Regulating the Supplements Industry

A  Mother Jones article some months ago explored an increasingly pertinent topic: the regulation of supplements and complementary drugs that have largely been devoid of oversight. This is an important issue given the rapid growth of the industry, which is estimated to be worth around $20 billion as of last year (the data seem to vary by source, but that’s the most common figure I’ve found).

It all begins with St. John’s Wort, an herbal remedy that’s been shown to treat mild and moderate depression to some extent, but is otherwise not a viable cure for such things, as is often believed or advertized. By the far most popular supplement on the market, Americans spend around $55 million on it annually, purchasing it mostly from large retailers likes GNC, Whole Foods, and the Vitamin Shoppe.

But SJW has been found to produce adverse affects with other medications, including antidepressants. While these kinds of drugs are legally required to undergo clinical trials, regulatory approval, and labeling, supplements are exempted:

The real problem here lies in transparency to consumers—a problem that goes directly back to the supplement’s manufacturers. In a 2008 study published in BMC Complementary and Alternative Medicine that tested 74 different SJW brands, less than a quarter of the product labels identified possible interactions with antidepressants. Even more disturbing was that only 8 percent identified possible interactions with birth control.

Many groups, like the Center for Science in the Public Interest, have tried to push the FDA to standardize SJW labels to properly reflect possible dangers. But since supplement makers are not required by law to warn consumers about health risks associated with their products, it hasn’t been easy. “These companies fight warning labels like the dickens, and whether they intend it or not, that affirms the belief that natural products are unequivocally good for you,” says Stephen Gardner, litigation director at CSPI.

It’s a common fallacy among many people that what is natural is therefore better and, conversely, what is synthetic is undesirable. This ignores the fact that nature is full of toxic things, while some artificial medicines – which are often derivative of organic substances – are demonstrably safe and effective (compare the prevalence of disease nowadays to what it was decades ago – both the variety of illnesses and their severity have gone done markedly).

Proposed cures and treatments, regardless of their origin, should be judged in a case-by-case basis. Their merit derives from their ethics, safety, and efficacy, not whether or not they’re traditional, natural, or made in a laboratory. Such origins are irrelevant as to their effectiveness, which is why we have experiments, clinical trials, and peer review.

So why don’t federal regulators force the supplement industry to include warning labels on their products? One big reason is that the industry has powerful allies in Washington. The current murky regulatory force in the supplement world is the Dietary Supplement Health and Education Act (DSHEA), which lets supplements fly to the shelves without first having to demonstrate either safety or effectiveness to the FDA. Unlike prescription meds, the burden of proof for supplements resides with the federal government: The FDA has to prove that products are unsafeafter the fact, rather than manufacturers having to prove that they are safe for use in the first place. (Think back to weight-loss supplementephedra, which took the FDA more than seven years to ban—despite being conclusively tied to heart attack, stroke, and death.)

Many have taken issue with the DSHEA, and in February 2010 Sen. John McCain (R-Ariz.) introduced a bill that would increase regulation of dietary supplements that might pose health risks. Enter Sen. Orrin Hatch (R-Utah), who has received upwards of $888,000 in campaign contributions from the health product industry since 2002. Hatch, one of the lead authors of the 1994 DSHEA, has even stronger ties than that—both his son and five former aides are lobbyists in Washington representing the very industry funneling him all that campaign cash. It shouldn’t come as too much of a surprise then that shortly after McCain’s bill proposal, Hatch met with the Arizona senator for some “real talk” on supplement regulation. In a letter released after their private meeting, Hatch thanked McCain for withdrawing his support for parts of the bill that “would do great harm to the dietary supplement industry.” A castrated version of the bill eventually made it through, and the supplement industry came out unscathed.

There’s no doubt that the pharmaceutical and medical lobbies can be just as conniving as any other special-interest group. Drug makers and doctors are just as liable to be mistaken or immoral as anyone else. The profit motive erodes efforts to find certain cures or manufacture certain drugs. The system clearly has its problems.

However, we’re only kidding ourselves if we think alternative medicine proponents are any more incorruptible and honest. There’s no doubt that many of them are sincere and well-meaning, and that they have some understandable qualms about the modern healthcare industry (as do a lot of doctors).

But humans are keen to exploit any money-making trend that they can, and the supplement industry is no exception: it has the same selfish and dishonest reasons to peddle it’s own cures as big pharma does, given how many people are uncritically shelling out billions for its wares.

Last year, Sen. Dick Durbin (D-Ill) introduced a new bill requiring that supplements that could cause health problems or interact with other drugs—like St. John’s wort—display mandatory warning labels on their products. The bill has not yet been up for a vote, but the industry has already riled up huge opposition—headed, you guessed it, by Hatch himself. The main argument, it seems, is going to hinge on the necessity of labeling products derived from natural sources.

