die each year from adverse effects of prescription medications that are properly prescribed and taken. Some of these outcomes may reflect not just scientific judgment, but the influence of marketing on what is studied, published, and promoted.
