Not being a TV watcher, I’d never actually seen PBS Frontline until I received some emails from patients and medical colleagues asking for my reaction to what sounded like a Fox News rant against the nutritional supplement industry. Since it’s my belief that such exposé-type shows exist mainly to enhance ratings, I wasn’t enthusiastic. If it were as dismal as I expected, it would be an hour of my life irretrievably lost.
It was Fox News disguised as Frontline, and yes, the hour is gone forever.
I’ll organize the program into its components and give my take on each:
Tainted supplements The first segment interviews the owners of a tiny supplement company that inadvertently mixed into a supplement blend what was discovered to be a tainted product from China. Although they recalled it as soon as possible, allegedly several consumers became ill. I say “allegedly” because there was a little inconsistency in the reported symptoms, which included hair loss, liver failure, skin rashes, and breasts developing in men. You did get the electric thrill of watching an outraged personal injury lawyer salivating over the financial possibilities of his lawsuit while the extent of the actual injuries remained hearsay. Unfortunately, the Frontline takeaway seemed to be that you face a risk of exposure to tainted product from all supplements and that you’re safest when you place yourself in the hands of your doctor and limit yourself to prescription drugs.
In actual fact, manufacturers of both generic pharmaceuticals and supplements purchase ingredients from chemical manufacturers worldwide. India has more than 400 such companies and China more than 500, producing the drugs and supplements you take every day. Anything might show up on our shores: capsules, tablets, or bulk containers with powders and liquids destined for encapsulation before being packaged into the bottle you see on your pharmacy or health food store shelf.
If you’re puzzled about why your generic drug comes from Hyderabad, India, as opposed to say, Naperville, Illinois, think Economics 101. Multinational companies–whether producing a Toyota or a Topamax, a Samsung or a statin–hunt out the cheapest labor force they can find. If you think the pharmaceutical industry is exempt from product recall, think again. Ranbaxy Labs (India) has had FDA citations for impurities. Click here for a list of generics they produce (you’ve probably taken one). And here’s an article from The People’s Pharmacy about the FDA’s reluctance to make the public aware the problem.
Only brand-name pharmaceuticals are the best in terms of reliability and product purity. They’re also egregiously expensive and generally not covered by insurance.
Labeling inaccuracies Frontline was outraged that they found evidence showing what a supplement said on a label did not match the capsule content itself. Herbal products didn’t contain the herb as listed. There was too much or too little of a vitamin.
Yes, this is a bad thing. But this is also old news and the problem exists with generic drugs as well. What’s supposed to happen is that manufacturers of both supplements and generic drugs are to certify they’re abiding by an honor code of good manufacturing standards. You may not know this, but no clinical testing–that is, checking for a drug’s effectiveness–is required of generic drugs. They simply sign a form promising their product is completely identical to the branded version.
Although Frontline implies the pharmaceutical industry is squeaky clean when compared to the unregulated supplement industry, anyone (physician or patient) involved with generic drugs will tell you there’s broad variability in quality. One brand of generic Ambien (zolpidem) will put you to sleep, another brand will do absolutely nothing. The generic version of Lexapro (escitalopram) usually requires a 50% dose increase to provide the same degree of effectiveness as the branded version.
Several months ago, I wrote about the attorney general of New York pulling a variety of supplements (mainly herbs) from the shelves of Walmart and GNC because the labeling didn’t match an analysis of the capsule contents. My advice in that Health Tip was this: when it comes to paint, tires, or nutritional supplements, you get what you pay for.
The superstars of the supplement industry operate manufacturing facilities that are indistinguishable from the best of Big Pharma. These companies sell products, labeled “pharmaceutical grade,” mainly to physicians, meticulously testing bulk product as it arrives from suppliers before encapsulating it or molding it into tablets. Their products are more expensive because they purchase the highest-grade product available and test it before you swallow it.
Regulation As for being unregulated, in fact once generic drug and nutritional supplement manufacturers provide the certifying documents of good manufacturing standards, they are subjected to FDA scrutiny. The manufacturers provide documentation when they’re about to introduce a product. If the FDA sees nothing amiss in their paperwork, they’re given a thumbs-up.
