Herbal Remedies Need Real Scrutiny

November 23rd, 2009 at 12:52 pm David Frum | 11 Comments |

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Did you know that there exists an all-natural remedy for memory loss? Weight gain? Macular degeneration? Prostate enlargement? These products are so successful that clinical testing has already begun! Just listen to the following testimonial from an unidentified person …

As these ads blare at you from your favorite AM radio station, perhaps you wonder: How can this be legal? Since the late 1960s, aspirin makers have been trying to win the right to tell the public that a daily low-dose tablet can help prevent heart disease. They have been told no, and no, and no again.

Federal regulators are so nervous about over-selling aspirin’s benefits that they have restricted statements about aspirin to the most bland and basic. Yet while the statements about aspirin have to be cushioned in the vaguest generalities, snake oil flim-flam can be huckstered in the most truth-defying way, thanks to a 1994 law coaxed through Congress by the people who make these drugs.

The law bears the long title of the Dietary Supplement Health and Education Act of 1994. It was sponsored in House of Representatives by Rep. Dan Burton, R-Indiana, and in the Senate by Orrin Hatch, R-Utah, and Dick Durbin, D-Illinois.

The DSHEA law draws a line between synthesized medicines like aspirin and remedies made from herbs, minerals, vitamins and amino acids. This latter group was recategorized as “dietary supplements” — that is, as foods rather than drugs.

“Drugs” are subjected to exacting scientific trial to prove them both safe and also effective. Sellers of dietary supplements are not required to prove that their remedies work. They are not even required to prove them safe — as “foods” they are presumed safe unless shown otherwise. “Drugs” must disclose any risk of side effect. (That’s why those erectile dysfunction ads terrify TV audiences with their references to four-hour erections.)

Dietary supplements bear no such burden — which is why St. John’s wort can be sold as an anti-depressant, without any mention of the disturbing indications that the herb weakens the effectiveness of birth control pills.

“Drug” advertising must be pre-approved by the Food and Drug Administration, which minutely reviews the ads’ accuracy. Dietary supplement advertising is regulated by the Federal Trade Commission.

So long as supplements avoid promises to cure a specific disease, their sellers can say pretty much whatever they want, provided only that they have some kind of supporting evidence on file.

That evidence does not have to meet any kind of scientific test: pretty much any pattern of ink on paper will do the job. I cannot say, “My rosemary-sage-thyme-and-oregano tablets cure AIDS.” But if I pay my cousin $100 to do a few experiments, I can claim, “My tablets boost the immune system — and clinical trials are under way!”

(There is an exception to the permissive rules about advertising natural products: wine. There is substantial evidence that a glass of red wine a day reduces the risk of heart attack. The laws of most states forbid any hint or suggestion that moderate alcohol use might confer health benefits. Still, if you ask the scientists, wine has better grounds to call itself a health food than does, say, echinacea!)

Fifteen years after receiving the favor of Congress, dietary supplements have grown into a $24 billion a year industry. Most of the products sold by the industry are merely useless.

For those who eat a balanced diet, scientists have found no quantifiable benefit from taking multivitamins. On the other hand, multivitamins probably won’t do any harm. It would be better to give the $10 you spend on a jar of pills to the Salvation Army, but at least you are not poisoning yourself.

The same could not be said, alas, for the unfortunate customers of a Belgian herbal dispensary who bought a supplement that contained the herb Aristolochia fangi. The A. fangi herb is rich in aristolochic acid, a carcinogen — and users experienced an outbreak of urinary tract cancers. A. Fangi has since been banned in the European Union. It remains legal in the United States.

As outrages go, Congress’ special favor to the herbal supplement industry might seem relatively small stuff: a splash in the torrent of the $2 trillion per year that Americans spend on health and wellness.

And yet in the midst of a great national debate over health care, this small outrage has some serious implications. Advocates for the herbal supplement industry justify their special sweet deal by championing the right of consumers to make their own “health choices.”

Individual choice certainly sounds like the American way. But the fact is that most of us are not well positioned to make intelligent health choices. If we try to play our own doctor, we are going to expose our health — and our money — to risk and exploitation.

