Selen Dar

Muscle-Building Workout and Diet

>>Paul Coates: So, now we’re
going to meet three people who do something a little
different in this space, and I’m not going
to introduce them with all of
their credentials. Rather, I’m going
to ask each of them to do what our
industry colleagues did: what do you do
in this space? So, the first of our speakers
in this segment will be Laura MacCleery
who’s from the Center for Science
in the Public Interest. What do you do Laura? [applause]>>Laura MacCleery: Well,
hi there I am Laura MacCleery, and I’m a lawyer. I’ve been doing
public interest advocacy work mostly
in the public health and good government spaces
for 18 years. And Center for Science
in the Public Interest is an independent,
by which we mean we take
no government donations or industry money,
nonprofit organization. And actually,
dietary supplements are, I would say, a very small part
of our overall docket. So, you know, here’s a snapshot
of some things that we do. Really, we are an Innovation Lab
to push for public health transformations
that drive change. So — you are —
one of our achievements is coming to a restaurant
near you or has, as of several weeks ago
calorie counts on menus. That was really an effort
that was led by us. The ban of trans fat
from the food supply and first its labeling was
an effort that CSPI helped lead. We led the fight
for healthier school meals for school children. And we use a mix of tactics
and methods to achieve the changes
that we seek. Everything from
regulatory involvement to litigation in the courts
on class-action claims around false
and misleading products to legislation and,
of course, public education. A centerpiece of our work
and our independence both is our Nutrition Action
Health Newsletter. This is a 10-times-a-year
publication. It’s very affordable.
I commend it to all of you. It’s a terrific magazine
that really reviews with rigor the science
behind a lot of claims that float around in the food,
health, and nutrition space. And over the years we’ve done
a lot to debunk and analyze the effectiveness of various
types of dietary supplements. So, this is the work that I draw
in as the regulatory lawyer thinking about what things we should bring to
the public’s attention and which things we should
bring to the Food and Drug Administration’s
attention about supplements. One of these Diabetes Defenses, I’ll talk about this
a little bit later, but it’s, you know,
in the area of unapproved drugs we have particular concerns. So, if there is a claim
being made that a supplement, you know, counters
the symptoms of diabetes or prevents some aspect
of diabetes we are going to take
a particular look at that. Most of the studies
you’ll see in this — you can’t read it up here. You have the slides
in the booklet — were actually underpowered to
the outcome or found no effect. And you do see these kinds
of stories populating the web. In particular, cinnamon
has magical properties. I think a lot of this is that
there’s a lot of magical thinking around food in general and dietary
supplements in particular. We also tend to look
at particular claims. So, the example in
the other article on Prevagen, for example, the company touted
the study but failed to disclose that the placebo
was equally effective. You know, this is not unusual.
There’s often a slim or no evidence
behind many of the claims, and it’s tricky from
a regulatory perspective because the Office of Dietary
Supplement Programs does attribute claims
that are around an article a product that’s being sold as a
supplement as imputed marketing. But oftentimes what you have
on the shelves are, given that companies
have gotten very savvy, is you’ll just have
the bottle say, St. John’s wort or cinnamon
capsules or something. And there’s no claim at all. So, therefore the consumer
is then vulnerable to reading about on the web
some separate marketing material that’s off the label
that may tout the benefits of a particular substance,
and yet it’s very hard for FDA to make the enforcement case
against the company. This is another example
of two Nutrition Action Health newsletter articles that
we published on on testosterone. It’s a three-page article. If you subscribe you’ll get
access to the full thing, but the upshot was that
while low testosterone is a legitimate medical
condition of course that needs treatment in some
cases that it’s being oversold and that actually taking
excess testosterone raises some risk of cancer.
It’s not totally clear. On the probiotics, you know, the recommendation
that came out of that was that they’re oversold. They don’t need
to be taken daily. They can help
with particular conditions, and there’s usually strains
that have been identified as helping
with particular things like while you’re taking
an antibiotic or if you have
some kind of other infection. So, you can take those
particular things, but that a lot of probiotics
offer scant or little benefit maybe one day
less of a cold for example. I got involved personally
in dietary supplements with a very dramatic case.
I read in the news — dietary supplements
had been part of my docket but in addition
to sort of Nutrition Action, doing these publications,
and the 2013 Durbin bill that we had been involved
in,as well as the industry and trying to push for
register product registration. This issue came up in the news, and I read the headlines
just like everybody else. And I became immediately
very concerned that pure, powdered,
or, in some cases, highly concentrated
liquid caffeine was being sold on the Internet. It was sold at 99.9 percent
concentrations. A tablespoon — in five-pound
bulk bags or two-gallon jugs, and a tablespoon
could kill an adult. A teaspoon could kill a child. The proper dose was a 1/32
of a teaspoon which no one has the ability
to measure at home. So, we wrote a citizen petition and submitted it to the Food
and Drug Administration. These two young men are Logan
Steiner and James Wade Sweat. We worked with their families
who came to Washington on their own dime
on multiple occasions to meet with lawmakers
and publicize about the issue. We had press conferences
on the hill. The FDA initially issued five
warning letters to companies that we had identified
as selling these products. We did a spot check
of the market within six to nine months later.
I forget exactly the timing, and there were still multiple
availabilities of this product on the internet.
You could just get it. So, we ordered the product.
We took it up to the hill. We had this kind of
show-and-tell with reporters that we could still
get these products even though the FDA
had issued a warning letter. There was also a third death that showed up
in the medical literature where a person had taken —
a man had taken the caffeine and thrown it up all over
the dashboard of his car and had went into
cardiac arrest which is how you die
from a caffeine overdose. And there may have been
occult deaths that were showing up
in the medical literature because if you take
a high dose of caffeine and then are going to exercise or, you know,
jog outside or something, and no one connects the
substance with the heart attack. If you had a normal autopsy
for a heart attack you wouldn’t be looking for
caffeine levels in the blood. So, there could have been
heart attack cases related to these products
that just didn’t show up because no one did
a second autopsy specifically looking
for caffeine levels. Just recently in April 2018
we were so heartened to see that the Office of Dietary
Supplement Programs actually put out
in a final guidance that these products are illegal
or adulterated per se because if they’re sold
in an amount that’s lethal
to the end consumer, if they’re sold in bulk, that even a scoop like a little
scoop that came with the bag, which is how they had been
continued to be sold, they said could be
separated from the bag and would pose a danger.
