Guest Post: “Perception is Power: How the Supplement Industry Bought Deregulation” by Tien Nguyen

Today’s guest post is from Tien Nguyen, an organic chemistry grad student at the University of North Carolina, Chapel Hill. Tien is passionate about science outreach through the printed word, social media, and multimedia. On Twitter @mustlovescience and at her blog Must Love Science, she posts about timely chemistry topics and showcases the educational videos about chemistry that she helps create, including “The Fresh Bread of Bel-Air”. She is also a regular contributor to the RSC Catalysis Science & Technology Blog. Here she discusses a chapter of a new book that’s galvanized her views on science communication. Take it away, Tien!

In 2008, more than 200 people were poisoned by massive doses of selenium in liquid multivitamin supplements, Total Body Formula and Total Body Mega Formula. One of the victims was a telephone repairman named John Adams. As reported by the Chicago Tribune, Adams experienced severe loss of hair, fingernails and toenails and fatigue. He eventually became too exhausted to work and was forced to retire.

Other symptoms of selenium poisoning include diarrhea, joint pain, cramps and blistering skin. The FDA found that on average each Total Body serving contained 40,800 micrograms instead of 200 micrograms as planned. Nearly 50,000 supplement related adverse health effects are reported each year. Most supplements, like the Total Body Formula multivitamins, have not undergone any safety testing nor were they required to by law.

That’s because almost 20 years ago, Congress passed the Dietary Supplement Health and Education Act (DSHEA) of 1994, establishing that dietary supplements—vitamins, minerals, herbs, amino acids, enzymes, organ tissues, glandulars (materials from animal organs, glands or tissues) and metabolites—do not have to submit to FDA safety testing before being available to the public.

Referring to the Act’s passage, author Dan Hurley wrote, “So began an unprecedented experiment to test whether the unbridled use of vitamins and other supplements would help or hinder health, with the American public as the guinea pig.”

As long as a supplement is labelled as such and includes a disclaimer stating the lack of approval from the FDA, the bottle is cleared for supermarket shelves. If, after wide circulation, the supplement causes adverse health effects, like organ failure or death, the FDA can step in and pull it off the market.

Say what? Oh, you didn’t know supplements were totally exempt from pre-market safety regulations? Neither did 68 percent of Americans, according to a 2002 Harris poll.

Nor did I, until earlier this year when I reviewed Paul Offit’s new book, “Do you Believe in Magic: The Sense and Nonsense of Alternative Medicine.” He dedicates a chapter to the DSHEA, setting the stage with a quote from prominent philosopher Isaiah Berlin: “Liberty for the wolves is death for the lambs.” He illustrates how a carefully crafted marketing scheme, rooted in manipulation and backed by millions of dollars, could effectively harness public opinion. This kind of branding would make even Mad Men’s advertising king Don Draper wish he had thought of it.

Launched by vitamin industry executives, Offit explains how the campaign took a multi-pronged approach. First, Congress was inundated with letters. Vitamin industry interests sent in pre-printed letters and offered consumers discounts at thousands of health food stores in exchange for writing letters backing the Act. The letters had a unifying message, which was people wanted freedom to choose when it came to their supplements.  The messaging was designed to stoke individualistic pride and incite distrust of government regulation.

The book recounts how supplement makers argued that deregulation would give the public access to the widest range of supplements, allowing the American people to decide for ourselves and our families if a supplement was worthy. But, as Offit points out, the Act ensures that supplement makers would not have to provide any safety or efficacy data for us to base that decision on.

According to Offit’s book, the vitamin industry also perpetuated the false dogma that their products are natural, and by default safe, while drugs are man-made and unsafe. This is a fallacy because many drugs are derived from natural sources and either way, any product’s safety can only be determined through testing.

The campaign’s most powerful line, “you have a right to your supplements and the FDA is trying to take one of your basic rights away,” was parroted by highly recognizable celebrities like Mel Gibson and Sissy Spacek in television commercials, gaining widespread traction with the public. Offit describes how opponents of the Act, like Congressman Henry Waxman of California, were dealt with head-on, with hecklers paid to shout over him at public speaking events.

Supporters of the Act believed the FDA was uninterested in safety and just wanted to clear a path for the pharmaceutical industry to profit. Offit suggests that it was actually the vitamin industry that put aside public safety and had the most to gain financially from the legislation. Having successfully rebuffed regulation, the supplement industry pulled in $28 billion in 2007, up from $4 billion in 1994, a tidy return on investment. Since then, about 51,000 new supplements have flooded the market. Only about 170 of those have any documented safety tests.

After reading Offit’s book and many articles supporting his points, I believe the campaign to enact the DSHEA is a stark example of using misinformation to mold public opinion and ultimately influence legislation. Supplement makers realized this goal by investing serious amounts time, money and effort. The scientific community needs to counter these movements with investments of our own.

