The doctor will sell you now

Elise Leonard seems like the kind of doctor everyone wishes they had. The Plantation ophthalmologist is friendly, listens well and likes to spend time with patients. But behind that demeanor is a growing frustration that her income, like that of many doctors, is declining -- even though she's treating more patients than ever. "All our years of work are not being compensated properly," she says, blaming Medicare and managed-care insurers for cutting her fees.

While scouting for new income sources two years ago, she received an audiotape from a lawyer friend. It touted an opportunity to make big money by selling dietary supplements manufactured by Rexall Showcase International (RSI) and by recruiting others to do the same -- a business known as multilevel, or network, marketing. Orlando ophthalmologist Stephen Brooks was among those who testified about RSI's impact, and his pitch spoke directly to Leonard. Brooks, too, had become depressed by managed care, and went looking "for alternatives to leverage myself away from the daily stresses and aggravations of practicing medicine," he said on the RSI audiotape, "Doctors Speak Out." After just two years, he said, he had through RSI been able to turn around both his outlook and his bottom line.

RSI is a division of publicly traded Rexall Sundown Inc., a $530 million company based in Boca Raton. Largely through the use of such tapes, RSI has lined up thousands of distributors around the country, about 30 percent of whom are doctors and other health care professionals. Net sales grew a sizzling 51 percent last year.

Although skeptical about network marketing at first, Leonard was impressed by the number of doctors on the tape testifying to the dramatic medical benefits of RSI products. (Brooks himself said that by using the supplements, he lowered his cholesterol level from 223 to 157 in three months, and dropped 20 pounds as a side effect.) She also was reassured by the Rexall name, which she fondly associates with the corner drugstores of her youth. Actually, that chain went bankrupt in 1985. A small suntan-lotion and vitamin firm called Sundown bought the Rexall trademark in 1989 for $2 million, changed its name to Rexall Sundown in 1993, and went public shortly after that. The remaining Rexall stores have no connection to Rexall Sundown.

But Leonard knows nothing of this history. "Since it's Rexall, it's nothing to be ashamed about," she said in a interview. "It's more appealing than selling Amway soap, and it's preventive health care, which fits better with my professional life."

Through RSI, Leonard offers what she considers a valuable service. She sells her patients vitamins, minerals and homeopathic and herbal remedies that she claims protect vision, lower cholesterol levels, and combat coronary artery disease, allergies, asthma and obesity. RSI encourages her and other distributors to make a profit by selling the products at 25 to 45 percent above cost, but Leonard says she adds only a "handling" charge -- for instance, $5 on a $17.50 product. She also recruits others, including patients, to distribute the products, so that she can receive a commission on their sales. "I've got three people distributing under me now, including one doctor, and it's becoming very lucrative," she said.

Flip Lechner is one of the patients whom Leonard convinced to try RSI products, though she declined the offer to sign up as a distributor. Although the 72-year-old retiree was surprised when her doctor offered to sell her dietary supplements, it didn't bother her. "She's done several operations on me, and I have a lot of faith in her," the chatty Long Island native, who suffered a heart attack last year, said during an interview a few weeks ago. "I don't think she's making money on this. Dr. Leonard isn't like that."

At a cost of $123 a month, Lechner started using three products in June -- for her partially blocked heart arteries, diabetes and cholesterol level -- and says she experienced great results in the first 10 days. "I've been taking a lot of vitamins and herbs for at least 50 years now, and I've never felt like this before," she gushed. "It's like I laid down on the ground, my body opened up, and out came a new person."

But the American Medical Association (AMA) worries that money-making pursuits like Leonard's could destroy the faith that Lechner and other patients have in their doctors. In June the Chicago-based medical group voted in favor of imposing strict ethical guidelines on doctors who choose to sell dietary supplements and other health-related products to their patients.

