Selling Health Products — Easy Money or Risky Business?
Laura M. Cascella, MA, CPHRM
The sale of nonprescription health products — such as dietary supplements, vitamins, essential oils, skin care products, and nutraceuticals — is big business in the United States and abroad. In fact, the global market for dietary supplements was valued at about $152 billion in 2021, and it is expected to expand at a compound annual growth rate of 8.9 percent from 2022 to 2030.1
In recent years, physicians, chiropractors, acupuncturists, physical therapists, and other licensed healthcare professionals have incorporated the sale of health products into their practices as a way to meet patient demands, increase convenience, and add new revenue streams — particularly as insurance reimbursements have declined and overhead has increased.
What may seem like an easy way to boost profits, though, can have serious legal and ethical implications. Numerous professional associations have issued guidance warning providers to avoid or use caution when selling health products directly from the office setting or through third parties that give providers a portion of the proceeds.
The perception of elevating profits over patient care can raise questions about financial conflicts of interest, potential patient coercion and exploitation, and negligence. The American Medical Association also warns that these sales can “erode patient trust, undermine the primary obligation of physicians to serve the interests of their patients before their own, and demean the profession of medicine.”2
Providers who wish to pursue the sale of health products, or who currently are recommending or selling specific products, should implement strategies that reduce ethical and legal risks and prioritize optimal patient outcomes and well-being. Examples of such strategies include the following:
- Carefully consider whether the health products you are selling, or considering selling, create a real or perceived conflict of interest or a concern about ethical practice.
- Be aware of whether the direct sale of products or the way in which you receive remuneration potentially violates state or federal fraud and abuse laws, such as kick-back or fee-splitting statutes.
- Perform due diligence and consult legal counsel before entering into license agreements or sponsorships with wellness or diet clinics. These arrangements can expose healthcare providers to legal and professional risks.
- Review your state’s laws on patient exploitation to ensure that selling products does not potentially violate these laws. Be particularly cognizant of sales to vulnerable patient populations, such as geriatric patients.
- Do not enter into exclusive distributorship or custom branding agreements with product manufacturers, which might trigger allegations of patient exploitation.
- Contact your state licensing board to determine whether it has any guidance or regulations related to the sale of health products to patients.
- Be aware of state laws for in-office ancillary services as they might relate to the sale of health products, and determine whether your state has limitations associated with profits from, or markups on, these products.
- Provide written and verbal disclosure of any financial interests you have in the sale of health products. Some state laws might require this disclosure, but it is prudent to disclose the information regardless.
- Ensure that patients are aware that they are not obligated to purchase products from the practice, and advise them of where they can find similar or alternative products for purchase. Review sales and marketing tactics to ensure they are not coercive or place undue pressure on patients.
- Make sure any communication with patients about health products — including verbal and written communication — is objective, truthful, and devoid of misleading or deceptive claims.
- Only offer products that have undergone reliable and credible scientific review to prove their benefits. Selling or promoting products that make dubious claims with no scientific validity raises significant legal and ethical concerns.
- Make decisions about which products to sell based on patients’ immediate needs, the clinical relevance to the patient population served, the availability of dependable evidence to support using the products, and potential barriers patients might encounter trying to obtain the products through other methods (e.g., time or geographic limitations).
- Provide patients with written and verbal information about the risks, benefits, and limitations of products so they can make informed decisions about their care. Make sure information is clear and understandable, and document the provision of information and education in patients’ health records.
- Monitor patients who purchase health products to ensure safety and address any issues that might arise with toxicity, adverse events, or lack of improvement in their symptoms or conditions.
- Pay careful attention to any patient complaints — to office staff, on satisfaction surveys, or online — about feeling coerced into buying products or uncomfortable with sales/marketing efforts meant to facilitate product purchases.3
Although many healthcare providers sell health products (either in their offices or through manufacturers/suppliers), this practice should not be approached merely from the standpoint of generating revenue. Providers must be vigilant in ensuring these sales do not create conflicts of interest, violate legal statutes, raise questions about ethical behavior, or supersede acting in the best interests of patients.
Approaching the sale of health products with caution and careful consideration can help providers manage the legal and ethical risks of product sales.
Endnotes
1 Grand View Research. (2022). Dietary supplements market size, share & trends analysis report by ingredient (vitamins, minerals), by form, by application, by end user, by distribution channel, by region, and segment forecasts, 2022–2030. Retrieved from www.grandviewresearch.com/industry-analysis/dietary-supplements-market
2 American Medical Association. (n.d.). Sale of health-related products: Opinion 9.6.4. In Code of Medical Ethics. Retrieved from www.ama-assn.org/delivering-care/ethics/sale-health-related-products
3 Cohen Healthcare Law Group. (n.d.). Key points for physicians and other healthcare licensees to consider when selling dietary supplements to patients. Retrieved from https://cohenhealthcarelaw.com/2014/12/key-points-for-physicians-and-other-healthcare-licensees-to-consider-when-selling-dietary-supplements-to-patients/; Cohen Healthcare Law Group. (n.d.). Physician sale of dietary supplements – legal and regulatory restrictions. Retrieved from https://cohenhealthcarelaw.com/2013/01/physician-sale-of-dietary-supplements-legal-and-regulatory-restrictions/; American Medical Association, Sale of health-related products: Opinion 9.6.4; Cohen, M. (2004, October 27). Advising patients regarding dietary supplements. Complementary & Alternative Medicine Law Blog. Retrieved from www.camlawblog.com/articles/dietary-supplements/advising-patients-regarding-dietary-supplements/; Adler, E. L. (2012, February 8). Physicians selling products: Legal and ethical considerations. Physicians Practice. Retrieved from www.physicianspractice.com/view/physicians-selling-products-legal-and-ethical-considerations; Cohen, M. H. (n.d.). Are physician online dietary supplement sales legal? FON Consulting. Retrieved from https://fonconsulting.com/blog/are-physician-online-dietary-supplement-sales-legal/
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