There is a lot of money to be made selling people products with claimed medical benefits. Prior to the FDA in the US was the age of patent medicine, when literally anyone could put whatever they wanted into a bottle and then market it as a cure for anything. This thriving snake-oil industry took a hit when the government decided to impose some standards, requiring evidence for safety and effectiveness, regulating what could be said to the public in marketing, and requiring physician supervision for the more complicated or serious drugs.
But by then the snake-oil grift was well established, highly profitable, and skilled at parting the public from their money. They weren’t going away quietly. This resulted in a constant battle to find ways around regulations, to weaken those regulations, and continue to make billions selling dubious medical products to the public.
Regular readers here will know that the snake oil peddlers have been largely successful. They have successfully lobbied state and federal government to loosen regulations and carve out exceptions. If nothing else, they have their political champions who do everything they can to make sure the regulatory agencies are underfunded and unable to adequately do their job.
Further, they have been very creative in trying to legitimize their snake oil. Perhaps their biggest victory was DSHEA – the Dietary Supplement Health and Education Act of 1994, which created a separate category for herbal supplements, allowing “structure function” claims (a deliberate back door to unregulated health claims). The industry exploded, and essentially became a major front for what is really a new patent medicine industry. That may sound harsh, but that is only because snake oil has been normalized through decades of lobbying and marketing.
I offer as evidence the well documented fact that the herbal supplement industry (just like the patent medicine industry before it) uses all the same tricks, including adulteration, substitution, and contamination.
There are several recent reports, including this one from Australia, indicating that adulteration, the deliberate inclusion of pharmaceutical drugs in products marketed as “supplements”, is still happening on a large scale. They found that many herbal product marketed for male erection, including Tantra Jelly, Bullblood tablets and Throb herbal supplements, contained regulated pharmaceuticals, including sildenafil, tadalafil or vardenafil (better known as Viagra and Cialis). This was more prevalent when purchased online from overseas companies.
This represents a serious health risk. These are essentially unregulated drugs, which have the potential for serious side effects and interactions. Also, many of the adulterants are not the pharmaceutical grade drugs, but analogues made in unregulated labs, sometimes they an analogue that have been pulled from the market for being unsafe.
Far from improving, adulteration is described by researchers as a “growing trend”: that is getting harder to regulate. The FDA has found that between 2007 and 2019, 1068 unique herbal products were found to be deliberately adulterated with drugs. Online sales is exacerbating this trend as foreign companies are much harder to regulate. Often the FDA, for example, will just send out a public notice warning about an adulteration (you get all those notices, right?).
There is a reason that many herbal supplements cheat by including actual drugs – because there is precious little evidence that herbal supplements generally work for anything. Most are thinly studied, if at all, with low quality studies. Those with high quality research generally show they don’t work. (A thorough review is beyond the scope of this article, but see here, here, here, here and here.)
This is not surprising. Herbal products are not purified, contain dozens or hundred of ingredients, generally have low doses and even lower bioavailability, with highly variable properties. If there is anything in a particular herb that is pharmacologically active it would be near impossible to effectively regulate dosing, timing, and interactions, without knowledge of half-life, absorption, protein binding, route of elimination, and drug-drug interactions. If you did the research to purify active ingredients and know all those things, you would have a drug on your hands.
But why bother, when you can sell useless products with any claims you wish”? Or if you want to get a leg up on the competition, throw in some actual unregulated drugs, but pretend it’s the proprietary blend of herbs that are actually working.
Snake oil peddlers have literally been doing this since at least the 19th century. They are just experiencing a renaissance because they are currently beating attempts at consumer protection and regulation.