Regulatory Actions against IV Nutrition Clinics

Stephen Barrett, M.D.

In recent years, IV lounges and mobile IV units have been popping up across the country with offers of speedy recovery from hangovers, jet lag, and other common problems. In a recent report, Stanley Goldfarb, M.D., a professor of medicine at the University of Pennsylvania, warned that few conditions require IV hydration, fast-buck operators could hurt people with unsafe practices, and that the practices need greater regulation [1]. This article explains why you should avoid such facilities and describes state and federal regulatory actions that involved three of them.

State Board Action (Kansas)

In December 2018, the The Kansas State Board of Healing Arts issued emergency suspension orders barring Tamara Zeller, D.C. and Angela Garner, M.D. from practicing at IV Nutrition in Overland Park, Kansas or administering intravenous therapy to patients at any substantially similar clinic [2]. The suspension order against Zeller charges that she committed gross negligence in relation to the care of three patients and improperly advertised that she could treat autoimmune issues, allergies, hormonal issues, short bowel syndrome, and other medical conditions with intravenous infusions [3]. The suspension order against Garner charged that she endangered patients by permitting clinic staff members to administer unknown doses of IV magnesium and delegating treatment to staff members who had not been appropriately licensed or trained to provide such care. The order also said that the clinic staff failed to do a diagnostic workup before treating a patient who had sought help for nausea and vomiting [4].

Records from the Kansas Secretary of State indicate that Zeller and another chiropractor registered IV Nutrition LLC in 2017 "to provide intravenous and supplement nutrition treatments." The current price per session is $65 to $105 for a 30-minute "express bag" and $75 to $220 for a "full intravenous drip." They also offer intramuscular injections for $25 each. The Web site makes the following claims, which I believe are false, misleading, or both:

The first three claims suggest that (a) it is difficult to get the nutrients we need from diet, that ordinary stresses and athletic activities increase our nutrient needs, (b) common symptoms are likely to be caused by nutrient deficiencies, and (c) virtually everyone needs nutrient supplements. These appeals to fear are not only untrue but ignore the fact that the main forms of bad nourishment in the United States are obesity in the population at large (particularly the poor) and undernourishment among the poverty-stricken. Poor people can ill afford to waste money on unnecessary vitamin supplements. Their food money should be spent on nourishing food [5].

The rest of the above claims falsely suggest that taking nutrient supplements is likely to benefit most people's health. Although diet is an important factor in some diseases (most notably coronary heart disease), most diseases have little or nothing to do with diet and even less to do with nutrient deficiency. Dietary supplements may help prevent a few medical problems but, for these, it is much less expensive and far more sensible to use pills. Common symptoms such as fatigue, lack of pep, headaches, other aches or pains, insomnia, and similar complaints are usually the body's reaction to emotional stress. The persistence of such symptoms is a signal to see a doctor to be evaluated for possible physical illness. Intravenous nutrients are useful in a few conditions, but these would require expert medical care, probably in a hospital.

In October 2018, the Kansas board entered into a consent agreement with Meredith Leach Snyder, MD, co-owner of Recovery Hydration Therapy (RHT), a mobile infusion business that offers intravenous fluids for conditions such as hangovers, jet lag, colds and flu, illnesses, and athletic performance and recovery. When Snyder applied for a Kansas medical license, the board reviewed the RHT Web site and patient records and concluded that the facility lacked proper protocols for handling complications and that its record-keeping was substandard. The matter was settled with a non-disciplinary order that requires Snyder to take extra continuing education in medical record-keeping and have her records monitored by a board-approved monitor for six months [6].

