One day last September, as BritneySpears was about to board a flight to

Los Angeles from London, a rectangu-lar blue bottle fell out of her purse. Shequickly stuffed it back in, but not beforethe paparazzi recorded the event.NeitherSpears nor her spokesman was willing tocomment on the contents of the bottle,but the next morning London’s Daily Ex-press published a page of pictures underthe headline “EXCLUSIVE: POP PRINCESS

SPOTTED AT AIRPORT WITH POT OF

SLIMMING TABLETS.” Spears was appar-ently carrying Zantrex-3,one of the mostpopular weight-loss supplements cur-rently sold in the United States.The pill,which retails at about fifty dollars for amonth’s supply, contains a huge dose ofcaffeine, some green tea, and three com-mon South American herbs that also actas stimulants. It hit the U.S. market lastMarch and has had a success that wouldbe hard to overstate. Millions of bottleshave been sold,and during the Christmasseason it was displayed in the windows ofthe nation’s largest chain of vitamin shops,G.N.C. (It is so highly sought after thatmany of the stores keep it in locked cab-inets.) Zantrex-3 is also sold at CVS,RiteAid, Wal-Mart, and other chains, andover the telephone and on the Internet. Ifyou type “Zantrex” into Google, morethan a hundred thousand citations willappear. At any moment, there are scoresof people auctioning the stuff on eBay.

Perhaps the most interesting elementof Zantrex-3’s success story, however, isthat it is far from unique.There are hun-dreds of similar products on the markettoday, and they are bought by millions ofAmericans.And though Zantrex’s man-ufacturer makes some heady claims (“themost advanced weight control com-pound period”), so do the people whosell Stacker 2 and Anorex (whose pub-licity assures us that the “genetic link” toobesity means that repeated diet failureis “not your fault”), along with those whosell Carb Eliminator and Fat Elimina-

tor.Almost all of these compounds sug-gest that they can help people lose weightand regain lost vigor, and often withoutdiet, exercise, or any other effort.

The diet-pill business may be themost visible segment of the vitamin-,mineral-, and herbal-supplement indus-try, but it is by no means the largest.Thousands of different tablets, elixirs,potions, and pills are sold in the UnitedStates, and remarkably little is knownabout most of them. That doesn’t deterconsumers. Since 1994, when Congresspassed a law that deregulated the supple-ment industry and opened it to a flood ofnew products, the use of largely unprovedherbal remedies—from blueberry ex-tract for impaired vision to saw palmettofor the treatment of enlarged prostatesand echinacea to prevent colds—has in-creased as rapidly as the use of any com-monly prescribed drug.

Since that legislation, the DietarySupplement Health and Education Act,became law,companies have been able tosay nearly anything they want about thepotential health benefits of what theysell. As long as they don’t blatantly lie orclaim to have a cure for a specific disease,such as cancer,diabetes,or AIDS, they canassert—without providing evidence—that a product is designed to support ahealthy heart (CardiAll, for example),protect cells from damage (Liverite), orimprove the function of a compromisedimmune system (Resist). There are al-most no standards that regulate how thepills are made, and they receive almostno scrutiny once they are, so consumersnever truly know what they are getting.Companies are not required to provethat products are effective, or even safe,before they are put on the market.

Still, there is more to the growing re-liance on supplements than the lapses ofa single law: Americans long ago wea-ried of taking doctors’ orders, and, in-creasingly, they are skeptical about themotives of big pharmaceutical compa-

nies. People want to feel in control oftheir own health. Supplements, withtheir “natural” connotations and culti-vated image of self-reliance, let them dothat.There is even a word to describe allthe things—other than plain food—thatpeople consume in the pursuit of health:nutraceutical.

Nutraceuticals are found everywheretoday, in foods fortified with “extra” vi-tamins, in sports drinks, in “enriched”water, and now even in candy. Six out often adults in the United States take oneor more supplements each day. Often,these include multivitamins, which arefrequently recommended by physicians,but a staggering number of amino acids,weight-loss cures, and herbal tonics arealso swallowed every day, all in the beliefthat they will improve health, fend offdisease, or make up for dietary and be-havioral habits that have placed obesityand indolence among the leading healthproblems facing the United States. Lastyear, Americans spent nineteen billiondollars on dietary supplements—nearlyfive times as much as they did just a de-cade ago. And they spent that money oneverything from Vitamin C to garlic (theuses of which vary, with benefits that are never clear), from kava (which theF.D.A. says may cause severe liver dam-age but which is still widely available inhealth-food stores as a remedy for stress)to comfrey (an herb of dubious valuecommonly used to quell irritated stom-achs), and even ephedra, which the fed-eral government only recently decided toban, despite reports over the last eightyears implicating it in scores of deathsand hundreds of strokes, seizures, andother severe maladies.

