Gimme the Pill! Seductions of Supplements (8/22/12)
Every Work Day
Just about every day I’m in the office patients come to me clutching a new pill bottle. Inside will be tablets or capsules purportedly containing anywhere from one to 50 or more ingredients.
What Do People Want To Know?
Will these pills work to cure their sleep problems/Crohn’s disease/heart disease/cancer/irritable bowel syndrome/memory loss/you name it illness – or will the pills succeed in “anti-aging.”
What’s Usually Inside?
Often, not what people expect. Frequently the ingredients listed – when tested in unaffiliated labs – are either absent or only in trace amounts, having disappeared somewhere in the manufacturing/distribution/retailing chain. Melatonin is one example of a pill notorious for having different biologically available amounts with every new batch.
Why Is This Stuff Legal?
The FDA has been toothless for decades regarding “health” supplements – as long as they’re not sold as foods. That’s where Lazy Cakes went too far – putting melatonin in brownies and selling it to kids finally made the FDA act. If they had just sold melatonin plus passion flower plus Chinese herbs and called it a “health supplement” they would have been legal.
Hey, we sell bath salts over-the-counter in this country – stuff that makes chemotherapeutic agents look like cherry cough drops.
Do the Pills Work?
A few actually do. There’s pretty good evidence for medications like tryptophan and melatonin demonstrating they modify sleep or biological clocks. Vitamins certainly have their uses – though recent data on middle aged Americans show the more vitamins people use, the quicker they die. Different populations certainly require different amounts of vitamins – which most can acquire through whole foods.
But the American love of a “bargain” works to the advantage of supplement manufacturers. Why settle for one vitamin when you can get 15 – plus boron and magnesium? It’s rather like the film “Supersize Me” – why settle for one burger and fries when you get a super Big Mac and Giant Fries for just 30% more!
However, most supplements are usually combinations of items that are perhaps individually effective but not been shown to work in tandem; or extracts of natural materials, like lycopene from tomatoes, that may possess little or nothing of the advantages of the whole food from which they derive.
Why Do They Claim The Stuff Works?
Because it’s easy to “prove” with “studies” that most stuff “works”. There are literally thousands of biases built into clinical trials. Controlling them – which the FDA generally requires from Big Pharma – is very expensive and time consuming. Please read David Sackett and his excellent epidemiologic group at Hamilton University to understand what clinical studies can and cannot do. Last I looked Sackett had identified around 2000 forms of volunteer bias alone – 2000 ways that the nature of people who volunteer for studies can change the outcomes of research. And that’s one factor among many.
In other words, you can get clinical “studies” to show what you like – or at least positive results – much of the time simply by tweaking study criteria. Placebos are powerful.
What Happens if the Data on Supplements are Not Positive?
Then you can lie. Large pharmaceutical companies do it frequently – and they’ve got the FDA watching them many steps of the way. Pfizer just paid $3 billion to the government for falsifying and hiding data – but made a lot more from the drugs it sold.
Most times, manufacturers don’t have to lie. They just claim nebulous health benefits and get an over-the-hill movie or TV star to extol its “incredible results!” Cue Donny Osmond.
Why Do People Like Supplements?
They’re magic. They’re “natural.” They’re a quick, “painless” fix. You don’t need a prescription. They’re “a secret doctors won’t tell you.” Often they’re cheap – at least in retail price – though not if you include the overall results. They’re sold everywhere, they’re legal, so how could they be bad?
So How Can They Be Bad?
Thousands of different ways. Sometimes the products are adulterated. They can interfere with or stop people getting treatments that actually are known to work. They can contain unknown ingredients that turn out to be toxic – a variety of ephedrine laced supplements of the last few years come to mind.
But mostly the effects of these “undrug drugs” are unknown – just plain not known. You’re shooting in the dark.
If you think of the body for what it is – an information processor – supplements are drugs that change basic body information. Sometimes they’re made up of stuff – like melatonin – that clearly have real uses.
But if you think of medications as information “words”, then combinations of different supplement elements are effectively word salad – which in humans can be a symptom of psychosis. The words “toy” “move” “flame” might eventually come together to help make a sentence, but does “toymoveflame” communicate something useful?
Now put those all those many different unknown information molecules inside your own body. Do you want to do that experiment?
What Could Be Done Instead of Supplements for “Anti-Aging”?
People could walk to lunch. Wear a fashionable hat. Eat lots of whole foods. Visit friends. Go see places they have not visited but think interesting. Make sure they rest enough. Have dinner parties. Get out in nature.
All have been shown to help people live longer and feel more whole. They’re also fun – but not as easy as taking a pill.
Why Are Supplements So Seductive?
Ultimately, because they’re magic. If your definition of magic is that we don’t know what they do, if they work or how – supplements can truly prove magical.
Especially for companies’ bottom lines.
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