"Doctors shouldn't sell Rexall products if they are not available in the stores," says Dr. Herbert Rakatansky, chairman of the AMA ethics council that drafted the policy, which he interprets as prohibiting doctors' involvement in network marketing. "It's taking advantage of a vulnerable population," he explains. "As a patient you have a right to expect your doctor to do what's best for you, not what's best for the doctor. There are lines one shouldn't cross in medicine, and this is one."

But a breach in doctor-patient relations is not the only line that Rexall Showcase and its distributors appear to have crossed. "Amazing" is the word one Federal Trade Commission (FTC) official used in describing RSI's promotional claims about the curative powers of its products, claims that may violate FTC rules against misleading advertising. And many RSI distributors admit they primarily focus on recruiting other distributors, not selling products to retail customers -- an indicator of a fraudulent pyramid scheme. Officials at the FTC and the Florida Attorney General's Office said these practices may prompt investigations by their agencies.

In addition, doctors selling RSI products may be violating state medical licensing rules that bar them from financially exploiting patients, says Tanya Williams, executive director of the Florida Board of Medicine. This week, as about 10,000 RSI distributors flock to Orlando to attend the company's semiannual corporate conference, the state board will consider whether to follow the AMA's lead and make the practice a violation that could lead to the suspension or revocation of a doctor's license.

Rexall says that the company and its distributors do not violate any government rules. Glenn Gold, RSI's vice president of marketing, suggested that if there are problems, they are caused by distributors acting on their own. "We monitor our distributors very, very closely to make sure that people who are not complying with the way we want them to do business do not stay in our distributor force," he said.

But Florida medical leaders share the AMA's concern that selling medically unproven products to patients in doctors' offices could erode public trust in physicians. Mathis Becker, a cardiovascular surgeon who is president-elect of the Florida Medical Association, says he hopes that the Florida Board of Medicine prohibits the practice. "Unfortunately," he says, "there are always going to be some doctors looking for new ways to make money."

Inside its gleaming, 141,000-square-foot headquarters and manufacturing facility in Boca Raton, Rexall Sundown, the nation's largest seller of vitamins and other dietary supplements, churns out about 1 billion tablets, capsules and soft-gel products per month. It employs 1,300 people at the plant and its warehouse and distribution center in Deerfield Beach.

Rexall Sundown launched RSI in 1990 to take advantage of the burgeoning interest in multilevel-marketing (MLM) and gain an edge over rivals in the fiercely competitive $8.9 billion nutritional-supplement industry. RSI's Gold said that having people sell these products to their relatives and friends is more effective than retailing them in stores, where consumers have dozens of brands from which to choose. RSI has mushroomed into a major division of Rexall Sundown, accounting for almost 30 percent of the company's revenue last year.

Proponents argue that network marketing is the wave of the future in retail selling because it cuts down on administrative costs like warehousing, inventory and advertising. More than 7 million Americans currently serve as distributors for hundreds of network-marketing firms, estimates Robert FitzPatrick, who co-wrote False Profits (1997), a book that criticizes MLMs. But total sales are only about $10 billion a year -- which works out to less than $1,500 per distributor.

In its required 10-K disclosure report to the U.S. Securities and Exchange Commission last year, Rexall Sundown claimed that 100,000 active distributors, mostly in the U.S., were selling RSI's 150 vitamin, herbal, homeopathic, personal care and water filtration products. And if past conferences are any guide, those who attend the Orlando gathering will hear star distributors deliver revival-style testimonials about how they became millionaires through RSI.

But FitzPatrick warns that people considering signing up need to take a closer look. "Dietary supplements and MLMs fit together well because both embrace magical thinking," he says. "You can make extraordinary promises without delivering. If someone takes a lot of vitamin C and still gets a cold, he usually doesn't say that the vitamin C failed. MLMs work the same way. People don't look at how many hours they'll have to work, how many people they'll have to contact or how much money they'll really make."

