Aug 04 2008

There’s Drugs in Those Drugs

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Comments: 24

My beef with herbal concoctions is not that they cannot work (like homeopathy or therapeutic touch) but that they are not properly regulated. Herbs contain chemicals that can have a pharmacological action in the body, can alter metabolism, have toxicity, and can interact with other drugs. In other words – they are drugs. They are simply not purified and quantified, and most countries do not require testing for herbs similar to pharmaceuticals. So they are unreliable drugs.

But another dirty little secret of the supplement industry is the occasional use of actual known drugs in supplement preparations to give it a real and quantifiable effect. The most common example of this are diet supplements, which commonly contain stimulants. I recently surveyed all the diet supplement products at my local grocery store and almost all of them had some form of caffeine as a major ingredient. It used to be common for such products to contain ephedra (another stimulant) – until it was banned by the FDA for causing cardiac deaths.

Last week Canadian news agencies reported about the death of trucker Michael Berggren, who fell asleep at the wheel. Routine blood screening turned up estazolam – a strong and addictive sedative in the benzodiazempine class of drugs (the same class as valium). Estazolam is not commonly sold in the US or Canada so this presented a bit of a mystery. It turns out that Berggren was likely getting the drug, unknowingly, in an herbal supplement he was taking called Eden Herbal Formulations Serenity II Pills.

It turns out that Health Canada has already pulled three herbal products for containing this same drug. Several products, mostly sleep aids, that were ultimately coming from manufacturers in China were found to contain estazolam, and were mostly being sold through acupuncturists or other purveyors of Traditional Chinese Medicine (TCM).

It turns out that the tradition is China is to put real known pharmaceuticals in their herbal remedies. When American investigators went to China to look into the claims of acupuncture anesthesia what they found is that they were putting morphine in the IV fluid. I guess it’s always a good idea to hedge your bets. This fact was not being hidden – it was openly admitted. It just didn’t occur to anyone that the acupuncture might be superfluous.

Prior to the FDA there was a tradition of putting known drugs into patent and herbal medicine in the US as well. The preferred drug for patent medicines was alcohol. The marketing strategy was clear – put some cheap and (hopefully) harmless ingredients in a bottle, along with some alcohol. It doesn’t really matter what else is in there. Then make up some health claims that will sell to a broad customer base. And include some alcohol so that people will feel a positive effect when they take the product.

The softdrink, Coke, actually once did contain cocaine.  This may seem strange now, but originally soft drinks were not sold as everyday beverages but as health tonics. That is why some drinks have survived with names like Coke, Ginger Ale, and Root Beer – they were herbal products. They were sold and consumed for their presumed health benefits, and like the herbal supplements of today sometimes contained real drugs – you know, something to give it a little kick. Soft drinks did not come to be consumed as beverages until after home refrigerators became common, and the grocery stores started selling 6-packs that could easily fit into those refrigerators.

Coke is now considering marketing Coke with herbal supplements – returning full circle to their roots as a purveyor of health tonics.

The common thread in all of this is deception in advertising. Herbs are consumer friendly, can have the label “natural” placed on them – which is marketing gold, and are generally not regulated or poorly regulated. Drugs, on the other hand, are tightly regulated and have a more complex image with the public. By surreptitiously putting some known drugs into an herbal remedy – you get the best of both worlds. That herbal sleep aid from China actually works because there is a powerful sedative in there.

The danger, of course, is that the consumer does not know what they are getting. They may become addicted, or may have dangerous interactions with prescription drugs. There is still an ongoing investigation as to whether or not Berggren’s death was caused or contributed to by the estazolam he did not know was in his supplement.

I am all for researching and marketing herbal drugs and even true nutritional supplements. I simply favor the honesty and transparency that we expect from science and other sectors of health care. Rather it seems that the patent-medicine hucksters of old have found a way to come back. They have had their revenge against the FDA and government regulators. We have come full circle – it’s 1900 again.

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24 responses so far

24 Responses to “There’s Drugs in Those Drugs”

  1. [...] Read the rest of this entry at the “Neuorologica” blog. [...]