Federal Trade Commission Action

In September 2018, A & O Enterprises Inc., doing business as iV Bars Incorporated and iV Bars, and owner/manager Aaron K. Roberts a/k/a Aaron Keith signed an FTC consent agreement under which they must refrain from making misleading claims for Myers cocktails and other intravenous products. The company, which was founded in 2016, operates clinics in Texas and several other states [7]. The products, sometimes referred to as "intravenous micro-nutrient therapy," "intravenous vitamin therapy," and "hydration therapy" are mixtures of of water, vitamins, minerals, and herbs administered directly into the bloodstream for between $100 and $250 per session. Page 2 of the complaint describes how the business was operated this way:

Respondents' first and primary iV Bars location is housed in a NextGen Wellness Center, an upscale gym and clinic that independently offers chiropractic care, pain management therapy, physical therapy, medical massages, and counseling. New iV Bars customers create an online account and complete a short health assessment questionnaire when making their first appointment. Respondents have an arrangement with a doctor who does a quick, online review of all health assessment questionnaires that customers submit to iV Bars. Respondents pay the doctor a flat fee of $250 per month for this service. Shortly before the customer arrives, an iV Bars employee takes about five minutes to mix ingredients obtained from a local compounding pharmacy into the customer's requested iV Cocktail. Once at iV Bars, the customer is asked to sign a release form that discloses risks and releases Respondents from liability. Thereafter an iV Bars nurse seats the customer in one of five oversized reclining chairs and administers the iV Cocktail to them over a 25-45 minute period. Respondents also maintain a "full service mobile vehicle" that allows them to "come right to your door to deliver the treatment of your needs." [8]

Like the Kansas clinics, iV Bars used a combination of scare statements and inflated promises to attract customers. The company's home page offered "medical IV treatments for sports recovery, anxiety attacks, neuropathy hydration, wedding disasters, flu / cold recovery, cancer, migraines, Bell's palsy, hangovers, and more." Another page listed 33 "conditions treated": adrenal fatigue, cancer, asthma, colds & flu, celiac disease, gluten sensitivity, chronic fatigue syndrome, chronic pain, congestive heart failure, dehydration, depression & anxiety, diabetes, effects of aging, infertility & pregnancy, fibromyalgia, gastrointestinal conditions, general wellness, hangovers, heavy metal toxicity, high blood pressure, immune health, aids in weight loss, injuries, low energy, poor memory, migraine & tension headaches, neurodegenerative disorders, nutrient deficiencies, post surgical healing, preventative care, skin conditions, stress, and revitalize hair & nails. Several pages falsely claimed that Myers cocktails had been proven effective against many of these conditions. The site also said:

The majority of us are in a constant state of toxicity, malnutrition and dehydration—and we don't even know it. We're exposed to environmental toxins on a daily basis. Diets heavy in nutrient-sparse foods rob us of vital vitamins, and damaged digestive systems prevent us from properly absorbing the nutrients we do eat. Busy lifestyles, stress and illness further deplete our supply, setting us up for chronic conditions and disease. And we never truly drink enough fluids, which is why dehydration is the #1 cause of aging and fatigue and a leading cause of disease.

Even the healthiest bodies are only able to absorb about 50% of the vitamins and hydration taken orally through food, drink and supplements. But IV drips bypass the gut, delivering essential nutrients and fluids directly into the bloodstream for quick and easy 100% absorption at high doses that would never be tolerated orally. This allows us to detoxify, nourish and rehydrate our cells from the inside out for dramatic, long-lasting and often instant results [9].

The Myers cocktail is named for John A. Myers, M.D. (1904-1984), a Maryland physician who used intravenous nutrient injections to treat many chronic conditions. The iV Bars Web site, on a page titled "Scientific Evidence," had reproduced an article by Alan R. Gaby, M.D., that stated:

Gaby also included case histories of patients he claimed to have helped with asthma, migraine, fatigue, fibromyalgia, depression, heart disease, upper respiratory tract infections, hay fever, narcotic withdrawal, chronic urticaria (hives), and athletic performance, and a few other problems [10].

Because iV Bars was using Gaby's case histories and other claims for promotional purposes, the FTC considered them to be be unsubstantiated advertising claims for which iV Bars was responsible. The FTC complaint, released together with the consent order, contains screen captures of the relevant pages. The FTC settlement agreement prohibits the company and its owner from making or implying any unsubstantiated claim that their IV cocktails produce fast, lasting results or are effective against cancer, cardiovascular disease, diabetes, fibromyalgia, multiple sclerosis, neurodegenerative disorders, or any other disease. It also prohibits them from falsely claiming that medical professionals have tested or approved the product or that the company has a research facility [11].

 iV Bars was also required to email a notice to customers who had received a Myers cocktail before the FTC-challenged claims were eliminated from the company's advertising. The notice, signed by Roberts, states:

As noted by David Gorski, M.D., Ph.D., the FTC action is a step in the right direction but pertains only to iV Bars' advertising and will not stop its questionable services. To protect the public, the FDA can and should crack down on compounding pharmacies that supply IV concoctions intended for the treatment of disease [13]. Many more actions by state licensing boards are needed.