Those who believe that Rexall Showcase is the same company that ran the once-ubiquitous corner pharmacies also need to think again. Gold stammered when asked whether it wasn't misleading for RSI's distributors and promotional audiotapes to claim -- as did one distributor in Gold's presence at a recent meeting -- that the company has operated pharmacies since 1903 and still has thousands of stores. "I never said that ... I can't answer that," he said. "The trademark Rexall continues on. The trademark stands for integrity, honesty and value. We continue to promote that today, just as it was promoted 75 years ago."

The new AMA ethics rules certainly don't help RSI's case. The guidelines, although not legally binding, allow physicians to distribute the company's products only if they make no profit on them. And physicians are not supposed to sell a product for which the benefits have not been scientifically demonstrated. They are discouraged from selling products that are similar to retail-store products offering comparable health benefits. To amplify its disapproval, the AMA also prohibits doctors from selling products that are exclusively available through physicians' offices. Physicians also must fully disclose to patients the nature of their financial interests in selling the products.

While Rexall opposes the AMA's adoption of this policy, Gold argued that the practices of RSI's doctor-distributors are perfectly consistent with the AMA stance. "If anything, [the AMA rule] reaffirms the way we do business and makes people proud to be part of Rexall Showcase," he said.

That's hard to figure. Contrary to the AMA policy, solid scientific support for the supposed benefits of many of Rexall's products does not exist. And doctors would be hard-pressed to argue that patients couldn't get comparable products at the supermarket.

RSI's position is that extensive research backs its health-benefit claims regarding the ingredients in its products and that clinical trials on specific combinations of ingredients are now under way. The company claims that evidence is particularly strong for Bios Life 2, a fiber supplement it touts as "patented" for reducing cholesterol. (Actually, the patent simply means that the product formulation is unique, not that it's been proven medically effective.) Indeed, there is evidence in major medical journals that various types of water-soluble fiber do reduce cholesterol. And many studies in these journals show that the antioxidants contained in products sold by Rexall and many other supplement companies protect against cancer and cardiovascular disease.

But there is no study in any established journal that proves RSI's products achieve many of the treatment and prevention benefits claimed by distributors and the company's promotional materials, says Stephen Barrett, a retired physician who heads Quackwatch, an Allentown, Pa.-based group that scrutinizes alternative health claims. Nor does any study in any of these journals show that RSI products are better than those offered by other companies or in supermarkets and drugstores. And research has been inconclusive about whether ingesting antioxidants in pills produces the proven benefits of simply eating more antioxidant-rich fruits and vegetables.

Homeopathic remedies also lack scientific support. These remedies are based on the unfounded theory that infinitesimally tiny amounts of offending substances -- on the order of one part in several million -- immunize the body against disease. Critics say that homeopathic remedies are nothing more than inert placebos that may help patients only by fooling them into thinking they've received an effective treatment. Over many years, researchers have found that about 30 percent of patients who receive placebos report improvement in their medical condition.

"You don't even know what's in dietary-supplement bottles, let alone whether they are helpful for anything, because these products are completely unregulated," says Dr. Marcia Angell, executive editor of the New England Journal of Medicine. That's because a controversial 1994 law, pushed through Congress by the powerful dietary-supplement industry, exempted supplements from FDA testing as long as manufacturers don't claim their products cure, treat or prevent disease. Angell co-wrote a scathing editorial last year urging that supplements be subjected to the same rigorous testing required for conventional drugs. "For doctors to sell products for which no one knows the safety and efficacy seems wrong and unethical," she says.

Another ethical problem is that doctors hawking RSI products are steering patients toward supplements that cost more than similar products available in retail stores, says Lisa Colodny, pharmacy services coordinator at Broward General Medical Center in Fort Lauderdale. For instance, RSI's Bio-C, a combination of vitamin C and bioflavonoids, costs $33.25 for 150 tablets while a similar product made by Lindberg, with most of the same ingredients and a higher dose of ascorbic acid, costs $4.20 for 100 tablets at Eckerd. In another example, RSI boxes 60 Bio-C tablets with 60 tablets of a multivitamin/protein combination in a package called Cellular Essentials, which costs $59.95. But if you go to Eckerd and buy a comparable multivitamin called Theragran M, along with Lindberg's C vitamin and Turbo protein tablets, you get a combination similar to Cellular Essentials, with a lot more pills, for only $28.98.