And that’s true. Logan Steiner s friend gave him
some of the powdered caffeine in a little baggie separated
from its original packaging. So, once these things are in
circulation it’s very hard. And I think the trend is very
concerning because what it shows is that there’s
a lot of bulk supplements that are kind of inputs
to formulated supplements by the major brands
and companies. And those you can purchase
directly from China or through bulk supplements
websites here in the U.S. And basically you’re dealing
with raw ingredients in their uncut form. So, you know, this is the FDA
kind of pushing back on the ability to turn around and then make a profit
by selling that. We also, in December, put out — as I said we’re very concerned
about unapproved drugs. Things that are marketed
essentially to treat disease as dietary supplements.
And FDA has a guidance that says that they’re going to prioritize
enforcement of unapproved drugs because they pose
as legitimate treatment for a medical condition. In the case of opiate addiction
there are medically approved treatment protocols
that are known to be effective for that condition.
Few people have access to them. Some may not
even know about them. So, the temptation to then
go to use a dietary supplement or not to have to go to a doctor that might be affiliated
with your employment and admit to an addiction
problem is very high. So, into that gap have rushed
a number of, as Duffy would say, bad actors. These are companies that were
marketing opioid withdrawal aids in the dietary
supplement marketplace. Some of which were sold on
Amazon or Ebay and other places. We wrote to the companies, and when I say
we I mean the grander we. David Schardt , my colleague, wrote them letters as CSPI,
you know: Do you have scientific studies
showing that any of the ingredients
in these products are effective
for opiate addiction relief? These are the responses
we got back: Scientific studies
are very costly. So, no, we didn’t bother.
We don’t really have any scientific studies
as such currently. These are, you know, very common for the bad actors
within the industry. I would agree
with the characterization that there are better and worse
companies in this space. The problem is that the worst
companies create an atmosphere of consumer confusion and fraud,
sometimes outright fraud. In January FDA and the
Federal Trade Commission, which we had also written to about the illegal marketing
of these products and which has already brought
several cases on the opioid dietary supplement
claims, took action. We were pleased to see that they
went out into the marketplace and found additional bad actors that we hadn’t uncovered
in our initial research, and they issued a number
of warning letters to those companies. So, that is the first step
in an enforcement action. I assume that the agencies
will follow up and see whether in fact the companies have ceased
selling those products. In some cases,
the Department of Justice or FTC may go after the companies
and seek aggressive, kind of, consumer penalties
and even repayment of consumers who were defrauded. Obviously, with a condition
like opiate addiction it’s life-threatening. With other products what we see
is that there’s just widespread economically
motivated adulteration which is lawyer speak for fraud. In the case of ginkgo we noticed that there was
industry monograph pointing to widespread
adulteration of ginkgo products which is one of the top sellers
among dietary supplements. And that there was strong
incentives to substitute other parts
of the ginkgo tree or buckwheat for the allegedly
active parts of ginkgo. It’s not a great supplement
to begin with because there really isn’t good
evidence that it’s effective for many of the things
that patients may take it for like memory loss
or muscle and joint benefits. So, we wrote FDA
and enforcement letter saying these are adulterated. It’s kind of like that joke,
you know, the food’s terrible and there’s not enough of it.
Right? These are adulterated
and they’re kind of ineffective. So, some of those things led us
to a recommendation to consumers to avoid ginkgo
balboa supplements. Our priorities when we think
about advocacy are, first, that we need
to protect the public from acute risks
like pure caffeine. We’ve also worked on the tainted
supplements that are, you know, tainted with often performance
-enhancing amphetamines or that sort of thing
for weight loss. Or from drug interactions we have
a long-standing citizen petition to have a warning label
on St. John’s Wort. We’re going to ask for the same
thing on beta-carotene because these have known
drug interactions. We also are concerned
about unapproved drugs. And then as a secondary concern
we work on things that are about efficacy where we
think consumers are being misled by an avalanche of claims. These are a number of really
in the weeds kinds of reforms, but basically they’ll add up
to we think there should be some
kind of mandated third party pre-market oversight
of safety and efficacy. We recognize this as a fight
that we lost in 1994. We think it’s worth
having another conversation with the industry about whether consumers
and the industry really benefit from the current Wild West
regulatory environment. We also would back
a registration system. We think FDA needs more
resources such as user fees, and that in a number of areas FDA should enhance
its regulatory oversight as such as for new dietary
ingredients. That’s the new Dietary
Ingredients Guidance. In addition, we think there
should be a requirement for a substantiation of claims
that things are effective for the purposes claimed. And that would sort of
get out of the conundrum that Duffy had laid out
which is how do you claim that something
doesn’t make you sick? And that there should be
ongoing prosecution where things actually
pose a hazard. Thanks so much. [applause]>>Paul Coates: Well, thanks
very much Laura. Tod Cooperman is
from and has been a regular
on our program for quite a number of years. The only thing I need
to watch out with Todd is that he always has so much
he wants to say. So, I won’t take
any of your time as long as you promise not to
take any more time than anybody.>>Tod Cooperman: I ll try. Thank you, it’s always
a pleasure to be here, and thank you Pauls and Luisa
for having me and ODS. I will try to get quickly
to really where I want to go is to talk about some of
the interesting things that we have been finding
at ConsumerLab. For those of you who are not
aware ConsumerLab has been around for 19 years.
