M-e-l-t-i-n-g.
Could it BE?

Weight Loss Surgeons Selling Supplements?

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 Someone asked me "Why do you care if surgeons sell products in their offices or online?"   

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 I didn't really, my only complaint up until recently was that if doctors were going to sell products that they have someone do it for them who understood the products and sales.  I would hope that the persons in charge of sales or the stores would have knowledge of the products they are selling to new bariatric patients.  

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I was sort of glad to see that surgeons would have product available to their patients to educate them on proper nutrition and supplementation.  Frankly, I was told about children's chewables (see above) and Tums back in the dark ages, and would have LOVED to find me some APPROPRIATE BARIATRIC SUPPLEMENTATION AT THE HOSPITAL.  However, at that time -- the hospital's weight loss surgery program did not provide that -- and I went home on Flintstones and Carnation Instant Breakfast!

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That was until I started seeing questions like this:

  • My doctor suggested I take ________ Vitamins, and he said that I have to buy them from him?  Why?  I can get them online for a lot cheaper, and I am on a budget!
  • My surgeon told me that I have to use ________ and I cannot afford it.  He requires that I buy a ______ week supply from his office -- or I cannot have surgery.
  • My surgeon's office "Strongly Recommends" the _______ shakes. He gives us a website that is supposed to get it at his cost. According to a __________ press release (announcing Carnie Wilson as spokesperson in 2006) he help develop the product. Well______ is now owned by a MLM! They only sell thru the doctors offices and sites for each Dr. I tolerated it... until surgery. I can't stand it now (have 3 unopened cans!). They tell me whey isolate... but I had to call the nurse on a product she showed me that was collagen protein

Is it okay for a surgeon to sell you products?  Typically - yes - if the products are health related, at a low cost and appropriate.  But, there are rules!

In this community, there is also the issue of conflict of interest.  In the WLS community, the surgeon/patient relationship can be tricky, some patients see their doctors as heroes, and frankly, if Doctor X was to sell them a car, they would buy it.   

See --

The for-profit sale of goods to patients by physicians inherently creates a conflict of interest. Physicians engaging in this activity have a direct financial interest in selling the goods to patients; but the sale may or may not be in the best interests of the patients. Physicians may be tempted to sell items for profit even though their patients do not need the products. Even if most physicians are capable of resisting such temptation, the more ethical course is for professionals to avoid placing themselves in temptation's way, This conflict of interest is particularly troubling in the office setting, where most patients appear because they are in need of medical attention. In the ordinary market setting, consumers can be trusted not to purchase items which they do not want, thus a voluntary sales transaction is taken to be in the best interests of both parties. But the voluntariness of any sale to a patient in a medical office setting is open to serious question.

And -

The offer of goods In the treatment setting puts subtle pressure on sick and vulnerable patients to purchase them. Patients may purchase goods out of a misplaced desire to please or to "get in good" with their physicians. They may feel that they have to purchase those goods in order to secure the physician's favor. These feelings, whether justified or not, may interfere with the open exchange and the level of trust between physician and patient.

The rules -

Opinion 8.063 - Sale of Health-Related Products from Physicians' Offices

"Health-related products" are any products that, according to the manufacturer or distributor, benefit health. "Selling" refers to the activity of dispensing items that are provided from the physician’s office in exchange for money and also includes the activity of endorsing a product that the patient may order or purchase elsewhere that results in direct remuneration for the physician. This Opinion does not apply to the sale of prescription items which is already addressed in Opinion 8.06, "Prescribing and Dispensing Drugs and Devices."

Physicians who engage in in-office sales practices should be aware of the related guidelines presented in Opinion 8.062, "Sale of Non-Health-Related Goods from Physicians’ Offices;" Opinion 8.06, "Prescribing and Dispensing Drugs and Devices;" Opinion 8.032, "Conflicts of Interest: Health Facility Ownership by a Physician;" Opinion 3.01, "Nonscientific Practitioners;" Opinion 8.20, "Invalid Medical Treatment;" as well as the reports from which these opinions are extracted.