"I do think antioxidant therapy [vitamins C, E and beta-carotene] can be beneficial," said Colodny, who compared products and prices for this article. "But do I think that the particular Rexall therapy is the best one? Not necessarily, especially when you look at the prices."

Gold said his company's products are more scientifically designed and of higher quality than those of other firms. But there is another explanation for the higher prices. Rexall Sundown's 10-K report states there is a higher profit margin on RSI products than on goods sold by the company's retail divisions. Commissions paid to RSI distributors account for most of the division's administrative and sales expenses, and RSI has higher overhead costs than Rexall's other units, the report adds. According to Sylvain Chevalier, a Miami-based RSI distributor, 60 percent of the company's revenues are paid back to distributors in commissions. Thus the high cost of paying commissions to tens of thousands of network-marketing middlemen helps to explain why patients seeking dietary supplements can get a better buy at Eckerd.

But patients aren't the only potential losers. Critics say doctors and others who become Rexall Showcase distributors may be falling victim to a classic, though well-disguised, pyramid scheme.

Last month, 44 prosperous-looking, middle-age people crowded into a monthly distributors' meeting at a Holiday Inn off I-95 in Hollywood. At least three doctors were in the narrow room, which buzzed with excited conversation beforehand. Dr. Daniel Schuman of Boca Raton, a head-and-neck surgeon, boasted to a clot of people in the hallway that his wife's RSI business had brought in enough income to allow him to sell his practice and teach medicine abroad. Dr. Rodney Cohen, a Boca gastroenterologist, told a visitor that he hopes his wife's RSI business grows enough so that he can follow in Schuman's steps and scale back his medical practice.

The host was Chevalier, a handsome French-Canadian who had recruited many of the distributors at the meeting and who specializes in signing up doctors. Standing before a slide-projection screen, Chevalier disclaimed any skill at salesmanship but proceeded to prove the opposite. "I'm the messenger of good news," he said. "How many people in this room would like to have more money and more time?" People smiled and raised their hands. He described how he'd replaced his six-figure income as an international banker with his income from RSI while enjoying the comforts of working at home. A slide he showed listed the average income of RSI distributors who have recruited five levels of active distributors, or downliners, as $21,867 a month.

"Everyone knows and trusts Rexall, a great American institution we all grew up with," he said. "It's a family of companies that still includes thousands of Rexall drug stores," he added, inaccurately. "We're at the right place and the right time. How many of you have missed a great business opportunity before?" A number of hands went up. "If you miss this, you'll remember it for the rest of your life." He then introduced Gold, who described the compensation plan for distributors as the "most lucrative" in the network-marketing industry.

Chevalier closed by assuring everyone that RSI distributors are not required to invest more than $49.50 for a distribution starter kit. He later said, however, that new distributors, particularly affluent professionals such as doctors, are encouraged to buy $4,000 in products to qualify immediately for a 5 percent commission on sales by their downline distributors.

There was very little talk at the meeting about the RSI products, which were arrayed in the front of the room. That's not as surprising as it seems, because Chevalier and other distributors, as well as the company's promotional audiotapes, say that's not where the real money is made. According to a handout Chevalier uses in training his downliners, distributors' long-term incomes from RSI are based primarily on personal consumption of products by their downliners and by the products these distributors sell to others. Indeed, none of eight RSI distributors interviewed put much emphasis on selling pills to people who are not downline distributors.