I’m a founder of the company. We are basically people
out there testing to see what’s really in supplements and other health
and nutrition products, and it’s nice to see
how the baton gets passed sometimes to the people of CSPI. We actually found some of
those problems with the ginkgo which were cited
into the policy work that that CSPI is doing
from time to time. Again, I’m going to try
to skip through some of the earliest stuff. Since 1999 we’ve tested
over 6,000 products. We put out a report
every three weeks on another category
of supplements. We have about five or six
categories always in testing, and that represents
about 850 different brands that we’ve tested from. And we’re supported primarily
by 77,000-plus individual subscribers plus libraries
and other institutions that subscribe to ConsumerLab.
It’s $42 dollars a year. And also if anyone’s
not a subscriber I’m happy to give you
a free access for 3 months. We’re going to pass around
a sign-up sheet which is what I do every year, and we’re happy to extend
that to you. We’re in the news a lot
just because our findings are quite interesting
to a lot of people. Again, I’m the founder.
I’m an M.D. Our head of research
is Mark Anderson who spoke here the last year.
Twenty-two years experience in the dietary
supplement area himself and an active member of the AOAC involved in developing protocols
for testing supplements. So, you know, why can’t we
just rely on the FDA and Good Manufacturing
Practices with supplements? Well, as you’ve been hearing
for the last two days you can’t because, one, the FDA
doesn’t approve supplements nor does it
register supplements. Companies have to register
but not the products themselves. Even though there are
some listings of products they’re not registered. Good Manufacturing Practices,
if you actually look at them, they can help,
but they really don’t include a lot of meat —
a lot of teeth to them. They don’t include
contamination limits. They don’t include ingredient
identity parameters. They don’t include
testing methods, and as, you know,
as you’ve heard you can use a very simple method
and find that a product has a hundred percent
of what it claims or you can use the right,
you know, rigorous method and find
that it has very little or none. So, manufacturers are the ones
who get to determine these issues,
you know, these parameters. They are supposed to, you know,
follow, you know, use good science behind them,
but it is up to them. So, you are trusting
the manufacturer. In 2016,
62 percent of the audits that were done of
manufacturing facilities failed to pass all the criteria. Typically, for the reason
that they were not specifying or verifying the identity
of ingredients. And you can actually link to our
— there’s a link there
on our site. You can actually see
which companies pass or fail that audit.
We put we post that every year. We’ll be doing that
in about a month again for 2017. So, what do we do?
We do a lot of testing. We put out product reviews on nearly every category
of supplements out there. About 10 to 40 products
are included in each of those. We also have the oldest
quality certification program. You may know that USP has one.
NSF has one. We actually have the oldest, and it’s actually the only one
to publicly freely publish our testing methods and criteria
for passing. We do some specialty testing
for academic researchers from time to time.
Really just to kind of help out, but really our big push
is really to inform the consumer and the healthcare provider as to really what’s inside
the bottle in these products. We also spend a lot of time looking at
the clinical literature because you can’t just look,
you know, just at the product as we mentioned
before, you know. Ginkgo we want
to test the product. We also want to tell our readers really what’s the evidence
for/against? What are the side effects?
What are the drug interactions? You know,
as Bill was mentioning earlier. We also answer a lot
of questions from consumers. We have over 500 questions
answered on our website. It would be hard to miss us if you have
a question about supplements and we don’t pop up on Google. We have an Encyclopedia of
Natural Products on the site giving more
clinical information. And also I realize
I forgot to have on here, but we also have our listing
of recalls and warnings that come out every week. And that’s an archive that
goes back over a dozen years. And a newsletter that goes out
to about a 190,000 people now twice a week
with the latest updates. These are just some examples
of the categories that we cover. Interestingly, this year we actually include
tested CBD supplements. Even though they are
technically illegal they are being widely sold.
We want to know what’s in them. Apple cider vinegar,
I’ll talk about that. So, it’s not just a, you know,
the traditional, you know, fish oils and —
and minerals and vitamins. We’re looking at
all kinds of things. We’re going to be testing
a canned tuna fish and canned salmon
shortly just because the evidence
for fish oil itself has waned, but the evidence
for eating fish, you know, just gets stronger. So, we want to find products
that actually have the omega-3s and are enter free
of mercury etcetera. So, why do people care? Our members say, you know,
I need to understand which supplements
are best quality. Physicians and dietitians
tell us I use your reports
protect my patients. And even the industry those
who actually have come to get products
tested through us. And by the way
it doesn’t protect them from us not being able to test
their products, you know, on our own,
but it gives us an opportunity to increase
the number of products because our real goal is to find
good products for people, you know, who are looking to
use them well. So, what does the industry say? This is a VP of Marketing
at a supplement distributor, you know, we’re — we’re
an independent organization that
consumers trust to help them choose quality vitamins
and supplements. So, what have we found? Well, one out
of every five supplements that we’ve tested has been found
to have been of poor quality. That’s a little bit better
than it was before. It had been one out of four. It’s nudging toward one
out of five. Herbals have the highest
failure rate, 39 percent, vitamins and minerals
20 percent, multivitamins higher than that though because they’re complex,
other supplements 18 percent, and then other nutritionals
is about 25 percent. So, overall it’s about 20 — let’s see 22 percent
of the products we’ve selected
if they have failed testing. That’s actually closer to,
yeah, one out of five. So, what do we find? We find too little or no
ingredient in some products. Too much ingredient
and I’ll show you an example of that
where you’re exceeding up or tolerable intake levels
for certain nutrients. Inadequate labeling
to describe ingredients, poor quality ingredients,
spoilage of oils, contaminations with
heavy metals, inadequate disintegration
of pills, and unapproved label claims. These are the kinds of things
we’re testing for. We actually do just a little bit
of testing in-house for disintegration make sure
that pills break apart properly, but we have to do
so many types of tests that we found it’s better
to use experts in different areas of testing.
