A really bad week for the supplements industry

If the ingredients in your pills don’t really work, does it matter if they’re correct?

Well, yes. Even if that echinacea pill doesn’t cure the common cold, if a supplement manufacturer sells you an echinacea pill, they have to put echinacea in it. 

Supplement makers can and do make all kinds of claims about the health benefits of the stuff they’re selling you. They claim that supplements can "boost your immune system," relieve aches and pains, improve memory, and promote "wellness," whatever the heck that means. Most this is nonsense, but thanks to the manufacturers’ special friend in the U.S. Senate, Senator Orrin Hatch, the federal government has almost no power to regulate these claims. Over the years, the supplement companies have been very generous to Senator Hatch, and he has returned the favor by defending them (though of course he denies any quid pro quo).

Even supplement makers have limits: they can’t sell you ground-up house plants, or rice powder, claiming that it’s St. Johns Wort. But as New York attorney general Eric Schneiderman revealed last week, that’s exactly what some of them have been doing. Amazingly, 79% of the supplements tested did not contain the primary ingredient listed on the label. Many of them contained other plant material, including plants that might cause an allergic reaction in unsuspecting customers.

You see, as cheap as most supplements are (compared to real medicine, that is), rice powder is even cheaper.

Attorney General Schneiderman sent letters to four of the largest retailers of supplements in the country: Walmart, Walgreens, GNC, and Target, demanding them to immediately stop selling supplements that were falsely labelled, including echinacea, ginseng, St. John’s Wort, gingko biloba, and others.

What did Schneiderman's office do? Well, they conducted a scientific study, using DNA sequencing to test the ingredients in six types of herbal supplements, looking at different brands from multiple stores. They tested each sample 5 times to ensure accuracy. They collected 78 different samples and ran 390 tests in all.

Here's what they found:

• GNC "Herbal Plus" supplements: gingko biloba, St. John's wort, ginseng, garlic, echinacea, and saw palmetto were tested. Garlic was the only one that consistently contained what the label indicated. One out of four bottles of saw palmetto tested positive, and none of the other four supplements contained the labeled herb. Overall, 22% of the DNA tests identified the labeled ingredient. Contaminants included rice, alfalfa, and houseplant DNA.
• Target's "Up & Up" supplements: gingko biloba, St. John's wort, Valerian root, garlic, echinacea, and saw palmetto were tested. Three supplements–garlic, saw palmetto, and echinacea–contained what they were supposed to. The other three had no DNA at all from the labeled ingredient. 
• Walgreens "Finest Nutrition" supplements: gingko biloba, St. John's wort, ginseng, garlic, echinacea, and saw palmetto were tested. Only one of these, saw palmetto, consistently contained its labeled ingredient. One sample of garlic actually contained garlic, and none of the other samples contained any DNA from the labeled ingredient. Overally, 18% of the DNA tests found the expected ingredients. Contaminants included rice, wheat, daisy, and houseplant DNA.
• Walmart's "Spring Valley" supplements: gingko biloba, St. John's wort, ginseng, garlic, echinacea, saw palmetto were tested. Walmart had the worst results: of 90 DNA tests on 18 bottles, only 4% found any DNA from the labeled ingredient. Only one bottle of garlic and one bottle of saw palmetto contained what they were supposed to. Contaminants included pine, grass, citrus, and cassava.

This is pretty stunning, and it's only a sample; see the AG's letters to each retailer for more details. According to the New York Times, the retailers agreed to pull the supplements off their shelves (in New York, at least) after receiving the AG's letter.

Just a couple of years ago, Senator Orrin Hatch successfully fought off an amendment that would have required supplement makers to register their products with the FDA and provide details about their ingredients. As the NY Times also reported, Hatch has received hundreds of thousands of dollars from the supplements industry over the years.

Of course, even if these bottles did contain what they were supposed to, their claims to improve memory, boost your immune system, and fight off colds are entirely unproven. Thanks to a 1994 law championed by Senator Hatch, the FDA cannot require supplement makers to prove that any of their products work, as long as they avoid specific claims to cure a specific disease. 

But if they say they're selling you gingko biloba or St. John's wort, they're supposed to put that in the pills. Instead, it seems they are selling ground-up rice and house plants.

One supplement did actually contain what it’s supposed to: garlic pills. Garlic has been investigated for its effect on cholesterol levels, where it seems to have at most a very small benefit. Garlic lovers would argue that you're losing the real benefit if you take it in pills rather than simply eating it.

And garlic does have one unique benefit: it is 100% effective at warding off vampires.

Anti-vaxxers are to blame for a new epidemic of measles in the U.S.

Measles is now spreading outward from Disneyland in California, in the worst outbreak in years. The epidemic is fueled by growing enclaves of unvaccinated people. 

The CDC reports that in just the past month, 84 people from 14 states contracted measles, a number that is certainly an under-estimate, because the CDC doesn’t record every case. California alone has 59 confirmed cases, most of them linked to an initial exposure in Disneyland. A majority of people who have gotten sick were not vaccinated.

For years, scientists (including me) have warned that the anti-vaccination movement was going to cause epidemics of disease. Two years ago I wrote that the anti-vaccine movement had caused the worst whooping cough epidemic in 70 years. And now it’s happening with measles.