“For many people, this whole thing isabout much more than taking their vita-mins,” Loren D. Israelsen, the executivedirector of the Utah Natural ProductsAlliance, and a principal architect of the1994 legislation, told me not long ago.“This is really a belief system, almost a

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64 THE NEW YORKER, FEBRUARY 2, 2004

A REPORTER AT LARGE

MIRACLE IN A BOTTLE

Dietary supplements are unregulated, some are unsafe—and Americans can’t get enough of them.

BY MICHAEL SPECTER

SEYM

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religion. Americans believe they havethe right to address their health prob-lems in the way that seems most usefulto them. Often, that means supple-ments. When the public senses that thegovernment is trying to limit its access tothis kind of thing, it always reacts withremarkable anger—people are even will-ing to shoulder a rifle over it. They areready to believe anything if it bringsthem a little hope.” Frequently, suchproducts come veiled in a cloak of sci-ence. Ads for Zantrex-3, for example,claim that its “superior power is validatedby a direct comparison of publishedmedical studies . . . scientific fact . . . ir-refutable clinical data.” The people whosell the pills on the telephone don’t relyon science at all, however, when they tellcallers that the capsules in those bluebottles could change their lives.

“When I train salespeople, I say tothem, ‘Do you know what people arecalling you for? It isn’t the pill. They arecalling you for hope. That is really whatthey want from you,’ ” Don Atkinson,who is the vice-president of sales forBasic Research, the privately held con-glomerate that distributes Zantrex-3,told me recently. I spoke with him in hisoffice in Salt Lake City, which regardsitself as the Silicon Valley of the dietary-supplement industry. Atkinson, a heartyand engaging man with a graying buzzcut and a firm handshake, slowly wrotethe word “hope” on a lined piece ofpaper soon after I came in. “The cus-tomer has been overweight for years.And they have tried everything. Andthey have been on Atkins and every-thing else and nothing has worked. Andsome of these people are so incapaci-tated by their weight and their problemsassociated with it that they would like todie. Just wish they could just die. Andthey dial up and they are unhappy peo-ple. And they think, O.K., if I take thisand it doesn’t work it’s further evidencethat I am a failure. Our job is to givethem hope.To say, ‘You know what? Youcan do this.’ ” Atkinson stopped for amoment and pumped his right fist inthe air. “I love my job,” he said. “And doyou know why? Because when I get upin the morning I know that somebody’slife is better because we are here. Some-body today got some hope.”

Atkinson told me that he was de-lighted by the Britney Spears news, not

so much because of the publicity wind-fall but for the larger message it conveyed.“You know what is great about that? It’sthe fact that she is using a weight-lossproduct and she looks terrific. Just thefact that we are even talking about whatBritney Spears uses or doesn’t use to keepher weight down tells the whole wideworld that it’s O.K. to be a little over-weight and it’s O.K. to work on it. Andit’s O.K. to use things to help you getthere. That’s what it all says to me, andthat is why we are here.”

Herbs have been ingested regularly,in every conceivable combination,

for thousands of years, and many areclearly beneficial.Vitamins and mineralsare essential for human health: calciumsupplements have prevented perhapsmillions of cases of osteoporosis; folicacid helps prevent neural-tube defects;insufficient amounts of Vitamin B12 canlead to dementia. Simply eating citrusfruit, and the Vitamin C it contains,was enough to vanquish scurvy,which in the mid-eighteenth century killed moreBritish sailors than the wars that Britainfought.

The way that nutrients work in foodshas come to be properly understood onlyin the past hundred years. Because of thelack of specific knowledge, the precedingera had been one of open and unapolo-getic quackery. Throughout the eigh-teenth and nineteenth centuries, patent-medicine men roamed the United States.For every illness imaginable, they prom-ised wondrous products and magical cures.

