Supplements: Government-Approved Dope, a Chapter from Spitting in the Soup

nutritional dietary supplements 800x600 SOUP

Chapter 16:  Supplements: Government-Approved Dope

by Mark Johnson

In 1812, typhoid fever ravaged the rural valleys of New England. In New Hampshire, a fever-stricken 6-year-old boy named Joseph Smith suffered sweats, chills, and diarrhea. Then living with his five siblings and parents, Smith escaped typhoid’s grasp after two weeks of delirium. Eighteen years later, Joseph Smith Jr. went on to found the Church of Jesus Christ of Latter Day Saints. His early brush with death and doctors helped make herbal medicine and self-healing integral to Mormon scrip­ture and life. A chain of events was set in motion that led to the birth of Utah’s $7 billion nutritional supplement business, unconditional government protection of that industry under the watch of a devout Mormon senator, and the U.S. Olympic Committee’s decision to accept funds from an industry that the IOC and the World Anti-Doping Agency had categorically rejected as poisonous to sport.

Although Smith survived typhoid, his childhood medical troubles had only begun. The typhoid infection ended up spreading to his bone marrow—a septic condition we now call osteomyelitis and a common side effect of typhoid in children. Summoned from Dartmouth College, the lead surgeon from a team of doctors confessed, “We can do nothing.”

Only leg amputation would save Joseph’s life. His mother, Lucy, pro­tested, demanding that the physicians instead attempt to remove the rotten sections of her son’s bone.

Lucy’s diary recounts what followed: “The surgeons commenced operating by boring into the bone of his leg, first on one side of the bone, where it was affected, then on the other side, after which they broke it off with a pair of forceps or pincers. They then took away the large piece of the bone. When they broke off the first piece, Joseph screamed out so loudly that I could not forbear running to him.”1 Remarkably, the boy survived both the surgery and the removal of 14 more pieces of bone that broke free in the following three months. Three years of recovery in bed and on crutches followed, and the Mormon founder walked with a hitch for the remainder of his life.2

Two other family dramas dimmed Smith’s view of modern medicine. His sister Sophronia was stricken by typhoid, and after 90 days of ill­ness, doctors said her death was imminent. With the defeated doctors packing their bags, Mormon lore has it that when Lucy clutched her daughter, the girl miraculously recovered.3 Where modern medicine failed, the parents believed prayer prevailed. Then, in 1825, Joseph’s brother Alvin was stricken by “bilious colic” the day’s term for what was probably a ruptured appendix. A physician administered a heavy dose of calomel, or mercury chloride, an all-purpose drug of the period. At a time when bloodletting and purging were go-to medical treatments for many human ailments, mercury chloride was thought to purge the body through violent vomiting and diarrhea. It cured you or killed you. After three days of suffering, Alvin died, most likely from calomel poisoning.

These sour experiences with orthodox medicine attracted Smith to the teachings of a New Hampshire herbalist named Samuel Thomson. Known as America’s foremost “botanic physician,” as one supporter put it in 1839, Thomson knew “the magnificent apparatus of the chemis­try of Nature.”4 Capitalizing on the great wave of evangelical revival meetings and camps that swept western New York and New England in the first quarter of the 19th century, Smith formed his church in 1830 and published its founding text, the Book of Mormon, the same year. Both Thomson’s do-it-yourself healing system and Smith’s homegrown church rode the Jacksonian spirit of the times, an anti-elitist world view that squinted suspiciously at monopolies and high priests, whether they be doctor, pope, or king. Where official doctors and monolithic religion so often failed, self-reliance and herbal healing would succeed.

In 1843, Smith told a Mormon congregation that doctors don’t know much. “They want to kill or cure you to get your money,” he preached. Reject modern medicine with its deadly potions and bloodletting cures, the Mormon prophet urged his flock. Instead of concoctions like cal­omel that “will kill the patient,” Smith admonished his disciples to “take some mild physic [purgative] two or three times and then some bitters [herbs]. If you can’t get anything else, take a little salt and cay­enne pepper.”5

Herbal supplements appear in the Mormon church’s founding texts, the Book of Mormon and Doctrine and Covenants, as natural cures essen­tial to divine living. Doctrine and Covenants explains that God placed herbs on Earth “for the constitution, nature, and use of man.” When followers of the Church of Jesus Christ of Latter Day Saints fall ill, they “shall be nourished with all tenderness, with herbs and mild food, and not by the hand of an enemy,” the text commands. Describing early Mor­mons who survived typhoid, the Book of Mormon recalls that “because of the excellent qualities of the many plants and roots which God had prepared to remove the cause of diseases,” Mormon ancestors thrived.

For Smith and his followers, using herbal medicine was an exercise in divinity, a component of the path to salvation. By the time Mormon pioneers settled in their promised land in the 1840s, “root medicine” was entwined with their faith in Jesus Christ—so much so that settlers took to using the term “poison doctors” to describe those physicians who practiced bloodletting and dispensed potions like mercury and opiates.6 Even today, the ephedra shrubs common to the southwestern United States and Mexico are known as Mormon tea for the early settlers who reportedly boiled their leaves and stems to make a beverage.

