GNC, Target, Wal-Mart, Walgreens accused of selling adulterated herbals
February 26, 2016 5:27 AM   Subscribe

The New York State attorney general’s office accused four major retailers on Monday of selling fraudulent and potentially dangerous herbal supplements and demanded that they remove the products from their shelves. The authorities said they had conducted tests on top-selling store brands of herbal supplements at four national retailers — GNC, Target, Walgreens and Walmart — and found that four out of five of the products did not contain any of the herbs on their labels. The tests showed that pills labeled medicinal herbs often contained little more than cheap fillers like powdered rice, asparagus and houseplants, and in some cases substances that could be dangerous to those with allergies. [NYTimes], [WaPo]

The Consequences of Ineffective Regulation of Dietary Supplements
Prior to enactment of the Dietary Supplement Health and Education Act (DSHEA) in 1994, the regulatory category of dietary supplements included substances used to treat nutritional deficiencies, such as vitamins and minerals. The DSHEA expanded that category to include botanicals and other traditional medicinal products, thereby excluding these products from effective regulation by the US Food and Drug Administration (FDA). Under DSHEA, manufacturers of dietary supplements are not required to provide premarketing evidence of safety or efficacy or, prior to 2007, to report adverse events. After 1994, sales of supplements rose rapidly, and in 2007, consumers spent $14.8 billion out of pocket for nonvitamin, nonmineral products such as herbals. Increased consumption of supplements was accompanied by reports of serious adverse events and adulteration of dietary supplements by prescription drugs and heavy metals. It is important for internists to understand the growing health problems caused by nonvitamin, nonmineral dietary supplements and the need to take action to protect the public.

All four have received cease-and-desist letters demanding that they stop selling a number of their dietary supplements, few of which were found to contain the herbs shown on their labels and many of which included potential allergens not identified in the ingredients list.
posted by Blasdelb (101 comments total) 33 users marked this as a favorite
 
HHS recommends that the FDA seek “explicit statutory authority to review substantiation for structure/function claims”
Dietary Supplements: Structure/Function Claims Fail To Meet Federal Requirements
WHY WE DID THIS STUDY
The Government Accountability Office and public interest groups have raised concerns about a specific type of claim-called a structure/function claim-that manufacturers may use on dietary supplement labels. Manufacturers have used these claims to promote health benefits of their products. Stakeholders have urged FDA to strengthen oversight of these claims because they are potentially misleading and may lack scientific support. FDA lacks authority to review or approve these claims before products enter the market. Manufacturers must have competent and reliable scientific evidence to show that claims are truthful and not misleading, but they do not have to submit the substantiation to FDA, and FDA has only voluntary standards for it. A manufacturer must notify FDA when it uses structure/function claims, and a product label must include a disclaimer stating that FDA has not reviewed the claim and that the product is not intended to diagnose, treat, cure, or prevent any disease.
HOW WE DID THIS STUDY
We analyzed structure/function claims for a purposive sample of 127 dietary supplements marketed for weight loss or immune system support. We reviewed the claims to determine the extent to which they complied with FDA regulations. We reviewed substantiation provided by manufacturers to describe the quantity and nature of the evidence. We also assessed the accuracy and completeness of notification letters that manufacturers must submit to FDA for their structure/function claims.
WHAT WE FOUND
Overall, substantiation documents for the sampled supplements were inconsistent with FDA guidance on competent and reliable scientific evidence. FDA could not readily determine whether manufacturers had submitted the required notification for their claims. Seven percent of the supplements lacked the required disclaimer, and 20 percent included prohibited disease claims on their labels. These results raise questions about the extent to which structure/function claims are truthful and not misleading.
WHAT WE RECOMMEND
We recommend that FDA seek explicit statutory authority to review substantiation for structure/function claims to determine whether they are truthful and not misleading. We recommend that FDA improve the notification system for these claims to make it more organized, complete, and accurate. We also recommend that FDA expand market surveillance to enforce the use of disclaimers for structure/function claims and to detect disease claims. In its comments on the draft report, FDA did not explicitly concur with our first recommendation, but said it would consider it. FDA concurred with our second and third recommendations.
posted by Blasdelb at 5:30 AM on February 26, 2016 [3 favorites]


Jon Oliver did a segment about why it's basically impossible for the government to do anything about this [Spoiler: we demanded it; in larger numbers than Americans have ever demanded anything else of their government]
posted by schmod at 5:39 AM on February 26, 2016 [5 favorites]


Guys it is the weirdest thing

I feel like it is socially the early 20th century in so many ways and yet I can't quite put my finger on it
posted by DoctorFedora at 5:58 AM on February 26, 2016 [49 favorites]


I feel like it is socially the early 20th century in so many ways and yet I can't quite put my finger on it

I am reminded of the patent medicines in the late nineteenth century, though with less opium.
posted by Dip Flash at 6:02 AM on February 26, 2016 [6 favorites]


It's fucking dumb that supplements are a Wild West and you still can't get Ma Huang / ephedra in herbal form to my knowledge. That was where the cracking down happened that led to Utah freakin' out but I guess they settled for "no ephedra but we can sell anything else and call it whatever. Yay"

Mind you, ephedra is dangerous and was being sold in wildly varying concentrations. I would've loved for the FDA to largely remain hands-off on regulating what is allowed while still treating it as a purity issue: a supplement might be toxic and untested but make sure it has the toxins in the concentration I was promised, dang it.
posted by aydeejones at 6:04 AM on February 26, 2016 [3 favorites]


People decided to do this and they ought to be put in f'ing jail. It is stealing.
posted by bukvich at 6:09 AM on February 26, 2016 [28 favorites]


What do you want to bet someone starts marketing dracaena as a supplement, since it's obviously already been used to "complement" so many things!
posted by blnkfrnk at 6:12 AM on February 26, 2016 [1 favorite]


I'd actually forgotten about the story of tryptophan (restored back to shelves awhile back) but that was an interesting case of trying to blame an amino acid for the sins of a single organization.