The rapid growth of patent medi-cines was largely a result of two unre-lated events, and they eerily foreshad-owed the 1994 Dietary Supplement Actand the rise of the Internet as a com-mercial tool. In 1793, Congress passedpatent legislation that permitted manu-facturers to protect their formulas (with-out requiring that they even work).Around the same time, the number ofnewspapers published in the United

States began to increase dramatically.Bythe beginning of the twentieth century,the patent-medicine business accountedfor more newspaper advertising than anyother kind of product. Many manufac-turers became rich; some became fa-mous. Lydia E. Pinkham’s VegetableCompound, advertised as “A PositiveCure” for “all those Painful Complaintsand Weaknesses so common to our bestfemale population,”made Pinkham’s faceas recognizable then as Martha Stewart’sis today.

In 1914, officials of the AmericanMedical Association decided to analyzePinkham’s compound. It turned out tobe twenty per cent pure alcohol andeighty per cent common vegetable ex-tracts. Most patent medicines had simi-lar ingredients. Sometimes they werelaced with cocaine, caffeine, opium, oreven morphine. It’s not surprising thatthey provided a few hours’ worth of re-lief. There was no restriction on the vastarmamentarium of remedies on the mar-ket until 1906, when the Pure Food andDrug Act was passed, mainly as a re-sult of the revelations in Upton Sinclair’sbook “The Jungle.” The act permittedthe Bureau of Chemistry, which pre-ceded the Food and Drug Administra-tion, to insure that labels contained nofalse or misleading advertising. For awhile, at least, snake-oil salesmen wentthe way of the Conestoga wagon.

Since then, the pendulum has swungbetween unregulated anarchy and re-strictions that outrage many Americans.It has usually taken a disaster to persuadeCongress to adopt strict regulations.Sul-fanilamide, a drug prescribed to treatstreptococcal infections, was used safelyand effectively for years in tablet andpowder form. Most children can’t swal-low pills, though, and in June, 1937, re-searchers at one company found that thedrug would dissolve in diethylene glycol;they tested the mixture for flavor,appear-ance, and fragrance—but not for toxic-ity—and then shipped it all over thecountry.They overlooked one importantcharacteristic of the solution: diethyleneglycol,normally used as an antifreeze, is adeadly poison. Within weeks, scores ofchildren were dead. The victims experi-enced severe abdominal pain, nausea,vomiting, stupor, and convulsions. In aletter to President Franklin D.Roosevelt,one woman described the death of her

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66 THE NEW YORKER, FEBRUARY 2, 2004

child:“Even the memory of her is mixedwith sorrow for we can see her little bodytossing to and fro and hear that littlevoice screaming with pain and it seems asthough it would drive me insane.” Thenext year, after a hundred and thirty-seven deaths, Congress passed the Food,Drug and Cosmetic Act, which finallygave the F.D.A. the authority it neededto regulate such products.

For many years afterward, there waslittle controversy about drugs or aboutdietary supplements, which mostlymeant vitamins and minerals. “It didn’tuse to be so complicated,” AnnetteDickinson told me. She is the presidentof the Council for Responsible Nutri-tion, which is the most influential of themany groups that look after the interestsof the supplement industry. Each year,supplement manufacturers contributemillions of dollars to political candi-dates.The industry has been remarkablysuccessful in arguing that, because theFirst Amendment protects commercialspeech, it can be used in defense of anyclaim that includes even a hint of truth.Dickinson is an aggressive supporter ofsupplements, yet she acknowledges thatcharlatans have proliferated wildly in thepast decade, making her job, and that ofmost reputable manufacturers, muchharder. In Dickinson’s view, the industrywould be better served if it returned itsfocus to the core nutrients—basic vita-min and mineral supplements. “In thebeginning,you had your one-a-days, andthere were minerals and herbal prod-ucts, too. A drug was something in-tended to treat or cure a disease, and youneeded to have proof that it could dothose things; the line between foods anddrugs was absolutely bright and clear. Ifyou made a disease-related claim forsomething that was not approved, theF.D.A. would come down on you like aton of bricks.All through the forties andthe fifties and the sixties, that was true.”