Joseph Smith also saw economic potential in herbs. In 1813, his homeopathic hero Samuel Thomson patented an herbal doctoring sys­tem, “Thomson’s Improved System of Botanic Practice of Medicine.” For $20 paid to a traveling agent, a family would obtain both Thomson’s instructional medicine book and the rights to administer Thomson’s botanical recipes. This early multilevel-marketing program offered both economic independence and the appeal of becoming one’s own physician. As journalist Dan Hurley puts it in his 2006 book on the sup­plement industry, Natural Causes, “Herbs, free for the picking, were all anyone needed. What could be more in keeping with America’s spirit of self-reliance?”7 These Thomson System agents were the predecessors to today’s herbal-supplement multilevel-marketing firms. By 1840, Thom­son had sold some 100,000 licenses—an astronomical take worth about $56 million today.

While growing up, Smith also endured economic privations he might not have suffered had his father not been swindled in an herbal-medicine trade deal. In 1784, a retrofitted Revolutionary War merchant ship named the Empress of China had opened trade between the United States and China. The boat’s payload on that inaugural 15-month voyage included 40 tons of ginseng, a root the Chinese treasured for its sup­posed sex- and vitality-enhancing powers. Chinese importers paid top dollar for New World ginseng. In 1801, four years before Joseph Jr.’s birth, Smith’s father had smelled opportunity. He collected masses of ginseng root from neighboring Vermont farmers and arranged for it to be shipped on the Empress of China for sale in Chinese markets. The deal was projected to yield a $4,500 windfall. Considering that Ver­mont farmland sold for about $2 an acre in the early 1800s, this was an extraordinary amount of money—enough to expand the family’s mod­est landholdings with plenty of cash left over for farm equipment and buildings. Smith Sr.’s ginseng made it to Canton and sold for a small fortune, but the shipping agent disappeared to Canada with the money, and Smith never saw a dime. The family had to sell the farm to pay debts related to the sour deal. Nevertheless, the financial and medical poten­tial of herbal remedies remained a family presence for the boy.

Although Smith met his end in 1844 in Carthage, Illinois, at the hands of a mob, his followers made their way west and eventually parked their wagons for good overlooking Utah’s Great Salt Lake. By the 1960s, the herbal medicine that steeped into Smith’s Mormon faith was being sold the world over by herbal and vitamin supplement outfits, many based in Utah like Weider, Nature’s Way, and Nutraceutical. The latter firm is a Park City–based supplement conglomerate formed by Mitt Romney’s investment firm Bain Capital in 1993. Also a Mormon, Romney would later organize the scandal-shaken 2002 Salt Lake City Winter Olympics and run for U.S. president in 2012. Many of the supplement firms that sprang up, such as Nu Skin of Provo, Utah, were multilevel-marketing companies that built their success on global networks of families and friends who sold products and the prospect of wealth to one another. These Utah pyramid sales enterprises were a Thomson System for the 20th century. Today, a quarter of the $36 billion U.S. nutritional supple­ment industry sales are funneled through Utah.8

By the 1990s, the salubrious sheen that had enhanced the dietary supplement industry was wearing off. In 1989, contaminated batches of the amino acid L-tryptophan sent at least 36 Americans to the grave.9 Touted as a cure for sleeplessness and anxiety, L-tryptophan supplements caused the crippling connective tissue disease eosinophilia-myalgia syn­drome (EMS) in some 5,000 people. Tests of other dietary-supplement products in the 1990s turned up arsenic, sheep placenta, and more sur­prises. When the California Department of Health Services tested 260 samples of herbal products from Asia, it found that 83 contained lead, arsenic, mercury, or drugs not on the label. When police pulled over an apparently drunk driver in Scottsdale, Arizona, it turned out that he had been poisoned by a nutritional supplement containing paint remover.

Six reports in the New England Journal of Medicine in 1997 depicted the behavior of an industry largely indifferent to the health of its customers. From a 15-year-old boy who was treated with herbs for the lymphatic cancer Hodgkin’s disease to a woman whose white blood cells were wiped out by a product that claimed it would clean her intes­tines, the Journal’s executive editor, Dr. Marcia Angell, stated that if the dietary supplement makers were held to prevailing safety and efficacy standards, “most of them would be shut down.10 In the process of con­ducting a tax evasion investigation on supplement maker Metabolife, the IRS discovered documentation showing that 5 deaths, 26 strokes, 18 heart attacks and 43 seizures had been attributed to its products.11

These were the sort of tragedies that had led to the creation of the FDA 90 years earlier. In 1905, journalist Samuel Hopkins Adams penned a series of articles for Collier’s magazine titled “The Great Amer­ican Fraud.” “Gullible America will spend this year some seventy-five millions of dollars in the purchase of patent medicines,” he wrote on October 7, 1905. This sum would buy Americans “huge quantities” of opiates, narcotics, “liver stimulants,” and above all, “undiluted fraud,” he added.12 In the series of articles, later published as a book, Adams documented how patent medicines and tonics made unverifi­able claims about their health-restoring powers, even though many of the “medicines” were in fact toxic. For example, headache medicines often contained acetanilide, a painkiller that, while powerful enough to temporarily alleviate pain, also caused heart attacks. “Fraud, exploited by the skillfulest of advertising bunco men, is the basis of their trade,” Adams fulminated.13