What distinguishes a "legitimate" MLM business from a pyramid scheme is that the former focuses on selling viable goods or services to retail customers, while the latter concentrates on recruiting as many distributors as possible and siphoning money from them, says Jim Lyons, a Tampa-based investigator for the Florida Attorney General's Office. According to federal and state case laws, MLM distributors must sell at least 70 percent of their products to retail customers who are not distributors. This is to protect unwary distributors from getting stuck with a garage full of inventory they were required to buy to qualify for commissions. Through the years the Attorney General's Office has taken action against 48 MLM companies that ran afoul of anti-pyramid rules, including major alternative-health firms such as Herbalife International and Nu Skin International.

But "False Profits" author FitzPatrick says virtually all network-marketing programs are pyramid schemes, because recruiting, not retail sales, is the true goal. It's statistically impossible for more than a tiny percentage of distributors to enlist enough downliners to succeed financially. "What people don't seem to think about is that because there are a finite number of people in the world, the people at the bottom rung can't find enough customers to make a profit," says Les Garringer, Florida's assistant deputy attorney general in charge of economic crimes.

One reason potential distributors don't grasp this concept is because MLM companies generally don't -- and are not legally required to -- disclose the average income of distributors, how many drop out within a year, or how many make the six- and seven-figure incomes with which the companies tantalize them. Downliners often end up losing the thousands of dollars they invested in distributorships and, even worse, alienating friends and relatives they tried to recruit, FitzPatrick says. The beneficiaries are the program's founders and first distributors, who often get rich off those below them in the chain.

Here's why Rexall distributors concentrate on recruiting rather than selling. According to a chart in Chevalier's handout, if a distributor starts with three customers, and if he and they each buy $100 of RSI products a month, the distributor collects only $15 a month in commission. But the returns are exponentially greater if those customers become distributors and recruit other people. The person at the top of this chain gets up to 10 percent of all downliner sales. If the first distributor ends up having five active distributors under him, each of whom has three customers, and each person in this network buys $100 a month of products, the original distributor pockets almost $11,000 a month. That soars to $50,000 a month if each downline distributor adds just one more customer.

Given the incentives, Chevalier and other serious distributors understandably put almost all their efforts into signing up downliners. They say most products are sold to people in the distribution chain, who use the stuff themselves. "The only people who sell to retail customers are the doctors," Chevalier said in an interview. "People like myself never sell. Five percent of what Rexall sells on a monthly basis is sold at retail prices to real retail customers. Ninety-five percent is sold wholesale to people like me and the rest of the people in my downline for our own consumption. It's a wholesale buying club like Costco."

In interviews, several doctor-distributors said they don't sell to retail customers either. "I'm not in the business of retailing products," explained David Kane, a Miami family physician. "I tell people about the products when I introduce the business to them."

"I don't ask people if they'd like to buy products," echoed Harold Glatzer, a Miami podiatrist. "I create interest in the idea of capturing market share or acquiring distribution rights."

Brooks, the Orlando ophthalmologist, said his income from direct sales was "miniscule." But he was aggressive about building an organization, and did so in weekly meetings to which he attracted friends and other physicians, especially family practitioners and internists -- some to whom he referred patients, and some of whom, he concedes, may have sold supplements to those patients. "Whether you sell that to the patient or someone else sells that to the patient, you can debate that," he said. Either way, to Brooks it's all about helping people. Prescription drugs, even in the correct doses, don't always help, and can do more harm than good, he said. And the RSI supplements sure seemed to work for him.

Brooks is no longer an RSI distributor. But he continues to use the products and remains heavily invested in company stock, with which he said he has enjoyed "a tremendous ride."

The company has clearly benefited from its distributors' focus on signing up new distributors. In its 10-K report, Rexall Sundown said the primary reason for RSI's 51 percent revenue growth last year was a 30 percent expansion in the number of distributors.

In an interview after the Holiday Inn meeting, Gold acknowledged that a big portion of his company's sales are to distributors. "Yeah, the distributors buy products and consume them themselves, absolutely. That is a large proportion of the products that are sold."