Finally, though, the public seems to be pushing back. Parents are starting to wake up to the danger that the anti-vax movement represents to their children and themselves. 

What's sad about this – tragic, really – is that we eliminated measles from the U.S. in the year 2000, thanks to the measles vaccine. As this CDC graph shows, we've had fewer than 100 cases every year since. 

But we had 644 cases in 27 states in 2014, the most in 20 years. And 2015 is already on track to be worse. Measles may become endemic in the U.S, circulating continually, thanks to the increasing numbers of unvaccinated people. Until now, each outbreak was caused by someone traveling from abroad and bringing measles to us. The anti-vaccine movement has turned this public health victory into defeat.

Anti-vaxxers have been relentless in the efforts to spread misinformation. Despite overwhelming scientific evidence that vaccines are beneficial, they endlessly repeat a variety false claims, such as

• Vaccines cause autism. They don’t.
• The preservative thimerosal in vaccines causes autism. It doesn’t.
• Natural immunity is all you need. It isn’t. Measles infects 90% of people exposed to it unless they are vaccinated.
• A healthy lifestyle will protect you from measles. It won’t.

Now, finally, some parents are pushing back. Parents and schools in California, where the epidemic began, are concerned that their children will be exposed to measles from unvaccinated children in schools. And the schools are starting to do something they should have done long ago: send the unvaccinated kids home.

The problem arises from California’s vaccine exemption policy: although public schools require kids to be vaccinated, parents can exempt their kids simply by saying they have a personal objection to vaccination. It’s not just California: only two states, Mississippi and West Virginia, don’t allow parents to claim a philosophical or religious exemption to vaccines  And Colorado has the worst rate of vaccination, at just 82%, primarily due to parents claiming a “philosophical” exemption.

These parents are the anti-vaxxers. Thanks to them, we now have large pockets of unvaccinated children through whom epidemics can spread further an faster than we’ve seen in decades. The CDC reports that in 2014, 79% of measles cases in the U.S. involving unvaccinated people were the result of personal belief exemptions.

Anti-vaxxers don't recognize the threat their behavior poses to others, especially to children whose immune systems aren’t functioning properly. CNN reported this week on the case of Rhett Krawitt, a 6-year-old California boy who has gone through 4 years of chemotherapy for childhood leukemia. His leukemia is in remission and he’s back in school, but the treatment wiped out his immunity, and he’s still not ready to get vaccinated. If Rhett gets measles, he might not survive. His father Carl wrote to school district officials to ask them to ban unvaccinated children from school.

Krawitt expects the schools to deny his request.

Meanwhile, the parents who refuse to vaccinate their kids aren’t budging. The New York Times reported on one mother, Crystal McDonald, who refused to vaccinate any of her four children, after “researching the issue” by reading anti-vaccine websites. When their high school sent her daughter home for two weeks, the daughter asked if she could get the measles shot so she could return. As quoted in the Times, McDonald told her daughter “I said ‘No, absolutely not.’ I said I’d rather you miss an entire semester than you get the shot.’”

Where does this breathtaking science denialism come from? It’s been building for years, as I and many others have written. The wave began with a 1998 paper published in The Lancet by Andrew Wakefield, claiming that the MMR vaccine was linked to autism. Wakefield’s work was later shown to be fraudulent, and his claims about the vaccine "dishonest and irresponsible." After lengthy investigations, the paper was retracted and Wakefield lost his medical license. Despite this very public repudiation, Wakefield has stuck to his claims, though, and has spent much of the past 15 years speaking (or perhaps “preaching” would be a better term) to anti-vaccine groups, to whom he is a kind of folk hero.

It’s not just Wakefield, though. Anti-vaccine messages have been broadcast aggressively by the group Generation Rescue, led by former Playboy playmate and MTV host Jenny McCarthy, and by Age of Autism, a group dedicated to the proposition that vaccines cause autism. (Age of Autism is doing it again right now.) And just last summer, Robert F. Kennedy Jr. published a new book further promoting the long-discredited claim that thimerosal causes autism. 

Most of the anti-vax crowd have no scientific training or expertise, which might explain (but doesn't excuse) their complete ignorance of the science. Over the past 15 years, dozens of studies involving hundreds of thousands of people have shown convincingly that neither vaccines nor any of the ingredients in them are linked to autism. Vaccines are not only safe, but they are perhaps the greatest public health success in the history of civilization.

Measles, though, is dangerous. The CDC’s Anne Schuchat had a message for parents this week:

“I want to make sure that parents who think that measles is gone and haven't made sure that they or their children are vaccinated are aware that measles is still around and it can be serious. And that MMR vaccine is safe and effective and highly recommended.”

Make no mistake, measles is a very dangerous infection. In the current outbreak, 25% of victims have ended up in the hospital. And it is extremely infectious: the CDC’s Schuchat explained that 

“You can catch it [measles] just by being in the same room as a person with measles even if that person left the room because the virus can hang around for a couple of hours.”

Perhaps the Disneyland epidemic, which has now spread to 14 states, will finally convince parents, schools, and state legislatures that they need to insist that children get vaccinated before going to school. Perhaps it will also convince parents to stop listening to nonsense, and choose wisely by getting their children vaccinated against measles. We won this battle before, and we can win it again.