The potion makers took steps to deflect Adams’s criticism. They enlisted a crafty bit of economic blackmail to force newspapers to take their side in the brewing war against drug safety legislation. The curative makers added a “red clause” to their advertising contracts stipulating that the agreement would become void if a law passed restricting the sale of their patent medicines. At the turn of the 20th century, newspapers were packed with advertisements for life-enhancing nostrums; the elixir makers provided a reliable stream of advertising revenue. The red clause helped ensure that the newspapers were financially motivated to agitate against government food and medicine regulation. Newspapers met leg­islative rumblings about clamping down on patent medicine fraud with stern editorials defending consumers’ rights to self-medication, manu­facturers’ liberty to pursue unfettered free enterprise, and the evils of an overbearing government.

Despite these maneuverings, Adams’s “Great American Fraud” eventually helped push Congress to pass the Federal Food and Drugs Act of 1906. Signed into law by President Theodore Roosevelt, the legislation made it a crime to transport across borders or sell an “adul­terated or misbranded” food or drug. The law also gave the government the power to test foods and drugs to ensure the contents matched the ingredients on the label. In 1916, the act ended sales of Clark Stanley’s Snake Oil Liniment, an elixir supposedly made with oil from snakes and bursting with the capacity to “oil dry joints” and remedy sprains, bunions, sore throats, and dog bites. Americans had been snapping up this wonder salve since 1897. When government scientists tested Stanley’s product, they learned that it held little more than mineral oil and a bit of beef fat. The product was shut down and the supplement industry had a new nickname.14

For the first time, the U.S. government was committed to protect­ing consumers from unscrupulous food makers and drug manufacturers. In 1927, the execution of the act was centralized under a new federal enforcement body, the Food and Drug Administration.

According to the original Food and Drugs Act, nutritional supple­ments fell within the scope of the FDA’s responsibility. According to the law, drugs “shall include all medicines and preparations recognized in the United States Pharmacopeia or National Formulary for internal or external use.” The clause that followed seemed to put herbal medi­cines under the FDA umbrella as well, since it governed “any substance or mixture of substances intended to be used for the cure, mitigation, or prevention of disease of either man or other animals.” However, the potion makers found an ingenious rhetorical out by claiming that their products were not designed to directly target illness in the manner of chemical-based pharmaceuticals but rather were meant to supplement diet. Drugs target disease. Food and food supplements just provide energy. The difference was critical, and it opened a back door to the supplement industry we know today.

This dodge goes way back. For example, in the early 1900s, edible potions and pills infused with radiation became all the rage. Popular­ized after Marie and Pierre Curie’s discovery of radioactivity in 1898, the idea was that minute doses of radiation would trigger the endocrine sys­tem and fire up the production of bone- and muscle-building hormones. One advertisement encouraged Americans to get plenty of sleep, exer­cise, eat unprocessed foods, and “drink plenty of fresh, invigorating, natural radioactive water from the Radium-Spa.” In 1927, a champion golfer and horse-racing aficionado named Eben Byers died at 51. A big believer in what was then called “mild radium therapy,” Byers had con­sumed 1,400 bottles of a patented and widely available radiation-laced energy water called Radithor. Byers also watered his racehorses with the drink to boost their performance. By the time of Byers’s death, gaping abcesses yawned where his jaws and teeth used to be, and cavities bored through his skull. Because Byers was a prominent eastern businessman and socialite, his gruesome death by radiation poisoning attracted the FDA’s attention. The agency eventually shut down the Radithor busi­ness. Byers’s obituary in the New York Times mentioned an FDA warning “against ‘radioactive’ drugs because of serious injuries to users.”15

Despite harming consumers, the supplement industry thrived throughout the 20th century by sticking to the message that its products were either food or a food additive—a mere spice, so to speak. Supple­ment maker and retailer GNC was a notorious offender. In 1984, the U.S. Postal Service brought charges against GNC for falsely represent­ing the healing powers of 13 products including “Risk Modifier,” “Life Expander,” and “Mental Acuity Formula.” That same year, the FDA prosecuted GNC for selling an evening primrose oil supplement as a cure for high blood pressure, multiple sclerosis, and arthritis. When reminded of these cases in a 1992 deposition, GNC CEO and chairman of the board Jerry Horn argued that while his company did sell pills, they were really “a food—it’s a food product.”16

Horn went on to describe an L-tryptophan pill as a form of suste­nance: “You know, like broccoli, you might buy broccoli in a pill form.” The deposing attorney poked at the CEO’s claim with a taunting query: “When people are thinking about taking an L-tryptophan pill, they’re not going to sit down and try to figure out which wine goes with it or anything like that?” The deposition was over a lawsuit regarding the contaminated batches of L-tryptophan that had made their way into supplements. The tryptophan caused a rash of hospitalizations for the incurable EMS. By July 1990, 27 of what would become 36 people had died and 1,531 EMS cases had been reported in the United States.17

With store-bought supplements killing or disabling alarming num­bers of Americans, in 1990, Congress finally took a harder look at the industry and its propensity to make drug-like claims outside the reach of the FDA. After two years of investigations, an FDA task force rec­ommended that many supplements with supposed therapeutic powers should be placed under the agency’s control and that the FDA should test the products’ health and curative claims before they could go to market. The 1991 proposal would hold vitamins, minerals, and herbs to the same standards as other FDA-regulated medicines.

