Social media has changed our lives irrevocably. Since the advent of the early days of the internet and chat rooms, people have gathered on-line to discuss different aspects of their lives, including their health. With the overwhelming popularity of Facebook and Twitter has come the widespread practice of “lay prescribing”. Just as friends and family members share recipes, photos and household tips, people share their healthcare practices.
Unfortunately, this practice is often rooted in folkloric beliefs, superstition or misinformation. Home remedies and unscientific treatments may translate into dangerous practices masquerading as helpful advice or holistic alternatives.
All advice is not equal
One of the most dangerous aspects of patients seeking advice on social media is the assumption that the recommendations made by friends and family should carry the same weight as a doctor’s advice. A recent example came from my own Facebook feed, from a friend soliciting advice on alternative treatment for hypertension. Within just a few hours, numerous individuals replied with recommendations on various supplements as well as suggesting yoga, meditation and stress relief. Few, if any, advised taking medically prescribed medications as advised as part of treatment.
There are multiple problems with this chat room approach to medicine and health.
1. Practicing medicine without a license
In medical practice, doctors and other licensed healthcare providers (nurse practitioners, physicians assistants and in some states, pharmacists) are licensed to practice medicine and prescribe medication based on years of education and experience. Clinical decisions such as prescribing medications or other medical treatment are based on a thorough knowledge of medicine, pharmacology, human physiology along with empirical research and evidence-based practice guidelines. The privilege of prescribing carries with it the responsibility for safe prescribing and medical practice, meaning that we can be held legally liable or responsible for our patient’s outcomes.
While friends or family members are often exempt from prosecution, when they recommend medications or treatments on Facebook, or in person, they are essentially practicing medicine without a license. While we hope that people have the commonsense to see a specialist, rather than their neighbor for advice, that is not always the case.
But it’s more than a legal consideration; it’s an ethical and moral one too.
If you are the advice giver, stop and consider for a moment: Are you willing to assume responsibility for the advice being given? In the example cited above, the advice seeker has high blood pressure and doesn’t want to take his medications. If that patient decides to forgo his medications and follows your advice, are you willing to take responsibility; if he has a heart attack, stroke or even renal failure from untreated blood pressure? If he developed liver failure from over-the-counter supplements?
Are you qualified to give this advice? Being an avid reader on the internet doesn’t count, nor does celebrity.
The celebrity advice giver: Jenny McCarthy
In recent years, a former Playboy Playmate has managed to single-handedly become one of the newest public health menaces. Just because Jenny McCarthy has a media platform to spew wildly inaccurate anti-vaccine rhetoric regarding childhood vaccines, doesn’t mean she’s qualified to do so. While posing naked is hardly a medical credential, her ignorance doesn’t abdicate her from resuming responsibility for her message.
Scott Hurst makes an excellent argument in the 2009 article, “Shouting Fire” that given her high profile, along with her virulent (and successful) campaign against childhood vaccinations, she should be held at least partially responsible for the upswing in preventable illnesses and outbreaks due to low vaccination rates in many parts of the country. In fact, the Jenny McCarthy body count website tracks the number of preventable illnesses and deaths due to anti-vaccination hysteria. In their view, parents of affected children should feel free to submit their medical (or funeral) bills to Ms. McCarthy. It may be the only way to get her to reconsider her position as a medical source for millions.
2. Substituting herbal supplements for prescribed medications
Of course, at the heart of this discussion is the misguided belief that supplements, herbal medications and so-called ‘holistic medications’ are somehow less hazardous, and less unnatural than pharmaceutical grade, FDA regulated products. With “Facebook medicine” many people are seeking and choosing to discontinue their prescribed medications in favor of vitamins, and supplements recommended by unlicensed non-healthcare personnel. In addition to the problems described above, the ingestion of multiple vitamins and supplements in lieu of, or even in addition to prescribed medications can be a risky proposition.
There are several reasons why people should think twice before attempting to treat medical problems using over-the-counter vitamins, dietary supplements and herbal preparations. All of these concerns revolve around the reason that these substances are over-the-counter in the first place: limited or no Food & Drug Administration (FDA) regulation and oversight.