As individuals, we have trouble distinguishing between anecdotes: “My neighbor took zinc for her cold and she said it really helped,” and data: Most colds last four days, so you could smoke yak-dung cigarettes on day three and feel better on day four.

We are poor balancers of risk: Look at the rising number of Americans who resist taking vaccines because of astronomically remote chances that something might go wrong.

We are vulnerable to placebos: “Hey — I took the 30-day free sample and I feel sure my vision did improve!”

We are swayed by prejudice and ideology: The film-maker Spike Lee wrote in Rolling Stone in 1992: “I’m convinced AIDS is a government-engineered disease.”

The reason we should defer to experts is not that the experts know everything. Of course they don’t. It’s just that they know more than non-experts do.

It’s not that science has all the answers. It doesn’t. It’s just that astrologers, shamans, and natural healers have none of them.

Americans spend over 50 percent more per person on their health than anyone else on earth. For all that extra money, Americans see very little benefit. Americans rank 42nd on earth in life expectancy, 29th in infant mortality.

Improving and rationalizing this costly and dysfunctional system is a gigantic, maybe impossible, task. But one small reform could strike a meaningful blow for reason and cost-effectiveness: Apply the rules governing the advertising of aspirin to the advertising of oregano tablets. Repeal the DSHEA law and give the Food and Drug Administration full authority over every manufactured substance that purports to promote health or relieve illness.


Originally published November 23, 2009 on CNN.com.

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11 Comments so far ↓

  • danally33

    First of all, how much are the pharmaceutical companies paying you to write this article?
    2nd, when was the last time that you studied herbs and supplements?
    3rd, study the asian culture…you will be amazed on how well they do with herbs etc…

    Get the facts straight. It is all about $$$…that is what the Pharmaceutical companies like. If they cannot patent it, they want to put you out of business.

  • Carney

    This was an outstanding article. I highly recommend QuackWatch.org as a website to get more information about pseudo-science and snake-oil salesmen, and the suckers, cranks, and victims bamboozled by them.

    Crystals, magnets, homeopathy, anti-vaccination, chelation therapy, colloidal silver, herbal remedies, “Traditional Chinese medicine”, holistic medicine, healing touch, copper bracelets, pressure points, auras, chiropractic, Scientology, Christian Science, etc etc. Our nation is awash in quackery, kookery, flim-flammery, and fraud, and the anti-science ignorance and paranoia necessary for it to flourish in.

    We need to forcefully crack down on the hucksters and educate the next generation in sound science and critical thinking skills.

  • joemarier

    Test ‘em for safety, maybe. Effectiveness? Probably not; I think it’d be a waste of resources to put, say, whole grain cereals through double-blind placebo tests if they want to put a heart logo on the box (What would you use for the placebo?). There are all kinds of other cases where nutritional supplements may save money; which is more expensive, joint health supplements, or physical therapy? Valerian, or prescription insomnia medications? That kind of thing.

    Also, are nutritional supplements even considered part of health spending? I mean, you can’t buy nutritional supplements with FSA/HSA dollars. And they’re far less expensive than MRIs.

  • cm

    To quote you ” But the fact is that most of us are not well positioned to make intelligent health choices. If we try to play our own doctor, we are going to expose our health — and our money — to risk and exploitation.
    As individuals, we have trouble distinguishing between anecdotes: “My neighbor took zinc for her cold and she said it really helped,” and data: Most colds last four days, so you could smoke yak-dung cigarettes on day three and feel better on day four.
    We are poor balancers of risk: Look at the rising number of Americans who resist taking vaccines because of astronomically remote chances that something might go wrong.
    We are vulnerable to placebos:” blah blah blah…..

    HOW OFFENSIVE!

    Since when do you decide with broad sweeping “authority” that most Americans who use alternatives are IDIOTS?
    I have been using Herbal remedies and alternative treatments for years. I do my homework. It is MY responsibility! It is also MY RESPONSIBILITY to decide if I want to take medicines from a Pharmaceutical company! And I DON’T!
    This is an obvious article from somebody who MUST have stock in Merck, Phizer and the likes…..
    The poisoners of the American Public who blindly go like sheep to the slaughter to the local pharmacy and ignore the DEATH warnings.