By the middle of the nineteen-seventies, as the complex relationshipbetween diet and health became morefully understood, the distinctions be-tween foods, drugs, and supplementsbegan to blur. First, with a major re-port issued in 1977 by the Senate SelectCommittee on Nutrition and HumanNeeds, and then with studies by the Na-tional Academy of Sciences and otherresearch groups, the government started

telling Americans to alter their diets ifthey wanted to have long and healthylives. Advice about ways to reduce therisk of heart disease, diabetes, and manycancers and other chronic illnesses be-came routine: eat less salt and fat and addfibre and whole grains; eat more fruitsand vegetables and watch the calories.Food companies were eager to promotemany of their products as medicallybeneficial. It was illegal,however, to sug-gest that there was a relationship be-tween the ingredients in a commercialfood and the treatment or prevention ofa disease. Then, in 1984, the KelloggCompany launched a campaign, in con-junction with the National Cancer Insti-tute, in which All-Bran cereal was usedto illustrate how a low-fat, high-fibrediet might reduce the risk for certaintypes of cancer. These days, it is almost

impossible to pass by a supermarket shelfand not encounter such claims; but All-Bran was the first case in which a man-ufacturer issued a statement that was interpreted widely as “Eat this productbecause it will help prevent cancer.” It ledto the era of product labels, and com-pletely changed the way Americans thinkabout not only foods but dietary supple-ments as well.

Since then, the English language hasbeen stretched to its limits in the at-tempt to link products to health benefits.Even claims that are true may be irrele-vant. Vitamin A, for example, is impor-tant for good vision—as supplements forsale in any health-food store will tell you.Insufficient consumption of Vitamin Acauses hundreds of thousands of cases ofblindness around the world each year,but not in the United States;here people

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“It saddens me to think that so many of my customers are going to Hell.”

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68 THE NEW YORKER, FEBRUARY 2, 2004

don’t have vision problems arising from alack of Vitamin A.Although statementsadvertising Vitamin A for good visionmay, like many others, be legally per-missible, they are meaningless. “Thelaws allow manufacturers to make finelegalistic claims,” Paul M. Coates, thedirector of the Office of Dietary Sup-plements at the National Institutes ofHealth, told me. “What we now have isan entire cottage industry of creative lin-guistics dedicated solely to selling theseproducts.” Instead of mentioning a dis-ease (which in most cases would be ille-gal without F.D.A. approval), compa-nies make claims that a food can affectthe structure or function of the body.Such claims can appear on any food, nomatter how unhealthy it is. You cannotassert that a product “reduces” choles-terol, but you can certainly say that it“maintains healthy cholesterol levels.”You cannot state that the herb echinaceacures anything, since it has never beenshown to do that. But there is no prohi-bition on stating that it “has natural an-tibiotic actions”and is considered “an ex-cellent herb for infections of all kinds.”Gingko biloba has been recommendedto Alzheimer’s patients because it “sup-ports memory function.” Does it? Sinceresearch is not required before a supple-ment is released, there are not nearlyenough data to know.

In a report published in the Journal of the American Medical Association, sci-

entists compared the effects of echina-cea with a placebo in treating colds.Echinacea is one of the most commonlyused cold remedies in the United States.But the study, of more than four hun-dred children over a four-month period,showed that a placebo worked just aswell, and that children treated with echi-nacea were more likely to develop a rashthan those who took nothing. Studieslike that are rare, since they cost moneythat manufacturers are not required tospend. But they are at least as likely todisprove benefits as to confirm them.Ginseng has long been promoted as anenergy booster, for example, yet the mil-itary, in studies of possible energy en-hancements for troops, has found itworthless. Still, in my local health-foodstore not long ago I saw more than adozen supplements advertising the “fact”that ginseng improves energy.

“It was all done for crass commercialreasons,”Marion Nestle told me.Nestle,the former chairman of the Departmentof Nutrition, Food Studies, and PublicHealth at New York University, is theauthor of “Food Politics,” which exam-ines in detail the ways in which the foodand supplement industries influence thenutritional policy of the United Statesand the health of its citizens. “In thename of health! The companies havemasked it in an argument for freedom ofspeech. And look at some of the ways itall plays out. Obesity is an epidemic in

our country. Is this helping? Not a bit.”She went on, “I was staying in Califor-nia this summer at the house of somefriends. They had all sorts of health-food products for kids, and, to my sur-prise, among them were shark-shapedfruit snacks with Vitamin C and gummybears with echinacea. It’s candy mas-querading as something that will im-prove a child’s health. It comes in one-ounce packages. Just the right size tothrow in a lunch pail. It’s brilliant mar-keting. Just brilliant.”

