Monday, January 4, 2010

The Era of Echinacea by Michael Spector

Not long ago, for reasons I still don't understand, I began to feel unfocused and lethargic. Work was no more stressful than it had ever been, and neither was the rest of my life. The bulk of my savings had been sucked into the vortex of the newly recognized black hole called the economy. But whose had not? I try to eat properly, exercise regularly, sleep peacefully, and generally adhere to the standard conventions of fitness. It didn't seem to be working. My doctor found nothing wrong and my blood tests were fine. Still, I felt strange, as if I were lacking in energy - or in something. So I did what millions of Americans do every day. I sought salvation in vitamins.

First, though, I had to figure out what variety of salvation to seek. There are many thousands of pills, potions, powders, gels, elixirs, and other packaged promises of improve vitality for sale just a few blocks from my home. I walked to the closest store, a place called The Health Nuts... Unfortunately the collection of pills was so enormous, the choice so vast, and the information so humbling that while I may not have been depressed when I arrived at The Health Nuts, spending half an hour there did the trick.

I went home and consulted the Internet, which was even more intimidating: there are millions of pages devoted to vitamins and dietary supplements. You could spend your life combing through them and then another life trying them all out. As fortune would have it, however, my eyes were drawn immediately to the Vitamin Adviser, a free recommendation service created by Dr. Andrew Weil, the ubiquitous healer, whose domed head and bearded countenance are so profoundly soothing that with a mere glance at his picture I felt my blood pressure begin to drop.

Andrew Weil seemed like just the man to lead me out of the forest of nutritional darkness into which I had inadvertently wandered. His Vitamin Adviser Web site assured me that, after answering a few brief questions, I would receive "a personalized comprehensive list of supplements based on my lifestyle, diet, medications, and health concerns. In addition, if I so chose, I could order the "premium quality, evidence-based" supplements in the proper doses custom packed in a convenient dispenser box and shipped directly to me each month."

If filled out the form, answering questions about my health and providing a brief medical history of my family. Dr Weil responded, recommending a daily roster of twelve pills, including an antioxidant and multivitamin. Also on my list: milk thistle (for those who drink regularly or have frequent chemical exposure), ashwagandha ( to help the body deal with stress and to enhance energy), cordyceps ( a Chinese fungus to increase aerobic capacity and alleviate fatigue) and eleuthero aka Siberian ginseng ( to treat lethargy, fatigue and low stamina). In addition, there was 1000 milligrams of Vitamin C ( which " may provide additional protection against the oxidative stress of air pollution and acute or chronic illness), saw palmetto mixed with stinging nettle root (to support prostate health), an omega-3 pill, Saint John's-wort, folic acid ( to help protect against heart disease, lung and colon cancer and to slow the loss of memory due to aging) and finally another ayurvedic herb, triphala ( a mixture of three fruits that help tone the muscles in the digestive tract).

The total "customized" package was priced at $1, 836 a year ( plus shipping and tax). I asked myself, what is worth more than our health? If that was how much it would cost to improve mine, then that was how much I was willing to spend. Dr. Weil, who argues that we need to reject the prevailing impersonal approach to medicine, reached out from cyberspace to recommend each of these pills whole-heartedly and specifically, just for me. Before sending off a check, however, I collected some of the information on nutrition and dietary health offered by the National Institutes of Health, the Harvard School of Public Health and the Memorial Sloan-Kettering Cancer Center. [ The Web site of the Mayo Clinic is also a useful resource for such purposes-J.S.]

It turned out that my pills fell essentially into three categories: some, like cordyceps and triphala, seemed to do no harm but have never been shown in any major, placebo-controlled study to do any particular good; others, like Saint-John's wort, may possibly do some good in some cases for some people, but can also easily interfere with a negate the effects of a large number of prescribed medicines, particularly the protease inhibitors taken by many people with AIDS. Most of the pills, however, including the multivitamin and antioxidant, seemed just plain dangerous.

Despite Dr. Weil's assurances that his selections were "evidence-based" not one of those twelve supplements could be seen to hold anything more than theoretical value for me. At best. One study, completed in 2008, of omega-3 fatty acids so beneficial when eaten in fish, found that in pill form they had no discernible impact on levels of cholesterol or any other blood lipids. The study was not large enough to be definitive; other trials are needed (and already underway). But it would be tough to argue with Jeffrey L. Saver, vice chairman of the American Heart Association's Stroke Council, professor of neurology at UCLA, and the director of its department of Stroke and Vascular Neurology, who called the findings "disappointing".

Others agreed. "You know, most of that stuff just comes right out at the other end," former surgeon general C. Everett Koop told me. The ninety-four-year-old Koop is congenitally incapable of ignoring facts or pretending they shouldn't matter. "Selling snake oil has always been one of America's greatest con games. But the more we know about our bodies, the more people seem to buy these pills. That part I never did understand, you would have hoped it would be the other way around. But every day it becomes clearer: we need to eat properly and get exercise. And every day more people seem to ignore the truth."

After following 161,808 women for eight years, a team of researchers from the Women's Health Initiative under the direction of the National Heart, Lung and Blood Institute found no evidence of any benefit from multivitamin use in any of the ten conditions they examined. There were no differences in the rate of breast or colon cancer, heart attack, stroke, bone fractures or blood clots. Vitamins did nothing to lower the death rate. Another major trial recently showed that the risk for developing advanced prostate cancer, and dying from it, was in some cases actually twice as high for people who took multivitamins as it was for those who never took them at all.

