Physician Bias: Conflicts of Interest in Conventional and Integrative Medicine

Every prescription we write and every supplement we recommend is filtered through one (of many) lenses we often pretend don’t exist—our own incentives.

1. A Tale of Two Clinics – Same Story, Different Props

Spend a morning on hospital rounds and you’ll see the traditional script: physicians invited to speak on advisory boards, researchers funded by the very companies whose molecules they study, and a steady procession of impeccably dressed reps bearing coffee, samples, and data “leave-behinds.”

Head across town to a functional or integrative practice and the scene looks cleaner—diffusers humming, kombucha on tap—but the economic underpinnings feel surprisingly familiar. Instead of drug reps we have wholesale supplement portals promising margins on every bottle shipped to our patients. Layered on top is a booming private-label market: the exact same multivitamin or protein powder—re-badged with a practitioner’s logo—now retailing at a premium because it appears “custom-formulated.”

The props differ, but the plot is identical:

1. A company needs distribution.

2. A clinician controls access to patients.

3. Money (or prestige) flows through that channel.

2. Why the Conflict Matters

Conflicts aren’t inherently evil; they’re simply gravitational pulls on our decision-making. The danger arises when we pretend the pull isn’t there.

• Therapeutic Creep – “If 2 g of curcumin is good, maybe 4 g is better.”

• Evidence Skew – We give attention to studies validating our favorite botanicals, while dismissing null trials as “poorly designed.”

• Cost Blindness – A month’s worth of supplements whose cost rivals a car payment can slip under the radar when we’re earning a slice of the receipts.

• Brand Halo – A private-labeled protein powder may look bespoke, but often the only thing truly unique is the margin.

3. Owning My Own Bias

Dignity Integrative maintains an online dispensary (managed by Fullscript) so patients can order supplements through our website. We do it for the many benefits Fullscript offers to integrative medicine doctors and the ease of use for patients. 

The reasons are sound—quality control, personalized protocols, ability to do cost comparisons, supply-chain transparency, adherence tracking, to name a few—but a financial incentive remains. I do not sell private-label products, yet I still earn a percentage when patients buy through my curated catalog. Denying that would be disingenuous.

4. New Players, Same Gravity – The Rise of Supp.co

Into this muddle of financial incentives for supplements, digital platforms have rushed to “objectively” rate supplements. 

Supp.co, for example, assigns trust scores to products and brands using dozens of quality attributes—everything from cGMP certification to third-party testing—and already catalogs tens of thousands of SKUs. I applaud the transparency push, yet potential biases linger:

• Revenue Model – If brands pay for deeper analytics or preferred placement, bias seeps back in.

• Affiliate Links – When consumers purchase through the app, commissions can fund the “objective” ratings.

• Expert Protocols – Some platform contributors simultaneously sell educational courses or products elsewhere.

Even the referee can have a side hustle selling jerseys. I’m not saying we should ban the referee, as the jerseys may be reasonably priced and high quality, just a caution to understand how the revenue flows and the inherent biases it may cause. 

5. Lessons From Pharma’s Playbook

Mainstream medicine hasn’t abolished conflicts, but tighter rules around disclosure and sunshine reporting have blunted some edges. We can borrow a few guardrails:

Pharma Lessons Learned	Integrative Adaptation
Mandatory disclosure of honoraria & research payments	Publish supplement margins (in general terms), dispensary relationships, and any rating-platform affiliations
Separation of sales & education at accredited conferences	Keep vendor promos out of patient-facing webinars & group visits
Limits on gifts (no more lavish dinners)	Resist perks like “free inventory” tied to volume thresholds
Peer-reviewed data requirement for formularies	Hold supplements—including highly rated ones on Supp.co—to evidence gradings (RCT > cohort > mechanistic hunch)

6. A Framework for Ethical Supplement Prescribing

1. Evidence First, Revenue Last — Rank research quality before considering cost, convenience, or brand prestige.

2. Cap the Cart — Aim for minimum effective protocols, not kitchen-sink stacks.

3. Disclose Early & Often — A single sentence in your intake packet beats pages of legalese.

4. Offer Non-Portal Options — Provide product names and third-party retailers so patients can comparison-shop.

5. Audit Yourself Quarterly — If you stock in a clinic, review top-selling SKUs (and any rating sites you reference): did they earn that spot by data or by discount?

7. The Patient Conversation

When patients ask, “Do you make money on these supplements?” my answer is simple: Yes, a modest margin that offsets the time spent researching and personalizing patient plans. You’re free to purchase anywhere; the protocol still stands.

That said, I realize the need to be more transparent as part of my care process. Transparency seldom erodes trust; more often it cements it.

8. Toward a Better Culture

The integrative medicine movement prides itself on root-cause medicine and holistic care. Living up to that ethos means acknowledging our own root-cause biases. Let’s:

• Normalize public disclosure of financial relationships—including any rating-platform collaborations.

• Create voluntary registries for supplement conflicts, akin to clinicaltrials.gov.

• Encourage patients to ask, “What’s your margin on this product?” without fear of awkwardness.

9. Closing Thoughts

We are all conflicted—myself included. The goal isn’t to achieve purity; it’s to cultivate awareness and design systems that keep our recommendations tethered to the patient’s best interest.

If conventional medicine teaches us anything, it’s that unchecked incentives corrode trust. Integrative medicine has a chance to write a different third act—one where transparency is the diffuser in every room.

Feel free to share your thoughts or your own strategies for navigating these waters. The conversation keeps us honest—and our patients safer.