“You should really try it,” Jen’s friend was saying.
“I’ve been going to this medical practice for a year, and my pain is completely gone!”
Jen was curious about this local doctor whose unconventional techniques produced amazing results.
What do I have to lose? Jen thought to herself.
She looked up the practice online and saw the doctor’s bio, list of services, and 5-star patient reviews. A page called “Nutrition” revealed pictures of vitamin bottles surrounded by colorful vegetables. She clicked on a 5-minute promotional video and listened as an enthusiastic product representative explained the benefits of adding vitamins to your diet.
Jen was surprised. Her previous doctors had never talked about supplements, but she was intrigued about her friend’s rave review. So she decided to call the practice and set up an initial appointment for the following week.
Once the appointment was confirmed, she received an e-mail with instructions to fill out paperwork online. Several of the questions were about her intake of vitamins and herbs.
That’s nice of them to ask, she thought. I’m not sure why that has anything to do with getting rid of my back pain… guess I’ll find out.
—–
At the doctor’s office, Jen saw big posters of the supplements from the doctor’s website. She noticed a stack of product brochures at the check-in desk. A friendly staff member greeted her, and she sat down next to magazines about health and nutrition.
Minutes later, a nurse called Jen’s name, checked her vital signs, and escorted her to an exam room. The doctor soon walked in.
Jen’s visit went well. She explained her symptoms, her health history, and therapy she had already tried. The doctor performed a physical exam and recommended tests and treatment methods to help reduce her pain.
Then the conversation turned to her diet.
“I see that you’re not taking any supplements right now,” said the doctor. “Studies have shown that a customized nutritional approach can reduce inflammation and improve symptoms of a variety of diseases. Would you like us to do a nutritional assessment for you today?”
Jen felt obligated to say yes. She hadn’t thought about the need to take vitamins; but since the doctor was strongly advising it, she agreed.
The doctor continued. “After we do the free assessment, any deficiencies can be fixed with a special blend of nutraceuticals that we make available to our patients. In fact, all of my staff members take these products, and so does my entire family. We really believe it’s the best option out there—although of course, you can use any supplements you want. My assistant will get you set up.”
With that, the doctor exited and was replaced by a nursing assistant, who reviewed Jen’s dietary habits and gave her a paper with a list of products she could buy to “reverse the damage” and improve her gut health.
“If you’re ready to start today, the combo pack is available at a 10% discount. Or you can sign up with our network, which lets you have the starter pack for free with your purchase, as well as a 30% discount on future products.”
Jen considered her options, handed her credit card to the front desk staff, and walked back to her car with a bag of vitamin bottles.
Back at home, Jen made a cup of tea and sat down at her kitchen table. She pulled a variety of bottles and powders out of the bag. As she reviewed the glossy handouts, Jen tried to rationalize the expense. Today’s visit was covered by insurance, but the extra $499 she had spent on supplements was out of pocket. Jen felt cautiously optimistic about the potential for these products to improve her health, but she was also nervous about how to pay $199 for a new supply every month.
They told me that if I get my family and friends to buy, I can earn my supplements for free, Jen recalled.
She decided to call her sister and mother and convince them to sign up too. They could all get healthy together, Jen would be able to afford the products, and she may even be able to convince them to recruit others into her network.
I’m so glad I found this doctor, thought Jen as she swallowed the first dose of supplements.
—
Jen’s experience is, unfortunately, very common in the healthcare field. She had unknowingly been persuaded to join a Multi-Level Marketing (MLM) network—a business model that requires both purchasing products and recruiting others to join in your “downline.” The MLM model (also known as direct sales) is used by hundreds of companies, and is estimated to be worth at $35.4 billion in the USA across all categories. The total health supplement market (not MLMs specifically) is expected to generate $278 billion in worldwide sales by 2024 [source: PRNewsWire]. The vast majority of MLMs are in the Health & Wellness field (read more: What’s the Difference Between Brick-and-Mortar, Franchise, Direct Sales, and MLM?)
Although healthcare providers have a professional obligation to look out for their patients’ best interests, they often struggle with burnout and keeping their practice profitable. The quest to find new sources of revenue puts doctors at risk of being targeted by MLMs, which promise unlimited residual income through the sale of “natural” and “safe” products.