    I am not against the medical community, nor the alternative …. I am ALL FOR INFORMED PERSONAL DECISIONS and NOT having somebody else’s well meaning will imposed upon me or my children.

    Pretty soon, I will have no choice if stupid, illinformed artilces like this keep circulating.

    I have to go and smoke my “yak dung” now, so I can get over my hot flashes.
    DUH!

  • PracticalGirl

    David, you stepped in the “yak dung” with this one…I truly believe that the strident “natural-only” crowd is alternative medicine’s biggest problem in this country. Most that I know only want to “beleive” in effectiveness and get very offended when anybody suggests real, scientific measurement of that success.

    I support some alternative therapies, and personally use a combo of natural products (recommended by my MD) to combat a degenerative inner ear issue for which there is no real medical treatment aside from radical surgery. But I also think that the strident “natural-only” crowd is alternative medicine’s biggest problem in this country. Why, if it all works so well, does this crowd fight any attempt to measure success? For some, it is easier just to “believe”.

    Drug companies and marketers certainly have a reason to fear some of these treatments, should they ever be tested in a rigorous way. But since they’ve also made it possible for people to live with AIDS and never think twice about polio, I think the industry is safe from extinction.

  • PracticalGirl

    Sorry about some of the repeats for the above post…

    A MI GOPER moment:

    MODERATOR: PLEASE HIRE AN EDITOR TO CLEAN UP PRACTICAL GIRL’S POSTS, AS SHE TENDS TO WRITE THEM WHILE ON CONFERENCE CALLS, AND WHILE SHE CAN PASTE, SHE CANNOT SEEM TO CUT.

  • BarryS

    I watch the commercials for pills and potions on the Tv. I am amazed at the possible serious side effects of a pill that is supposed to be curing a relatively benign non life threatening problem.

    Why would I wish to risk a dozen possible side effects including death to cure my restless legs?

  • Carney

    BarryS, those disclaimers are forced on drugmakers by the FDA, regardless of how freakishly rare those symptoms are.

    As for the suckers who use “alternative” methods and think that the placebo effect or personal anecdotes refute or substitute for proper, double-blind studies in peer-reviewed journals edited by credentialed experts who understand and accept the scientific method, I pity you, and ask you to realize that those of who do understand science and critical thinking and the rules of evidence are not all “paid off” by eeeevil drug makers. Your conspiratorial thinking just puts you further out on the kooky fringe.

  • sinz54

    A big step backward for scientific medicine,
    and a big step forward for medical quackery,
    came about when Dem Sen. Tom Harkin forced the NIH to open up a National Center of Complementary and Alternative Medicine (NCCAM), to look into all these alternative remedies.

    Harkin had been using bee pollen for his allergies and swore by it. And he just wanted all us citizens to benefit from these amazing cure-alls.

    “The product he used was Aller Bee-Gone, a secret-mix concoction which included more than just bee pollen hawked by Royden Brown of Arizona. Not long after converting Harkin to his bee pollen cure, Brown’s CC Pollen Company was fined $200,000 by the Federal Trade Commission for falsely claiming that his bee pollen products could cause consumers to lose weight, alleviate permanently their allergy symptoms, and reverse the aging process.”

    http://www.ncahf.org/articles/a-b/beepollen.html

    However, the NIH hasn’t allowed itself to be corrupted by such as Harkin. MedlinePlus tries to present unbiased information about these remedies:

    http://www.nlm.nih.gov/medlineplus/druginfo/herb_All.html

  • sinz54

    PracticalGirl: Most that I know only want to “beleive” in effectiveness and get very offended when anybody suggests real, scientific measurement of that success.
    It may surprise both fans and foes of alternative medicine that scientists HAVE gotten around to testing many of these remedies in rats, and sometimes even in clinical trials in humans.

    http://www.Pubmed.com is a great resource for all the scientific papers.

    MedlinePlus is a great resource to summarize what’s known about the most popular supplements.

    http://www.nlm.nih.gov/medlineplus/druginfo/herb_All.html

    And stay away from NCCAM: That’s Tom Harkin’s baby, and I fear they know which side their bread is buttered on.

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