Unproven and unscientific
Basically, the bar or set standards for sale and consumption are lower for items like cosmetics, vitamins or supplements. Unlike drugs or medications which are required to demonstrate both safety and effectiveness for FDA approval, there is no such requirement for many of these items. That’s because, in the past, the majority of these items were considered fundamentally harmless.
At the same time, the FDA does restrict manufacturer’s ability to make claims regarding these products. For example, vitamin E capsules (and the company manufacturing these capsules) do not have to prove that their capsules contain vitamin E, nor do they need to conduct randomized studies to prove it works. However, it is illegal for the company marketing the vitamin E capsules to then make health claims by saying, “Vitamin E will improve vision, and reduce the incidence of heart disease”. Now often consumer companies may make false or exaggerated claims, but that’s when the FDA should step in and issue warnings for such violations.
Not required to be proven safe or effective
While manufacturers of these supplements have no responsibility to demonstrate the safety or efficacy of their products prior to making it available to consumers, the FDA can recall these supplements once they have been demonstrated to harm the public. However, it may take several instances of serious adverse events or even deaths for a recall to occur.
According to Alison Young’s recent article, over half of the recalls of drugs for serious or fatal adverse effects were herbal supplements.
Unmeasured versus inert (aka, What’s really in this stuff, anyway?)
There are two very specific but contradictory concerns for herbal and supplemental products. Products can be either pharmacologically active (thus a drug) or biologically inert. For pharmacologically active ingredients, purity and dosing become important considerations. While most people wouldn’t take a blind handful of blood pressure medications, many people don’t think twice about taking unregulated herbal medications or vitamins, even in mega-dose quantities.
“Herbal” is a misnomer. This terminology is used to imply to the substance is somehow more pure or safe than its pharmaceutical counterpart. In reality, the opposite is true.
Almost all drugs come from natural plants and herbs. However, the refining process for pharmaceutical use is essential to maintain equal dosing to ensure the medication strength is consistent from pill to pill or bottle to bottle. This is particularly important for medications that require only minute quantities. Take foxglove, or the digitalis variety. Extracts from this pretty flowered plant family (digoxin) are used to treat serious cardiac arrhythmias such as atrial fibrillation as well as congestive heart failure. However, the amounts used to treat patients therapeutically are measured in micrograms (or 1/1000th of milligram) which makes it an extremely toxic choice for do-it-yourselfers or unregulated botanicals. Too much digoxin can cause severe bradycardia, nausea, vomiting, changes in vision, seizures, collapse and can be fatal.
A good way to think of this unmeasured versus inert is: “If substance X actually works, then it’s a drug (and should be regulated for purity and quality). If it doesn’t actually work, then it’s a waste of money.
What’s on the label isn’t always what’s in the bottle
Since herbal compounds and vitamin supplements aren’t regulated by the Food and Drug Administration (FDA), there is no quality oversight or assurance that capsules, supplements or tinctures actually contain any of the desired substance. Stoeckle et al. (2011) revealed that even commercially available tea preparations were often contaminated or substituted with common weeds and grasses.
A widely publicized report by Canadian researchers made headlines this year when it was revealed that less than half of all tested herbal compounds actually contained the marketed product. In the study by Newmaster et al, (2013) the researchers used the plant’s DNA to identify the mystery substances of 44 products by 12 popular companies. The researchers found that several herbs were substituted with ingredients that were either toxic or known to cause cancer. Other products used unlabeled fillers containing wheat, rice or soybean based items, which could be potentially life-threatening in people with allergic conditions.
Herbals tainted with drugs
In other cases, the so-called supplements were actually spiked with pharmaceutical medications, in unknown quantities. In a recent investigative series by USAToday journalists, Alejandro Gonzalez, Alison Young and Jerry Mosemak, it was revealed that numerous supplements were intentionally tainted with antipsychotics, human growth hormones, amphetamines and other drugs by the manufacturers to promote sales.
So in the end, remember that medical advice is all about promoting health and safety. Unless you are the treating provider, never advise anyone to quit their current medications, avoid vaccinations, ingest unproven 'remedies' or ignore the treatment prescribed by their doctor. For those seeking medical information - stick with the professionals with bonafide credentials; medical physicians (MD or DO), physician's assistants (PA-C), nurse practitioners (NP) or pharmacists (PharmD).