A natural conspiracy

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You've been to your doctor over and over again, and you feel great frustration because your GAD has only gotten worse and it seems to be spreading. You suspect that you might be developing GTD, but cannot be sure. You feel desperate and will try anything to cure it. Since Lipopaxia was taken off the market you have felt rather hopeless. Dreams of being able to fit in an airplane seat without the seat belt extender have slowly faded. One night, you are up late polishing off a pint of Ben and Jerry's and taking occasional breaks to reach for the remote. Thinking you have found some soft core porn on one of the movie channels, you flip back and discover an infomercial for a dietary supplement. In it, the company claims that you can lose weight by increasing your metabolism, that you will not want to eat as much and will feel great, all without the pain of exercise and dieting. All you need to do is call. Since they clearly said that their supplement was totally natural, you assume that it is safe. In a moment of weakness you make the call and give them your credit card number.

In 1994, the US Congress passed the Dietary Supplemental Food Act, which deregulated the dietary supplement industry. Since then there has been an avalanche of new dietary supplements introduced to the market. The companies that market these supplements are allowed to say almost whatever they want about the supplement as long as they do not claim that it cures or treats a specific disease.

Undeterred, supplement companies started to use creative language to sell their snake oil. The best example is vitamin A. Companies cannot claim that vitamin A helps restore vision loss or that it will enhance vision, so they simply state that vitamin A is 'essential for proper vision'. Consumers do not read into the nuanced language - they just buy it and expect results. Not only are the implied claims of effectiveness disingenuous;the actual content of supplements is completely unregulated because the FDA has no power to pull a product if it thinks the content claims are bogus - that is the job of the Federal Trade Commission. But the FTC is not concerned with the content of the pills, just the labeling and advertising.

A recent Harris poll showed that most Americans believe that if a dietary supplement is sold, it must have been approved by some government agency, that a company can only make claims if it provides clinical data in support of them and that companies are required to warn potential customers of potential health risks or side-effects of their product. As it turns out, none of this is true. The dietary supplement industry lobbied Washington very hard to make sure that the Dietary and Supplemental Food Act actually ensured that the government had virtually no right to regulate their actual products. The FDA can only act on dietary supplements if there is evidence that it is actually harmful to health. So, unlike all prescription medication, the onus is on the FDA to prove that a supplement is dangerous. They have no oversight of the content of the supplement, consistency of the product or effectiveness. So even if an overwhelming amount of data is presented that the ingredients of a supplement provide no benefit to health, they cannot take any action.

The FDA and those who actually understand that supplements can be dangerous to health have expressed great frustration over the situation. To maximize the little protection they can provide the public, the FDA has chosen to look at reports on the safety of specific ingredients rather than specific products. This is because a company can just withdraw a product and release it under another name or via a subsidiary if the company is targeted for investigation. Since companies do not have to report any adverse effects associated with their product, the FDA has to rely on publicly funded research into the effectiveness of and possible dangers associated with different products. In essence, tax dollars are doing the work that companies traditionally have to do when bringing a consumer product to market.

When your package of supplements arrives you quickly open it up and are on your way to the normal sized underwear you had when you were on Lipopaxia. The bill for the pills is enough that you briefly think about how you are going to afford all those new clothes you will need. A quick calculation on cost-cutting on your kids college savings plan and you're all set. You quickly discover that the bottle has no information on possible side-effects or the amount of the active ingredient, but you follow the directions and take one pill before dinner. You follow the routine and continue taking the pills. You actually start to feel better and have more energy, so you begin to exercise more. One side-effect is that you find it hard to sleep some nights, but that is a small price to pay.

Three months into the regimen you have lost a total of 5 pounds and are starting to suspect that this pill is no miracle. This moment of clarity is your first indication that you have been swindled. You go to the Internet and find that four of the ingredients are considered stimulants. The truth is you bought a pill with caffeine in it, which gave you more energy, which motivated you to exercise, but it did not melt the fat and did not change the molecular structure of your cells. It did boost your metabolism, but only during the time the caffeine was in your system. The cold sense of self-realization washes over you when you realize that a cup of coffee would have had the same effect.

The FTC has had its hands completely full chasing the false claims that dietary supplement companies make about their products. In 2002, it found that more than half of all dietary supplements had exaggerated or false claims made about them in their advertising. But the supplement industry is savvy and is now far more careful to imply effectiveness without stepping over the arbitrary legal line. This does not mean that it isn't still ripping people off though.

Not long ago I went into my local 'nutrition' store on a bullshit hunt. The door had not even closed before I realized that almost every bottle and advertisement had manipulative language designed to stretch the truth. For example: a bottle of apple cider vinegar (natural source of vitamins and minerals important for maintaining health), vitamin A (essential for normal vision and necessary for eye health), Ginkgo biloba (helps support blood flow to the brain and supports mental sharpness), and echinacea (helps support the body's natural resistance). Other products were essential for liver function, detoxified the liver, oxygenated the blood, and enlarged the size of cells. Each of these products walks the legal line, but in reality the statements made are more akin to fraud than reliable health information because they are designed to imply that they will do something that they have not been shown to do. Is vitamin A essential for normal vision? Yes, but will taking it improve your vision? No. Does Ginkgo blioba improve memory and mental acuity as has been touted? Nope. Is apple cider vinegar going to provide you with the nutrients you need? Maybe. But so will an apple, for much less money than the stuff in the store.