But Carol Walters, an RSI spokesperson, notes that, in keeping with the FTC's anti-pyramid guidelines, the company offers distributors a 90 percent refund on all unsold products and requires them to certify that 70 percent of what they bought has been sold to others before they can order a new shipment. The company's compensation plan brochure, however, makes no mention of the government's requirement that 70 percent of sales must be to retail customers who are not distributors. RSI refused to provide records of distributor compliance with these rules, on the grounds that these verification reports are proprietary information.

Told of the distributors' statements that their main emphasis is on recruiting rather than retail sales, Lyons, of the attorney general's office, said: "That's very troubling. If they are focused on recruiting rather than retailing, they are operating their own personal businesses probably as a pyramid. We would expect the company to crack down. If it is a pyramid instead of a bona fide MLM, either it will collapse on its own, or we or some other regulator will shut it down."

Cohen and the other doctors who have signed up with Rexall Showcase do not want to hear criticism from the AMA, the FTC, or anyone else about their new business enterprise. They complain bitterly that the steady pressure applied by managed-care insurers is squeezing their incomes. "For the AMA to say doctors shouldn't make a profit, what's the point of that?" Cohen asks incredulously.

Most Americans would laugh at these doctors' financial complaints. Last year net income for nonsurgical physicians like Cohen rose 1.4 percent, to a median of $144,000 nationally, according to Medical Economics magazine. Surgical specialists like Leonard reported a drop of 3.8 percent in net income last year, but still enjoyed a median income of $207,000.

Still, Cohen admits he feels uncomfortable selling RSI products out of his office. So he refers patients to his wife. She sells the products to them at cost, hoping they'll reorder at the higher retail price and possibly become distributors. The AMA ethics policy, however, notes that there is no difference between selling products in a doctor's office and recommending them for purchase elsewhere if the doctor benefits financially either way. An even bigger ethical concern is that several of his patients have become downline distributors for his wife. The AMA's Rakatansky called the practice of doctors recruiting patients as distributors a clear form of "exploitation."

Dr. Leonard, who didn't believe in dietary supplements before signing up with Rexall, justifies the high prices of RSI supplements by explaining that the company offers the best combination of vitamins and minerals on the market. Unlike with other manufacturers, she says, patients can be confident that "what Rexall says on the box is what you're getting."

Actually, consumers have to trust Rexall's word on that. RSI's distributors and promotional audiotapes repeatedly claim that the company's products are "regulated" by the U.S. Food and Drug Administration. But the 1994 Diet Supplements Health and Education Act essentially deregulated supplements. So it's a buyer-beware market.

Last year the Los Angeles Times commissioned an independent lab to test 10 brands of Saint-John's-wort, a popular and expensive herbal remedy for depression. The Times reported that Rexall Sundown's product had about 20 percent of the labeled potency, while two other brands each had less than 50 percent. When Rexall protested that the results were false and misleading, the newspaper hired a second lab, which confirmed the results.

"That was a healthy wake-up call for the industry," says Mark Lange, science director of the Institute for Nutraceutical Advancement in Denver, which is developing standardized testing procedures for the supplement producers.

Dr. Leonard isn't fazed by the lack of FDA testing. "It's only our modern era that came up with double-blind studies and FDA regulations, but people have always used nutritional supplements with good results," she said. "Nothing in the products can hurt me, and if it can help me, why not take it?"

"That's an attitude left over from the Dark Ages," replies Dr. Angell, of the New England Journal of Medicine. "No person can tell for himself whether a drug is good for him or harmful. That's why we have the FDA."

In many cases RSI's enthusiastic doctor-distributors are merely repeating the product testimonials from the company's promotional audiotapes. On "Doctors Speak Out," released by RSI in 1996, people who identify themselves as MDs, dentists, chiropractors and hospital administrators tout these remarkable results from RSI products:

• A man with angina lowered his cholesterol 80 points and was able to play golf with no chest pain.