A lab in Japan was quietly producing a specific form of tryptophan that was dangerous due to its molecular structure (many supplements come in multiple forms where the cheapest least bio available form is popularly sold, and are often racemic even when advertised as enatiomerically pure) so the FDA moved to ban all tryptophan. Not a bad short term solution based on the information they had but it was certainly more nuanced than "this amino acid bad"
posted by aydeejones at 6:16 AM on February 26, 2016 [1 favorite]


Orrin Hatch, ladies and gents.
posted by lalochezia at 6:17 AM on February 26, 2016 [12 favorites]




[Spoiler: we demanded it; in larger numbers than Americans have ever demanded anything else of their government]

Oh horseshit. If you were involved in an industry that is selling rice powder for a 1000% markup, of course you would go all out in a lobbying effort to prevent any sort of regulation. It is more profitable and way safer than selling cocaine. If they have to comply with ingredient labelling, the profits will go down tenfold. If they have to comply with proving efficacy, the herbal industry will not exist. Most of the supplements do nothing. Of the supplements that do something provable, you have to identify the active ingredient to be able to safely dose people with it. Many of the herbal compounds (curcumin from turmeric, EGCG from green tea, genistein from soybeans, and resveratrol) which have been screened a lot and have many in vitro papers behind them are cell based screening artifacts. The few herbal supplements that would survive after proving purity, safety, and efficacy would fit on a nightstand, rather than filling up half of Walgreens.

Legit pharma companies are sane, well regulated entities by comparison with the herbal supplement gang.
posted by benzenedream at 6:23 AM on February 26, 2016 [23 favorites]


You want these pulled, allege that the herbs they contain are marijuana.
posted by shakespeherian at 6:25 AM on February 26, 2016 [4 favorites]


The funny thing is, I remember seeing petitions in health food stores in the nineties (when I was a mere slip of a thing! So old now.) about how the government should not regulate supplements, it would destroy the ability of health food stores to sell perfectly good and legit supplements.

If memory serves, there was a real issue, and it's the same issue with organic certification - getting and maintaining the certification is very expensive, so even small growers and producers who are completely in compliance with the policy don't always go for the certification. If memory serves, this is why Zapatista Coffee had no organic certification even though they were an organic producer.

I assume that at the time, people did not anticipate the take-off of mass production supplements/herbs/etc at Walmart, and so did not think through the idea that while Joe's Hippie Ginseng Locally-Produced Pills might be what it said on the tin even if there was no certification process, mass suppliers were unlikely to be so scrupulous.

To my mind, a solution for all this would be (totally impossible, just like most good things in America these days, of course) to have either a substantial subsidy for inspection and certification or else simply to support it through the state for all producers under a certain size.
posted by Frowner at 6:25 AM on February 26, 2016 [2 favorites]


You want these pulled, allege that the herbs they contain are marijuana.

Or booze.
posted by benzenedream at 6:33 AM on February 26, 2016 [1 favorite]


The crap often sold at even reputable stores is unregulated because the lobby for herbs etc managed to keep the govt from regulating it. If you do not like regulation via the govt, this is what you get. If on the other hand you want vitamins, herbs, etc regulated, then you need to do something about the lobbies.
posted by Postroad at 6:34 AM on February 26, 2016 [5 favorites]


I for one am shocked--SHOCKED--that the free market hasn't sorted this all out on its own, as the GOP has so often promised it would.
posted by Mayor West at 6:44 AM on February 26, 2016 [58 favorites]


Ooooh, a manufacturing defect type retailer liability approach! Nice.
posted by internet fraud detective squad, station number 9 at 6:44 AM on February 26, 2016 [4 favorites]


This is timely for me. I've been experimenting with valerian tea to help with my very, very terrible anxiety -- Ativan isn't cutting it by itself anymore and I'd rather not just keep ramping up the benzos. But the valerian in tea form isn't doing anything for me and it tastes like plant food smells. So I went to Walmart on Monday and thought, I'll just get some capsules.

Some little smart part of my brain said, Look it up -- there's no way to know what you're getting in those capsules, if anything. And I did, and saw the results of a study that specifically mentioned valerian root capsules.

So instead, I bought myself some empty gelatin caps, and decided to make my own. Still doesn't seem to be helping, but it tastes better, and at least I know what's in it -- my local herb source is knowledgeable and trustworthy.

I've been following the dietary supplement hijinks for years. It'd be a wonder if we could finally manage to do something about it. It feels like 1899 around here. Tonight we're gonna party like it's 1899.
posted by fiercecupcake at 6:47 AM on February 26, 2016 [6 favorites]


People decided to do this and they ought to be put in f'ing jail. It is stealing.

I mean, yeah, among other things, it's definitely theft. It's also fraud, and practicing medicine without a license, and conspiracy to commit bodily harm to a bunch of people. When you fill a prescription, there's an entire chain of people who are responsible for making sure that none of the other medications you're taking are likely to react badly with it. As soon as you introduce a class of supplements outside that chain, you're implicitly saying that you trust the supplement industry to list any possible interactions on the side of every bottle. Guess how many of them do that.
posted by Mayor West at 6:48 AM on February 26, 2016 [10 favorites]


(For example: St. John's wart! A totally safe and natural alternative to antidepressants, right? Sure, as long as you're not taking antiretrovirals, or are a candidate for organ transplant, or taking anything that's cross-indicated with MAOIs, or relying on HBC for birth control. Then you're fucked coming and going, and no one is going to tell you about it unless you specifically ask. I'm sure that's loudly advertised on the side of every bottle of "energy boosting" supplement, right?)
posted by Mayor West at 6:55 AM on February 26, 2016 [19 favorites]


I'm a licensed massage therapist, which means I spend a lot of time around other massage therapists, which means I've heard a LOT of pseudoscientific raving about natural remedies (hell, "pseudo" is generous) and ranting about Big Pharma. Like, this is an actual thing that I've had recommended to me by a well-meaning colleague when I told him about my sleep problems.

So anyway, I was taking a Continuing Ed class last year, and the instructor was talking about the myriad health benefits of Vitamin D. And everything she was saying was more or less legit. But then she started talking about how EVIL LOBBYISTS for BIG PHARMA are trying to get Vitamin D regulated as a pharmaceutical rather than as a supplement, just so they can get their grubby hands on that sweet, sweet Vitamin D money. I hope and pray with all seven of my culturally appropriated chakras that she's right, because I trust the regulations placed on medicine way more than those on supplements.
posted by duffell at 6:58 AM on February 26, 2016 [28 favorites]


For example: St. John's wart! A totally safe and natural alternative to antidepressants, right?