Echinacea is one of the worst culprits. This stuff has been touted as a cure for the common cold, or at the very least has been claimed to be effective in reducing the intensity and duration of a cold. Study after study has shown that it is ineffective against colds and often contains less ingredient than is advertised on the bottle. Nonetheless, literature in the store directed people take it every two hours at the first signs of a cold to reduce the severity of the illness. The woman in the store pointed me right to it when I asked what to take for a cold and told me 'this stuff works great.'

Many supplement companies have started to realize that there are some people who want to hear that their product has been clinically tested for efficacy. They are less concerned about safety than about being ripped off. So, many companies have started to make such claims about their drugs. (I am starting to get tired of calling them supplements when they are actually drugs.) Few of them will tell you what they mean, but when they do reveal their evidence, it is rarely anything that even approaches a legitimate clinical test. Some of them have even gone so far as to conduct their own 'clinical trials'. None of these has been published in peer-reviewed journals because they are laughable. One I found had followed eight people taking a weight loss pill. Others openly, or not so openly, extrapolate efficiency from legitimate research, making exaggerated claims that the scientists who did the research would never have made. These companies can take comfort in the fact that even if they were able to post the entire text of the research that they claim supports the efficacy and safety of their product, the public is too stupid to know how to judge the research. Frankly, even if the public had a sound educational background that allowed them to comprehend basic science it wouldn't stop them from buying the product because, more than anything else, companies that market nutritional supplements are selling hope, not cures. This is nothing more than parasitic fraud.

Ripping off the public is not the only danger in this industry. Some of the products have been shown to be downright dangerous. In 2004, the FDA was finally able to ban the inclusion of ephedra in dietary supplements. Pills containing ephedra were touted as weight loss miracles and energy boosters. It was the most popular of supplements because it gave people a rush of adrenaline that made them feel energized. It accounted for about 10% of all dietary supplement sales, totaling over a billion dollars. There was this tiny issue though. Ephedra use, especially in packages that are not required to standardize the dose, had been linked to heart attacks, strokes, anxiety and a host of other nasty side-effects that make it pretty dangerous stuff. The fact that it is isolated from a Chinese herb called ma huang did not make it any safer.

This is the point: these products are claiming to contain and often do contain pharmacologically active compounds. Treating pharmacologically active products called supplements differently from pharmacologically active compounds called drugs makes no sense at all, especially because they often are pushing and pulling the same biochemical pathways. Ephedra is especially weird because other ephedra-like compounds found in cold medication have been tightly regulated since the 1980s. On top of all that, it was well known at the time that the Dietary Supplemental Food Act was passed that ephedra could be used to make methamphetamine, one of the most dangerous abused drugs known because it is so terribly addictive. So much for the war on drugs: let's make it easy to get lots of the key ingredient. Putting the responsibility to prove it unsafe on the FDA was directly responsible for the deaths of thousands of Americans. Put in perspective: more people died of ephedra-caused heart complications in any given week than died from anthrax in 2001.

Issues of safety are not just related to adverse side-effects from the compound itself. Take St John's wort, for example: this unfortunately named supplement is basically ground-up plant. It has been touted as a 'cure' or 'treatment' for depression by many in the industry, and there are thousands of web sites dedicated to it. There is conflicting evidence that St John's wort has an effect on depression, so effectiveness is an issue, but more disturbing than that is the fact that the likely active ingredient, hyperforin, acts as a serotonin reuptake inhibitor. In English, this means that it works on the same brain chemistry as Prozac, Paxil, Zoloft and a host of other antidepressants. It also happens to affect the body's ability to process approximately 40% of all prescription medication by interfering with the regulation of the genes that control their normal processing.

Finally, there have been several research studies that have shown up to 100-fold differences in the amount of the active ingredient in St John's wort and wildly varying consistency from batch to batch from the same brand. All this adds up to a very dangerous situation, where people taking prescription medication and St John's wort can have a very bad drug interaction and can experience wild mood swings when going from one brand to the next or when opening a new bottle.

All attempts in Congress to put tighter restrictions on supplemental foods have been thwarted by Senator Orrin Hatch of Utah, the lead on the Dietary Supplemental Food Act that deregulated the industry. Not coincidentally, many of the largest supplemental food companies happen to operate in his home state, and the Senator's son is reported to have close ties to the industry as well. I wonder if the public or the media will ever look for the blood on the Senator's hands when the next unregulated supplement pill is shown to have killed people.

As culpable as the Congress and supplement companies are, the modern day snake oil salesman is the industry's pimp. There are now thousands of books, infomercials, web sites and print ads oozing over the information landscape making fraudulent claims about how nutritional supplements will cure disease and heal the sick. One character in particular is a used car salesman with no formal medical training. He was brought up on fraud charges by the FTC and on credit card fraud and served time! He claimed that there was a machine that could be dialed to a specific frequency that would rid the body of cancer. His book has sold millions of copies.

It may sound like I am demonizing all nutritional supplements. I am not. I am demonizing the rampant hyperbole within the industry. Many products put out by reputable companies are quite useful and do improve health. This is mainly because Americans have such shitty diets that they need to go to pills to get the nutrients they need (I include myself in this). I am saying that the industry has been unwilling to police itself and Congress is 100% culpable in the proliferation of massive hype to the citizenry that is endangering lives.

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