Unfortunately, the sale of products in a physician’s office—especially nutritional supplements—violates the ethical standardsof several professional organizations, including the American Medical Association, the Canadian Medical Association, and the Australian Medical Association. This is because the sale of supplements can cause physicians to:
- exploit patients for financial gain
- use products of unproven scientific validity, and
- have an inappropriate bias in recommending a particular product, even if it’s not necessary for that patient’s health condition.
[source: Ethical Standards on the Sale of Products in Healthcare]
In Jen’s story (which is fictional but based on real experiences), she was presented with products at several points in her visit: online, on posters & brochures, and in person.
She said she felt obligated to agree to a nutritional evaluation and agreed to purchase the products only because the doctor strongly advised that she do so.
Based on this patient-provider trust, Jen joined a sales network and spent hundreds of dollars on products.
She decided to convince her family members into signing up, in order to ease her monthly burden of buying the expensive—but in her mind, necessary—supplements.
When a healthcare practitioner focuses on “profit before patients,” this puts people like Jen at risk.
What You Can Do as a Patient
If you know of a physician who sells and promotes products through a multi-level marketing or direct sales model, here are some ways you can respond:
1. Confront your doctor.
No patient should feel uncomfortable about their healthcare experience. You have every right express your concerns about the in-office sale of products by telling your physician directly. If you prefer a less direct approach, you could write a letter or e-mail, or send a message through the practice’s secure patient portal.
2. Communicate anonymously.
Maybe you feel concerned but don’t want to put yourself in an adversarial position. If so, you have the option to send a message anonymously by using the practice’s anonymous tip line or leaving feedback on a card in the office. Another option is to write an anonymous letter to the doctor, explaining your concerns about their conflict of interest.
3. Find another doctor.
Except in rare cases, you are under no obligation to continue seeing a physician with whom you feel uncomfortable. When a doctor is not serving your best interests, it might be time to find a different practice. There are many ethical physicians to choose from (check out this video by Dr. Arthur Caplan, professor of bioethics at NYU Langone Health; MedScape login required).
4. Rate on social media.
Online ratings can be a good way to get a physician’s attention if other methods don’t work. You can share your experience on social media or a health rating tool like HealthGrades or Yelp, which will alert other potential patients to the practitioner’s unethical actions.
5. File a BBB complaint.
Another option is to fill out a Better Business Bureau complaint or report a scam—or use an equivalent tool for your country. Check out this list of 14 business rating websites.
6. Report a violation.
Physicians who sell and recruit patients into an MLM are violating several code of ethics standards according to many associations around the world (you can see them here). If you believe a medical professional is behaving unethically or failing to provide a standard of care to patients, the best way to respond is to report their behavior to the local medical licensing board.
- In the United States, look up your state on the Federation of State Medical Boards website.
- For US military personnel, a grievance form against TRICARE physicians, dentists, and pharmacists is available.
- In Australia, you can “Raise a concern” about health practitioners.
- Canada’s government provides links to file “Complaints concerning practice of medicine.”
- In the Czech Republic (Ministerstvo zdravotnictví České Republiky), you can file a complaint against any healthcare services received.
- In the United Kingdom, the National Health Service explains how to file a complaint about a GP, dentist, optician, or pharmacist.
- Ireland’s Medical Council (Comhairle na nDochtúirí Leighis) has its own complaint form.
7. Contact your local news.
When all else fails, a final way to raise the alarm about a physician’s unethical behavior is to contact the media. It might interest them to know that:
- the US FTC [Federal Trade Commission] has issued a serious warning to companies which make false claims about products such as CBD
- individual MLM sellers are at legal risk and may be required to pay large a fine if they deceive people by promising significant income (as recently happened to AdvoCare’s top four promoters), and
- doctors can be publicly reprimanded for failing to disclose their income and other unprofessional conduct (such as this Australian physician).
The bottom line is that practitioners who provide ethical treatment to their patients don’t need to resort to selling products, especially through multi-level marketing. And as a patient, your opinion can make a big difference when you encourage your doctor to make ethical, patient-focused business choices.
Grace LaConte, MS, RHIA
Founder of LaConte Consulting
The Anti-MLM Coalition 
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