So, if we get like a fish oil it may go out to one lab
for PCBs and other ones for omega-3s and other ones
for heavy metals etcetera. So, we’re coordinating
a lot of testing as well as doing some testing. We select the products
that we test for our reviews. We purchase multiple samples
at retail. Products can never
be sent to us. As I said pill disintegration
testing is done inside. Others are done out
at other laboratories. We publish the results. All the results for the products
that we buy and test on our own are published on our site
for our members. As I mentioned it includes
the latest clinical information, consumer tips, and we include
in there any products that pass through our voluntary
testing as well. We publish, as I said,
all our methods if you want to see how we tested
and evaluated any product anyone
is welcome to click that link, and it’ll show you
how we test everything. And I wanted to show you an example
from our multivitamin report. Again, for those of you
who aren’t familiar with what our reports look like
and what we’re providing here. So, this is from last year. We do this report every
two years on multivitamins. It’s an extensive report. Summary, 46 percent of the
multivitamins we test it failed. The biggest problem was actually
with gummy vitamins. They are,
as it was mentioned earlier, they are very difficult to make. I think it’s very hard
to control the quality in these, and I’ll show you some examples
of the other kinds of problems that we’re seeing
with the gummies. We, you know,
we start off with these reports with a lot of background
about the clinical studies. Actually, Dr. Sesso is mentioned
in the in his study with centrum as mentioned earlier.
What we test for. What we found. We then move on to talk about,
you know — oh, here’s an example
of disintegration. You can see how this product
even after 60 minutes — pills should break apart
within 30 minutes. Even at 60 minutes
we gave it a, you know, more time it still
didn’t break apart completely. There should be nothing here at
this point just as an example. We show our kind of top picks for different
categories of supplements. But I want to get down to kind
of the heart of our reports which was really here. Which is what we show in terms
of the results for each product. In terms of whether
they are approved or not based on
how they fared in our testing. It doesn’t mean
they work or not. We have other information about
really what you should look for in terms
of whether something might work, but here we’re just showing
from a quality perspective whether it had what it claimed. And I’m going to shoot
down to — as I said it was actually — I mean like here’s a gummy
from Walgreens. It claimed 400 milligrams of
folic acid it had 757 percent. As some of, you know, folic acid
converts to folate at a higher rate
than just the folate itself. So, that it’s actually
equal to about twelve hundred and eighty-seven dietary
fully folate equivalence. So, you’re going from
what claimed to be 400 — sorry I may have said
milligrams, micrograms. And we’re finding 1,287. So, we’re finding three times
as much, you know, folate equivalence
in this product. The upper limit is 1000. So, you’re actually potentially
doing yourself harm, you know, by taking this multivitamin. This is some more
quick examples, and it’s not every gummy where
we find the problem that we — here’s another one 174 percent. We found the number to be
to be off on their vitamin A levels. This is a tablet
that was off on its folic acid. And companies are allowed to,
and they should put in a little more than, you know,
than is necessary to make sure that it lasts
through the expiration date. But these are really,
it’s in our opinion, excessive. Let s just go through.
And here’s Vitafusion, I know we have a representative
from that company. Again, way much more folic acid
than claimed. So, 1,382 dietary
folate equivalents instead of, I believe, 400. Here’s another one Bayer that
one actually had what it claims. So, you can make a good gummy,
but I think it’s very difficult. I’m going to jump out of this
go back to the presentation. So, some other interesting
recent findings, as was mentioned, ginkgo biloba. So, four out of
the ten supplements that we purchased off
the shelf were found to be — only four were approved.
I’m sorry six failed. They were basically adulterated. They were spiked with compounds
from cheaper plants to make low quality ginkgo
appear to be high quality. And the way that herbal
companies do this, herbal suppliers,
is they can take — take a real herb squeeze it out basically, you know,
get a good extract from it, sell that, keep the junk
that’s left over — you know,
it’s kind of like making coffee and selling the grounds
and calling it coffee. They’ll throw back in maybe
one compound that they know a test
is looking for. They’re spiking it
with that compound, and then it’ll pass whatever
that test is that’s looking for
that single compound. But if you’re looking
at the whole product, you know, the whole array of compounds
it will fail testing, and that’s what that’s what’s
going on with ginkgo. One product actually had no more than three percent of
the expected ginkgo compounds. Apple cider vinegar,
interestingly, all — good news is all these vinegar
bottles these were all fine. They all had about 5 percent
acetic acid plus compounds that indicated
they were made from real apple. We also looked at these tablets
that are being sold these because, you know,
once something’s out there there’s going to be a pill.
So, we’ve looked at these, and what we found is that
the amount of acetic acid which is probably what’s
really making these — these products help people
lose weight in this sense. They’re potentially upsetting
their stomach with the acetic acid. They don’t have as much
of an appetite. And these pills
have some acetic acid, but you really have no idea
how much is in there. We found as little
as 0.4 percent acetic acid to over 20 percent. Actually, based on just
the amount of powder was about over 30 percent. It turns out that if you sell
a consumer product, you know, like Drano that that that has over
20 percent acetic acid it’s supposed to be
labeled a poison. This product, you know, was not. The company responded
saying that well, you know, it’s not
a consumer product. It’s a dietary supplement.
It’s exempt from that law. My reading of the law is,
actually, there’s another place it says
if you if, you know, there’s a danger
you have to label it. In any event they did come back
and agree to change the labeling
to add that, you know, you shouldn’t separate
this product this capsule. You should take it with a lot
of water and take it with food. So, it is nice to see that
there is some improvement. In all of our reports you will
see at the top of every report it’ll state, you know, the back and forth
between these companies. So, if they approached us
we will we will also offer to send it to another laboratory if they’d like
to have it tested. You know, almost every time
it comes back finding what we found,
and it’s not that the companies were really trying
to do something bad. They often just didn’t know
what they were doing. Last slide, goldenseal talked
about earlier in terms of not
actually being goldenseal. You can see on the left
this is real goldenseal it has kind of
a slight golden hue to it. This is another one saying
it’s a golden seal root powder, definitely not. Didn’t have any berberine in it
which is the key compound. It’s not yellow. It’s it would
taste bitter which it didn’t. So, I could talk
for a long time, but I’m going to stop. And again if you put your name
on that list we will sign you up
for a membership to ConsumerLab for three months.