When people talk about "natural," I always mutter under my breath "Sure it's natural! Like cobra venom!"
posted by ROU_Xenophobe at 6:59 AM on February 26, 2016 [12 favorites]


At one point in time both my doctor (GP) and the psychiatrist I was seeing told me to get more Vitamin D. I tried buying a bottle, but honestly, I never incorporated it into my daily routine. I just don't know what the hell I was taking and I don't need 300% of the USDA daily recommended intake of arsenic in my diet.
posted by Hactar at 6:59 AM on February 26, 2016 [1 favorite]


It's fucking dumb that supplements are a Wild West and you still can't get Ma Huang / ephedra in herbal form to my knowledge.

Just so you're aware (and you might already be), while you can't get herbal ephedra, you CAN get ephedrine. I believe it's prohibited to market it as a stimulant or weight-loss thing, but it's the main ingredient in the decongestant drug "Bronk-Aid", which is usually sold by pharmacies in the same way pseudoephedrine is: over-the-counter, but you have to enter yourself into a database with your govt-issued ID so they can find you if they think you're using it to make meth. Anyway, this is my helpful "Here's where to find drugs" advice for the day!
posted by Greg Nog at 7:02 AM on February 26, 2016 [7 favorites]


Is this the final showdown between evil government forces who want to regulate everything and the forces of FREEDOM? Watch as ignorant consumers and true believers alike are trampled in the dust! See Senator Hatch square off against ACTUAL COMMUNISTS in the FDA!!!

Tune in next week for the exciting conclusion!
posted by sneebler at 7:03 AM on February 26, 2016 [3 favorites]


I can't read any of the links (nytimes paywall, jama paywalled, documentcloud blocked at work). So can someone tell me: are we talking about vitamins? Like a bottle advertising itself as "Vitamin C 500mg"?
posted by paper chromatographologist at 7:03 AM on February 26, 2016


The whole industry is shady. Flintstone vitamins contain less than 10 ppm of Barney Rubble, well below FDA guidelines.
posted by dr_dank at 7:04 AM on February 26, 2016 [26 favorites]


When people talk about "natural," I always mutter under my breath "Sure it's natural! Like cobra venom!"

My go-to is "hemlock," but I think I'm going to steal yours.

I'm still trying to figure out why the supplement industry hasn't been crushed beneath the weight of a thousand lawsuits. I would bet you any sum of money that people are dying from taking mislabeled or outright fraudulent pills, and without a functioning regulatory body, I'm having a hard time figuring out why some enterprising personal injury lawyer hasn't noticed how deep the industry's pockets are.
posted by Mayor West at 7:05 AM on February 26, 2016 [3 favorites]


Re: Vit D: I take Target-brand Vitamin D3 (the little gel/oil tabs) and FWIW, bloodwork confirmed that my Vitamin D level went up to normal levels after taking them. I am basically a cave-dweller so I can only assume the capsules in question contained actual Vit D. (My blood hasn't been tested for arsenic, though.)

But yeah, herbal and homeopathic stuff is dangerously unregulated. I've seen way too many stories about mercury or belladonna in homeopathic remedies to ever be interested in taking the stuff.

paper chromatographologist: the NYT link is talking about herbal supplements, since the case in question involves the use of DNA fingerprinting to see what's actually in them. However, the issue extends to the larger supplement market, including vitamins and pre/probiotics and homeopathic remedies.
posted by pie ninja at 7:06 AM on February 26, 2016 [2 favorites]


ROU_Xenophobe: When people talk about "natural," I always mutter under my breath "Sure it's natural! Like cobra venom!"

This reminds me about the game where, when someone is talking about 'toxins', you mentally replace the word 'toxin' with 'evil spirits'.
posted by Mitrovarr at 7:06 AM on February 26, 2016 [25 favorites]


So can someone tell me: are we talking about vitamins? Like a bottle advertising itself as "Vitamin C 500mg"?

From the article:

Three out of six herbal products at Target — ginkgo biloba, St. John’s wort and valerian root, a sleep aid — tested negative for the herbs on their labels. But they did contain powdered rice, beans, peas and wild carrots

So, no I think your Vitamin C tablets are probably exactly as advertised because they're not caplets containing herbs, which is what the article is talking about. But Vit C for immune system might not be as valid as some, maybe not you personally, think anyway, but I digress.
posted by RolandOfEld at 7:08 AM on February 26, 2016 [3 favorites]


I thought I was having severe deja vu, but thankfully not. While this is a good and worthwhile FPP, it's worth noting that this all happened more than a year ago -- the articles linked are from last February.
posted by McCoy Pauley at 7:09 AM on February 26, 2016 [9 favorites]


St. John's wart!

Eww! (It's St. John's wort, as in "plant." LOL.)
posted by fiercecupcake at 7:12 AM on February 26, 2016 [8 favorites]


...which means I've heard a LOT of pseudoscientific raving about natural remedies (hell, "pseudo" is generous) and ranting about Big Pharma.


I have learned that pretty much any time someone refers to pharmaceutical companies as "Big Pharma" everything else they say is about to be pernicious bullshit.

This is not to say that the industry is without many faults, but that particular terminology seems to be very popular with the sort of people who corner you at a party and start ranting about chemtrails.
posted by louche mustachio at 7:14 AM on February 26, 2016 [10 favorites]


MY SCURVY!
posted by blue_beetle at 7:17 AM on February 26, 2016 [4 favorites]


The whole industry is shady. Flintstone vitamins contain less than 10 ppm of Barney Rubble, well below FDA guidelines.

Although a recall was issued after several lots were found to contain traces of Dino DNA.
posted by mandolin conspiracy at 7:18 AM on February 26, 2016 [4 favorites]


This is Jack's lack of surprise.

These sorts of studies have been done lots, and it's pretty much always the case that none of this stuff is what it says on the tin. I used to work at a couple of natural food stores that sold supplements and they and the people who sell them are 1000% BS. Go to a natural products convention with your empathic hat on and you'll notice a whole lot of salespeople who are fully aware that what they are selling is fake. Like, they can hardly keep from smirking as they describe the many valuable characteristics of their $50 bottle of rice bran powder. Disgusting.
posted by soren_lorensen at 7:19 AM on February 26, 2016 [2 favorites]




It's fucking dumb that supplements are a Wild West and you still can't get Ma Huang / ephedra in herbal form to my knowledge.