  2. JustinWilsonon 04 Aug 2008 at 9:45 am

    Honesty, it would be nice to have a little of that stuff in all forms of marketing and every day life. But, honesty doesn’t sell. I remain hopeful that people are smarter than the statistics say they are and they can read between the labels in advertisements.

  3. weingon 04 Aug 2008 at 10:07 am

    That reminds of the herbal arthritis meds from Mexico that were found to have dexamethasone added just for good measure.

  4. arbitrary.markson 04 Aug 2008 at 11:58 am

    This makes me think of a parallel situation. Claims of religion’s benefits often overlook the fact that “there’s drugs in those drugs”–that religious organizations involve social activity and support, something which is generally good for people. It isn’t that being *religious* benefits you intrinsically, but being socially connected does.

    Like the herbal anesthesia which has morphine, the belief in the supernatural, the rituals, etc, are superfluous to the benefits delivered.

  5. Fifion 04 Aug 2008 at 12:12 pm

    arbitrary.marks – “Claims of religion’s benefits often overlook the fact that “there’s drugs in those drugs”–that religious organizations involve social activity and support, something which is generally good for people. It isn’t that being *religious* benefits you intrinsically, but being socially connected does.”

    Good point and something I’ve often wondered vis a vis some CAM treatments. For instance, I wonder how much a homeopath sitting and listening to someone’s symptoms and woes for an hour has to do with them feeling “cured” or better afterwards since it’s essentially active listening with a – albeit unconscious and untrained – therapeutic aspect. Ditto gentle physical touch, it’s soothing (unless someone has neurotic issues about being touched) which, if someone’s “symptoms’ are merely a manifestation of anxiety, would help assuage the anxiety (hardly magic!). That said, I personally think that people who need therapy would be better off with a trained therapist who is conscious of what they’re doing and trained to provide psychotherapy than a CAM practitioner who already has issues distinguishing fantasy from reality.

  6. saraGon 04 Aug 2008 at 12:36 pm

    Is the problem marketing or that most people can’t read labels themselves and/or are reluctant to take responsibility for their medical care? Protecting the public needs to go hand-in-hand with educating them.

  7. Fifion 04 Aug 2008 at 2:10 pm

    saraG – The problem is a combination of things.

    1. Poor consumer protection laws around vitamins and supplements in Canada and the US (partially due to intense government lobbying and public disinformation campaigns).

    2. These inadequate laws mean that what’s claimed on the bottle or in advertising may not be true – so people can’t reliably know what’s actually in what they’re taking. This removes the public’s ability to make an informed choice.

    3. This is big business so there’s lots of money spent on advertising campaigns, and propaganda/advertising is often presented as a gras roots campaign (when it’s actually astroturf) or a neutral “medical” body that promotes science-based medical practices when they do quite the opposite (particularly prevalent in terms of promoting supplements, some of these actually operate as non-profits even though it’s easy to follow the money).

    4. Poor regulation of industry in China and outright corrupt practices like adding melamine to protein to make it look like it contains higher levels of protein (as was the case with pet food). Add in increased trade with China and that China has essentially become America’s manufacturing agent (without the environmental and health safety safeguards – or worker protections – that are mandatory in America and Europe), and you’ve got way more Chinese products coming into Canada and the US. (China is perhaps even more significant as a trading partner for Canada than for the US.)

    Overall, this is sneaking pharmaceutical drugs into “natural” herbal preparations so outright fraud on all levels.

  8. Ribozymeon 04 Aug 2008 at 5:13 pm

    Talking about herbal remedies, I just noticed it is you “enjoying” one on the right of the picture in last month’s Scientific American, in Michael Shermer’s column. At first I didn’t know it was you (you aren’t identified by name), but the face (not one of your best!) kept looking familiar.

  9. Steven Novellaon 04 Aug 2008 at 6:25 pm

    Yep – that’s me. The body of the article does mention who is in the picture. That wheat grass juice was simply awful.

  10. HCNon 04 Aug 2008 at 9:27 pm

    saraG said “Is the problem marketing or that most people can’t read labels themselves ”

    But what about “herbal” remedies that don’t list all of the ingredients?