Thank you. [applause]>>Paul Coates: So, now I’m going to
introduce James Hamblin, and we’re going to do something
just a little bit different with James’s presentation. I’m going to ask him
to kind of introduce himself and what he what he does. And then I’m going to
interview him a little bit. We’ll see how that goes, but James
would you please start?>>James Hamblin: Yeah, so,
I don’t have formal remarks. I’m here representing
all of journalism, the entire profession. But I want to represent
that point of view which is a broad one. I write for a general
interest magazine that was founded in 1857.
We covered the American idea. I came on to start the
health section six years ago. I left a radiology residency.
So, I am an M.D. and I constantly question
that decision, but it’s been great.
And the reason I did it was so that I could meet people
and tell stories and constantly learn
about the world. And be — the Atlantic’s motto is that we are of no party
or clique. And that was really important
to me that I not be tethered to any
particular agenda or industry. I still have the physicians code
to do no harm. I’m trying not
to misinform people, but I’m not pro any
particular — I m not pro regulation,
anti-regulation, pro-big-government,
pro-supplement, anti-supplement. I can take each story
as it comes and try to shine a spotlight where we need to
and to contextualize and to inform and to offer
nuanced stories to our readers. So, I’d like to be here
to be part of the discussion to offer that perspective,
and I’ll talk to Paul now.>>Paul Coates: Why don’t you
come on and sit down, and I’m going to maybe
encourage you to particularize some of
the things that you just said. Why are — why did we ask you
here to represent journalism? Which is essentially
what you’re doing.>>James Hamblin: Yeah, I mean
I think that there, you know, there’s a lot of misinformation
on the internet, and if you’re a clinician,
you know, a lot of people are coming to you having
some idea of one thing that they read
about one supplement. And they don’t know
if it’s true. And when you trace it back it can often come
from a third party that is definitely not
a disinterested party that is trying
to sell the supplement or from even a physician
who’s selling both books that purport to inform people
on a new diet plan and then also on their personal
website selling supplements that are recommended
in the book. So, it’s really important that
journalism exists as an institution
where you know that no one — if you’re seeing this
at on the Atlantic, on the New York Times,
the Wall Street Journal, you’re reading this from someone
who is not also taking money from any of
the interested parties and is doing their best
to simply cut through it all. And as I go through more and
more nonsense on the internet you can at least go
to these places and not trust everything
that you read blindly but have a much higher threshold
for thinking this is probably accurate. This person is probably
in good faith tried to give me the best
information that they could.>>Paul Coates: What have you
written about supplements that people –>>James Hamblin: I’ve written
so much. I get sort of — the couple interesting things
to know are like — yeah it’s — so, like I said
I started the health section. So, I was covering everything
that had to do with health. We moved very quickly. Like when you’re working
with journalists if you want to be involved,
be interviewed, you know, make contact information
readily available make as much information
available as you can. Make yourself accessible because
people move real quickly, and they’re often working way
out of their depth. I mean there’s something good
to have reading a story by a journalist
about caffeine supplements when that journalist
is coming into this fresh, and they don’t really have
a lot of background with caffeine supplements. So, you know,
they’re going to come they’re going to talk to people. They’re going to make
sense of it. This is a smart person
who knows about science, and you’re going to read
their take away. There’s something
nice about that. As opposed to getting a story
from someone who’s been covering
the industry for 20 years, and it has lots of biases and kind of probably
didn’t have that. But at the same time that means
that that journalist who’s coming in fresh needs — probably has a few hours
to talk to as many people and learn as much about this
as they can, you know, especially
if it’s a news story. So, everything’s not always
going to be perfect, but the more that all of you
can make yourselves available and be part of
the conversation the better. And then, to that end,
I’ve written about pretty much almost every kind of supplement. Yeah, lots about caffeine,
lots about vitamins, melatonin.>>Paul Coates: So, tell me —
you mentioned caffeine a couple of times —
what were you trying to learn? What were you trying to convey
to people about caffeine
containing dietary supplements?>>James Hamblin: There have
been a few different stories. I have — I wrote a —
there’s a company that was selling
topical caffeine sprays that interested people
for a while. So, it’s kind of
when there’s a new product or something people
are talking about I’ll try to cut through
how much of this is accurate? How much of it is not? And I don’t know
there have been, yeah, multiple different
sort of takes on it I guess. Caffeine is something
that fascinates people because to so many people
it’s totally fine when you drink it in coffee. In fact, it’s almost weird if
you don’t like drinking coffee. And then it becomes very weird if you’re spraying
caffeine on your skin, and even weirder if you’re
spraying it at other people. They just — and then just think about why
that distinction should be and then why you should be
thinking about one thing that is a supplement which — which is a stimulant
which can have serious effects and we regulate that
as not pharmaceutical.>>Paul Coates: It’s obviously
come up a few times I think. I don’t know whether
it was covered earlier, but I did come in during
Patty Deuster s presentation. And you expressed concern
about the levels of caffeine exposure that warriors
and their families are likely to be engaged in. So, it’s — there have
been regulatory efforts. So, what was your take on it? Was it that you were concerned
about the health of people? That they were not paying
attention to the signals? Were — was there
some other aspect of this that got your attention?>>James Hamblin: I think
it’s really easy in a meeting of people
who think about this stuff as much as all of you do
to forget about the average level
of literacy around supplements, and I’m constantly
confronted with that. My readers write to me
all the time and that does inform my work. And a lot of people
just have no idea that anything they’re buying
from the store could be potentially less
than a hundred percent exactly what it’s labeled to be.