Threatened by accountability, the supplement industry had a fit. When you traffic in snake oil, the last thing you want is a federal chemist testing the purity and efficacy of your potion. With the dietary supple­ment industry and the lawmakers on its payroll spinning the FDA proposal as an example of jackbooted federal forces trampling sacred constitutional rights, retailers urged customers to tell Congress to halt the looming clampdown on American freedoms. Health food store handouts warned customers, “Write to Congress today or kiss your sup­plements goodbye!” Stores kept notepads on display for customers to jot angry missives to their representatives.18

Longtime Utah senator Orrin Hatch managed to put a moratorium on the proposed FDA regulations until March 1993. A Mormon raised on Joseph Smith’s scriptures, Hatch had sold vitamins as a boy and claimed he used them every day. Utah’s supplement industry leaders were reliable contributors to Hatch’s election coffers, and the stalling tactic bought time for Hatch to introduce a law that protected the sup­plement industry from FDA busybodies. The law was called the Dietary Supplement Health and Education Act (DSHEA). Hatch pressed his case for this supplement-industry protection act in a series of congressional hearings in July and October 1993. In July, he told a House of Represen­tatives subcommittee that just as the FDA does not prohibit people from eating foods that are high in fat, cholesterol, or sugar, “so it should not attempt to impose unreasonable and unnecessary regulations on dietary supplements that many consumers want.”19

Aligning himself with the 100 million Americans he claimed also used supplements, at an October 21, 1993, hearing Hatch testified that he had personal skin in the game. “I really believe in them,” he said. “They make me feel better, as they make millions of Americans feel better. And I hope they give me that little added edge as we work around here.”20

Reaching to herbs and vitamins framed Hatch as a traditionalist, a regular family-values guy following in the footsteps of his Mormon ances­tors. “For 4,000 years, nutritional supplements have complemented the daily diet,” he stated. And that was a heritage worth saving, a legacy of benefits “passed down from generation to generation.”21 Even though the 36 people killed by contaminated L-tryptophan supplements had tombstones testifying otherwise, Hatch argued that supplement makers should be trusted with the “primary responsibility to self-regulate and to assure the public of the integrity of their products.”22 Further, allowing the industry to keep its own nose clean would keep the economy pump­ing in Utah. “The State of Utah has an important nutritional supplement industry that contributes over $700 million to the national economy,” Hatch reminded his fellow lawmakers. “We must consider the adverse economic impact that burdensome regulations could have on Utah and other states.”23

In Hatch’s view, Americans did not need protection from supplement sellers; they needed safe harbor from a freedom-, health-, and industry-killing FDA. Without the DSHEA, Hatch said the FDA would “continue its life and death grip on products which have been proven to enhance public health.”24 In addition, Hatch argued at the same hearing, when it came to self-medicating with supplements, Americans were grown-ups. “I think it is time to quit treating the American consumers like we are a bunch of idiots,” Hatch protested. “We are not a bunch of idiots. We can make consumer choices and we do know what we are doing.”25

In an October 5, 1993, editorial, “The 1993 Snake Oil Protection Act,” the New York Times blasted Hatch’s ploy. The fight the supple­ment industry billed as a matter of protecting consumer choice was really “about the right of unscrupulous companies and individuals to maximize profits by making fraudulent claims,” the paper wrote.26 But the supplement industry was too powerful to be halted by worries over consumer protection. On October 25, 1994, President Bill Clinton signed the DSHEA into law; the industry was given a federal blessing to carry on its traditional ways.

Reflecting on the legacy of the DSHEA, in 2002, U.S. Anti-Doping Agency chief Frank Shorter said it was like building a freeway across a state, but with only “one patrolman for the entire state.” With sup­plement manufacturers racing for market share, and with a federal law protecting them from the consequences of their claims, Shorter pointed out that plenty of supplement pushers were speeding, and a lot of athletes were getting caught for illegal substances found in the supple­ments, including the anabolic steroid nandrolone.27

From the time of Joseph Smith’s medical tribulations to today, the appeal of herbal supplements lies in their so-called naturalness. Herbal medicine is attractive because the synthetic chemical pharmacopeia has such a rotten reputation. Taking supposedly “natural” supplements to heal ailments gives people a sense of agency over their health while also giving a satisfying finger to the nefarious Big Pharma forces who pay doctors to prescribe their products. Whether in 1830, 1930, or today, there is an oft-justified perception that orthodox pharmacology is rigged and does not have patients’ best interests in mind; as a result, the public is drawn to self-diagnosis and the benign appeal of natural medicines.

The DSHEA became law the year that the Netscape Navigator web browser made the Internet accessible to everyone. And with the expan­sion of the World Wide Web in the mid-1990s, the public suddenly had at its fingertips a resource that made everyone feel like a medical expert. As Oklahoma State pharmacology professor Steven Pray wrote in the Journal of Child Neurology in 2012, with the web, a seeker could instantly conjure up a multithousand hit throng of homegrown solu­tions to any human condition, ailment, or disease.28 The DSHEA gave supplement sellers the legal freedom they needed to supply this new world of Internet doctors.