One recent Harris poll found thatmost people believe that if a supplementis on the market it must have been ap-proved by some government agency (nottrue); that manufacturers are prohibitedfrom making claims for their productsunless they have provided data to backthose claims up (no such laws exist); andthat companies are required to includewarnings about potential risks and sideeffects (they aren’t). “When somethinggoes wrong, though, most people expectgovernment health officials to find a so-lution,” David A. Kessler told me. Kess-ler,who is the dean of the School of Med-icine at the University of California atSan Francisco, was the F.D.A. commis-sioner when Congress passed the DietarySupplement Act, which he adamantlyopposed.“This is really the classic Amer-ican ambivalence, and it has always beenpart of our nature,”he said.“The view ofmost people is simple: I want access toeverything and I want it now.”The Fed-eral Trade Commission—not theF.D.A.—regulates supplement advertis-ing. But the F.T.C. is principally con-cerned with commerce, not science: itfocusses on the content of the labels, notthe content of the pills. Although since1994 the agency has sued more than ahundred diet-pill companies, in 2002 itfound that at least half of all weight-lossads contained false or misleading state-ments. Despite its vigilance, the agencyhas an impossible job; for each success,ten new companies seem to appear.

When people get sick, Dr. Kess-ler pointed out, the refrain is always“ ‘Where the hell is the F.D.A. to protectme?’ The supplement industry doesn’thave to report adverse events, so theF.D.A. doesn’t have the data it needs toprotect people. You cannot prove some-thing is unsafe if you don’t have the data.It’s the ultimate Catch-22. It is also a

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colossal failure to protect the publichealth of this country.”

Until a year ago, when Steve Belcher,a twenty-three-year-old pitcher for theBaltimore Orioles, died of heatstrokeafter taking an over-the-counter productthat contained ephedra, it was by far themost popular supplement in the UnitedStates, bringing in a billion dollars a yearand accounting for more than ten percent of the supplement industry’s an-nual sales. Ephedrine, the herb’s activeingredient,boosts adrenaline, stresses theheart, raises blood pressure, and increasesthe rate of a person’s metabolism. De-rived from the Asian herb ma huang, itseems to help with short-term weightloss and with increasing physical stam-ina.When used in combination with caf-feine, as it often is, ephedra is associatedwith an increased risk of heart attack,stroke tachycardias, palpitations, anxi-ety, psychosis, and death. Even though it was cited as a contributing factor inBelcher’s death, only three states—NewYork, California, and Illinois—subse-quently banned supplements contain-ing ephedra.After numerous studies andnearly a year of review, the F.D.A. an-nounced, on December 30th, that itwould prohibit the sale of such supple-ments.Yet,because ephedra is not a drug,it will be several months before the rul-ing works its way through the federalbureaucracy. (The agency has recognizedfor years that ephedra can be dangerous;its use in over-the-counter medicine hasbeen regulated since 1983.)

Despite the risks, the appeal of dietpills is not hard to understand.Each year,obesity kills millions of Americans andcosts billions of dollars. Data from theNational Health and Nutrition Exami-nation Survey show that almost sixty-five per cent of the adult population is overweight.The prevalence of obesityamong children is spreading, and if cur-rent trends continue more than forty percent of Americans will be clinically obesewithin five years. The burden on thehealth system,not to mention the weak-ened quality of life that obesity causes,will be enormous.

I stumbled across an advertisementfor Zantrex-3 while riding on the

subway in New York one day.The nameseemed coolly futuristic, and the ad wasinviting, featuring an impossibly lithe

and attractive couple dancing the tango.The copy beneath them promised—in“one amazing superpill”—both weightloss and incredible energy. “You are not obese,” Zantrex-3 ads say. “You just need to lose a quick ten to fifteenpounds . . . and you want energy . . .plenty of energy.”

