This is a depressingly old scam – centuries old. Snake oil is marketed to the public with whatever image is considered fashionable at the time, although the “natural and wholesome” image is most common. In the 19th century there were many elixirs and tonics that claimed to be not only “natural”, but derived from either exotic tropical locations or the wisdom of native cultures.

But at the same time these products included ingredients that were known powerful drugs. Alcohol was common, but narcotics and cocaine were also used. In the US the FDA ended the patent medicine industry and marginalized this practice, but the Dietary Supplement Health and Education Act (DSHEA) of 1994 has brought it back. The modern deregulated supplement industry is a recapitulation of the patent medicine industry of a century ago.

Now we have supplements, including weight loss supplements, that claim to be herbal and “all natural” that are secretly cut with pharmaceuticals, some of which are illegal drugs. A recent analysis of 81 weight loss supplements marketed in Hong Kong found that 61 of them contained two or more pharmaceutical agents, and two supplements contained six different drugs.

These drugs include those marketed previously for weight loss, but removed from the market (at least in the US) because of unacceptable risks. The most common was sibutramine, a weight loss drug recently removed from the market because it increased the risk of heart attacks and strokes. Another is fenfluramine (remember Fenfen), also now removed for side effects.

What was not specifically stated was the inclusion of caffeine or caffeine derivatives or other stimulants that are not pharmaceuticals. Stimulants are included to give the feeling of having more energy, and also to stimulate activity in order to promote weight loss (not a good long term strategy). But again, they are just other forms of drugs, and are not entirely safe.

An example of this is ephedra, which was eventually pulled from the market by the FDA following over a hundred deaths attributed to this stimulant. Ephedra was included in “natural herbal supplements” for weight loss because it is a strong stimulant. The marketing deception is the same – ephedra is a drug, but those buying products containing it thought they were getting something more safe and gentle than a drug, or that “supplements” somehow work through their effect on nutrition.

Also – don’t think this is a problem isolated to Hong Kong or not a problem for the US. US regulations and enforcement do not adequately protect the public from this type of adulteration. As quoted in the news report:

“This is exactly the same issue that we’re faced with here,” said Dr. Pieter Cohen, a general internist at Cambridge Health Alliance and an assistant professor of medicine at Harvard Medical School. Cohen said that due to their surveillance procedures for drugs, researchers in Hong Kong are “often on the vanguard of identifying problems.”

Even when not adulterated with pharmaceuticals, weight loss supplements are not a good idea. There is no evidence to support their efficacy and they are inadequately tested for safety.

Conclusion

There really is no meaningful difference, in my opinion, between the modern supplement industry and the patent medicine hucksters of the 19th and early 20th centuries. The marketing hype is similar, as is the ploy of mixing in some actual drugs. The entire concept of “herbal supplements” is flawed, as herbs are just another form of pharmaceuticals.

But the supplement industry has pulled off a spectacular scam, with help from their influence in Washington, most notably embodied in DSHEA. They have also successfully blocked efforts to refine DSHEA to give consumers more protections. The interests of consumers have been sacrificed to corporate self-interest and the public has largely just said, “thank you” because they have so thoroughly bought into the marketing ploy of the industry.