Exploring the Ethical Issues Surrounding Dietary Supplements
By Dayaal Singh
Amongst modern health and wellness culture, dietary supplements have risen to great popularity. People use them in an effort to improve their health, prevent illnesses, or address specific nutritional deficiencies. From vitamins and minerals, to herbal remedies and protein powders, there is an immense variety of products promising an array of health benefits. Despite their widespread use, the supplement industry faces several challenges, such as health risks, wasted money, and unethical business practices, that present serious consequences for consumers.
One major concern is the lack of strict regulatory oversight, which compromises consumer safety and informed decision-making. Unlike pharmaceutical drugs, dietary supplements are not required to go through rigorous approval processes set by the Food and Drug Administration (FDA). Consequently, they can be produced without proof of their safety or efficacy for users, leading to issues regarding impurities, hidden ingredients, and inconsistent amounts of active substances because manufacturers may not always follow good manufacturing practices [4]. For example, some supplements have been found to contain prescription drugs or other substances not listed on the label, posing serious health risks to certain populations.
On a similar note, this lack of regulation has real-world consequences. Each year, approximately 23,000 emergency room visits in the U.S. are linked to dietary supplements [3]. Weight-loss and energy products are primary culprits, especially among young adults aged 20 to 34 [3]. These supplements often contain stimulants and other ingredients that, in high doses, can cause serious issues including heart problems and high blood pressure. For instance, products containing the stimulant ephedra were linked to adverse cardiovascular events before being banned by the FDA. Young adults are not the only ones affected by this misregulation. Children accidentally ingesting supplements account for over 20% of these ER visits because vitamins and similar products do not employ child-resistant packaging [3]. The risk of a toddler accessing such supplements could lead to potential complications, and in extreme cases, death. Older adults face risks as well—large supplement pills are choking hazards for such populations [3]. These considerations highlight serious failures in product labeling and design, which consequently fails to protect such vulnerable demographics.
Misleading labels and advertisements further exacerbate matters by exaggerating benefits and downplaying risks. The Dietary Supplement Health and Education Act of 1994 affords manufacturers much freedom in establishing vague health claims without providing robust evidence that their products are safe or effective [2]. They may include phrases like "supports immune health" or "boosts energy," which sound appealing but are not necessarily supported by clinical evidence. Some companies have even gone to the extent of making illegal claims that their products can treat or cure diseases [6]. Such baseless claims undermine the public's ability to make fully informed choices about their health and only mislead them into purchasing faulty products. Moreover, this supposed regulatory environment contributes to the public’s false sense of security. People may assume that if a product is available for purchase, it has been tested and approved for safety and effectiveness, which is not the case for most supplements [6]. Those looking for affordable health solutions may waste money on ineffective or even harmful products instead of investing in proper medical care.
Healthcare professionals also face challenges while trying to balance respect for patient choices with evidence-based recommendations. Many patients rely on personal stories or cultural beliefs when choosing supplements, influenced by a diet culture that praises "natural" or “organic” products [4]. A common misheld belief is that "natural" products equate to safety, which has been contradicted by herbal supplements like kava that are linked to liver damage. This can erode a patient’s support for credible medical advice, despite the presence of little to no scientific support for a supplement's effectiveness or safety.
Conflict of interest is another potential issue, as healthcare providers can both recommend and sell supplements directly to patients. Professionals thus must be transparent about any financial ties to supplement manufacturers to maintain trust and uphold professional standards [5]. If a practitioner profits from selling a product, there is a risk they may prioritize earnings over the patient's best interest. As such, the Academy of Nutrition and Dietetics advises practitioners to avoid bias and ensure that recommendations are based on current scientific evidence [5]. Failure to do so can compromise patient trust and quality of care.
On another note, the mismanagement of supplement regulation has incited an array of consequences that leaves the consumer unaware about the controversial world of multi-level marketing (MLM) of supplements. The usage of MLM strategies to sell products raises serious ethical implications because this business model conflicts with principles of promoting well-being, avoiding harm, and respecting autonomy [1]. MLM schemes pressure distributors, enticed by promises of substantial income, to purchase large amounts of product before receiving approval to sell it, leading to potential unsold inventory and debt [1].
Selling supplements with unproven health claims through MLM channels can be risky for consumers, too. The distributors tend to be salespeople, not health professionals, and do not have the proper training to provide credible health advice [1]. Without proper medical guidance, this puts people at risk of harm from products that could be toxic or induce drug-drug interactions with other medications.
Despite increasing scientific evidence that many supplements offer limited benefits and might even be harmful, people continue to use them. Over half of U.S. adults used supplements between 1999 and 2012 and were seemingly unswayed by studies showing minimal benefits and possible risks [2]. As such, it seems the general populous may make health decisions based on misleading marketing rather than credible evidence.
The strongest way to address these issues is through better regulations and standards for supplements. Stricter rules requiring companies to prove the safety and efficacy of their products before being introduced to the market is the best way to protect consumers [6]. Enforcing accurate labeling and prohibiting misleading claims are also crucial for regulating supplements. In addition, raising public awareness about supplement regulation and seeking credible medical advice can also empower consumers to make informed choices. Aside from consumers, healthcare professionals have a role to play as well: they must educate patients about the real benefits and potential dangers of supplements to help them make informed decisions. By providing clinically-supported advice and being transparent about any financial interests, practitioners can support their patients' wellbeing.
The problems around dietary supplements are complex, involving misinformation, insufficient regulation, and conflicts of interest that can harm consumers and undermine informed consent. Without strict oversight, harmful products can enter the market and violate the basic expectation that products should be safe. Misleading marketing interferes with people's ability to make informed choices, and unethical business practices like MLM schemes can exploit both consumers and distributors. Solving these issues will require a collaborative effort from regulators, health professionals, and the supplement industry. By reinforcing regulations, ensuring honest marketing, and adhering to guidelines that prioritize consumer safety and well-being, we can help protect public health. This approach can bridge the gap between consumer expectations and the realities of dietary supplement use, creating a healthcare environment that's both responsible and effective.
Review Editor: Sheldon Liu
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