Who could argue with that? I lookedfor the name of the company at the bottom of the ad: Zoller Laboratories.When I called the 800 number printedon the advertisement, the woman whoanswered told me that the company wasbased in Salt Lake City, but I couldn’tfind it listed in any of the databases thatI normally use for research. Then I noticed, in an article about BritneySpears’s “weight problems,” that thechief scientist at Zoller was quoted byname. I dialled the 800 number againand asked to speak with him. He an-swered the phone, but was startledwhen I asked if I could fly out and talkwith him.He promised to call me back.He never did,but eventually the public-relations representative for a companycalled Basic Research invited me to visitBasic’s headquarters, in Salt Lake City.He told me that Basic was the exclusivedistributor of Zantrex-3. Zoller Labo-ratories does exist, but there are no of-fices and no labs. It’s a company createdby the marketing team at Basic becauseits name sounds scientific.

Basic Research is a privately held con-

glomerate based in a modern, hundred-and-fifty-thousand-square-foot factorythat was previously the U.S. assemblyheadquarters for Palm Pilot. Havingtripled in size in the last year alone, thecompany is looking for more space nearby.The headquarters is a five-minute drivefrom the Salt Lake airport, and there are more than a dozen similarly squat industrial buildings scattered along thehighway among the Days Inns and GuestQuarters. Most are home to companieswith names like Utah Scientific, Ce-phalon, and Compeq. With the vigor-ous help of Senator Orrin G. Hatch, aprincipal sponsor of the Dietary Sup-plement Health and Education Act, thearea has become a magnet for supple-ment companies.Hatch has been the in-dustry’s greatest champion and has con-sistently fought tighter regulations onproducts like ephedra. (So has his son,Scott,who has earned millions of dollarsfor firms that lobby on behalf of supple-ment companies.)

Arriving early for my meetings, Iwaited in the lobby, which was fes-tooned with flyers and advertisementsfor a stupefying variety of herbal tonicsand miracle cures. A banner bearingthe company motto—“We help peoplefeel great about themselves”—wasstretched across an open bullpen areawhere dozens of salespeople workedthe phones. Basic has a remarkablyhigh “closure” rate; more than sixty per

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70 THE NEW YORKER, FEBRUARY 2, 2004

cent of callers make a purchase. An ad-vertisement for Zantrex-3 on the walldeclared, “Dietary Supplement Indus-try Pinning Hopes on New ‘SuperStimulant,’ Non-Ephedra Diet Pill.Decline in Ephedra Diet Pill Sales Reversed by Zantrex™-3’s SuddenPopularity.”

Basic puts out scores of products,which are marketed under the names ofnearly a dozen companies—a practicethat, according to Dennis Gay, the pres-ident and C.E.O., is intended to confusecompetitors and “protect our brands inthe Wild West atmosphere that existstoday in the supplement industry.”WithZantrex-3, Basic has seized cleverly onthe fears about ephedra—marketing thepills as the “high-tech” substitute. Butthe company has many similar products;the cynically named Anorex, for exam-ple, is “the first weight-control com-pound designed to mitigate the pro-found effect that variations in the humangenetic code have on the storage, use,and disposition of body fat,”and Relacoreis the “most significant weight-controladvancement in more than a decade.”(“Excess tummy flab is not your fault.”)There is also Sövage Breast Augmen-tation Serum, a topically applied bustcream (“Yes They Are Real Breasts,”onehighly illustrative ad says), and SövageLip Plumper, to increase the fullness ofone’s lips. The company also marketstummy gels that promise “ripped abs”(NutraSport Cutting Gel), and a varietyof tonics to help one think, relax,or sleepmore soundly.

One product, Strivectin-sd, a creamthat is sold for more than a hundred dol-lars a tube in Nordstrom,Lord & Taylor,and other stores, is made by a companycalled Klein-Becker USA, which callsitself “the industry leader in providingpatented and exclusive weight-controland life-enhancement products thatmeet your individual needs.” There is,however, neither a Klein nor a Becker,nor are there any specific employees whowork there.Like Zoller Labs, it’s a com-pany created by Basic because the namesounds impressive and pharmaceutical.Strivectin was originally intended for useby women to reduce stretch marks (andin many stores it is still marketed thatway), but people soon began to rub it ontheir faces as well; Strivectin now asks,without any data to justify the compari-

son or the question, “Even better thanBotox?”