That's not necessarily a bad thing. I got a bottle of Ma Huang like fifteen+ years ago, and one evening after a series of emergencies necessitated me pulling an all-nighter before work the next day I decided to have one pill to try and stay awake through the morning. After 30 min I was still about to pass out, so I took a second... 30 minutes after *that* I was vacuuming my entire house in the nude. Put myself together and headed into work a little while later, and found that I couldn't do anything because my hands were shaking and twitching too much to type. I had to head back home 'sick' and find a quiet dark space to curl up in while my heartbeat erratically thrashed for several hours. That stuff should *not* be on the market.

Altho of course, as poorly regulated as the market was, the pill might have contained 0% Ma Huang and just have been entirely meth or something. Who knows.
posted by FatherDagon at 7:22 AM on February 26, 2016 [4 favorites]


I've seen way too many stories about mercury or belladonna in homeopathic remedies to ever be interested in taking the stuff.

These would be rare cases of homoepathic remedies that contain any active ingredients whatsoever.
posted by mandolin conspiracy at 7:25 AM on February 26, 2016 [7 favorites]


Of course, we could fund more research through the NIH, thereby getting around a lot of the "Big Pharma" business...but that would involve the government, plus giving pointy-headed eggheads money to, like, study really dumb stuff like how one kind of molecule interacts with another one (totally a waste of time! we should have clinical trials of everything right now), plus of course who trusts the gummint anyway?

It is so frustrating to me that we have a perfectly adequate scientific infrastructure in this country that is not Big Pharma, but that is being slowly permeated by Big Pharma because it does not have enough state support.

Frankly, as an anarchist I still much, much prefer the fairly decent track record and probity of NIH over private industry. NIH and academic researchers generally are not always honest, and there are replication issues with even quite serious research, but as a broad generality, you're dealing with people who want to do what they say they'll do, and who want to do it because they want to find out the answers to scientific questions. If anything, better and more stable funding is going to produce better results because there won't be so much publish-or-perish-so-here-goes-with-the-dodgy-journal business.
posted by Frowner at 7:26 AM on February 26, 2016 [30 favorites]


Can we somehow redirect the anti-GMO people to this issue?
posted by sallybrown at 7:29 AM on February 26, 2016 [10 favorites]


People decided to do this and they ought to be put in f'ing jail. It is stealing.

Well, in the allergy cases it's also poisoning...and assault.
posted by sexyrobot at 7:29 AM on February 26, 2016 [6 favorites]


pie ninja: But yeah, herbal and homeopathic stuff is dangerously unregulated. I've seen way too many stories about mercury or belladonna in homeopathic remedies to ever be interested in taking the stuff.

If you're going to do something completely contraindicated by all of modern science, why not just make up a spell and cast it for free?
posted by Mitrovarr at 7:35 AM on February 26, 2016


There is the idea, right or not, that FDA is really controlled by Big Pharm, and they hate the supplement industry, not regulated by FDA; and by contrast, many on the right and the lobby groups for supplements cry out about govt regulations and a free market. No regulations means some bad stuff gets on the shelf. Regulations might mean some worthwhile stuff will not be approved or will undergo years of study.
posted by Postroad at 7:39 AM on February 26, 2016 [1 favorite]


No regulations means some bad stuff gets on the shelf.

Frances Oldham Kelsey proved that beyond a reasonable doubt.
posted by mandolin conspiracy at 7:43 AM on February 26, 2016 [2 favorites]


[Spoiler: we demanded it; in larger numbers than Americans have ever demanded anything else of their government]

Oh horseshit. If you were involved in an industry that is selling rice powder for a 1000% markup, of course you would go all out in a lobbying effort to prevent any sort of regulation.


I mean, it's true that there was a massive lobbying effort, but it's also true that more Americans contacted their congresspersons about deregulating the supplement industry than about the Vietnam war. This was an issue that had massive public support, not divided along political lines. Sure, the supplement companies (which, in many cases, are owned by the same parent companies as the "big pharma" companies that people distrust so much) engaged in a massive PR campaign to make it possible for them to sell mystery pills with no oversight, but the reason that campaign was so successful was because of a background level of ignorance, anti-scientific sentiment, knee-jerk opposition to government regulation, identity politics, and skepticism of the medical establishment in the wake of some high profile violations of public trust (e.g., the Tuskegee study).
posted by biogeo at 7:44 AM on February 26, 2016 [13 favorites]


I teach pharmacology to medical students and have an herbal lecture. So I get to tell them about the effects of a dozen to a score of different herbals and then I have to include a slide that says: by the way, none of this matters. You want an herbal supplement, you won't get anything, anyway.
By the way. Big Pharma does make herbals.
posted by dances_with_sneetches at 7:54 AM on February 26, 2016 [3 favorites]


Hey! I was promised my homeopathic remedy contained nearly nothing and it actually contains something! I'm going to sue.
posted by meinvt at 8:01 AM on February 26, 2016 [1 favorite]


Re: allergies, lol. You don't have to label most allergens; it's a fucking crapshoot even in the "regulated" industries.
posted by internet fraud detective squad, station number 9 at 8:02 AM on February 26, 2016 [3 favorites]


more Americans contacted their congresspersons about deregulating the supplement industry than about the Vietnam war.

That might set a new bar for depressing "did you know" facts.
posted by sallybrown at 8:06 AM on February 26, 2016 [9 favorites]


Bad sammyo has every so often had the desire to produce an authentic homeopathic snake oil supplement. Just for the lulz, (homeopathic with sanitary distilled water so it was basically just pure water so as safe as possible), but it'd certainly hit the sweet spot for the folks that need a highly effective placebo.

