Why doctors don't like to talk about antioxidants.

Health and medicine explained.
Aug. 3 2011 10:04 AM

The Doctor and the Pomegranate

Antioxidants don't work, but no one wants to hear it.

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Whether this line of inquiry turns out to be hokum or the first step toward elucidation of antioxidants' role may take years to sort out. What is evident immediately however is the wishy-washiness of your local doctor throughout the antioxidant debate: We were slow to jump onto the antioxidant bandwagon and are slower still to jump off.

This brand of muddle is standard operating procedure for clinicians; we are eternally trying to appear modern and open to the new, while remaining anchored in a reality-based mindset that demands facts and data. Many patients are put off by such caution and come to view us as fuddy-duddies, self-promoting sticks in the mud, flapping bags of hot air (not to mention greedy bastards who may be invested, literally, in maintenance of the status quo). Or else we are seen as being handcuffed and controlled by the rigid iron of Big Pharma.

With something as popular as antioxidants, which comprise a substantial piece of the $23 billion U.S. vitamin and supplement market, the problem is particularly acute. If we swim against the riptide of popular delusion and warn our patients against them, it's like we're denying the benefits of sunshine and fresh air. Any appeal to "evidence" in support of that view would have little traction with the consumer; double-blinded medical studies are counterbalanced, in America, by a parallel system of peer review in the form of a nonstop confab of health-themed talk shows, print magazines, and blogs.

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So when a patient comes in to ask (or tell) me about the curative powers of antioxidants, I am stuck. I can give him a boring recitation of the latest findings, or mention that the National Center for Complementary and Alternative Medicine has declared that "there is limited scientific evidence to support the use of antioxidant supplements to prevent disease." And he'll tell me that the pills worked wonders for his sister-in-law out in Queens. We both sigh and look away. If he goes ahead and starts guzzling pomegranate juice, he doesn't tell me.

This momentary awkwardness exposes a larger and potentially troubling problem: the fragility of that most complicated of all partnerships, the one between doctor and patient. Many are in an ongoing tug-of-war because of a simple difference of opinion: The patient wants to live forever (natch!) and may embrace any harebrained scheme available (cf.: antioxidants); in response, the doctor assumes the chilly pose of the threatened medical ruling class.

Usually, the tug-of-war doesn't amount to much. Most doctor visits turn out to be a big nothing: a bump that isn't; a pain that fades; a rash that will go away. But once in a while, and especially as people descend the hill from middle age, that routine visit finds its way to a miserable, frightening place. Bad news is disclosed; plans must be made. And that's when antioxidants do their real harm. The arguing through the years regarding pomegranate juice and vitamin E and whether to buy a juicer has slowly corroded the mutual confidence that underlies the doctor-patient relationship. And this is a damage that has no quick remedy, real or imagined.

Kent Sepkowitz is a physician in New York City who writes about medicine.

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