    What I read about the trucker in Canada was that herbal remedy contained a very strong prescription tranquilizer that was NOT on the list of ingredients. In the article I read his wife said that he was trying to use natural herbs and avoid dangerous drugs. From the article linked to above: “And how did a rare, powerful sedative come to be in the body of a fit 55-year-old northern Alberta health nut, ”

    How was he supposed to know he was ingesting a strong drug if it was not listed?

  11. saraGon 04 Aug 2008 at 10:46 pm

    Agreed – it definitely is a problem is ingredients are not listed. But sometimes label reading would help (e.g., caffeine in diet aids) and, once labeling is better for agents included and not prohibited, you are going to have to read the label.

  12. [...] From Around The Blogosphere 8.4.08 The hidden drugs in supplements and Coca Cola maybe returning to the woo in which it came -Last week a trucker, Michael Berggren, fell asleep at the wheel. Routine blood screening turned up [...]

  13. HCNon 05 Aug 2008 at 3:04 am

    And if we all believe very very hard in fairies, then Tinker Bell will get better!

    So if we all believe just as hard, the “herbal” remedies will not have any real unlabeled prescription drugs. All we have to do is wish the fraud away!

  14. deciuson 05 Aug 2008 at 4:32 am

    arbitrary.marks

    The same simplistic defence of religion that you attempted could apply to a number of organisations which entail extensive social ramifications and form a network of mutual support for their members.

    Here are just a few: the Italian mafia, the Young Pioneers of North Korea, the Hitler Jugend.

  15. Fifion 05 Aug 2008 at 8:45 am

    decius – Was it a defense of religion? I guess I didn’t see it that way, I just saw it more as an observation about one of the reasons people are into religion. No doubt people get a sense of belonging from being part of the Mafia (Italian, Irish or Moroccan, everyone’s got one), The Glee Club, Aryian Brotherhood, The Masons, being part of a certain profession, etc…not to mention nationalism as a means to whip up a sense of belonging/us. Needing to feel part of the/a tribe or family, having a place and purpose, are pretty fundamental human needs. I’m not saying every way of filling that need is equally constructive (or that churches, the mafia and the Aryian Brotherhood don’t manipulate people through their need to belong), it’s just worth understanding why people are into something and what purpose it serves for them. It’s pretty clear to me that most CAM treatments serve a purpose (or purposes) for people, just as religion does – it’s not just a matter of everyone else being stupid rubes.

    I’m curious, would you consider feeling better after an hour or a course of psychotherapy to be a placebo effect?

  16. daedalus2uon 05 Aug 2008 at 10:21 am

    Fifi, I do consider the effects of psychotherapy to be due to the placebo effect. I don’t consider that to be a bad thing. I say that as someone who has been on the receiving end of psychotherapy for many years.

    Good psychotherapists (the only ones I am familiar with) don’t lie to themselves or to their patients about what it is that they are doing. They don’t have mystical woo-mediated CAM that they are pushing.

    There are many different theories of psychotherapy, many different styles, many different schools. They all seem to “work”, the physiology behind how it is that they do work remains unknown. I think it has to do with the neurogenic production of NO mediated through socially activated pathways. Those pathways have to be reconfigured to change the neurologically mediated behaviors that are the focus of the therapy. The only way those pathways can be reconfigured is by using the brain’s own mechanisms to do so.

  17. superdaveon 05 Aug 2008 at 4:26 pm

    decius I refer to you to logical fallacy number “8. False Continuum The idea that because there is no definitive demarcation line between two extremes, that the distinction between the extremes is not real or meaningful: There is a fuzzy line between cults and religion, therefore they are really the same thing. “

  18. arbitrary.markson 05 Aug 2008 at 4:34 pm

    decius, it wasn’t a defense of religion, no, it was an observation. (You can read my own blog to see whether you think I am the kind of commenter who’d put up inane comments defending “religion” simpliciter.)

    That said,
    1) I’d grant you your point about the Hitler Youth, etc., not because I think those organizations ought to exist, but that there’s a similar effect that can go on there, too. (Why else would they exist and be seen as beneficial from those participating? Social cohesion is one reason.)

    2) As to the “simplistic” charge – I’ll admit that the description of the effect was a simple analogy. That doesn’t mean that the effect itself is “simplistic.” As superdave points out, understanding what religions are in the first place is an important subject. Second, disentangling what it is the cause of a set of purported benefits isn’t straightforward.