But on googling, OMFwackyG, it's quite available and on the market. What is wrong with this world????
posted by sammyo at 8:09 AM on February 26, 2016 [4 favorites]


There's a talk I give to all the patients in my family medicine clinic who come in with questions about herbal/natural/complementary/alternative medicines and it roughly covers:
  • Not all that is "natural" is effective. There are only a few herbal remedies that have been substantiated by high-quality research.
  • Not all herbal supplements can be taken with your other medications or if you have certain conditions. Some can interact badly with your liver or in other strange/interesting ways.
  • Not all supplement makers are the same. Only trust products guaranteed by USP, or by European manufacturers that benefit from more rigorous regulatory oversight.
  • Americans have very expensive urine. There is no evidence that a daily multivitamin/mineral pill reduces disease risk in healthy people; excess intake of water-soluble vitamins gets rapidly excreted. Notable exceptions: 1) vitamin D in postmenopausal women, breastfed infants, and people with diagnosed deficiency; 2)Folic acid in women who might become pregnant; 3) B12 in people with impaired uptake, or vegans who don't know how to eat right; 4) Iron supplements in pregnant women, sometimes.
  • Homeopathy is paying money for bottled water. We've known it basically since it was first proposed, but just as homeopathy's placebos overtook the toxic fad of mercury salts, so did evidence-based pharmacology ultimately win out over the placebos. Take it from a guy who graduated from the former Homeopathic Medical College of Pennsylvania.
  • Of course, that takes about half to all of the standard 15-minute visit depending on the patient's level of paranoia, but when I'm patient and decaffeinated enough to talk without making the patient feel small or stupid I can change a mind or two.
    posted by The White Hat at 8:18 AM on February 26, 2016 [31 favorites]


    If you're going to do something completely contraindicated by all of modern science, why not just make up a spell and cast it for free?

    Because expensive placebos work better than cheap or free placebos. If you want your made-up spell to work, you're going to need to spend at least a few bucks on it.
    posted by pie ninja at 8:18 AM on February 26, 2016 [4 favorites]


    Bad sammyo has every so often had the desire to produce an authentic homeopathic snake oil supplement. Just for the lulz, (homeopathic with sanitary distilled water so it was basically just pure water so as safe as possible), but it'd certainly hit the sweet spot for the folks that need a highly effective placebo.

    But on googling, OMFwackyG, it's quite available and on the market. What is wrong with this world????


    It turns out "snake oil salesmen" were in fact the forebears of GNC, Target, Walgreens and Walmart. While I can't personally vouch for its effectiveness, extracts from the Chinese water snake were traditionally used in Chinese medicine to treat inflammation. Chinese-American railroad workers popularized the remedy, quickly leading to the proliferation of knockoffs that promised all manner of health benefits--but didn't include the key ingredient. The American use of the term "snake oil" comes from the popularity of American knockoffs that were not derived from Chinese water snakes. Snake Oil thus became an umbrella term for false cures.

    Again, I make no claims about the actual effectiveness of Chinese water snake oil, but hey, interesting factoid for parties!
    posted by duffell at 8:20 AM on February 26, 2016 [4 favorites]


    homeopathy's placebos overtook the toxic fad of mercury salts

    lol so it turns out homeopathy was actually beneficial, in a certain wacky way. ;-)
    posted by sammyo at 8:23 AM on February 26, 2016 [2 favorites]


    Don't confuse 'homeopathic' products (which chemically should do nothing), with herbal products. St. John's Wort has been shown to actually be effective for mild depression, although there are interaction effects with other drugs that could be very bad. If a company labels something as St. John's Wort and it's actually something completely different, this is a much worse thing and it shouldn't be dismissed as "Haha, look at those morons with their fake medicine". I hope studies like these lead to more stringent content labeling for these types of products.
    posted by demiurge at 8:24 AM on February 26, 2016 [4 favorites]


    Last time I was at Whole Foods I was in line behind a real chatty Kathy who was buying a bunch of supplements. She buying quite a few but there was one that, when she saw the price, she asked the cashier to remover it. It was oregano oil, $60 for a little one ounce bottle. She said "for that price I might as well go dig it up in the woods." I couldn't resist pointing to the produce section as a nearby place where oregano could be acquired by the pound.

    When people talk about "natural," I always mutter under my breath "Sure it's natural! Like cobra venom!"

    Me too. One time someone was berating me about using an organic dry cleaner and I wanted out of that conversation so I went straight up Hitler and used Zyklon B as my example of an organic "cleaning" fluid. I am a jerk when it comes to these things and explaining the different meanings of the word organic wasn't breaking through the woo.

    Re: allergies, lol. You don't have to label most allergens; it's a fucking crapshoot even in the "regulated" industries.

    The Food Allergen Labeling and Consumer Protection Act covers the 8 allergens that cause 90% of food allergies. The problem with supplements is that they are not considered food, they are covered under the DSHEA which is craven, industry-friendly bullshit. Of course both laws suffer from the the same problem, the systematic under-funding of our health, safety, and environmental regulatory systems.
    posted by peeedro at 8:29 AM on February 26, 2016


    There was a similar test a while ago where they found that the only reliable supplier for this kind of thing is Costco.
    posted by w0mbat at 8:41 AM on February 26, 2016 [1 favorite]


    When people talk about "natural," I always mutter under my breath "Sure it's natural! Like cobra venom!"

    At the recent Cactus and Succulent Society meeting I attended a woman in the audience recommended a book on growing plants without chemicals. The speaker crankily muttered "That's hard to do without water".
    posted by srboisvert at 8:44 AM on February 26, 2016 [12 favorites]


    Please can they come for Essential Oils next? I had to put the term in my Facebook filters because JFC people, get over your medical phobias and take your kids to the fucking doctor.
    posted by Lyn Never at 8:46 AM on February 26, 2016 [22 favorites]


    At the recent Cactus and Succulent Society meeting I attended a woman in the audience recommended a book on growing plants without chemicals. The speaker crankily muttered "That's hard to do without water".

    Required: SMBC comic strip.
    posted by duffell at 8:46 AM on February 26, 2016 [5 favorites]


    If you're going to do something completely contraindicated by all of modern science, why not just make up a spell and cast it for free?

    Because expensive placebos work better than cheap or free placebos. If you want your made-up spell to work, you're going to need to spend at least a few bucks on it.

    posted by pie ninja at 10:18 AM on February 26 [+] [!]