“Supplements are largely based on food and widely considered to be safe, so they don’t need to be labeled,” says Mike Greene, vice president of government affairs at the Council for Responsible Nutrition, the industry’s largest trade group. “For example, you don’t see anyone labeling grapefruit, even though it interacts with Lipitor.”

Whether or not the Durbin bill will make it through the Senate remains to be seen. In the meantime, though, Gardner takes issue with Greene’s argument. “You don’t see people selling grapefruits as cancer cures,” he says. “Look, we’re not interested in stopping people from buying SJW if they know what they’re getting. But we are interested in stopping them if they’re in the dark about it. These companies have prevented people from knowing when they should question them. That’s not logic and that’s not fair.”

So what do you guys think – should government regulate this industry, and does it even have an obligation to in the first place? Or is this best left up to consumers to figure out for themselves?

Sensible Policies and Reasonable Priorities

Unsurprisingly, big companies are abusing the public’s concern about the economy for their own interests. Every time a new regulation of some sort is proposed, there are always cries from business lobbies – and their colluding political allies – that it will “kill jobs” and “weaken growth.” Business health is important, sure, but so is reigning down on abuses in finance, ensuring public health, protecting the environment and water supply, and maintaining worker safety.

Obviously, there are good regulations and bad ones, and we need to discern between the two.  Any regulatory regime or legislation dealing with the private sector must be crafted cleverly and cautiously, balancing the interests of business with that of the public as a whole. We can’t overdue it either, given that freedom breeds innovation. But there’s more to the well-being and health of a society than happily profiting corporations, and it’s absurd that we can’t even propose these things without either visceral demonizing or vacuous claims of malfeasance.

Besides, what’s good for business isn’t always good for the average American. Many companies have been making record profits throughout this recession, but this hasn’t translated into more jobs and higher wages (indeed, average wages have only grown 2% since the economy first faltered, versus the growth of executive salaries by 24%).   Reports have found that most industries don’t even contribute to domestic job growth or economic well-being: only healthcare, government, retail, and hospitality have contributed anything meaningful with respect to jobs; even then, most jobs in the last two are low-paying, while the public sector is scaling back positions. 

The fact is, our understandable concern about jobs and economic health is presenting a major long-term risk: that we’ll do anything and everything in the name of raw economic prosperity, at the cost of neglecting the many other crucial elements that make up a successful and progressive society. Do we really want to scale back on protections against pollution, water-contamination, and environmental degradation? Do we really believe that canceling the billions of dollars of taxpayer money that go into key corporations will lead to economic ruin, especially when that money could be more beneficially spent on things like job training centers?

Any and all regulations cost something. Business will always take some sort of hit no matter how well-designed a policy or oversight regime is. But we must apply a cost-benefit analysis: at what cost to society will we help the interests of businesses who’s success rarely benefit ourselves? How much are we willing to give up in order to “grow jobs” and “strengthen the economy,” even if neither is guaranteed to happen (indeed, taxes in the US are among the lowest in the world, and in our own history, and that hasn’t satisfied the cost-cutting instincts of modern day companies; heck, the markedly business friendly period under George W. Bush -2001 to 2007 – had some of the lowest job creation since World War II).

Ultimately, we need to stop framing policies in such zero-sum terms. Let’s be honest and admit that most laws and regulations will have some costs but some benefits too; some folks will benefit more than others, or even not at all. But let’s determine the best way to meet at the middle, and look at the bigger picture. Financial regulations might restrict corporate profits, but they might also restrict the next recession too (Canada, New Zealand, and Germany had some tight rules, but they also got away relatively unscathed by the recent global financial crisis).

Sure, environmental regulations can be a pain to abide by, but if it keeps the air and water clean, you make the area a far more attractive place for people to move to and live in; you might even create a whole new industry of eco-tourism (in fact, my state of Florida was historically bi-partisan when it came to being pro-environmental, largely because we realized how crucial our ecosystems were to attracting visitors and thus industries).

The countries that top lists relating to standard of living, economic growth, and high employment – such as the Scandinavian nations, Germany, Canada, and Australia  – are those that have found the proper balance between sensible policies and regulations. Public and private sector come together to devise policies that serve both their respective interests while giving some ground; business and labor leaders work to keep employers profitable without making employees miserable (and the other way around); rigorous means-testing, experimentation, and pragmatic open-mindedness facilitate the introduction of effective policies, as well as ensure their efficiency. None of this yields perfection of course, but it’d certainly help to address what we’re contending with: low job growth, crumbling infrastructure, stagnant public education, and widening income disparity.

But as long as our political and social cultures continue to breed conflict and confrontation: – between workers and bosses, public and private sector, business and government, rich and poor – we’ll never be able to set aside ideological and factional biases and try to hammer out what actually works. Desperation and crisis should breed cooperation and a willingness to do what it takes to address our mutual concerns – but lately, the opposite seems to be happening, and the long-term costs will just get higher and higher.