Dr Pieter Cohen is scanning the shelves inside a shop in Chinatown here when something familiar — and potentially dangerous — catches his eye.
“What’s that yellow box, behind the other one?” Cohen asks the clerk.
It is Pai You Guo, a supposedly natural weight-loss supplement from China that, according to US federal authorities, has tested positive in the past for containing two hazardous drugs, including a suspected carcinogen. The product was recalled in 2009. One of Cohen’s patients in the Boston area ended up in the hospital last year with a range of ailments after taking Pai You Guo (排油果), a brand-name that, loosely translated from Chinese, means “the fruit that eliminates fat.”
But he has seen worse: kidney failure, heart problems, depression, addiction — all, he says, caused by tainted products sold openly as dietary supplements in shops across the US and on the Internet.
“My patients are being harmed by this,” says Cohen, an internist at the nearby Cambridge Health Alliance and an assistant professor of medicine at Harvard Medical School.
Marketing drugs in the guise of supplements is illegal in the US. Tainted Pai You Guo is just one small part of that global business. Federal authorities are struggling to identify and intercept these black-market goods, which, they warn, pose grave health risks.
The makers of legal dietary supplements — the kind found at GNC, for example — acknowledge that they are reluctant to raise too many alarms. Even though there is little evidence that many dietary supplements provide real health benefits, legal supplements, from multivitamins to ginkgo biloba, are a big and growing business. Americans spent US$28.1 billion on them last year, up from US$21.3 billion five years ago, according to estimates from Nutrition Business Journal, a market research firm.
Many millions more are also being spent annually on black-market products, particularly those marketed for weight loss, bodybuilding and sexual enhancement. Some of these products, according to the FDA, contain amphetamines, synthetic steroids, laxatives and compounds like the active drug in Viagra. Officials say such products can cause heart attacks and strokes, and can damage the kidneys and liver. A few people in the US, they say, have died after taking them.
Industry representatives say a vast majority of supplements are safe, and they fault regulators for failing to stop the influx of illegal products from places like China. But few seem willing to tackle the problem openly. Unlike, say, the fashion industry, which has lobbied for increased regulation to combat knock-off products and has vociferously publicized the issue, the supplement industry is at best waging a whisper campaign.
“We walk a fine line,” says Steve Mister, president of the Council for Responsible Nutrition, a trade group in Washington that represents supplement manufacturers and ingredient suppliers. “We want to protect consumers, but we also don’t want to alarm consumers so they stay away from the whole marketplace.”
Mister says legitimate manufacturers ensure product safety. Under federal law, supplements are defined as products that contain only supplemental dietary ingredients, like vitamins and minerals. People who knowingly make or distribute products spiked with drugs, he says, are outliers. His group recommends that people buy nationally recognized brands — like Centrum, One A Day and Nature Made — from its members and avoid those that make miracle claims.