    Or have it be sufficiently complicated.
    posted by fiercecupcake at 8:47 AM on February 26, 2016 [1 favorite]


    Don't confuse 'homeopathic' products (which chemically should do nothing), with herbal products. St. John's Wort has been shown to actually be effective for mild depression, although there are interaction effects with other drugs that could be very bad. If a company labels something as St. John's Wort and it's actually something completely different, this is a much worse thing and it shouldn't be dismissed as "Haha, look at those morons with their fake medicine". I hope studies like these lead to more stringent content labeling for these types of products.

    Too right. I've taken St. John's Wort on and off for the last 5+ years to mitigate chronic mild seasonal depression, mainly because it was fairly cheap, seemed effective, and didn't have the side effects (drowsiness, mainly) that I'd experienced under various prescription antidepressants. Now I'm in the weird spot of having to wonder if I've just been placeboing myself with ground rice all these years. And there's absolutely no way to know for sure.
    posted by Strange Interlude at 8:57 AM on February 26, 2016 [4 favorites]


    Please can they come for Essential Oils next? I had to put the term in my Facebook filters because JFC people, get over your medical phobias and take your kids to the fucking doctor.

    Prepubertal Gynecomastia Linked to Lavender and Tea Tree Oils:

    We conclude that repeated topical exposure to lavender and tea tree oils probably caused prepubertal gynecomastia in these boys.
    posted by mandolin conspiracy at 9:03 AM on February 26, 2016 [5 favorites]


    Now I'm in the weird spot of having to wonder if I've just been placeboing myself with ground rice all these years. And there's absolutely no way to know for sure.

    Place-Boing!

    I smiled.

    It works!
    posted by srboisvert at 9:08 AM on February 26, 2016 [4 favorites]


    Please can they come for Essential Oils next? I had to put the term in my Facebook filters because JFC people, get over your medical phobias and take your kids to the fucking doctor.

    Seriously. And get over your bleach phobia and disinfect your damn house. Thieves oil for cleaning up after a kid with the flu? Does that even sound like it makes sense? This time of year I have no patience for the woo crap that encourages daycare workers and restaurant owners to swap out bleach for oil and vinegar. Herbs don't work when it's serious.
    posted by witchen at 9:23 AM on February 26, 2016 [4 favorites]


    Don't confuse 'homeopathic' products (which chemically should do nothing), with herbal products.

    Part of the problem is that this confusion is now becoming normal parlance. I was listening to a BBC podcast where they were talking about "homeopathy", but what they actually meant was natural/herbal/folk cures (cabbage for mastitis, etc). I have also seen scientific articles where the term homeopathy is used to describe all holistic/non-western medicine.

    It's frustrating, but hard to stop at this point.
    posted by a fiendish thingy at 9:36 AM on February 26, 2016 [5 favorites]


    Here is a fairly detailed description of what lead up to DSHEA (The Dietary Supplement Health and Education Act of 1994). Be warned that it's on a website for supplement sellers, so there's an obvious underlying pro-supplement stance, but the legislative history seems unbiased and is actually pretty interesting. It passed in a fairly non-standard way.
    posted by benito.strauss at 9:38 AM on February 26, 2016


    A recent Frontline episode on this topic.
    posted by jeffamaphone at 9:47 AM on February 26, 2016 [1 favorite]


    Look for the USP (United States Pharmacopeia) logo. They're a nonprofit organization that publishes reference standards for medicines, food ingredients, and dietary supplements. The FDA uses USP standards in its regulation of drug manufacturers--i.e., they're the real deal. They offer a voluntary program for manufacturers of herbal supplements. The manufacturer submits to auditing, documentation review, random off-the-shelf testing, etc, and in return they get to stick the fancy USP logo on their product. It doesn't tell you anything about the safety or efficacy of the product, but at least you know what you're getting.

    Also, if you use any supplements regularly, tell your doctor and pharmacist. That goes double if you use St. John's Wort or are taking warfarin or antiretrovirals.
    posted by dephlogisticated at 10:06 AM on February 26, 2016 [3 favorites]


    At the recent Cactus and Succulent Society meeting I attended a woman in the audience recommended a book on growing plants without chemicals. The speaker crankily muttered "That's hard to do without water".

    Prickly situation, eh?
    I'll show myself out.
    posted by mandolin conspiracy at 10:14 AM on February 26, 2016 [8 favorites]


    Look for the USP (United States Pharmacopeia) logo.

    Personally, I wouldn't put much faith in logos on the label. That tactic gets abused all the time.
    posted by Xyanthilous P. Harrierstick at 10:20 AM on February 26, 2016


    I was about to start taking green tea extract and now I'm scared to buy any.
    posted by agregoli at 10:21 AM on February 26, 2016


    This one of the reasons I am skeptical about the multivitamin increased mortality findings that have been talked up a lot recently. It's not that I doubt the dependent variable of increased mortality. It's that I am not sure that I can be sure of the independent variable of multivitamin consumption is accurate. People who report taking vitamins may have been taking all kinds of different things ranging from the actual vitamins to harmful toxic substitutes and there is no way to know.

    Given that it is entirely reasonable to see increased mortality as some people who were counting on vitamins to address dietary deficiencies will be let down and some people will be actively poisoned.

    The course of action though, is still the same as if I believed the research. You pretty much have to stop taking multivitamins because you just can't trust them.
    posted by srboisvert at 10:55 AM on February 26, 2016


    Is there any follow-up coverage of this? It seems weird that the attorney general's office goes after these huge companies, and then there's pretty much no coverage of the situation over the following year.
    posted by a box and a stick and a string and a bear at 11:05 AM on February 26, 2016 [1 favorite]


    I believe this to be a decent source for information on supplement quality.
    ConsumerLab.com

    They don't cover every type of supplement out there but they do have a whole bunch of stuff tested including various herbal products. According to their "About Us" page they've tested 4,400+ products from 450+ brands.
    To get the test results you'll need to pay for a membership subscription which they say is their main source of revenue and what makes them independent.

    We've used it to identify decent brands for the supplement mix we need to add to our diy cat food recipe.
    posted by Hairy Lobster at 11:09 AM on February 26, 2016 [1 favorite]


    One of the reasons people take supplements is that visiting a doctor may not be feasible (I may have $50 a month for my mandatory insurance payment, but I don't have a $20-100 visit copay, and a $10-? Rx copay, and a day off work that I can use, and transportation to a doctor who may not listen or respond with civility to my actual complaints if I am, say, female) and your next option for feeling like you're in control of your health is to buy an $8.99 bottle of multivitamins when you remember next time you're in Walgreens.

