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Food supplements can rob our wallets and make us even sicker
Iwan Darmansjah , Jakarta | Tue, 09/30/2008 10:18 AM | Opinion
A 50-year-old male patient with a body weight of 91 kg consulted me one morning with a long-standing cough which I diagnosed as bronchitis. It had been preceded by a short period by a flu, which is known as a viral infection, but all the symptoms had disappeared except the hacking, phlegm-producing cough.
Bronchitis is an irritating disease that may last for weeks or months, often hard to cure, even much more difficult than the more serious pneumonia (infection of the lung tissue). While community-acquired pneumonia is easily cured by antibiotics, bronchitis is difficult to manage and reacts best with rest and anti-asthma drugs because antibiotics don't work. This patient, however, was given -- by his doctor -- one course of unneeded antibiotics and seven food supplements, costing him Rp 1.4 million.
The free trading of these dietary supplements was initially triggered by the U.S. Food and Drug Administration's (FDA) Dietary Supplement, Health and Education Act (DSHEA) of 1994. This law makes it easy to market dietary supplements because no data on safety and efficacy are needed. This means that no basic studies or clinical trials are required.
Before long, all nations silently applied this rule in their respective countries. Many governments and professionals have questioned this controversial act and The New England Journal of Medicine has in recent years published several critical papers on the subject.
In about 2004 the European Parliament voted 26 to one to require hard data on the marketing of supplements, but that was silently abolished the next year. Prof. John S. Dowden from Australia wrote an article in the Australian Prescriber last year entitled "A century of concern about complementary medicines". From the UK are warnings about how toxic popular food supplements can be, especially when over used or large doses are taken.
In 1994 it was reported that the estimated 600 dietary supplement manufacturers in the United States produce approximately 4,000 products, with total annual sales reaching at least US$4 billion. Nowadays, that figure is estimated at over a trillion dollars and Nutrilite, the top vitamin, sells a record $3.1 billion. For Indonesia, sales of herbal medicines is only said to be Rp 1.5 trillion.
The Drug Store News (Aug. 18, 2003) reported,"Despite controversy over credibility, dietary supplement sales surge, it is the only category in the front end of a drug store that generates as much controversy as it generates sales".
The main issue is that while drugs undergo rigorous evaluation of efficacy and safety before marketing, these supplements were allowed -- up until now -- on the market without the required scrutiny. Manufacturers were only limited by how it could label the product; they could make general health claims, but could not declare the product was able to heal diseases.
But it is often difficult to differentiate between health and disease, and soon we witnessed all types of diseases, such as diabetes, cancer and tuberculosis, to be reasons for use -- of course, lacking evidence. This leaves the beholder to be attracted by its flashy advertisements. It is also contradicting current medication requirements which practice evidence-based medicine, a strategy that should be followed by the entire medical profession, including nurses, clinical laboratories and hospitals.
The use of any drug must be supported by clinical evidence of its efficacy and safety ("labeled use"). Without a double-blind controlled clinical trial one may not claim efficacy, because any lay opinion of a medicine's efficacy may in fact be riding on the powerful placebo effect. This effect may be seen in a very large percentage of users; for some diseases (such as an antibiotic for the flu) it might be 90 percent or even greater.
Many medical practitioners are also unaware that supplements are not drugs and are devoid of any evidence of clinical trials that prove efficacy -- and safety. Many supplements have adverse reactions, and combined with polypharmacy (using more drugs than is really needed) are causing interactions between molecules in the body, causing unknown and problematic body reactions -- not to be excluded -- this includes cancers. The rage of antioxidant consumption, for instance, has been said to be a trigger of cancer.
Antioxidants are good for preserving food, especially cake, but there is no positive proof (evidence) that it preserves human health needs, notably when overused. An array of different brands and shapes of bottles filled with oxygenated water is also beginning to replace the wine list in European restaurants and hotels.
Food supplements are eating up household money through useless health cravings, often aided by doctors' prescriptions. The DSHEA caters to businesses rather than to human health.
Imagine that, perhaps now, at least 20 to 30 percent of the world is using or trading supplements, further stimulated by multi-level marketing, a business that is nonfunctional and contributes nothing of lasting economic value.
It is created by today's style of business -- short-term gains by such events such as holiday sales and discounted prices for things we really don't need or use. We may, perhaps, have the largest number of malls (relatively speaking) in greater Jakarta, but yet the city is still building more.
Economically the entire nation may suffer from a backlash of real growth, and may therefore lack innovation to make a positive change. Malls are also providing the place to spend that kind of money; they even have become the playgrounds of children and adults, causing transmission of airborne diseases.
As the name suggests, DSHEA stipulates that the Act includes education of the public. This would fall on the shoulders of the U.S. FDA, and indeed a large budget accompanies this activity. Informative leaflets are to be inserted in each packet and the internet and other media contributes ample warnings and caveats on supplements.
In developing countries, however, no impartial information is provided by governments, while deceptive advertisements in all media forms are widespread. While some supplements are producing beneficial results in selected users, very often devious marketing tactics are attracting sick people who then do not use the available efficacious drugs, overthrowing entire therapeutic systems.
The serious question to be asked is whether this phenomenon, together with all the other unethical marketing scams in the world, may lead to an aftermath following the global housing and credit crunch that may be greater than anything imagined, affecting the 6 billion have-nots on our planet.
The writer is a Clinical Pharmacologist.