Once the new product is out, the manufacturer can be visited by the FDA if there are complaints or there may be spot checks like random IRS tax audits. However, there are thousands of companies around the world and the FDA can’t inspect them all, although especially in response to complaints by physicians or consumers the FDA will check the strength and purity of generic drugs and supplements. It was in response to one such complaint that the tainted product described earlier was found.
If something’s not right, the FDA issues cease and desist orders. In the case reported earlier, Frontline accused the FDA of not acting quickly enough. Considering the vast number of products and foods it investigates (it was the FDA that handled the Chipotle mess), I thought they did a reasonably good job. The moment the owners received word of a possible problem with their product, they concealed nothing and promptly recalled it.
Unsubstantiated claims Frontline suggested there are unsubstantiated health claims made by supplement manufacturers and if such claims are made, they should be subjected to the same scrutiny as new prescription drugs. In fact, there are only very vague statements on product labels. You’ll never see “Helps Depression” on a bottle of St. John’s wort but rather “supports mood.” In addition, there will always be wording that releases the FDA from actually recommending the supplement.
What Frontline is asking of the supplement industry is actual clinical testing of each supplement. This means placebo-controlled clinical trials, which cost millions. Big Pharma will spend money like this only on products that can be patented and sold exclusively by them. Since herbs and supplements cannot be patented (hence their reasonable prices when compared to branded prescription drugs), no one will spend the money on clinical trials.
Parenthetically, you must know by now that clinical trials are not all they’re cracked up to be. The physicians conducting these trials are vastly overpaid and have been known to conceal data from the FDA if a drug isn’t working as well as it was hoped. They’ll sweep side effects under the rug. Volunteers in clinical trials receive a paycheck for their work and are skilled at telling the physicians what they want to hear so they’ll be rehired for the next clinical trial.
But the real issue of asking supplement manufacturers to produce clinical trials is this: how much proof for an herb or supplement is needed when there are already dozens of published studies from around the world? If, for example, the British Medical Journal reports that St. John’s wort is as effective as Zoloft for mild depression, do we really want or need another study on St. John’s wort, this time funded by the makers of Zoloft?
Conclusions
My suggestion is that you not let Frontline do your thinking for you. If you’re concerned about a particular supplement or manufacturing company, investigate it yourself. Let’s say you’re wondering whether or not to start the popular supplement Resveratrol, reportedly effective in preventing age-related dementia and even cancer. Don’t just accept the hype. Type into your Google bar “resveratrol effective for” or “resveratrol clinical studies” and make your own decision.
And since tainted anything–from supplements to generics to Chipotle burritos–is certainly a cause for concern, stick with quality. When it comes to supplements, buy fewer but buy the best you can afford. Don’t go bargain hunting (would you choose to be operated on by the cheapest surgeon you could find?).
Choose from among the top brands. These include Metagenics, Integrative Therapeutics, Pure Encapsulations, Emerson Ecologics, Allergy Research, Xymogen, Ortho Molecular, Eclectic, Douglas Labs, Thorne, and Designs for Health.
Be well,
David Edelberg, MD
I have worked for many years with my dreams. Recently, a voice came to me saying the “pharmaceutical companies are committing crimes against humanity” Sounds like Nazi Germany and is so true. They should be shut down and closely overseen.
William Risley, D.C.
Dr. David,
You certainly cut through the clutter of nutritional supplements, so thank you. Another great resource is: The NutriSearch Comparative Guide to Nutritional Supplements™† independently reviews and compares 1,500 nutritional products and features product ratings.
A 5-Star Gold Medal rating is the highest rating a product can receive.
Each product is given a starred rating based upon a model developed by NutriSeach known as the Blended Standard, which. is based on a compilation of recommended daily nutrients from 12 independent nutritional authorities.
Within the Blended Standard, there are 47 nutrient categories, consisting of 19 vitamins or vitamin-like factors, 15 minerals, a number of antioxidant and bioflavonoid complexes, and more.
The recommendations for daily intake in the Blended Standard are the appropriate levels healthy adults should take for 18 different health support criteria, including, but not limited to, completeness, potency, and mineral forms.
Products awarded 5 stars represent products possessing health support characteristics that are clearly superior to the majority of the products on the market.
All 5-star rated products are invited to submit proof of manufacturing quality and product content in the form of certification from independent certifying authorities. Those who provide such standards qualify for the NutriSearch Medals of Achievement Program.