In 2007, the Journal of the America Medical Association published results from sixty-eight trials that had been conducted during the previous seventeen years which found that the 180,000 participants received no benefit at all from antioxidant supplements. In fact, vitamin A and vitamin E actually increased the likelihood of death by 5 percent. Vitamin C and selenium supplements had no significant effect on mortality.

Kelly Brown, director of the Rudd Center for Food Policy and Obesity at Yale University has studied the impact of nutrition on human health for years. "Vitamins in food are essential. And that's the way to get them. In food." With a couple of exceptions like folic acid for pregnant women and in some cases vitamin D, for the vast majority of Americans dietary supplements are a complete waste of money. Often, in fact, they are worse. In May 2009, researchers from Germany and the United States reported in the Proceedings of the National Academy of Science that antioxidants like vitamin C and E actually reduce the benefits of exercise. "Antioxidants in general...inhibit otherwise positive effects of exercise, dieting and other interventions."


  1. According to the National Health Statistics Report Americans spent $23.7 billion on dietary supplements in 2007, not including added dietary ingredients like fortified cereals and energy drinks which now seem to fill half the supermarket and health food stores shelves in the country. There were approximately 4,000 supplements on the market in 1994, when the industry was deregulated by Congress, which was accomplished by the seemingly unlikely alliance of Orin Hatch and Tom Harkin. Today the exact number is almost impossible to gauge but most experts say that there are at least 75,000 labels and 30,000 products.

    It would require Dicken's narrative skills and Kafka's insight into bureaucratic absurdity to decipher the meaning of most products for sale in American health food stores today. In the world of alternative medicine, words become unmoored from their meanings. As long as a company doesn't blatantly lie or claim to cure a specific disease such as cancer, diabetes, or AIDS, it can assert- without providing evidence of any kind- that a product is designed to support a healthy heart, or that it protects cells from damage or improves the function of a compromised immune system.

    It's still against the law to claim a product cures a disease- unless it actually does. But there is no injunction against saying that a food or supplement can affect the structure or function of the body. Such claims can appear on any food, no matter how unhealthy. You cannot advertise a product as a supplement that "reduces" cholesterol, but you can certainly mention that it "maintains healthy cholesterol levels." It would be illegal to say that echinacea cures anything, since of course it has been shown to cure nothing. But its perfectly acceptable to say that echinacea is "an excellent herb for infections of all kinds," although no such thing has been proven to be true.

  2. Denialism; How Irrational Thinking Hinders Scientific Progress, Harms the Planet, and Threatens Our Lives by Michael Specter;
    Penguin Press, 2009

    Mr. Specter examines many of the conflicts and controversies between science and the popular imagination that have arisen in America in recent decades, including those surrounding vaccines and autism, organic food vs. genetic engineering , and other aspects of the 'conventional' vs complementary and alternative medicine.

    In some respects, however, Mr. Specter shares in the same faults and irrationalities. which is to suggest he invests too much promise into such expensive scientific enterprises as the genome project and synthetic biology. He could stand a bit more familiarity with the basics of evolutionary biology, - the innumerable weakly acting causes which determine individual destiny.A $10,000 or even a $500 test, ( which have cost hundreds of millions of dollars to develop) to discover an individual's genetic structure whose use has only managed to replace the simplest of clinical procedures or confirm risks factors which are common enough to be taken as tantamount to universal seems a bit absurd. Once again: a uniquely American idea of freedom: freedom to expect a miracle and pursue it far into the future ( like the colonization of distant planets) no matter what untended social difficulties in the present.

  3. Another paradox in this work: Whereas multivitamins, antioxidants, various exotic supplements and fanciful treatment regimes such as homeopathy and chiropracticism show nothing in terms of the prevention, much less cure, for diseases or prolonging life and in some cases depending on the character and circumstances of their application may do harm, who is to say that they are completely ineffective with respect to the vague feelings of lethargy and unease which inspired Mr. Specter to consider them in the first place? In fact, the placebo effect (the positive power of wishful thinking) is a significant component of every kind of medical treatment and Mr. Specter does cite some studies which have been trying to isolate, define and understand exactly how it works with a view to maximizing its potential.( One problem is, of course, the ability of a placebo to generate sustained effects. The "new and revolutionary" is apt to become the "tired and convention" in short order.)

    This should not blind us to the massive fraud and waste which is attendant upon the world complementary and alternative medicine, which now consumes vast amounts of both the private and public monetary resources of the American people. My book on the subject, however, would focus on the what might be called the "moral displacement" that seems to be accomplished by all this. Americans have a deep-rooted sense of unease, that something is not right about the way they live their lives. Rather than address the real problems directly (unjust wars, economic inequality, environmental devastation, prejudice, bad education) they go after their own interior feelings as they might be controlled and manipulated through direct consumption, the presumption being "innocence".

  4. Photo:

    "Crumb's bearded guru is too unapologetic to be called a con man. Despite his renunciation of the material world, he's an unrepentant sybarite. His straight talk, while refreshing, can get him into trouble, as when he was kicked out of heaven for telling God it's "a little corny" in "Mr. Natural Meets God". Mr. Natural is chronically plagued by tight-ass neurotics like Flakey Foont and Schuman the Human. But he may be the only Crumb creation who is genuinely likable.[2] Mr. Natural's aphorisms such as "Keep on Truckin'" form a disconnect with his image as a sage, and his inventions are at once brilliant and crackpot."