Would you ever pay money for pills containing crushed-up houseplants, powdered rice or fragments of psychiatric medications? If you’re one of the tens of millions of Americans who take dietary supplements, the answer could very well be an unknowing yes.
It may surprise people to learn that there are hardly any regulatory requirements for vitamins and supplements in the U.S. The $36 billion industry has avoided Food and Drug Administration rules that generic medications must adhere to, such as testing products to prove that they are effective and safe before they go on the market. In fact, a 1976 congressional amendment pushed through by Democratic Senator William Proxmire ensures that the FDA can never limit the potency of vitamin pills, classify them as drugs, or require that they can only contain useful ingredients. This loose oversight opens the door to all kinds of errors, from mislabeled ingredients to overly strong suggested doses that can leave consumers with lasting health problems.
Arriving at this regulatory no man’s land was no easy feat. Since the scientific underpinnings of vitamins were first discovered in the 1920s, a two-headed pro-vitamin propaganda campaign has been launched by the Dietary Association of America and by industry lobbyists and their supporters in Congress. In the 1940s and ‘50s, food scientists and marketers promoted vitamin- and additive-enriched foods, advertising their longer shelf lives and vague “nutritional benefits.” This strategy, which allows companies to artificially inflate prices and promote nutritionally vacant products as healthy, endures. At the same time, alternative medicine advocates, supplement industry leaders and their beneficiaries in the House and Senate have fought proposed regulations tooth and nail, arguing that they infringe on our ability to make our own healthcare decisions.
As journalist Catherine Price argues in her book Vitamania: Our Obsessive Quest for Nutritional Perfection, this multi-decade effort has worked. Over half of American adults currently use dietary supplements, according to the latest Centers for Disease Control figures, and even those of us who don’t likely assume they are safe. We have blindly accepted vitamins and supplements as miracle cures for our ailments, without even knowing what we’re putting into our bodies. In a phone interview, I spoke to Price how our vitamin obsession came about and what we can do to curb it.
Editor's note: This interview has been condensed and lightly edited for clarity.
Allegra Kirkland: Why do you think people remain so unaware of the lack of research supporting supplements and vitamins? Would you attribute it primarily to misleading messages promoted by supplement makers or just the faith that people have in the government to only approve products that are safe for consumption?
Catherine Price: I think both of those are probably true. I also think that vitamins and supplements are covered so often in the news that it seems like we should know a lot. I should clarify that when I’m talking about vitamins I only mean the letter vitamins, so just the 13 A, C, D, E, K and B vitamins. Every other week there’s a story about Vitamin B, right, so that gives the sense that scientists are on it even though there are often contradictory stories. The widespread coverage of vitamins makes it seem like we know more than we do.
AK: At this point it there have been a number of health outbreaks and major public lawsuits, like New York Attorney General Eric Schneidermanforcing major retailers to stop selling mislabeled store-brand supplements. But they don’t really seem to have made a difference in people’s perceptions.
CP: With the attorney general stuff that’s been going on in New York, the supplement industry is taking the stance of ‘the public didn’t trust us already and this is making them trust us even less.’ It’s so interesting because I think from the consumer’s perspective, you’re saying the consumers are weirdly trusting and it doesn’t matter how many stories they are. The people who love supplements are still going to think their brand is fine.
AK: Do you think it’s a good approach to target retailers instead of manufacturers?
CP: First I should say that the supplement industry is pushing back and saying that they used the wrong testing methods. They used DNA barcoding. … That’s the number-one defense being made by the supplement industry, that therefore it’s all invalid. …It’ll be very disappointing if it is because that’s just so sloppy, but the problem is that the FDA just doesn’t have the money and the manpower to enforce its own very limited ability to regulate the industry. …They are actually serving a public good in investigating stuff the FDA hasn’t been able to.
I think it’s going to be a more efficient way to shed light on the problem than it would be to try to change everything in terms of the legislation. It’s interesting to me that they started off going after the highest level [retailers]: Walmart, Target, GNC. That just speaks to how complicated and difficult it is to pin blame and to actually figure out who to go after in the world of supplements because it’s such a long supply chain. They’re basically just the last step in the chain. They’re getting someone else to put together the store-brand supplements and then basically just putting their name on them. In the beginning I was like, well this is a little ridiculous because you’re basically asking Walmart to open up a chemistry lab and test every supplement that it's selling. That’s not going to happen. But it seems now they’re trying to go further down the supply chain.