And that it won’t definitely do exactly what the label implies
that it will do. And just constantly
reminding people of that. And then the duality of,
you know, when people buy something when
they need a prescription for it they tend to take
that very seriously and follow the label
to the T. And when it’s something you can
buy as much of as you want there seems to be no reason
to not take as much as you want. So, just reminding people
this is not necessarily pure. It’s not necessarily
good for you, and you can overdo it.
More is not necessarily better. Those are probably three themes
that people seem to want and need to be told
again and again about different supplements.>>Paul Coates: So, do you —
you’re kind of leading to something that
I was going to ask you about. You get reactions to your
stories, and do you then — does that lead to
a conversation with readers?>>James Hamblin: I wish it was
more interactive. I mean we sort of use
social media to try to make it not feel like you’re just proclaiming things
to people or decreeing. So, we were talking
about this earlier. There’s a lot of mistrust
of journalists right now. Like 12 percent
of Americans trust the media,
which is a term I don’t like. But the one group of people
who have made it their job to just simply
try to discern truth and convey it to people
are very mistrusted right now. And part of that
is this sort of elitism of just seeming like we know
exactly how the world is and is supposed to be. And I get that, so I try
to be interactive with people and be open-minded
and say what we know, and say what we don t know. And not try to be talking down
to people as the definitive source on exactly how much vitamin D
they should be taking or — but at the same time not
leaving it up to people to — not implying that
we don’t know anything.>>Paul Coates: Do you feel
you ve learned a lot from –>>James Hamblin: No, I mean
I m in it because I because I want
to just keep learning.>>Paul Coates: What are
the big messages for somebody like you?>>James Hamblin: Health of
communicating around?>>Paul Coates: Sure –>>James Hamblin: Yeah.>> Paul Coates: Of course
I’m interested in the supplement component –>>James Hamblin: Sure, sure. It s —
so, people I mean on so many — I think people are really,
really drawn to supplements because they offer
something that is — it helps them feel control. Most health solutions
are about control and making sense of something
that doesn’t make sense to you. Especially when
it’s a serious diagnosis. It’s very rare that someone
can be diagnosed with a cancer, and they could say,
Oh, yeah, well, that makes sense
that would happen to me. You know? And then you’re
just grasping for solutions and the medical establishment tends to be really rational
about saying, Okay, we can give you
this chemotherapeutic agent. There’s a 70 percent chance it will increase your lifespan
by this many years, and you’ll have
these side effects. And then you can also go
to the store and have something or read
something on some blog about something that seems
just absolutely perfect. Like almost no side effects,
relatively cheap, and it cured this
one person’s kid. So, they offer that sort of, even to rational people
who are science-minded, to just say, Yeah, I mean why
would I not at least try it. So, I don’t know. I guess I think a lot
about the the appeal of that. And then how to not rob people
of that effect by debunking it because I think
there’s value in that, but then also accurately
telling people you’re probably
wasting your money or possibly hurting yourself. You re possibly miss-focusing
your energy on something that is nonsense
as opposed to emphasizing the things we do know
that could be helping you.>>Paul Coates: You actually —
you used an interesting word there that I think we’ve used
in our own thinking about how consumers
approach dietary supplements. It’s to take a little
more active control of their own health. Sometimes it’s in the context
of maintaining health, and that’s a somewhat
different circumstance from somebody who is
seeking remediation of — you used a potentially,
you know, very strong — a poor outlook
for a disease state that’s not going to get
any better by itself. My words to convey
what you said. But for the most part its
consumers who are seeking health that are taking
dietary supplements. That’s not everybody. We know
there’s no everybody in here. But for those who were
taking dietary supplements as part of a healthy
pattern of health seeking behaviors do you
see them as a different
kind of audience from the ones
that you just described? Where they are maybe
actively seeking solutions to acute problems.>>James Hamblin: Yeah,
I think — and that’s probably
most people who are going
and reading New York Times general interest magazines
about the latest supplements. And whether they should be
taking a multivitamin. And whether something
is going to be, you know, helping them prevent
a heart attack later on. You’re not getting
as many people who are reading about
their specific condition. And that’s part
of the interesting thing about a general
interest magazine. You want things that are going
to be interesting to most people not just to people
with polycystic kidney disease. So, that’s who we end up
writing to most of the time. And you could almost
break it down further. Right? People who are just hoping
to maintain the status quo. And then people who are trying
to improve themselves. Like in the case of military
uses those are all supplements that are actually
making you better at performing or promising to
make you better at performing. And, yeah, it’s a simple idea
of maintaining status quo. It’s, again, very easy
to sell people on the idea that it’s harmless. It’s — you’re not spending
a ton of money. Worst case scenario
you’re flushing some vitamins down the toilet, and I also like
to remind the psychology that we were always
making trade-offs. And that we’re justifying
things to ourselves. And that when we do
take a multivitamin it likely changes our calculus on how healthy we need to be
in the rest of our lives. And this is mostly — I don’t have a study off
the top of my head, but I have a lot of anecdotes
of people who will think they can take
the multivitamin and eat pizza. And if they didn’t have
that multivitamin then they might have ordered
something healthier. So, we’re not exactly comparing
the exact same life plus or minus a multivitamin. It’s how does that change
the psychology of the user?>>Paul Coates: That’s
reasonable thing to say. I’m looking at the clock
only because I want — I have a feeling
that you may have stimulated some thoughts in our –>>James Hamblin: Oh yeah,
I’d love to talk about whatever anybody’s curious
about in journalism.>>Paul Coates: So, what I’m
going to do now is invite all three of
the panelists from this session Laura MacCleery, Todd Cooperman,
and you to hang out here and take some questions
from people in the audience. And then we will end the day
