Dietary Supplements: Is the Fox Guarding the Hen House?
Alvin B. Lin, MD, FAAFP
Dr. Lin is an associate professor of family and community medicine at University of Nevada School of Medicine and an adjunct professor of family medicine and geriatrics at Touro University Nevada College of Medicine. He also serves as an advisory medical director for Infinity Hospice Care and as medical director of Lions HealthFirst Foundation. Dr. Lin maintains a small private practice in Las Vegas, NV. The posts represent the views of Dr. Lin, and in no way are to be construed as representative of the above listed organizations. Dr. Lin blogs about current medical literature and news at http://alvinblin.blogspot.com/.
Last summer, I wrote a series of posts on the topic of dietary supplements. Given the news about NASCAR driver and Olympic athlete expulsions over failed doping tests, I thought it'd be apropos to briefly review the dietary supplement industry once more, given that we're all seeking that little extra edge over our competitors. In fact, despite (or probably because of) the Food & Drug Administration's recent approval of two prescriptions for weight loss, Belviq followed by Qsymia, its first in well over a decade, the American public is searching (and paying) for a quicker promise to greater weight loss at less cost without any side effects. The only problem? No such thing exists!
Let me be more explicit: no medication, prescription or over-the-counter, and no dietary supplement, no matter how 100% natural, pure, organic, herbal, etc, nothing is side-effect free. There is no free lunch! You have to be willing to take some risk. Which is why I only recommend something, whether it be a diagnostic test, procedure or medication, which will make a difference such that the potential for benefit is greater than the potential for side effect(s). I find myself sounding more and more legalistic when I say this but there's no other way around it. Don't take (or do) something unless you know how you're supposed to benefit from it and what you (might) risk or lose instead.
But here is what separates the $62 billion-per-year US dietary supplement industry from the $289 billion-per-year pharmaceutical industry: the latter is required by federal law to prove that their product is safe and works as intended prior to marketing it. Granted, errors occur, we uncover new issues as more people take a medication, and sometimes leadership loses its way. But the supplement manufacturer is not required by federal law to prove safety nor efficacy prior to making nothing short of miraculous claims in order to separate you from your hard earned dollars. All they need to do is hide behind the ubiquitous disclaimer: "This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease."
Here's something else that separates most of the blindly trusted dietary supplement industry from the much maligned pharmaceutical industry: research. What I mean by that is peer-reviewed, published data. Not necessarily self-funded & self-funded, although that does occur in the latter, too. But at least we've become more aware of this bias and attempted to decrease the influence of the pharmaceutical industry on what is published. On the other hand, there is scant research, if any, to suggest that supplements actually work as promised and marketed.
Finally, if you've followed me this far, there's one more difference between David & Goliath: quality control. Dietary supplement contamination remains a major issue of manufacturing practices more akin to Whac-A-Mole for the FDA to wrap its legal arms around. This typically comes out after the fact whereas the pharmaceutical industry often pulls bottles prior to reaching the store shelf. In that vein, I'd like to point your attention to a recent article in the Chicago Tribune that highlights some of the issues in manufacturing of dietary supplements.
Now don't get me wrong. Just as there are less than ideal pharmaceutical companies, there are also dietary supplement manufacturers that belong on a pedestal for setting a very high bar for everyone else in the industry. But when you look at the two industries as a whole, caveat emptor is the key phrase to remember when buying supplements based on sexy ads. After all, you never know when your company or recreational sports league might start requiring random drug testing. Wouldn't it be a shame to fail without knowing where you goofed?