[Related: Dr. Ferrari Was Right, a Chapter from Spitting in the Soup]

The DSHEA locked out the FDA by formally classifying supplements as foods rather than food additives or drugs. In the United States, foods are presumed safe until they cause harm. Drugs and food additives are presumed unsafe until the manufacturer proves them harmless. It’s a difference in assumed wholesomeness that allows supplement manu­facturers to push products with none of the mandatory testing costs borne by the pharmaceutical industry. Because the FDA could only act against a supplement manufacturer after its product harmed or killed, the DSHEA effectively turned the public into the supplement makers’ lab animals. As Pray put it in 2012, the “DSHEA provides that manufac­turers can sell dietary supplements for virtually any medical condition without pretesting for safety on humans or animals. Patients who pur­chase dietary supplements take the place of the laboratory rats used in legitimate safety research.”29

The DSHEA was in fact so artfully designed to protect Utah’s “Cel­lulose Valley” of herbal supplement makers that they have no legal obligation to turn over adverse findings to the FDA. Unlike the pharma­ceutical industry, if a supplement maker knows its products are making people sick or killing them, the manufacturer can keep that knowledge under its hat. By effectively shielding the supplement industry from lawsuits and pushing the cost of supplement quality control onto tax­payers, the burden for testing supplement safety was shifted to the FDA, an organization Hatch and other conservative lawmakers repeatedly criticized for being slow, ineffective, and clogging up America’s right to healthy business and life-improving potions. Another supplement industry supporter, New Mexico congressman Bill Richardson linked this personal right to federal savings. At an October 21 hearing, Rich­ardson stated that “the safe use of dietary supplements could save this country billions of dollars in health care costs each year if adequate information could be given to the public on labels and pamphlets and the public was allowed to make choices.”30 DSHEA supporters saved the supplement industry from oversight by assigning responsibility to a government agency, cursed that same bureaucracy as an example of overreaching big government, and then boasted about how much money the government would save when Americans supplemented themselves into good health.

As for the notion that supplementation saves health care dollars, a 2015 study of the nation’s emergency rooms published in the New England Journal of Medicine suggests that might not be the case. The study authors tracked ER visits in 63 hospitals between 2004 and 2013 and discovered that 23,005 of the visits during that time were for com­plications related to dietary supplements. A common cause for the emergency room visits was cardiovascular events related to weight-loss and energy products. Hospitalization was required for 2,154 of the sup­plement emergencies—a significant financial burden for taxpayers and supplement takers alike.31

Every year, Utah companies do over $7 billion worth of business sell­ing vitamins, testosterone boosters, and herbal remedies. In the six-year election cycling leading up to 2012, some of those billions sloshed back to Hatch as $1.1 million in campaign contributions from the pharmaceu­tical and nutritional products industry. The senator is well compensated for protecting the industry that walks in the footsteps of Joseph Smith’s advocacy for self-prescribed herbal medicine.

And because the supplement industry has served up a mislabeled or unlabeled consumer buffet of ingredients that include arsenic, radiation, pesticides, cow brains, sawdust, and the anabolic steroid nandrolone, it has a chair right next to Big Pharma in the pantheon of business sleaze. In February 2015, the New York State attorney general sent cease and desist letters to Walmart, Target, Walgreens, and GNC when analysis of supple­ments bought at the four retailers revealed that as many as five out of six products did not contain the herbs on their labels or contained unidentifi­able substances. For instance, analysis of GNC ginkgo biloba supplements turned up asparagus, rice, and spruce, but no ginkgo biloba.32

THE 2002 WINTER OLYMPICS took place in Utah, and in advance of the Games, IOC medical commissioner Prince Alexandre de Mérode accused supplement makers of compromising athletes with impure root medicines. Concerned about the Olympic brand becoming tainted by the seedy supplement industry, Mérode committed the unpardonable sin of publicly accusing Senator Hatch and his home state industry of poisoning the world’s finest athletes.

At a December 12, 2000, IOC athlete and Medical Commission meeting, IOC members and athletes discussed the risks inherent to sup­plements, both for athlete health and in terms of violating anti-doping regulations. With supplement manufacturers under little financial or legal incentive to accurately label their products, Olympic athletes could easily test positive for a substance they had no way of knowing was in a supplement. And they did. In advance of the 2002 Olympics, American bobsled team member Pavle Jovanovic was disqualified when he tested positive for traces of the steroid norandrostenedione. He blamed it on a contaminated supplement, and IOC and USOC tester Don Catlin agreed that the metabolites found in the rider’s system were probably from a tainted nutrition booster.33 Contaminated supplements were a risk not just to athlete health and eligibility but also, more importantly for the IOC, to the scandal-free shine of the Olympic brand.