    There are lots of different studies you can find in peer-reviewed journals saying what I did in fancier language, if you’d rather :)

    (Long-winded way of saying, I’m not an anti-skeptic troll, if that’s your complaint!)

  19. dinamoeon 05 Aug 2008 at 5:03 pm

    Hi everyone,

    Great discussion. The supplement L-Theanine is an amino acid derived from tea and touted for stress relief in health food shops. As a non-scientist I find this a particularly interesting one because it’s derived from a plant that I’ve already got a lifelong addiction to… Apparently in Japan this stuff is regarded as very safe and available in chewing gum! Now I understand that just because tea is safe, it doesn’t follow that an extracted substance is safe… But what level of risk are we talking about here, and what kind of controls are reasonable? I think a typical pill is the equivalent of three cups of tea (i.e. my normal breakfast intake).

    Cheers,

    Paul

  20. deciuson 06 Aug 2008 at 2:39 pm

    arbitrary.marks

    Thanks for your clarification and I will briefly address your comment, as I am deluged with work, atm.

    Let’s take this right off the table: I had perfectly clear that you are not an “anti-skeptic troll”, don’t worry. :)
    My concern was that you fell for a dubious way of evaluating the impact of religion on society.

    I didn’t know the paper that you linked, but I am familiar with a variety of studies, which narrowly focus on a single aspect associated with a complex social phenomenon or with a belief-system, and hastily draw up general conclusions. Inevitably, such studies end up waved around by religious apologists and advocates for dubious ideologies.

    Since we both agree that identical beneficial effectsresult from aggregating people in a cohesive social network – be it secular or religious in nature – you will concede that it is disingenuous, to say the least, to single out a religious organisation and credit religion with such an effect on its members. In fact, it would be a case of forcing causation where only correlation could be inferred.

    However, the abstract of the particular study that you indicated concludes by saying “in light of the cross-sectional design used in the present study, and given that religion may have both positive and negative consequences further research is needed to determine the extent to which promoting religiosity may increase or alleviate distress”. This, to me, appears to further validate my point , if anything.

    Whatever its conclusion, what do you find more relevant to the well being of HIV/AIDS patients?
    The fact that they may find comfort with religion, or that the same religion is wilfully responsible for helping spread the virus with genocidal effects, by demonising the use of condoms, promoting idiotic doctrines of abstinence, and opposing sex education?
    The paper specifically mentions Baptist and Pentecostal denominations, both actively perpetuating this egregious medieval stupidity. Now, do we really have to admire the executioner for furnishing the guillotine table with a comfortable pillow?

    Superdave

    Sorry, but you missed my point. I hope that my answer to arbitrary.marks helps clarify what I meant and failed to convey in my previous post.

    Fifi

    Psychotherapy is not a topic that I feel qualified to comment upon, sorry.

  21. Fifion 06 Aug 2008 at 3:30 pm

    decius – Fair enough! I brought it up because it seems to me (subjective hypothesis alert!) that some of the perceived “benefits” of CAM therapies that involve hanging out with someone who’s listening intently to you for an hour or so about what ails you seems pretty equivalent to calling a help hotline or bending a good friend’s ear, or therapy if the “healer” is particularly insightful. I’m not suggesting it’s actually as useful as psychotherapy (and it’s a rich ground for unconscious transference and counter-transference so potentially more problematic than helpful) but I do suspect this is part of the attraction for people and part of what the subjective perception of “feeling better” is based upon.

  22. deciuson 06 Aug 2008 at 3:48 pm

    Fifi

    That seems entirely reasonable.

  23. Joeon 07 Aug 2008 at 12:31 pm

    Regarding Dr. Novella consuming wheatgrass. Around ten years ago comedian Andy Richter (of the Conan O’Brien Show) went to a health expo in New York City. There, he encountered wheat grass. The purveyor told him that dogs are smart-enough to eat grass when they don’t feel well. Without missing a beat, Richter responded that they also eat out of the cat’s litter box …

    I think that about sums it up.

  24. [...] right – herbs are drugs. It’s as if Kaufmann has been reading this blog. Actually, this is a reality that should be obvious to any medically trained person, so I hardly [...]

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