In-office sale of health-related products by physicians presents a financial conflict of interest, risks placing undue pressure on the patient, and threatens to erode patient trust and undermine the primary obligation of physicians to serve the interests of their patients before their own.

(1) Physicians who choose to sell health-related products from their offices should not sell any health-related products whose claims of benefit lack scientific validity. When judging the efficacy of a product, physicians should rely on peer-reviewed literature and other unbiased scientific sources that review evidence in a sound, systematic, and reliable fashion.

(2) Because of the risk of patient exploitation and the potential to demean the profession of medicine, physicians who choose to sell health-related products from their offices must take steps to minimize their financial conflicts of interest. The following guidelines apply:

(a) In general, physicians should limit sales to products that serve the immediate and pressing needs of their patients. For example, if traveling to the closest pharmacy would in some way jeopardize the welfare of the patient (eg, forcing a patient with a broken leg to travel to a local pharmacy for crutches), then it may be appropriate to provide the product from the physician’s office. These conditions are explained in more detail in the Council’s Opinion 8.06, "Prescribing and Dispensing Drugs and Devices," and are analogous to situations that constitute exceptions to the permissibility of self-referral.

(b) Physicians may distribute other health-related products to their patients free of charge or at cost, in order to make useful products readily available to their patients. When health-related products are offered free or at cost, it helps to ensure removal of the elements of personal gain and financial conflicts of interest that may interfere, or appear to interfere, with the physician’s independent medical judgment.

(3) Physicians must disclose fully the nature of their financial arrangement with a manufacturer or supplier to sell health-related products. Disclosure includes informing patients of financial interests as well as about the availability of the product or other equivalent products elsewhere. Disclosure can be accomplished through face-to-face communication or by posting an easily understandable written notification in a prominent location that is accessible by all patients in the office. In addition, physicians should, upon request, provide patients with understandable literature that relies on scientific standards in addressing the risks, benefits, and limits of knowledge regarding the health-related product.

(4) Physicians should not participate in exclusive distributorships of health-related products which are available only through physicians’ offices. Physicians should encourage manufacturers to make products of established benefit more fairly and more widely accessible to patients than exclusive distribution mechanisms allow. (II)

Report: Issued December 1999 based on the report "Sale of Health-Related Products from Physicians' Offices," adopted June 1999.

Clarification of Opinion 8.063

Do the guidelines discussing the sale of health-related products (8.063) and the sale of non-health-related goods (8.062) apply to physicians’ practice Web-sites? Yes.

The physician who provides or sells products to patients must follow the above guidelines regardless of whether the products are provided in the physician’s office or through a practice Web-site. Adopted December 2000 as "Addendum III: Council on Ethical and Judicial Affairs Clarification on Sale of Products from Physicians' Offices (E-8.062 and E-8.063)

    I asked for opinions on Facebook - and here are some of the replies so far:

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  • Surgeons, Drs.. usually get some sort of cut for soliciting there drugs, vitamins, whatever ... My surgeon recommended a brand and I went with another!
  • I think it helps patients...often if they have to go far to get something chances are they wont....thats why i believe many drs say get a regular vitamin, flinstones etc...cause they are readily available EVERYWHERE...they would much rather them take something as opposed to nothing....so if they offer great products in their office, viola they have complient patients!
  • Absolutely a conflict of interest IMHO
  • You don't want me to go there. Really. Because I'm not medicated enough. Nor caffeinated enough. So insert an appropriate amount of snark and a disapproving "death glare" and assume you can guess my reaction
  • I would be uncomfortable if my surgeon tried to sell "product" at his office. He/his dietician gave me a plethora of options and photocopies of examples (BA, other brand names), but mainly gave me the minimum of what I would have to take on a daily basis, and I took it from there. 
    My medical group's bariatric support group sometimes has
    representatives from BA and other companies, but the facilitator is clear that we do not HAVE to take these products..we just need to know what is available, esp for pre-ops and newbies.
  • I don't have a problem with it personally as long as they are nutritionally sound for a bariatric patient AND they don't make me feel badly if I choose otherwise based on personal preference. 
    Considering what the insurance company reimbursement rates are, I can't really blame them at looking for alternative resources of income. I don't think it's different than any other self-employed person promoting their services/products.
  • I believe it helps with patient compliance. However, I do not believe a doctor should enforce brand, if they have a store in the office and the patient does not like that brand they should encourage them to seek something they like. FOr me, my surgeon carried product and it made it easy to pick up at his office. I did that for awhile, then researched and found products that I enjoyed. Basically the responsibility still comes down to the individual.
  • I love my surgeon I never felt like he was selling me on him or the surgery he really made sure i was right for me and then told me good bad and then gave me his refrences and said you decide and let me know ...then with the products as long as I was supplied choices I would be ok with it but pushing only one product would make me annoyed...
  • There was absolutely no pressure from my surgeon as far as products go...the facility has a shop that sells protein and vitamins, but it was never pushed...and I like it that way!
  • My surgeon/office still says Flintstones are ok... I wouldn't really trust what she would be trying to sell right about now... surgically wise - I've had no problems - so as a cutter I say she did ok.
  • It wouldn't really bother me, but to me, it would be like a heart surgeon trying to perform a tummy tuck. Just because my surgeon has expertise in gastric bypass, doesn't mean he knows squat about brands of vitamins and their contents. Same with protein and other products he may have.
  • I believe it's a conflict of interest.
  • Do you mean providing vitamins and such in their office - that would be okay provided there were various companies available.
  • I don't take health advice from people who shill products, be that Jillian Michaels or a bariatric surgeon. I have no respect for him and, if my surgeon started shilling a product like that, I'd be very upset.
    Advertising is different, IMO. When I was just starting out, I had a heard time figuring out who the 
    bariatric doctors were and seeing ads on places like OH helped me find a few names. Then again, when I saw those 1-800 ads for a "free" lapband the last time in LA, they just screamed "scam" to me so the LA Times article about what a scam that place was didn't surprise me at all. So it's a delicate balance.
    Having a store to sell bariatric products? If it's low key, it's okay. Again, finding a lot of that stuff can be hard so it helps. But some surgeons do things like make you use their products for the pre-op diet and that is starting to cross the line for me.

  • Well, since we live in the middle of BF nowhere and it is VERY difficult to find ANY products locally, I don't have a problem with it. Mine does sell a few WLS products but no one EVER even mentions that they do. We aren't required to buy them but it is wonderful to have a place "locally" to buy Pro, vitamins and the like when I am there, then we don't have to be out postage!
  • Good question! Does it make people feel better when a protein is endorsed by a physician?
  • Just to clarify, I love my surgeon (who runs a COE practice) and his gym and his cafe and his support group meetings (with a superb moderator who does NOT push his products, which everyone really appreciates) a LOT. His office staff is hit or miss. I'd recommend him to anybody wanting an RNY. But, you asked and this DOES bug me.
  • I have mixed feelings. having protein pwders available in the office for new post ops may be a service - but he should sell them at cost. Maybe it should be a service not a for profit part of his practice. 
  • My surgeon does this, at least though the medical office he works with - the offices are divided up. They do it for both pre- and post-op, but only the pre-op are required. Post-op the dietician will tell you that only a very short list of commercial protein products are recommended, but I've been ignoring her for 7 months. They only sell one of the commercial products on her list, but they will only tell you about the alternatives *after* you've tried the one they sell and hate it.
  • My surgeon's office "Strongly Recommends" the ________ shakes. He gives us a website that is supposed to get it at his cost. According to a  press release (announcing Carnie Wilson as spokespersonin 2006) he help develop the product. Well ________ is now owned by AMWAY!! They only sell thru the doctors offices and sites for each Dr. I tolerated it... until surgery. I can't stand it now (have 3 unopened cans!). They tell me whey isolate... but I had to call the nurse on a product she showed me that was collagen protein.
  • My surgeon's office doesn't sell any products. The nutritionist(s) at the nutritional class(es) gave recommendations for various things like proteins, multi-vitamins, calcium, etc but gave multiple choices for each. They did give some samples out too. People have to find what is palatable to them and that they can afford and never be pushed into buying something specific that is made to seem like the one brand it is a medical requirement.

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