At a December 2000 IOC session in Lausanne, Switzerland, Mérode singled out Hatch and American supplement manufacturers for endan­gering athlete health. “He is directly implicated in this affair,” Mérode said of the Utah lawmaker’s efforts to protect supplement manufacturers. Mérode also suggested that the United States was the biggest user and misuser of supplements.34 WADA chairman Richard Pound also chimed in from Lausanne, criticizing the American supplement industry’s “not at all reliable” product labeling. “There are tons of prohibited drugs in the middle of all that,” Pound warned of the contaminated products.35

For Hatch, Mérode’s charge was insufferable. “I am tired of this childish finger pointing,” the senator grumbled from his office in Wash­ington, D.C. “The last time I checked, neither the prince nor the athletes were experts in food and drug law.”36 Speaking to Salt Lake City’s Deseret News, Hatch spat, “I’m offended by these jerks. The IOC does not have the privilege of making U.S. food and drug law.” The senator found the European sporting administrators’ paternalism and concern for public well-being particularly offensive. All the IOC should be con­cerned with, Hatch said, “is the impact of supplements on athletes in competition.” Outside of a sporting event, the IOC had no business for­warding its opinions about “whether supplements should be sold to others,” Hatch told his local newspaper. “Those jerks don’t know what they are talking about.”37

While it is best to regard the IOC’s expressions of concern for athlete purity with a degree of suspicion, the constant parade of athletes test­ing positive for polluted supplements was a public relations nightmare, especially in the run-up to the events. Long before the commencement of the 2002 Games, elite athletes had on more than one occasion tested positive for nandrolone and other steroids and claimed that the ille­gal drug came from contaminated supplements. The IOC’s concern was such that it funded a study to find out just how often supplements are contaminated. In 2000 and 2001, University of Cologne researchers tested 634 supplements purchased randomly in shops, online, and by phone in North America, Europe, and Australia. Of these, 14.8 percent contained steroid prohormones. The researchers found that supple­ments from companies that also sell prohormones are more likely to be contaminated with those same subtances.38 Although blaming contami­nated supplements is often a cheater’s first line of defense, thanks in part to the regulation-free zone the DSHEA had built around supplements, many really were dirty, and the IOC and WADA were justified in taking a devoted supplement champion and protector to task, especially as his state would be hosting the Olympics in two years.

With hard proof on hand that supplements were often laced with performance-enhancing drugs, in advance of the Salt Lake City Games, the IOC sent two letters to the FDA imploring it to take steps to clean up America’s dietary supplement industry. At the December Lausanne meeting, however, Mérode said that the FDA never replied.39 The IOC also urged Olympic teams and national organizing committees not to strike sponsorship deals with American supplement companies.

I asked WADA science director Olivier Rabin how the organiza­tion deals with a country like the United States where federal law bans oversight of the production and sale of supplements. “For us, it is very simple,” Rabin told me. “We list the doping agents based on three usual criteria. One, performance enhancement; two, risk to the health of the athlete; and three, potential violation of the spirit of sport. So we don’t really care where the drug is going to end up.” In other words, WADA’s banned substance list indicates what is legal and what is not, but WADA stays out of the business of telling countries how to police their own drug and potion makers. In the United States, with the government banned from taking an aggressive approach to policing supplement makers, that puts the burden of keeping illegal stuff out of their bodies on athletes.

“We’ve got a high number of examples of so-called dietary supple­ments that are contaminated with synthetic drugs,” Rabin told me. A pharmacologist and toxicologist who worked in drug development and marketing before joining WADA, Rabin believes that the high con­tamination rate stems from the fact that many supplements are useless. “Most of the time, natural products that are sold by these companies don’t have an effect, and if they want their product to have an effect, and for people to buy these products again, they put something into it that has an effect.”

Knowing they are selling a high percentage of snake oil, some sup­plement manufacturers add drugs to their remedies so consumers will feel the kick promised on the product label. Mixing in unlabeled steroid precursors, for example, ups the chance that customers see an improve­ment in their musculature and form and come back for more. According to Rabin, what makes this reality scary is that the purity of the drugs used to spike supplements is often dodgy. “Sometimes the quality of the drugs we find is very, very poor,” he said. Additionally, Rabin noted that drug concentrations in laced supplements vary wildly. Sometimes “we find cases of dietary supplements that are adulterated with supra­pharmacological concentrations of drugs,” he said. “The drugs that are contained in those products are even higher than pharmaceutical grade. This can only create very serious side effects.” Confusing labeling is another problem. Rabin told me that if the drugs are on the label, “they are presented in such a way that it would be very, very difficult for most people to be able to identify that this is a drug of risk.”

While the IOC medical commission was worried about supplements ruining athletes’ careers and Olympic sponsor reputations, the USOC did not mind. In advance of the 2002 Salt Lake City Winter Olympics, the Salt Lake City Organizing Committee and its fellow benefactor, the U.S. Olympic Committee, cashed $20 million in sponsorship checks from Utah-based anti-aging-elixir sales company Nu Skin. The deal also provided for a Nu Skin subsidiary, Pharmanex, to become the exclu­sive Olympic licensee for supplements. That is, the deal allowed a supplement company to bless itself with Olympic symbols.40 It was a mutual-back-scratching arrangement. American athletes got money to help with their training, and Nu Skin got to bask in the cleansing glow of Coubertin’s chivalric spirit of sport.

