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Yvonne Abraham

Dietary supplements, largely unregulated, deserve the state’s skepticism

Welcome to the Wild West of your local pharmacy, otherwise known as the dietary supplements aisle

In the supplement aisle, shiny, expensive boxes of pills and powders promise to slim your gut, improve your sexual performance and much more. But the industry is almost totally unregulated, and a Massachusetts lawmaker is hoping to change that.
In the supplement aisle, shiny, expensive boxes of pills and powders promise to slim your gut, improve your sexual performance and much more. But the industry is almost totally unregulated, and a Massachusetts lawmaker is hoping to change that.The New York Times

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Welcome to the Wild West section of your local pharmacy, otherwise known as the dietary supplements aisle — a place so dangerous, and so unregulated, that it would try the most dedicated libertarian.

There, shelves are jammed with shiny, expensive boxes of pills and powders, their word-salad labels promising to shrink bellies, improve concentration, build muscle, and improve sexual prowess.

Americans embrace those spurious claims to the tune of some $50 billion a year. Who knows what’s really in those boxes? Hardly anybody on the planet. The manufacturers literally do not have to tell us.

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“If a company says its product is safe, the Food and Drug Administration has to take their word for it, unless somebody ends up in the hospital or dies,” said Pieter Cohen, a doctor at Cambridge Health Alliance who is an expert on dietary supplements.

At best, these products are a waste of money, Cohen says. At worst — well, the worst can be very bad, indeed. Weight loss, energy, and other supplements send tens of thousands of people to emergency rooms each year, according to a CDC study. Some have led to liver failure and death.

This week, I took a spin with Cohen through a couple of stores to see what was on offer.

“See here?” he said, turning over a black box and peering at the tiny print. “Yohimbine. This shows up in a lot of male enhancement products.”

It’s a bark extract believed to be an aphrodisiac. It’s also been linked to high blood pressure, panic attacks, headaches, and, at high doses, heart failure and death. High concentrations of caffeine, which is packed into every other product on these shelves, are similarly dangerous.

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The stuff on some of these labels is troubling enough, but what they leave out worries Cohen just as much: Companies can hide ingredients by calling their blends proprietary. There’s no way of knowing if a product is naturally derived, or even if it’s laced with some amphetamine-like substance manufactured in a country with even worse oversight than ours. Nor do they have to back up their spurious health claims with reputable science.

We’re on our own, thanks in large part to former senator Orrin Hatch who represented Utah, where a big share of the dietary supplement industry has made its home (and contributed generously to his campaigns). In 1994, Hatch shepherded through legislation effectively excluding those supplements from FDA oversight. Under his rules, the federal government must rely on supplement companies’ own claims of safety and efficacy. The FDA can’t demand testing before a diet pill hits the shelves, or stop companies from making bogus health claims. Essentially, the legislation prevents the government from protecting us until people start falling ill. And even then, toothless federal authorities have moved glacially.

It’s bad enough that adults take their chances on this snake oil. But we currently allow kids to buy these products, too. That’s right: Your 13-year-old can go into Walgreens or CVS, plonk down 30 or 40 bucks, and walk out with a box of “Sexual Peak Performance” or an “ultimate super fat-burning belly bulge kit.”

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Obviously, kids are particularly susceptible to these products’ claims — especially when they’re being sold in drug stores, which lend them a veneer of cred they don’t deserve.

“We have young people growing up believing the way they appear physically is their defining feature,” said Bryn Austin, a professor at Harvard’s Chan School of Public Health who specializes in eating disorders. “That sets them up for escalating weight control methods, and for any kind of pill or potion they can find that will keep them from gaining weight.”

Can we at least agree that kids deserve the protection withheld from the rest of us?

Representative Kay Khan sure hopes so. The Newton Democrat has been working with Austin on a measure to ban sales of these dietary supplements to minors altogether. Her bill would also move the supplements to a more inaccessible location — behind a counter or in a locked case, for example.

Both measures should be no-brainers. Kahn says she is hopeful the bill will make it out of the Joint Committee on Public Health by a Feb. 5 deadline, given “the growing awareness around toxic diet culture.”

At a time when a large chunk of the federal government seems determined to dismantle itself to honor some distorted definition of liberty, the dietary supplement industry is a vivid reminder of the absolute necessity of oversight.

But Washington seems unlikely to step up any time soon. So it’s up to Massachusetts legislators to step up and do some good here.

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And more than good: They could actually save lives.

Globe columnist Yvonne Abraham can be reached at yvonne.abraham@globe.com and on Twitter @GlobeAbraham


Globe columnist Yvonne Abraham can be reached at yvonne.abraham@globe.com. Follow her on Twitter @GlobeAbraham.