Daniel B.Mowrey, the man responsi-ble for creating most of these products, isa gentle-looking figure with blue eyesand gray hair that is thinning at the top.The day I met him, he was dressed inchinos, a denim work shirt, sneakers, anda loud paisley tie. “I used to be a hippie,”he said, shrugging,when he saw me star-ing at the tie. He told me he bought it long ago in Haight Ashbury. Mowreyis the director of scientific affairs at Basicand one of the three owners. Everyonecalls him Dr. Dan. He received a Ph.D.in psychology from Brigham Young Uni-versity, and although he never studiedbotany formally,he has written widely onthe medicinal uses of herbs. He laid outhis philosophy quite clearly in his book“The Scientific Validation of HerbalMedicine,” published in 1986:

The scientific method is a powerful tool,but it has its limits. . . . Medical science inAmerica is a unique combination of economicand political factors, which fuse together al-most religiously to promote synthesized, highlyactive chemicals.

Mowrey told me he believes that there isalmost always a “natural” alternative tosynthetic drugs: “One that is cheaper,safer, and, often, more effective.”

Mowrey came up with the compo-nents of Zantrex-3 the way he comes upwith the elements of most of the com-pany’s products: by surfing the Internet.“I never understand why my competi-tors don’t spend more time just look-ing at the information on the Web,” hetold me. “It’s all out there,” he said,showing me how he uses public data-bases—such as those kept by the Na-tional Institutes of Health—to see what’snew in fields like weight control, mem-ory, and aging.

Basic makes two major claims forZantrex-3: that it will provide an imme-diate and sustained burst of energy, andthat it will help people lose weight rap-idly. For the first claim, Mowrey reliedon a study by the U.S. military that ex-amined the effects of caffeine on NavySEALs who had been deprived of sleepand exposed to the extreme stresses of atraining week.The study concluded thatit is more effective in combatting fatiguethan a placebo.One dose of Zantrex-3 islike drinking four cups of strong coffee.Whatever the merits of that study, al-

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“I put them up after the divorce so he knows his father is still a part of his life.”

most anyone who takes the pills is sure to feel the jolt—and many people buythem for that reason alone. (The clerk at my local G.N.C. warned me to takethe pill with food, or I might get “toohigh.”)

The company attaches a tiny bro-chure to the neck of each bottle whichsays that Zantrex-3 caused “546 per cent more weight loss” than America’sNo.1 ephedrine-based diet pill—“with-out diet and exercise.” It goes on, “Pub-lished clinical studies don’t lie.’’ I askedMowrey to show me the data he used toarrive at that figure. He acknowledgedthat the figure was based not on a directcomparison of the two diet products buton extrapolations of results from unre-lated studies.

One of the studies,which Mowrey de-scribes as a “groundbreaking”paper,pub-lished in 2001 by two Danish researchersin the British Journal of Human Nutrition

and Dietetics, evaluated the effectivenessof a mixture of three South Americanherbs—now used in Zantrex-3—in aid-ing weight loss by making people feeltoo full to eat.The study followed forty-six subjects for forty-five days.Half weregiven a placebo and the others receivedthe herbal mix. At the end of the study,the herbal group had lost eleven pounds,on average,whereas the other group hadlost less than one. Seven participantswere followed for another year, duringwhich they neither gained nor lost moreweight.

The subject of obesity, after beinglargely ignored by the medical estab-lishment, has finally gained currency inthe United States, and many majormedical schools and scientific institutesnow are pouring research money intothe field. Yet, despite thousands ofweight-loss studies and an increasinglyfocussed search for solutions, there is

no evidence that any prescription, over-the-counter product, or supplementhas ever kept a person’s weight downfor much more than a few months. Atbest, such drugs or supplements areshort-term answers to lifelong prob-lems; at worst, they intensify the dis-orders they attempt to cure. I askedMowrey if it was fair to assert, as hehas, that “whether weight managementor energy management is your goal,Zantrex-3 represents the very best op-tions available anywhere.”

“What options are better?” he asked.“We have to look at the study. We arenot free to go beyond it, but it’s not fairto ignore it, either.”