    I kind of wonder if people who take a multi are doing so because that's the best they can do (I mean, that was me before I could get Healthy SF/insurance.) That would be a reason why mortality is up, and it's a reason why herbal supplements are such a big business.
    posted by blnkfrnk at 11:14 AM on February 26, 2016 [4 favorites]


    When people talk about "natural," I always mutter under my breath "Sure it's natural! Like cobra venom!"

    My goto example is Botulinum toxin, which is super natural, and also the deadly compound to humans by weight.
    posted by sideshow at 11:16 AM on February 26, 2016 [3 favorites]


    Two problems with herbals with active ingredients: the amount of active ingredient may vary significantly more than a pharmaceutically prepared agent, and there may be additional toxic compounds (think heavy metals).
    posted by fraxil at 11:31 AM on February 26, 2016


    For the first time ever I had a doctor ask me if I was taking any supplements. I thought that was interesting, particularly given the discussion above about how some of these "natural" products have significant interactions with other drugs.

    The woo that boils my blood is the fake medicine aisle in every Whole Foods. I mean it's bad enough it's a grocery store full of smug that refuses to carry a bunch of basic products like bacon or sausage. But then there's this one aisle chock full of homeopathic bullshit that at best is fleecing customers out of money.
    posted by Nelson at 12:01 PM on February 26, 2016 [3 favorites]


    Your Whole Foods doesn't have sausage or bacon?
    posted by mmascolino at 12:17 PM on February 26, 2016 [2 favorites]


    I think Whole Foods used to have a thing where they refused to carry white sugar, and a few other "highly processed" standard items. I think those are the "basic products" Nelson is mis-remembering. Mine certainly has bacon, and I don't know if they've changed their stand on sugar.
    posted by benito.strauss at 12:22 PM on February 26, 2016 [1 favorite]


    Your Whole Foods doesn't have sausage or bacon?

    They don't carry meats that contain added nitrates or nitrites, that cuts down on bacon, ham, hot dogs, and sausage (used as a preservative and to fix the color). They do usually have uncured versions, and "no added nitrate" versions (but these are kinda bunk according to some people, as stuff like celery juice, naturally containing nitrates, is used to cure the meat but allows them to claim no nitrates are added).

    There's a big list of unacceptable ingredients they won't carry.
    posted by peeedro at 12:40 PM on February 26, 2016 [4 favorites]


    blnkfrnk hits on something; that women are treated horribly by the medical industry. At best, their very real concern are downplayed or dismissed. I struggled with a long time trying to understand why it was the women around me that flocked to herbal supplements to address medical concerns. It wasn't until someone here on Metafilter pointed that out that I had an "oh damn." moment.

    I don't know how to address that to women friends, especially those who really believe in it. I generally say thanks for the suggestion and move on. Part of me wants to inform them they are being scammed, but I don't know how without crossing some serious friendship boundaries.

    (I'm not saying men don't use supplements, look at any body building forum. But it does seems to be much more prevalent casually with women.)

    The FDA regulating supplements has it's own problem - ESPECIALLY if they continue to allow companies to do their own testing. The People's Pharmacy is great for talking about medication blunders and many are due to lax regulation or allowing pharmaceutical companies to do their own testing (or not as the bupropion debacle showed). I was just reading how a popular drug had a much lower efficacy than was officially reported and published. The unpublished studies showed a much lower positive response rate. (For the life of me, I can't remember what the drug was. I thought gabapentin, but can't seem to find the paper.)

    I know, the answer is to improve the FDA or NIH as suggested above. But half the country thinks the government is evil. If we started treating supplements like prescription medications, all we'd have is big pharma producing bogus studies to show how various supplements worked. That terrifies me more than the current system.
    posted by [insert clever name here] at 12:49 PM on February 26, 2016 [4 favorites]


    Ya gotta go with reputable dealers, kids. I would never buy herbs from those giants, who knows who is supplying them, and I know the only thing these retail behemoths care about is the bottom line, not their reputation as to the quality of their herbals.

    How to find quality? Try scanning some of the entheogen (i.e. "drugs") boards until you find some people discussing which suppliers are good, who is kinda sketchy, etc. Many reputable suppliers also offer plenty of non-psychoactive herbs, and then, if all else fails, maybe learn some botany, some herbology, and some horticulture and grow your own.

    Simply disparaging herbs in general compared to pharmaceuticals is lazy as fuck.
    posted by telstar at 12:49 PM on February 26, 2016 [1 favorite]


    A bunch of the marketing on the sports radio in my area is supplements for: memory, weight loss, testosterone, prostate, eyesight & hearing. I am not interested in these products but it is sure noticeable they are buying as many advertising slots as auto dealers and furniture stores and auto parts retailers and other businesses that make beaucoup bucks.

    (They don't appear to be raking it in like the fantasy sports gambling business though)
    posted by bukvich at 12:53 PM on February 26, 2016 [1 favorite]


    Simply disparaging herbs in general compared to pharmaceuticals is lazy as fuck.

    telstar, that has been discussed on the blue ad nauseam. There are many more. Google it.

    No one here has forgotten to look at the efficacy of herbal medicines, we've just had that discussion, mostly agreed it's bunk, and moved on. You're free to try and make your case, of course. But it's silly to pretend the commenters have just overlooked that one important facet.

    Sometimes I wonder if Matt (and now Cortex) has a slew of sock puppets just to offer the opposing opinion to serve as a counter point when things get too echo-chambery.
    posted by [insert clever name here] at 1:19 PM on February 26, 2016 [1 favorite]


    Apologies all - I made my above post sound there was a consensus between all the members and I spoke for them. All I meant to convey is that with the history of discussion on this topic, it is incorrect to assume members participating in this thread have not considered the efficacy of herbal supplements or that the negative views expressed are not well thought out and researched views.
    posted by [insert clever name here] at 1:30 PM on February 26, 2016


    Ya gotta go with reputable dealers, kids.