Nu Skin’s acquisition of Pharmanex had followed Hatch’s dereg­ulation of the supplement industry in 1994. The purchase added Pharmanex’s cash cow of nutritional supplements to what was then Nu Skin’s portfolio of age-defying skin creams and hair-restoration tonics. Today, a 1-ounce bottle of Nu Skin’s ageLOC Future Serum lotion costs more than $200. To move its expensive products, Nu Skin relies on a multilevel-marketing scheme. An important part of the Nu Skin business involves recruiting new sales agents who pony up cash to start their own Nu Skin microdistribution businesses. It’s a pyramid structure in which salespeople are measured as much by their ability to bring in more sales­people (who have to purchase $1,200 starter kits) as by their ability to sell to end consumers. Fortune magazine reported in 2012 that these distributors are the source of much of Nu Skin’s income. “To qualify for multilevel commissions, they must purchase or sell at least $100 of its merchandise every month; they and their recruits must collectively gen­erate at least $2,000 in monthly sales,” the magazine reported.41

In exchange for its $20 million donation to the USOC, the supple­ment maker became an official Olympic sponsor with the right to associate its name and products with Olympic athletic endeavor. Nu Skin even splashed Olympic symbolism—rings, torches, inspirational sporting videos—into its sales force recruiting meetings. The Nu Skin donation was part of an $840 million sponsorship program called Olympic Properties of the United States (OPUS). The advertising deals bankrolled both the Salt Lake City Games and U.S. Olympic team prep­arations for the 2004 Athens Summer Games. Nu Skin founder Steve Lund and his wife also personally donated $506,000 to the Salt Lake City Organizing Committee.

Salt Lake City’s Deseret News reported on October 16, 1999, that at the previous day’s 10th annual Nu Skin convention, then–Olympic organizer candidate Mitt Romney told 10,000 Nu Skin distributors that the Olympics and Nu Skin sales were both “about taking control of your life and managing your own destiny.”42 Nu Skin’s $20 million donation was more than a philanthropic gesture to help Salt Lake City dig out of the financial shortfall it faced in preparing for the Games. At the sales meeting that rallied sales associates with a flame-lighting show and Olympic sports video, Lund explained how Nu Skin now had the right to print the Olympic rings on its business cards. Although a small detail, the Olympic symbol granted legitimacy in a world wary of multilevel-marketing supplement dealers and fly-by-night supplement hustlers. “We have aligned ourselves with the Olympics because this alignment helps you do your jobs better,” Lund proclaimed. Connecting Nu Skin with the Olympics would “further mainstream our brands in the busi­ness community.”43

Speaking to a Deseret News reporter about the deal in 2000, one mar­keting expert said, “People are going to assume Nu Skin products are of Olympic caliber.” Another industry observer told the paper that Nu Skin would make its $20 million investment back “in spades.” With the Olympic endorsement as a counter to public relations scandals then dogging the company and the dietary supplement industry, he said, “They have just given every single one of their salespeople ammunition to make sales.”44

Mainstreaming Nu Skin—“Olympi-cize our entire operation,” in the words of a Nu Skin spokesman45—also meant pushing it out from under a cloud of product sales and marketing lawsuits, nearly $3 mil­lion in Federal Trade Commission fines, and a devastating 1991 exposé on the ABC news show Nightline. In that news program, reporter Bar­bara Walters asked her American audience, “Is Nu Skin nothing but a scheme promising the American dream while for many delivering only the nightmare?”46

When Lund’s friend Mitt Romney decided to run for president a decade later, Lund used two shell companies to channel more than $2 million in donations into Romney’s presidential political action com­mittee. Nu Skin is also a longtime contributor to supplement hero Orrin Hatch. Hatch’s son Scott is a supplement industry lobbyist.47 When IOC medical commissioner Mérode warned athletes to stay away from sup­plements, Romney joined Hatch in defending the Utah industry from the meddlesome Belgian, arguing that Pharmanex was a model company when it came to product testing and labeling.

Today, Nu Skin promises that its products like ageLOC Future Serum and the $60-per-month ageLOC Vitality nutritional supplement will turn back time. In the words of the company’s chief scientific officer Joseph Chang, the company’s research has “given us a key to the preservation of youth.”48 Harkening back to French testosterone pioneer Charles-Édouard Brown-Séquard telling his audience at the Société de biologie in Paris in 1899 how injections of dog testicle juice gave him energy to bound up stairs like a man half his age, an ageLOC promotional video shows two mice aged “the equivalent of 96 years old.” One mouse’s diet has been supplemented with an “ageLOC Vitality Ingredient.” The other rodent gets its regular diet, but no ageLOC boost. The video shows the mice in side-by-side cages. Save for the occasional twitch of an ear, the elderly mouse on the left looks one paw this side of mouse heaven. Meanwhile, the 96-year-old mouse with ageLOC coursing through its veins roots around in his bed of straw like an Olympic decathlete.49