USANA Quality Guaranteed and Verified.
USANA guarantees the quality and potency of our products. Our promise to you is a guarantee that what is on the label is what’s in the bottle, and it has been made to the highest quality standards.
A highly respected independent certification organization, NSF International, has registered USANA for meeting Good Manufacturing Practices for dietary supplements as well as certified a number of our supplements.
A leading provider of independent testing to verify the contents of dietary supplements, ConsumerLab.com has certified many USANA products.
Founded by immunologist and microbiologist Myron Wentz, Ph.D., recipient of the Albert Einstein Award for Outstanding Achievement in the Life Sciences
USANA’s Salt Lake City, Utah, facility is certified by NSF International and became a registered United States FDA Drug Establishment in 2011
60+ in-house scientists conduct research and collaborate with institutions like The Orthopedic Specialty Hospital
Official Health Supplement Supplier of the Women’s Tennis Association
Official Health Supplement Supplier of the United States Ski and Snowboard Association
More than 700 elite athletes trust USANA, including almost 200 2014 Winter Games Olympians
Love life & Live it
Kathy
Kathy Dmura
Hi Elizabeth
Both the companies you mention are excellent and are known for quality products
Dr E
Dr E
Thank you so much for your reply to my questions. I am glad to hear that the companies I am using are considered good quality.
Elisabeth Swisher
do you know anything about this company called “Stop Aging now”?
Elisabeth Swisher
Thanks for this insight. For the recommendation of supplement companies I would think “True Botanica” would be worth it too.
Elisabeth Swisher
Thank you for good article ,did mess with my mind
Because I must take a generic for my RA
I’m not worse or experience any horrible side effects. You have given me information that will make me
Aware of any change in my RA.
No generic drugs years and years ago .Greed has no limits !God bless Dr.E for protecting us.
Kathleen A- pepsnik good
No question that the Frontline piece on supplements was a hatchet job. Not sure, however, why you would assume initially that it was a Fox News hatchet job. PBS and the other networks are just as biased as Fox News, just in different directions on different issues.
Rick Farmer
Thank you. This is a relief. I can’t tell you how that Frontline interview messed with my thoughts. It was very upsetting. I knew I couldn’t trust what I was hearing…because I am well aware that there are many prescription drugs that are anything BUT safe.
joann
Another fantastic article with practical and meaningful tips for us to follow. Thank you, Dr E!
Shalini Mendelsohn
Thank you, Dr. Edelberg,
When I saw the e-mail notification from Frontline (yes, I subscribe) on that topic, I cringed. Even though Frontline does a superlative job on many topics, I knew this wasn’t to be one of them.
Thanks for suffering through it for us, and countering it here.
Gina Pera
What about Consumer Labs? I rely on them for the supplements I purchase.
Janis Wrich
I watched this episode as well and was surprised by the departure from their typically more balanced reporting. I think you summed it up well as far as the take away from this: Do your own research and “When it comes to supplements, buy fewer but buy the best you can afford.”
Ron Benninga
Hi Kathy
It is very difficult to get a straight answer from the companies but from conversations of people in the pharmaceutical industry, I am told branded meds are made in the US, Canada, the UK and Europe
Generics, on the other hand, are made wherever it’s cheapest at the time
Dr E
Sadly, along with our politicians and most mainstream media, PBS and Frontline seem to be mouthpieces for pharma. They are funded by organizations with roots in pharma. I no longer expect unbiased reporting from PBS and Frontline as I once did.
Madworld
Thanks for speaking about this. There are burgeoning resources that are doing independent analysis of supplements that are worthy of attention:
John Smith
I spent thirty years as a broadcast journalist and handled a number of significant investigations. I’ve respected much of the work Frontline has done. I’m disappointed the producers of this piece took such a biased view of the supplement industry. Yes, consumers need to be warned that not all products are worthwhile and that, indeed, many may not be safe. I expected that. What I didn’t see coming was the lack of balanced reporting. As you note, where were the interviews with the companies that represent the best of the business?
I’ve always regarded investigative journalism as a sort of surgery. In this case, the producers went after the disease with a hatchet instead of a scalpel…and it’s pretty obvious how the “patient” fared.
Doug Cummings
Are you saying brand name pharmaceuticals don’t contain ingredients from China and India?
kathy christensen