by having all six of you join us up front here and engage
in further discussion. So, thanks a lot James. [applause] So, we have an opportunity
to talk to these folks. First, I see Duffy
in the back with a question.>>Douglas MacKay: You ever saw
— from the media perspective
I’m always curious. You know, we do
our advertising review, and we try
to self-police there. And it’s often shocking
that reputable organizations will take terrible advertising that’s just clearly with claims
that are too good to be true, you know, promising things
that could not be substantiated. I’m just wondering do do
any of these newspapers do you ever hear them having policies
in place that says, you know, we should not just
take these people’s money we should vet
the claims a little bit?>>James Hamblin: Yes,
the critical thing about — you guys probably
mostly know this, but the structure of any
journalistic media organization is there s a thick firewall. We do not even share
any of the same space with people who have anything
to do with advertising. So, no journalist has any say
in any of the ads that go into our magazine
or onto our website. If we see something that seems
particularly egregious we’re welcome to file
a complaint or send it over to — but it’s a completely
separate area of the business. And it’s it’s meant
to be that way. And I know that they —
within Atlantic media they have standards
and don’t want to be misinforming people
with any ad content. I don’t know exactly
how those calculations are made at other places. We certainly wouldn’t run an ad
that seemed to be, you know, doing harm
for the world. But I’m yeah —
I guess the important takeaway is that I have nothing to do
with that and no journalist does. And a lot of people think
that’s or don’t understand that that’s the case.>>Paul Coates: Other questions
from the audience or perhaps do you have questions
for one another on the panel? There’s a lady in the back here. All the way in the back, yes,
and then the lady in front.>>Female Speaker: Yeah,
this question is also for James. What kind of sources
do you use? Do you use
responsible journalism like our PubMed and CINAL for some of your sources
when you’re doing a story, or do you —
what kind of sources do you use?>>James Hamblin: Yeah, I’m — certainly not
irresponsible sources. Yeah, so, I just finished up
my MPH actually. So, now I feel really good at vetting methodology
and statistics. I have statisticians on call who
I will try to vet studies for. I’ll try to, you know,
I have higher thresholds for going for studies
that are in bigger journals, but I’ve seen terrible stuff
published in JAMA and the New England Journal.
And you just try to — you know, I have a network of people
who I’ll send it to and be like, Do you have any time to look
at the methodology on this? Because probably I’m going
to write something in a day, and the people who can
give me a comment are not always going
to be available or always going to feel like they can really dig
into this study in order to say
whether it’s good or not. So, thankfully I’m able to do
a lot of that myself. And then the longer
reported things yeah. You dig into — I’ll spend a lot of time getting
to know one particular source and then find that they got
all of their funding, you know, on this study on biotin
from the Egg Council. And that’s going to cause
a lot of problems. So, it’s not just about whether
someone seems like they know what they’re talking about, but where’s their funding
coming from and how is that going
to appear to a reader. Yeah it’s extremely complicated. But the longer
you’re in journalism the more you get a good sense of
who’s trying to sell something, and who’s just trying
to do science.>>Female Speaker: Good.
One more thing, do you usually
put in recommended dosages that the American
Heart Association or the FDA would recommend for a specific
dietary supplement in your articles?>>James Hamblin: It’d probably
be a little too granular.>>Female Speaker: Okay,
thank you.>>James Hamblin: Yeah.>> Paul Coates: There was
another lady on the right-hand side
and then Naresh.>>Female Speaker: Hi, I’m a
psychiatric nurse practitioner and what drove me here was
my patients asking questions. And, like you all mentioned, I have no idea
how to how to answer them. But also what you mentioned
Dr. Hamblin that I’ve had supplement
companies approach me to sell their products online. And it seems unethical
to do that. I’m glad to have these
third-party organizations like ConsumerLab that I can now
refer patients to. But is there any ethical
implication or legal implication for providers
selling supplements?>>Paul Coates: Do you have any
thoughts about that folks?>>Douglas MacKay: It s
regulated by your state medical board, and it s different state
to state.>>Paul Coates: But do you have
any –>>James Hamblin: I mean
as a person who is — I would just find it —
anyone who’s recommending something that they’re also
selling it’s just really hard. It’s like not like
your car salesman can’t be honestly giving you
information about that car, but I wouldn’t trust them
as the definitive source on making — you know, are they really
telling you everything that you need to know?
I would definitely, you know, go talk to other car dealers
or other places, and read Consumer Reports, and find, you know,
more objective outlets before taking the recommendation
of someone who’s also
selling the product. Not to say it can’t happen
symbiotically.>>Paul Coates: Laura?>>Laura MacCleery: So,
you know, there is a legitimate role
for medical providers that are truly informed
about the efficacy research and the risks and medical
counterindications — right? — to know about
dietary supplements and to be able
to inform their patients. I think trainings like this
are great for filling in
some of those gaps, but to become a full expert on,
you know, everything the patient might ask you
would be a big job. And I think that level
of medical knowledge varies widely
among providers. That’s one end of the spectrum someone trying to provide
legitimate medical advice. Is it worth it to spend
your money probiotic for this medical condition? For example,
to mention something that we’ve done some research
on, you know, for vaginosis. There are some strains
that might be helpful, but in general probably
not worth your time and money as a sort of dietary
daily habit. But, you know,
more troublingly there are. so many examples
of diet books or doctors who are also essentially
running a supplement company and selling their name
as part of that. You know, there’s one
that hits my Facebook feed with real regularity. And the nutrition device
is wackadoo and the supplements
are like the third thing that they’re selling you. There’s one that
we’re looking into right now where there’s a guy
who runs a gambling hotline and basically does tele-
counseling for gambling addicts and then also sells
a line of supplements that are supposed to help
you stop gambling. You know? [laughter] So, there’s a —
it’s snake oil. Right?
