We’ve all seen the commercials. “Prevagen, a dietary supplement shown to improve memory, contains a unique ingredient originally discovered in jellyfish.*” What we often miss is the clarifying asterisk, that “these statements have not been evaluated by the Food and Drug Administration (FDA)” and that “this product is not intended to diagnose, treat, cure or prevent any disease.” The truth is that the supplement industry is built on the premise that you can equate supplements wit FDA-approved drugs which have been subjected to the rigors of research, development and clinical testing (or at least that you won’t be able to distinguish between the two).
Like Prevagen, only some of these false claims are charged as fraudulent—and often years after many hopeful Americans have been conned into buying the product. An article in The Atlantic this week discusses the booming dietary-supplement industry and its unencumbered sprint to free-market success at the cost of both credible science and our wallets. Dr. James Hamblin explains the case that many supplemental companies make when selling their product:
A metabolite that no one could ever get from food, and in which nearly 100% of people are deficient, represents a big market. And while consumers are waiting for clinical trials to play out, people don’t need to wait to buy [it].
What’s scary is that supplements are treated more like foods than like drugs by the FDA. They can go straight to market without requiring evidence of efficacy. When provoked, the men in suits pushing supplements will admit that their product is not a drug, but will often continue to make the argument that it is better than food. Again, Dr. Hamblin:
I reacted by asking him about broccoli and salads, and why those aren’t medical foods. They make people with diabetes and heart disease less sick, when used regularly. Conversely, chronic abuse of Pop-Tarts and Pepsi contributes to lethal disease. Eating mostly whole plants will protect most hearts more effectively than the most widely prescribed cardio-protective pharmaceuticals, statins, and yet food is not medication.
So a product that is treated like food—while claiming to be better than food—lacks credibility to be a drug. What can be done?
The future of the dietary-supplement industry might lie in the hands of Dr. Scott Gottlieb, President Trump’s pick to lead the FDA. Gottlieb has received criticism for taking millions of dollars from nearly 20 biopharma and health firms while vowing to fight the opioid crisis. He stands for a libertarian, regulation-free approach and even accused the FDA of evading the law.
But how can a free-market approach to supplements succeed when consumers in the marketplace are unable to tell when a product is actually helpful? As a future physician, I am terrified by the idea that a low-budget commercial for a product with no clinical evidence for efficacy can bear the same weight as my own medical advice developed over years of grueling education.
I’d like to believe that the answer is adequate patient education and more deliberate communication. I learned a lot about the power of “fake news” recently; but unfortunately, convincing those around me that the facts still matter may be one of the toughest tasks in my own career down the road.
Image: Harvard Health