Scientists raise eyebrows when they hear about such dodgy anti-aging claims. “If someone tells you they know what the mechanism of aging is, they are trying to kid you,” National Institute on Aging research scientist Richard Millar told Fortune magazine, dismissing the ageLOC gene-transformation claims as marketing hype.50 Both Nu Skin and Pharmanex have spent significant time in court defending themselves against, and settling fines over, charges that their products don’t do what their advertising and sales agents claim. As New York Times reporter T. W. Farnam detailed in 2011, among Nu Skin’s fines is a $1.2 million settlement with the Federal Trade Commission over bogus advertising that was later upped by another $1.5 million when Nu Skin was found violating the terms of the original settlement.51 In 2014, the Chinese government accused Nu Skin of running a pyramid scheme and fined the company $540,000 and six employees $241,000.52 In early 2016, the company paid $47 million to settle a class-action lawsuit related to the Chinese pyramid scheme claims.53

When America’s Olympic athletes promoted the Nu Skin brand by wearing its logo on their clothing, they helped scrub off a little of this bad PR grime. The sponsorship granted a noble Olympic aura to a com­pany and industry that has steadfastly resisted efforts to regulate the purity and efficacy of its products. In the interest of paying the bills and offering athletes financial support, the USOC had to pay lip service to notions of pure sports and link up with an industry with an abhorrent record of failing to go the extra mile to protect its customers. As dop­ing historian John Hoberman explains in Testosterone Dreams, with the supplement industry, doping is “a matter as much of semantics as of pharmacology. From a marketing standpoint, the ideal product would combine the power of a doping drug with the comfortable familiarity of a home remedy.”54 Sponsoring Olympic athletes helped push along this semantic shift by aligning supplement products with Coubertin’s endur­ing spirit of youthful restoration through sports. Indeed, Coubertin’s vision of the Olympics as a revitalizer of body and spirit, as something that delivers “a delicate balance of mind and body, the joy of a fresher and more intense life, the harmony of the faculties, calm and happy strength,” could well stand in as a Nu Skin marketing promise.55

When the USOC accepted $20 million from Nu Skin, it was a work of legerdemain showing that, as Hoberman put it, “some sports officials are perfectly willing to encourage athletes to stuff themselves with chemi­cals if this practice can be presented as an alternative to what is officially defined as doping.”56 Enlisting American athletes as TV pitchmen for Nu Skin demonstrated the U.S. Olympic movement’s reluctance to spit in the financially nourishing but ethically curdled soup of supplement industry support.

In 2011, a team of British medical researchers found that athletes who consume nutritional supplements are three and a half times more likely to also use performance-enhancing drugs than athletes who avoid supplements. Additionally, the researchers found that supplement-using athletes have a more positive attitude toward performance-enhancing pharmaceuticals and are more willing to believe that those substances will improve their performance. According to the research, supple­ments seem to smooth the transition from legal herbal aids to illegal performance-enhancing drugs while also priming young athletes to experiment with doping drugs.57

Other research shows that amateur athletes take doping behavior cues from professionals and Olympians who make supplements part of their performance-enhancement regime. In 2012, a team of George Washington University social scientists found that when athletes make the decision to take potentially harmful drugs like anabolic steroids, the choice is not the studied result of careful deliberation about doping’s health risks. Instead, the researchers found that athletes use intellectual short cuts—a heuristic, in academic jargon—when deciding to dope. A heuristic is a rule of thumb drawn from previous experiences that helps us make quick decisions in the face of ambiguity. In the case of dop­ing, in their study published in the Journal of Health Psychology, the researchers found that when athletes debated whether legal or illegal drugs were more powerful, the athletes’ rule of thumb was if it’s illegal, it must be better.

This study did not assess whether illegal drugs actually made an athlete perform better than when on legal nutritional supplements. It evaluated what athletes think is more effective and how that conclu­sion might affect their willingness to dope. The study surveyed 132 randomly identified male NCAA and summer competitive league col­legiate players from sports including tennis, basketball, swimming, soccer, golf, diving and lacrosse. Of these, 75 percent reported having used legal performance-enhancing substances during their lives—for example, protein powders or creatine. None admitted to having used illegal performance-enhancing drugs.

Results showed that a belief that illegal drugs are more effective than legal drugs was a strong predictor of an athlete’s personal willingness to dope. In other words, news reports of pro athletes being busted for dop­ing convinced collegiate athletes that illegal drugs must be better than the stuff available at the local GNC. Why? Athletes concluded that even if the IOC and WADA had strongly warned athletes away from dietary supplements, if pros were willing to risk their careers to use these and stronger products, then the stuff must make a big difference. “We call this the illegal-is-effective heuristic,” the researchers concluded.58

And so, with the U.S. Olympic athletes proudly displaying the Nu Skin logo, youngsters and oldsters around the world got the message that in spite of the constant barrage of stories regarding the danger of taking supplements, they must be worth it. After all, if the best in the world were using them, shouldn’t everyone?

Spitting in the Soup by Mark JohnsonIn Spitting in the Soup, sports journalist Mark Johnson explores how the deals made behind closed doors keep drugs in sports. Johnson unwinds the doping culture from the early days, when pills meant progress, and uncovers the complex relationships that underlie elite sports culture. Spitting in the Soup offers a bitingly honest, clear-eyed look at why that’s so, and what it will take to kick pills out of the locker room once and for all.

Read more on doping in sports from Spitting in the Soup here. Take a look at this overview of each chapter in Spitting in the Soup.

For the citations referenced above, please see the bibliography of Spitting in the Soup, which is available online in this pdf that includes Chapter 1.