It’s chicanery, and that sort of thing it’s been
going on for a long time. And it’s just unfortunate
that those kinds of practices are allowed to persist by a very loosey-goosey kind
of regulatory infrastructure. So, I think there’s
a range of things. And I think for those
that latter category there are real ethical questions
about whether the medical advice that they’re providing
to their sensible patients is in conflict with
their license and complications.>>Paul Coates: Todd did you
have any comments about this part of it? And others turn off
your microphones. Thank you.>>Tod Cooperman: Yeah,
not in terms of the legality of selling it. I defer to more experts
on the law there, but we do test those brands
also, the professional brands. They do tend to be higher
quality not guaranteed though. We do find problems
from time to time. They are a lot
more expensive also. So, I mean as a physician I would I think it’d be better
just recommend something that you know is good
and inexpensive, you know, then something
that might be good and expense. So, that just
my two cents on that. I would say also the multi-level marketing companies
that are out there. The Nutralite, Amway,
USANA similarly the product the products
tend to be higher quality there, but also just, you know,
a lot more expensive.>>Paul Coates: Naresh?>>Naresh Chand: Dr. Hamblin,
you look young M.D. are you taking
any supplements? [laughter]>>Male Speaker: I wondered
when a question like that would come.>>James Hamblin: I’m
thirty-five actually.>>Naresh Chand: Okay?>>James Hamblin: No, I don’t
— I don’t take any,
any myself, but I — yeah, I’m fortunate to have
access to a good food system [phonetic sp].>> Paul Coates: Good answer.
Yes, next to Naresh. Yep.>>Female Speaker: So, this
question is for Dr. Hamblin. So, I was raised in an area where people don’t really
trust science very much. So, I get a lot of questions when I go back
to visit my family about why science
keeps changing. Like they read coffee’s good
for you one day coffees bad for you another day. And as a researcher I understand
why that happens, but what do you think
the role of the journalist is in trying to put
the information that they’re communicating
in terms of the whole picture of what’s been happening
in the past and research.>>James Hamblin: This is like
my favorite question. I’ve written about this
a few times with one story called New Nutrition Study
Changes Nothing. Which kind of gets into this
like extensively, but there is — there’s a problem of the problem
of the news cycle. Everyone wants something new.
Everyone wants to be talking about whatever
the thing is today, and the editors and writers
have to come in and have something new. And a good story is something
that changes your perspective. Right? That challenges
what you already thought. No one needs
to be told again, Oh, also probably
drinking water is better than drinking soda, yet again today.
Right? We need something new.
Then the news story would be, Drinking soda,
not as bad as you thought. You know, maybe you don’t
need to be running. That is something
that’s just a good story. That’s interesting. So, how do you square that
with actually being the fact that science moves like there
is slow twists and turns to it but not something
that’s going to engage like the whole big
general interest audience. So, you can find lots of other
ways to make stories interesting and good than trying
to completely change someone’s world view. Which is to highlight
an element of it that people
don’t know enough about, trying to highlight
the personal stories behind it, trying to make it funny
or entertaining in a way that’s not
necessarily over-promising or scaring people,
and definitely not misinforming. Yeah, I could go on and on, but that’s a main job
of what I think the main thing I think about our job
as being is contextualizing. It s like I’m going to tell you
about this new study that everyone’s talking
about today, and I’m going to put it in the
context of 30 years of knowledge which have been building
to this point. So, this is not
taken in isolation.>> Paul Coates: Other
questions? Mary you had your –>>Mary Hardy: I had
my microphone on. This is a good lead-in
to something that I find challenging
as both a performer of research, as a provider
counseling patients, and as a person making
my own individual choices. It seems to me
that there’s a taxonomy or just what I could describe
as a typical arc of a story for a dietary supplement. And the first time
it comes up it’s terrible; it’s wonderful, brilliant. You’ll find people
who are cured of something. Then they look
for a new story is — after that’s not
a new story anymore. Then you start to see
that negative stories come. It’s caused this much harm;
it’s terrible. So, I guess what I’m asking
about is this bias or over interpreting
both in the positive side but also in the negative side? And I published something
in the New England — I mean in the JAMA years ago. And when we looked at the
consumer extract from our study it left out a huge part
of our results. It only wants to talk
about the negative results, and I’m finding
that challenging that, you know, the assessment of risk
is risk versus benefit, risk versus opportunity,
and the personal choice. How would you address that? All of you in the work
that you’re doing? Keeping both ends
of the spectrum alive without over exaggerating
either one.>>Laura MacCleery: So,
this issue that is — that’s a like a wonkier version
of the last question in a way. It’s sort of, you know — and I think it it comes up
with dietary supplements. Or, as I said I — you know,
there’s a lot of magical thinking people
want to believe that, you know, this cinnamon that
tastes good on their pop-tart is actually doing something really beneficial
for their health. But it also is magical — there’s a lot of magical
thinking nutrition. Right? So, there’s all these trends
and diet fads and also thinking. And, really, as Dr. Hamblin
implies dietary advice hasn’t changed much
in the last 40 years. It’s basically, you know,
eat more vegetables eat, more whole grains, don t — avoid salt, sugar,
and saturated fat. And you’ve had a fight maybe over defining
fat more precisely. But there isn’t sort of a — there’s a lot of savvy
among brands and among food manufacturers and among dietary
supplement manufacturers about how to create
that kind of mental permission for someone to go and take something that’s just
a little bit better for them and think of it
as a health food. So, you know, the example
that I always use veggie sticks. You have these little
potato sticks. And now when I go out
to birthday parties for my seven-year-old
they’ll show up at the party because they’re — they wouldn’t put a bowl
of potato chips there, but there’s like a picture
of spinach on the front of the package. And there’s like
a dusting of spinach. And they’re sort of greenish. So, now everyone can eat
the veggie sticks. It’s because we want to eat
the potato chips. You know? But we want to also
feel healthy. So, there there’s a brilliant
sort of exploitation of that, and then there’s the rebound
effect that was talked about where, you know, you eat
something healthy and you think, Oh, I could indulge
a little bit more. So, if I have
my vote multivitamin how does that affect
my overall diet quality? >>Paul Coates: This might —
I’m sorry to interrupt you, but this might carry over
a little bit into our broader discussion. So, what I’d like to do
at this point is to thank and congratulate our speakers
from this panel and then invite
our other panelists from the previous session
to come on up. And we’ll re-engage in
some more discussion. Thank you. [applause]

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