• Urinary problems due to an enlarged prostate disappeared.

• Congestive heart failure symptoms vanished.

• A young woman was cured of borderline anorexia nervosa.

The Rexall Showcase International Corporate Profile Booklet from 1997 further promises that its products control blood sugar, protect children against various diseases, relieve menstrual symptoms and ease pain from arthritis. The company's 1998 booklet tones down these claims, and its website now offers a disclaimer that the products are not intended to treat, cure or prevent any disease.

Gold said that his company reviews labeling and promotional claims for products "very, very, very closely." All promotional audiotapes, including "Doctors Speak Out," were submitted to the company for compliance review before being sold by distributors, he noted. Under FTC guidelines for dietary supplement advertising, companies must be able to show reliable scientific evidence to substantiate claims that their products are beneficial in the treatment of a disease. Rexall Sundown's 10-K report claims that the company's current advertising is in "substantial compliance" with those rules.

But Richard Cleland, a senior staff attorney in the FTC's Bureau of Consumer Protection who reviewed a transcript of "Doctors Speak Out," had a different view. "It's pretty amazing," he says, adding that he can't comment specifically without further agency investigation. "I can say that the types of claims here would legally require competent, reliable scientific evidence, or else the company must clearly and prominently disclose that these are not typical experiences and the consumer shouldn't expect to have similar results."

Dr. Barrett, of Quackwatch, says research does not support most of the claims on the tape. The most plausible claims, he believes, are those made for Bios Life 2. But it would take years of study to prove that taking the fiber supplement, without dietary or exercise changes, reduces cholesterol as sharply as claimed on the tape, says Barrett, who co-wrote "The Vitamin Pushers," a 1994 exposé of the supplement industry. Researchers would have to compare patients on Bios Life 2 to those not using the product, and they shouldn't know during the study which group is which.

After initially defending the promotional claims on the tapes, Gold distanced RSI from them, saying that all tapes are produced and sold independently by distributors, who are not employed by the company. But the company's copyright symbol is printed on the "Doctors Speak Out" cassette. Asked if he thought the treatment claims were consistent with federal rules, he hedged. "I can't answer that specifically," he said. "I imagine [the people on the tape] are giving their own personal testimonials based on their own experiences. That would not necessarily indicate that that experience would be had by everyone."

But Cleland said those arguments don't get Rexall Showcase off the hook. "The company cannot make representations through testimonials that it couldn't make directly itself," he says. "Generally the parent company is liable for representations to sell their products that they know or should know are being made, particularly if they take no action to police their distributors."

Dr. Leonard is so impressed with the benefits of Rexall products that she isn't willing to wait for scientific evidence and believes she's on solid ethical ground in promoting them to her patients. But money is also very much on her mind. "The bottom line is that network marketing allows doctors to practice the way we want, to spend more time with our patients, and to have the lifestyle we want," she explained.

Robert FitzPatrick, however, fears that Leonard and her colleagues are jeopardizing something precious in the pursuit of wealth. "What these doctors are offering you isn't just vitamin pills but a business for you to get into," he says. "When you realize that your doctor is looking at you altogether differently than you wanted, as someone who has a good network that could be enrolled, it will change your relationship to that doctor drastically."

Flip Lechner, Leonard's patient, suffered a second heart attack last month -- three weeks after starting on Rexall Showcase products. Her cardiologist took her off all dietary supplements so there would be no possible harmful interactions with her prescription drugs. Shortly after leaving the hospital, she said she plans to resume her Rexall supplements once her condition stabilizes and her cardiologist tells her it's OK.

"Dr. Leonard could tell me to jump off the Brooklyn Bridge and I would, she's such a fantastic doctor," she added. "There are a lot of wackos out there who give you a song and dance, but advice coming from a doctor you trust makes a big difference. This Rexall, it's terrific. I'd recommend it to anyone."


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