Book Review

Natural Causes: Death, Lies, and Politics in America's Vitamin and Herbal Supplement Industry

N Engl J Med 2007; 356:2659June 21, 2007

Article

Natural Causes: Death, Lies, and Politics in America's Vitamin and Herbal Supplement Industry
By Dan Hurley. 336 pp. New York, Broadway Books, 2006. $23.95. ISBN: 978-0-7679-2042-1

The health sections of bookstores are crowded with books that promote the use of herbal and other “natural” remedies but contain few that disclose the dangers and uncertain efficacies of these products. Natural Causes skillfully interweaves the stories of people who were harmed by such products with accounts of the political machinations that have allowed their manufacturers to flourish during the past decade. The author, Dan Hurley, a journalist and investigative reporter, has written an engrossing book that should help to offset the indiscriminate promotion of these products in books and other media. The events he relates are documented in 34 pages of references.

The prologue to the book relates the experience of a woman who used two herbal remedies, bloodroot and Cansema, to treat a lesion on her nose. As a result, the soft tissue of her nose became necrotic and fell off. She has since undergone six operations to reconstruct her nose, and more will be necessary to complete the process. Hurley relates similar incidents involving the use of shark cartilage, L-tryptophan, kava, St. John's wort, and other so-called natural treatments. Many products with unproven efficacy and safety are sold by companies run by individuals who have no scientific or medical training, some of whom have been accused or convicted of criminal conduct. These companies remain in business because the Food and Drug Administration (FDA) and Federal Trade Commission cannot monitor the tens of thousands of products on the market, and the FDA's authority to do so is limited by the Dietary Supplement Health and Education Act (DSHEA).

As Hurley points out, the enactment in 1994 of the DSHEA, termed “The 1993 Snake Oil Protection Act” by the New York Times, opened the floodgates for the sale of “natural” treatments. After its passage, sales of these products rose from approximately $4 billion in 1994 to $20 billion by the end of 2000; evidence of their harmful effects also mounted. “Natural” treatments are used as medicines in the United States and all over the world. Their designation as “dietary supplements” in the DSHEA was a brilliant industry tactic that has allowed these treatments to largely escape regulation by the FDA and has given consumers the idea that they are safe and gentle products. In chapter 4 of the book, Hurley describes the campaign that led to the passage of the DSHEA. The industry sponsored misleading advertisements proclaiming that the FDA was going to restrict access to vitamins and minerals. A typical advertisement read: “Write to Congress today or kiss your supplements goodbye!” Health-food stores provided form letters for customers to mail to Congress, and actor Mel Gibson starred in a television commercial that showed a SWAT team invading his home and confiscating his vitamins.

In the final section of the book, Hurley proposes 13 initiatives to protect the public. They include improving regulation of the manufacture and labeling of supplements, requiring proof of safety before the supplements go on the market, and giving the FDA increased resources and authority to regulate supplements. Many of these worthwhile proposals have been made previously by medical organizations and consumer advocates. Hurley also briefly considers the role of consumers who accept the health claims companies make about their products. I believe that this is the crux of the problem and that providing the public with unbiased and accurate information is just as important as better regulation.

Although Natural Causes is written for the general public, it contains information that may be unfamiliar to students and practitioners of medicine. It is a much-needed corrective to the promotion of so-called natural treatments by the integrative medicine programs at some medical schools and by health care professionals who believe incorrectly that herbal remedies and dietary supplements are harmless. The book deserves a wide audience.

Donald Marcus, M.D.
Baylor College of Medicine, Houston, TX 77030
dmarcus@bcm.tmc.edu