More Reasons for Skepticism

Single case reports cannot distinguish between the effect of the treatment and the natural course of the patient's ailment. In 1992, when Dr. Gaby and I were guests on The Phil Donahue Show, I pointed this out to him and said that in order to demonstrate effectiveness, it would be necessary to do controlled trials. In December 2018, searching PubMed for his name, I found no evidence that he has ever conducted one. Searching for "Myers cocktail," I found only one small study (not conducted by him) in which patients who received Myers cocktails for fibromyalgia did no better than a control group that did not.

In addition to the above facts, common sense should make you suspicious. Intravenous infusions are far more expensive than pills. So even if supplementary nutrients could help you, taking pills would make more sense. If you are worried about whether or not you are getting what you need in your diet, keep a food diary for several days and either use ChooseMyPlate.gov to check your diet or seek professional advice from a registered dietitian (R.D.) or physician. If you have a shortfall, try to correct it by adjusting your diet. If this is impossible, and you conclude that you need a supplement, purchase one whose label lists nothing above 100% of the Daily Value—and take one every other day. Since products meeting this description can be obtained for about a nickel per pill, this method would cost no more than a dollar a month [14].

The Bottom Line

The widely advertised claims made by intravenous nutrient clinics are not supported by scientific evidence of safety, effectiveness, cost-effectiveness, necessaity, or superiority to standard management of the conditions for which they are offered. Although intravenous nutrients are useful in some situations, mostly for hospitalized patients, I believe that the clinics that feature them should be avoided.

References

  1. Thompson D. "IV lounges" a trendy health fad, but are they safe? CBS News, Jan 31, 2018.
  2. Marso A. JoCo doctor and chiropractor barred from working at IV vitamin and mineral clinics. Kansas City Star, Dec 28, 2018.
  3. Emergency order of temporary limitations and emergency proceedings. In the matter of Tamara S. Zeller, DC, KSBHA Docket No. 19-HA 00041, Dec 21, 2018.
  4. Emergency order of temporary limitations and emergency proceedings. In the matter of Angela J. Gardner, MD, KSBHA Docket No. 19-HA 00040, Dec 20, 2018
  5. Barrett S. Twenty-eight ways to spot quacks and vitamin pushers. Sept 30, 2018.
  6. Consent order. In the matter of Meredith Leach Snyder, M.D., KSBHA Docket No 18-HA-00042, Oct 16, 2018.
  7. FTC Brings first-ever action targeting "iV cocktail" therapy marketer: Order settling complaint bars Texas-based firm and owner from making unsupported claims that iV cocktails can treat serious diseases and produce fast, long-lasting results. FTC news release, Sept 20, 2018.
  8. Complaint. In the matter of A&O Enterprises, Inc. and Aaron K. Roberts. Before the Federal Trade Commission, file no. 172 3016, Sept 20, 2018.
  9. Why drip? iV Bars Web site, archived March 23, 2016.
  10. Gaby AR. Intravenous nutrient therapy: the "Myers cocktail." Alternative Medicine Review 7:389-403, 2002.
  11. Agreement containing consent order. In the matter of A&O Enterprises, Inc. and Aaron K. Roberts. Before the Federal Trade Commission, file no. 172 3016, Sept 20, 2018.
  12. Roberts AK. Notice to all iV Bars customers who received a Myers cocktail before March 1, 2017. Sept 20, 2018.
  13. Gorski D. The FTC cracks down on iV Bars for false advertising claims about its "intravenous micronutrient therapy. Science-Based Medicine, Sept 24, 2018.
  14. Barrett S. Dietary supplements: Appropriate use. Quackwatch, Nov 12, 2010.

This article was revised on January 7, 2019.

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