AK: Subsequent efforts to pass or amend legislation completely have been shut down by the supplement industry and its supporters in Congress. What do you think the best approach is for weaning the public off of them?
CP: I think we should approach this on multiple fronts, probably. But I also think you can divide the public into one side which could be swayed and then one side that loves their supplements so much and distrusts Big Pharma so much that they’re just not going to listen. … I think journalistic investigations are useful but I don’t think we’ll ever get to a point where you can wean everyone off these things unless they just weren’t on the market. And that would be kind of impossible because you can still buy everything on the Internet.
One of my hopes for my book and for other investigations is for people to become more aware of the information that’s out there and make an intelligent decision about it. So at least you have to admit that there are issues in this industry before you take the pill. …
It’s funny. Even when people know that supplements haven’t been tested for safety or efficacy, people who love them will still be like, "Well I know this company, they grow their own herbs." Or "This is a big company that makes multivitamins."
For the most part, multivitamin companies are never going to try to cheat you or hurt you deliberately, but there are still issues that come up just like there are issues that come up with generic medications. Buyer beware for all of this stuff.
AK: Utah Senator Orrin Hatch took a lot of flack for his support of the supplement industry because it funded his reelection campaigns. In general, does the fight for tighter regulation of this industry fall along partisan lines, with Republicans opposing what they see as big government’s intrusion into their personal healthcare choices and Democrats advocating for consumer protection?
CP: I would say no. In general, yes, the Republicans are anti-regulation and the Democrats are more into consumer protection. But in terms of who the biggest supporters of the supplement industry are, Orrin Hatch is Republican, but the guy who inspired the National Center for Complementary and Alternative Medicine, [former Iowa Senator Tom Harkin], was a Democrat. They’re on both sides of the aisle and a lot of that has to do with what the businesses are in their states.
In the southwest for whatever reason, supplements are huge. In Utah it’s the number-one industry in the state. I think the last count was something like $7.2 billion a year. So that explains Orrin Hatch. And some of the other ones I think it's just those are their constituents, they have businesses there, they’re giving them campaign donations, and these guys are just [being] politicians.
AK: Big Pharma companies like Pfizer are now manufacturing these products, but they don’t seem to be on the receiving end of any of the supplement industry criticism. Why do you think that is?
CP: The one thing I know Big Pharma companies are involved in are multivitamins and minerals and Omega-3 products—kind of the more common ones. I think that they’re not getting flak in part because people don’t realize that Pfizer creates One-A-Day. People don’t recognize the affiliation, but also they’re kind of staying in safe grounds. Multivitamins and minerals are less problematic, Omega-3s are less problematic. If you do have a big brand there is of course still the possibility that there could be problems, but they actually do want to protect their reputation. The people I’ve spoken to have said that’s a good place to start when trying to assess one of these products: how big is the manufacturer?
I also heard an interesting talk by this woman at the FDA about good manufacturing practices, which are basically rules that are supposed to help make sure that what’s on the label is in the bottle. The FDA has been finding that 70 percent of the supplement firms that they’re inspecting aren’t compliant, which is horrifying because the GMP has been fully implemented since 2010. But they’re finding that places that have over 500 employees tend to have GMPs in place. They’re doing a much better job, they know the rules and they’re trying to both source their ingredients from reputable companies.
AK: A lot of these products were only developed in the last decade or two and there’s hardly any research into the long-term effects of taking them, or taking them in combination with prescription drugs. So even if you do ask your doctor if a certain combination is safe, you can really only get a qualified answer because they don’t know yet. How do we address that?
CP: You’ve raised a good point. All the default advice is, talk to your doctor. And it will say that on the back of your supplement label, too. But in reality, not only are a lot of doctors not aware of this issue, but it would be impossible for them to tell you, not just because there hasn’t been research done on every interaction or every product but again, you don’t really know if what’s on the label is actually what’s in the supplement bottle.
