NATURAL CAUSES

Death, Lies, and Politics in America's Vitamin and Herbal Supplement Industry

The Good An angry expose of the $21 billion supplements industry.The Bad The book's irate tone, however justified, grows tiresome.The Bottom Line A well-written and well-reported account.

It's easy to hate the pharmaceutical industry. Prescription drugs are expensive, sometimes dangerous, and often overhyped. So why not turn to so-called natural remedies, the kinds of herbs and minerals that have been used for thousands of years by indigenous peoples?

That's what Sue Gilliatt, a 49-year-old nurse in Indianapolis, figured when she decided to treat a benign tumor on her nose with a product made by a Bahamas company, Alpha Omega Labs. On its Web site, Alpha Omega blasts the "Cancer Industry" for preventing "safe, inexpensive, and often more effective treatments from reaching the mainstream." That sentiment resonates with the demographic most likely to buy alternative medicine: college-educated people between the ages of 36 and 49 who have annual incomes over $50,000.

So Gilliatt called Alpha Omega and bought a salve called Cansema, priced at $49.95 a jar. She added in a paste based on the herb bloodroot. After two weeks of a burning sensation and oozing pus—all signs, according to Alpha Omega, that the ointment was working—she removed the bandage, looked in the mirror, and discovered that her nose was, well, gone. "I was had by con men," she now admits.

Gilliatt's horrifying story opens Natural Causes: Death, Lies, and Politics in America's Vitamin and Herbal Supplement Industry, an angry and detailed exposé of the largely unregulated field. Medical writer Dan Hurley has gathered considerable data on the steady flow of deaths, disfigurements, and injuries linked to this $21 billion-a-year business. More than 60% of Americans use herbal and dietary supplements, yet the Food & Drug Administration (FDA) has virtually no authority over these so-called safe and natural wares.

The book is a sometimes strident wake-up call. After all, how many people do you know who take vitamin C and echinacea to prevent colds, melatonin for insomnia, or St. John's wort for depression? Reputable study after study has failed to show that these are effective.

Questionable supplements have a long history in America. In 1630, a Massachusetts merchant was fined for selling a would-be scurvy cure that was merely water. And in the late 1800s there really were snake-oil salesmen, led by Clark Stanley, the self-described "Rattlesnake King." Stanley made a fortune selling his pain liniment, reputedly made from oil extracted from snakes, until 1915, when the U.S. government shut him down for making false claims (and no, there was no snake oil in the product).

Stanley would have an easier time of it today. In 1976, Congress barred the FDA from regulating the contents of vitamin and mineral supplements, saying they were natural products and should be treated like food, not drugs. The FDA was further defanged by the Dietary Supplement Health & Education Act (DSHEA) of 1991. The FDA had been trying to gain more control over supplements in the wake of the L-tryptophan scandal of the late 1980s, when hundreds suffered life-threatening illnesses after taking the supplement for insomnia. But the herbal industry fought back, spending millions on lobbyists and campaign contributions.

Then-FDA Commissioner David A. Kessler testified that supplements should be treated much the same as drugs. But his rational arguments carried little weight with senators. The supplements industry ended up with the right to make all kinds of claims about their products without proof, and sales took off. The only supplements with unqualified support are calcium and vitamin D for women at risk of osteoporosis, folate for pregnant women, and fish oil, containing omega-3 fatty acids, for lowering cholesterol and blood pressure. Multivitamins, taken by more than half of all adult Americans, have been largely dismissed by the National Institutes of Health.

Hurley offers a thorough, well-written account of the fallout from the DSHEA. He describes case after case, from ephedra, the weight-loss product that contributed to the death of Baltimore Orioles pitcher Steve Bechler, to teenagers dying from supplements meant to get them high "naturally." But his irate tone, however justified, gets wearing. And while properly attacking hucksters' claims, he lets another key player pretty much off the hook.

That would be us, the customers. Only at the very end of his book does Hurley point out that "in an age of post-modern cynicism toward experts, doctors, politicians, and reporters of every stripe, we have made a special exception for the claims of supplement manufacturers—precisely because they prey upon our skepticism toward all other sources." In other words, we're still buying that snake oil.