    Not to be argumentative but are there really suppliers that have ongoing certification by independent laboratories? Just because a company seems 'nice' and there are positive comments on a forum or two is that a reasonable case for reliable medicine? I use that word as if a 'supplement' is efficacious it is an unregulated medicine, argue good/bad/whatever but if it works it's essentially medicine. Oh and don't self medicate.

    Anyway, eat your veggies kids.
    posted by sammyo at 1:49 PM on February 26, 2016 [1 favorite]


    Oh, herbal medicine's been around for thousands of years!” Indeed it has, and then we tested it all, and the stuff that worked became ‘medicine’. And the rest of it is just a nice bowl of soup and some potpourri, so knock yourselves out.
      ― Dara Ó Briain
      There was a similar test a while ago where they found that the only reliable supplier for this kind of thing is Costco.

    Well, at least they seem to have stopped selling shark cartilage, which puts them above GNC.
    posted by scruss at 2:16 PM on February 26, 2016 [3 favorites]


    One good evidence-based place to go for info on supplements is Berkeley Wellness.

    They approach it pretty even-handedly. Usually the advice is: Save your money and eat your veggies.

    In paraphrase, they also say things like...

    Vitamin D? Yes, you may need it, if...xyz

    X herbal supplement? Likely bullshit, also consult your doctor. In some cases it's a maybe, or there's some evidence it's helpful if...but caveat per the FPP that you don't know what you're getting.

    Yes, folate during pregnancy is a good idea. But guess what? The "non-natural" folate is more easily absorbed.

    Various little clinical details like that.
    posted by mandolin conspiracy at 4:48 PM on February 26, 2016 [2 favorites]



    Seriously. And get over your bleach phobia and disinfect your damn house. Thieves oil for cleaning up after a kid with the flu? Does that even sound like it makes sense?

    It probably works just fine, actually, because influenza virus only lives from a few minutes up to maybe 24 hours on hard surfaces. It's a pretty wimpy virus, as viruses go. Certainly some ingredients in Thieves Oil have shown in vitro effects against flu virus in dose-dependent amounts.

    Norovirus, on the other hand, requires bleach to disinfect.
    posted by oneirodynia at 5:27 PM on February 26, 2016


    Fire would be my preferred method.
    posted by Justinian at 6:16 PM on February 26, 2016 [4 favorites]


    The woo that boils my blood is the fake medicine aisle in every Whole Foods. I mean it's bad enough it's a grocery store full of smug that refuses to carry a bunch of basic products like bacon or sausage.

    The Whole Foods that I go to once in a while has really sad looking bacon out in the packaged meat cooler, but several varieties of quite decent bacon in the main meat counter. Same for sausage -- the stuff in the meat counter is great, but there is some strange stuff over in the packaged section.

    On topic, I do wonder how the products for sale at an expensive place like Whole Foods would compare to those at mass market retailers? The entire marketing basis for places like Whole Foods is their knowledge of and control over their supply chain, but whether or not that would actually extend to the supplements is an interesting question.
    posted by Dip Flash at 8:22 PM on February 26, 2016


    My supplement conspiracy theory is that the real reason ephedra was taken off the market is because it was becoming a feedstock for methamphetamine. (Yes I know it's dangerous in itself, a kid at my middle school apparently died from it.)
    posted by atoxyl at 12:04 AM on February 27, 2016


    The whole food ones are crap too. The business of supplements is corrupt all up and down its supply chain.

    It doesn't really matter if you're taking echinacea or sawdust and wax. It's the same bullshit. And for all the SJW love above, realize it's only very minimally "effective" even in the few real trials that show it works better than placebo. Plenty of well run trials show no efficacy and advocates cherry pick the good results all the time in this pseudo world. Caffeine is very nearly as effective.
    posted by spitbull at 2:53 AM on February 27, 2016


    As I've grown on in years I've learned that there's no clear dividing line between "medicine" and "food". Yes, pharmaceuticals developed for specific responses can be wonderfully efficacious and I use a couple of them. But herbals, which can be thought of as "concentrated aspects of certain foods" can be very useful in certain applications. Don't think so? Well, there are millions of cannabis users who use a simple herb in direct defiance of hundreds of warnings and lifelong exposure to anti-"drug" propaganda. Another example: your morning coffee. Did you just spit yours out thinking that I'm touching your sacred coffee with the "herbal dirty stick"? Sorry, coffee is a plant, grown, roasted and ground for you to extract the active component out at home. Herbal highs FTW!

    One very big blind spot in the pharm industry is that nothing (except by accident) is allowed to be pleasant per se. But people want and need (in a therapeutic sense) to feel pleasant feelings sometimes in a form as convenient as an herb they can prepare right now. Although puritanical types would deny that right at this point quality herbal suppliers are one of the few legal avenues open to that kind of exploration. To repeat, reputable, quality dealers are paramount.

    But again, it's not all about "getting high". There are plenty of herbs that simply add to the flavor of foods. That make a relaxing and refreshing tea. That, when burned, give your house a pleasant mysterious aroma. That are simply beautiful plants that are pleasant to have around, maybe have a nice aroma while growing. That really do have medicinal effects, efficacious as any pharmaceutical. To dismiss the herbal world because of abuses of mega-retailers is a step I'm simply not willing to take.

    To end, it's been fun learning about herbs over the last thirty years. Yes, there is an ocean of bullshit claims out there to navigate. I wish I could wave a magic wand and make all that go away. But education, experience and exploration are the antidotes to the BS.
    posted by telstar at 9:27 AM on February 27, 2016 [1 favorite]


    We may never run out of reasons to love love love (love love love!) Mel Gibson.
    posted by NortonDC at 4:32 PM on February 27, 2016


    > And get over your bleach phobia and disinfect your damn house. Thieves oil for cleaning up after a kid with the flu? Does that even sound like it makes sense?

    If your woo-y acquaintances are like mine, we can be consoled that their kids probably had bad colds, not the flu, in the first place.
    posted by The corpse in the library at 9:00 AM on February 28, 2016


    There is no evidence that a daily multivitamin/mineral pill reduces disease risk in healthy people

    And in fact multivitamins may increase some types of risks. Overview from sciencebasedmedicin.org because it contains a bunch of interesting related material.
    posted by sneebler at 12:34 PM on February 28, 2016


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