Since its inception, the Food and Drug Administration has approved thousands of drugs for medical use. And for clinicians, learning the names, types and dosages of all of these drugs, as well as the new ones entering the market, can be overwhelming. But medical school training ignores another widely used type of medication: herbal supplements. These are universally available in supermarkets around the country, with millions turning to them for a variety of ailments, from cold remedies to pain relief. But a new study has shown that most are fraudulent — filled with substitute ingredients, contaminants and fillers. But more importantly, due to a lack of government regulation, many of these false remedies persist despite a lack any scientific support for their efficacy.
This month, the scientific journal BMC Medicine published a study investigating the authenticity of 44 different herbal supplements from 12 different companies. Using DNA analysis, they found that 83 percent substituted another plant species instead of the one labeled, and 33 percent had contaminants or filler plant additives. Shockingly, only two of the companies had products with correct contents as advertised. Based on these data, if anyone were to purchase an herbal supplement, there is a good chance it may be either mostly filler or even a different plant derivative entirely.
How could this happen? It originates from the way supplements are regulated in the United States. Although they are purchased for their purported health effects, they are not considered drugs; the 1994 Dietary Supplement Health and Education Act mandated that they be regulated as food products. Therefore, the FDA does not test them for safety and efficacy, and none of their health claims are ever validated. Companies that produce supplements are not allowed to advertise the treatment of any specific disease, but that does not stop them from making outrageous and vague claims such as “boosting the immune system” without any evidence or repercussions. In many ways, these companies have free reign to make whatever claims they wish.
Regardless of their contents, these supplements likely do not have much of an effect. Herbal supplements are not based in science or evidence and are instead falsely rooted in an appeal to ancient wisdom. Many plants do have true pharmacological properties, and if any effect is found, the active ingredient is purified, tested and manufactured into a reliable drug for mainstream medicine. Herbal supplements simply represent those medications left behind by scientific investigation, where the data showed no use for their application. For example, repeated studies have shown that gingko biloba does not improve memory, and that Echinacea does not treat the common cold. But the modern mythology behind these herbal supplements continues, despite clear evidence to the contrary. If any of these supplements worked, they would have been quickly folded into the standard of care utilized by mainstream medicine.
Although the effectiveness of herbal supplements may be limited, they still pose a substantial risk to individuals requiring real medical care. Many may view these herbal supplements as true alternatives to science-based medicine, which can prevent those suffering from severe disease from starting useful therapies that have been rigorously tested by scientific investigation. There is nothing more heartbreaking than witnessing a cancer patient forgo potentially lifesaving treatment for an unproven, unregulated herb. Furthermore, these herbs have chemical and pharmacological properties of their own, and there have been many reports of herbal supplements causing direct harm to patients. They have the potential to interact with other drugs, leading to catastrophic consequences, including organ transplant rejection, cardiovascular collapse and even death. These supplements, which are readily available without prescription, supervision or regulation, are neither efficacious nor safe.
Herbal supplements are the vestigial organ of the modern healthcare system. They are a relic from a time before the integration of science and medicine. But despite the lack of evidence to support their use, they persist with a pardon from true governmental oversight. They are not even internally consistent, with new data showing that most supplements either use the wrong herb or are made with filler material, an error in fundamental consumer safety. Their danger is masked by their banality, with their generic labels and ubiquitous presence in every pharmacy. Only by witnessing the limitations and risks of herbal supplements can we begin to appreciate the only trustworthy metric in medicine: science.
Sai Folmsbee is a Feinberg graduate student. He can be reached at [email protected]. If you would like to respond publicly to this column, send a letter to the editor to [email protected].