There have been instances as I mentioned in the book where they’ve tested and found things like analogs of prescription or illegal drugs in supplements. So you think you’re taking an herbal remedy for something and you’re actually taking an anticoagulant. That’s one reason that I personally don’t take any of that stuff, because you just don’t know.
But there’s an interesting example from the Children’s Hospital of Pennsylvania, with this doctor named Paul Offit. … He established this requirement at the hospital where they only have a tiny number of supplements that they allow to be given to patients. They have to have scientific evidence behind them and be proven to be safe. So basically when a parent comes in with a kid, they ask what supplements they’re on. Because a lot of the time the parent gives the hospital a supplement that they want them to administer to their kid, but the hospital will not [necessarily] do that…. [If the supplement is not on the approved list] you need to sign a waiver that says, we don’t know what’s in it, we don’t know what it’s going to do or how it’s going to track, and none of this is our liability.
I think that responsible hospitals and responsible doctors are moving in the direction of admitting their ignorance and saying, Hey, we’re not going to be involved in this because we don’t know what it will do.
As an example of how crazy this can get, people talk about Big Pharma, but Big Supplements, I mean, it’s a $36 billion industry and when they instituted this policy some of the industry groups launched a letter-writing campaign to his bosses and the board of the hospital demanding that he be fired. He didn’t, but it turned out some people on the board really loved supplements and this became an issue. If you speak out against this and you’re forceful enough, there are concentrated efforts to silence you.
AK: Have you received any negative press or pushback?
CP: Well as a freelancer I’m like, thank God, I can’t get fired. What I found is that I get accused of being a shill for Big Pharma.
My response is that I think Americans are totally overmedicated also and the reason we want to take pills of all kinds is because we don’t want to make the lifestyle changes necessary to actually improve our health.
AK: We’re so obsessed with the veneer of health and willing to throw money at the problem, but not do the actual work of getting healthy. In terms of vitamin-enriched foods, do you think people are specifically seeking them out or are they so ubiquitous at this point that we can’t avoid them?
CP: I think it depends on the consumer. I think some people just aren’t paying attention at all. They’re probably the people who should be taking a multivitamin and changing their diets. But they wouldn’t be added to products if they didn’t help sell products. You know, Vitaminwater justgot sued and it exists because the extra vitamins make it appealing to people. It was similar to the POM Wonderful ads. You know, the death-defying pomegranate juice? There was abig case against them and this is similar, in terms of having labels that are misleading in terms of what they were promising. ...There’s an uptick in class-action lawsuits against these guys.
AK: The looseness of the language is so interesting. They can’t use specific words like "treat" or "cure’"or "prevent" but they basically use synonyms to make very bold claims.
What are some key words people should look out for? How can you know if a product is legitimate or shady?
CP: I would say that your first instinct should be that it’s shady. I think your second step should be to ask yourself why you’re taking it. If you think about it, if you’re taking a supplement that’s not a vitamin, that’s not a mineral, one that wasn’t recommended by our doctor specifically for a deficiency, then you’re taking it because you want a drug-like effect. If you want to improve your prostate health or support urinary continence or whatever, that’s a medicinal use. So it doesn’t matter what the label says; if you’re taking it as a drug that’s a pretty good sign that it should be thought of that way and treated with that kind of caution.
But if a consumer is still insistent about taking these things, they should do their homework and there are a couple of resources that I can recommend. One is the National Center for Complementary and Integrative Health. They have a section called Herbs at a Glance and they round up the science or non-science around a lot of these plants, which is useful and free.
Consumerlab.com is a company that tests products to see if they really contain what they claim and they also do a really good roundup of the science and the concerns. USP and NSF are two verification programs that try to prove that what’s in the bottle is on the label and vice versa. Companies pay to verify their products and then have a seal put on them. So if you’re just trying to verify that you’re taking what you think, that’s a good thing to look for.
The basic takeaway is: ask yourself why you’re taking it, and buyer beware. People simultaneously take supplements for drug-like purposes and then justify it by saying they’re natural. And what I try to communicate is that those two things don’t go together.