From translating studies that evaluate the safety and efficacy of certain supplements to clarifying legislative acts like this one, we have to make this information accessible to as many people as possible. Improving science literacy and public opinions of science can feel like an uphill battle, but with human lives at stake, it is one worth fighting.

Editor’s Note: If you’d like to read a full review of “Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine”, please see the review from C&EN’s Nader Heidari in our Sept. 2 issue.

Author: Carmen Drahl

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16 Comments

  1. I haven’t read the book and enjoyed your mini-review, Tien. Question- to what extent have social scientists studied why consumers take vitamins and supplements? I’ve always figured it’s had to do with the idea that vitamins/supplements are giving you control over your own health, but what do I know? Scientifically, the idea may be true up to a certain threshold (enough vitamin C to prevent scurvy, enough iodine to prevent goiter) but beyond that? Not sure.

  2. Thanks Carmen and great question. I haven’t looked much into the psychology of why people take supplements, but I just came across this March 2013 JAMA Int. Med. Article (173(3):355-361)

    [http://archinte.jamanetwork.com/article.aspx?articleid=1568520]

    The study finds that most people take vitamins/supplements to improve or maintain their overall health, with a small percentage doing so at their doctor’s recommendation.

    To add my own speculative conclusions drawing from the book and other articles, I do think the idea of being pro-active and taking control of your own health does play into it. More than half of US adults take supplements and I think it’s socially encouraged. I think potential adverse effects/lack of proven benefits doesn’t get much airtime in the media so those deterrents don’t slow down public consumption.

  3. Really interesting topic and a great example of current science illiteracy

  4. One of the frustrating things for physicians, because the idea that supplements are harmless is reinforced by the lack of regulation, is that patients often do not talk about the supplements they are taking, supplements that do have biological effects and can interact with prescription medications.

  5. Following on Carmen’s excellent question – what I don’t understand about (specifically vitamin) supplements is why they often provide 2,000 – 3,000% of your RDA of a vitamin (or vitamins if it’s a multi). I find it illogical – either the other 1900% is a waste of my money or more of something than my body should have – or both. Doesn’t it just lead to very expensive pee?

    • Good question Melody- I demand a joint post from Tien and C&EN’s urine specialist Lauren Wolf on this topic.

  6. Thanks for highlighting this book! I’m looking forward to reading it.

  7. I think you nailed it Melody, if you eat a normal balanced diet (like most Americans) and have no diagnosed deficiency, it is illogical. In my research, I have yet to find a study that shows positive benefits from taking megadoses of any vitamin.

    Carmen-I’d be happy to consult with Lauren Wolf on this vitamin in pee conundrum, indeed science demands we answer these questions.

  8. @Josh – So true. Patients also may not know that some of the foods they eat (I’m looking at you, grapefruit) can interact with their medications as well.

  9. Well, I’m game for a urine/vitamin post. I had heard that a lot of the vitamins in supplements don’t get taken up by the body (and thus get peed out). Therefore, manufacturers put more in to ensure an efficacious dose. But of course, I have no science at the moment to back that up. It’s just hearsay.

    On a separate note, did anyone see this recent supplement safety story?
    http://www.huffingtonpost.com/2013/10/15/craze-sports-supplement-meth_n_4100119.html

  10. Glad I found this original piece. This post has a great reference value to me. Thanks for sharing.

  11. Thanks to everyone for the kind comments! Happy that this post was helpful.

  12. Tien, you make great points, including those about the FDA. Remember, when the FDA was created, only those two areas were monitored: food and drugs. Nothing existed that was called a food supplement. Part of the long term prevention here might be a Congressional re-mandating of FDA’s mission. I and a colleague have been looking into food supplement composition with our students. Most mis-representations do not appear to involve adding something toxic. Rather, we have found some that appear to be nothing more than some sort of whey or animal protein in powder form. Mark

  13. FDA’s mission was re-mandated in 1997, 2007 and again 2012. Devices was also monitored by FDA since 1938.
    To answer some of your questions regarding vitamins, you need only to be concerned with overdosing your fat soluble vitamins A,D,E and K, especially A, D and K-these can be stored and have toxic effects. Otherwise, the water soluble vitamin B complex and vitamin C vitamins are poorly absorbed and thus peed out without much if any storage, unless you are extremely vitamin deficient in these vitamins which is rare. Too much vitamin C can acidify your urinary pH.

  14. Mark, thanks for sharing your thoughts and research. I imagine in most cases the threat posed by supplements is the lack of demonstrated efficacy, either financially or physically if someone was to forego effective treatment. Glad to hear that you’re not finding toxic additives, I was wondering what would the next steps be if you did?

  15. David, thanks for your reply about the solubility of vitamins. Great information to have!