Losing eleven pounds in forty-fivedays certainly sounds promising,but theresults of a single six-week study involv-ing fewer than fifty people would almostnever provide enough meaningful datato prove the value of a drug or supple-ment of any kind. It usually takes yearsand involves hundreds, if not thousands,of subjects before a study of a new drugcan yield clear evidence that it is effec-tive. The main herbs in Zantrex-3—guarana, yerba maté, and damiana, cou-pled with caffeine, zanthene, and greentea, among other ingredients—are stim-ulants, laxatives, and diuretics. You donot need a degree in nutritional sciencesto realize that if you take a combina-tion of stimulants, laxatives, and diuret-ics for six weeks you are going to loseweight, or to know that, over the longrun, such a diet plan is certain to fail.“The idea that a pill, a mixture of herbs,or anything else will allow people to loseweight and keep it off without any othereffort is completely ridiculous,” KellyBrownell told me when I called to askhis opinion of Zantrex-3. Dr. Brownellis the chairman of the psychology de-partment at Yale, and he is also the di-rector of the Yale Center for Eating andWeight Disorders. “You look at a studythat, in the end, followed seven peoplefor a year and you can conclude nothingfrom that.”

Mowrey argues that Americans oughtto have the chance to make decisionsabout the value of supplements for them-selves. “There are a lot of pharmaceuti-cals derived from plants,” he said. “Lotsof times, the safety issues are not impor-tant. And you have to remember whatyou have to do if you develop a drug

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today.Say you do a small study of maybea hundred and fifty people and you findthat as a result of the study eighty-five ofthe women who take this who wouldotherwise get breast cancer don’t. TheF.D.A.demands that the company spendseveral billion dollars and fifteen years ofresearch answering every little questionthat comes along. Every nitpicky littlequestion. Now, how many people haveyou killed before you introduce this drugto the market?

“Drug companies don’t offer money-back guarantees,” he continued, empha-sizing one of Basic’s main policies. “Wedo. And if it isn’t going to work, if it’snot effective, then we have the ability togive money back. There is satisfactionguaranteed here. Can you imagine adrug company doing that? We are in thebusiness of wellness, not of curing sickpeople. A lot of dietary supplements aredesigned to prevent problems from everhappening.There is no drug that is goingto prevent illness. Drugs treat illness.They are going to be very, very invasive.Whereas dietary supplements are notinvasive.You can combine vitamins withminerals and plants together in a thou-sand ways without anything happeningthat is bad.”

The notion that herbal combina-tions are “natural” and therefore

can’t cause harm serves as a first princi-ple for many people who take supple-ments as a solution to their medicalproblems. Even the most seeminglybenign substances, however, can turnout to have significant and wholly un-expected effects. Perhaps the best ex-ample is grapefruit juice, which can dis-rupt the work of a series of enzymesthat are found in the small intestineand which serve to break down drugsbefore they are absorbed into thebloodstream. Taking medicine withgrapefruit juice permits it to enter thebloodstream in dangerously high con-centrations, which keeps it from do-ing its job and can intensify many sideeffects. Many common pharmaceuti-cals—including antidepressants, anti-histamines, and cholesterol medica-tions—are not metabolized properly ifthey are taken with grapefruit juice.

There are numerous examples ofherbs,drugs, and supplements that causereactions or that when taken together

are harmful. Beta-carotene, found incarrots, has always been consideredpurely beneficial, yet recent research hasshown that, for men with certain typesof cancer, those who took beta-carotenesupplements had a significantly worseprognosis than those who did not.Thereis a scientific maxim that the dose makesthe poison—that any substance,no mat-ter how useful, can cause trouble if youtake too much of it. Mostphysicians don’t even knowwhat supplements their pa-tients are taking, let alonehow much, so trying to warnpeople about possible inter-actions among them is im-possible. “The remedy for allthis is to stop dangerouslypretending that pharmacologically ac-tive substances called dietary supple-ments should be treated completely dif-ferently from pharmacologically activesubstances called drugs,” Sidney Wolfe,the director of Public Citizen’s HealthResearch Group, told me. “You cannotdetermine if they are safe or effectivewithout doing the studies. And withsupplements the studies are almost neverdone.”

Some herbs do work, of course, yetthe absence of effective manufacturingstandards in the United States meansthat even then consumers can’t rely oncommercial formulas. Black cohosh hasbeen used for centuries to treat a varietyof common ailments, including,most re-cently, menstrual and menopausal prob-lems.In Europe, it is considered a drug—and many studies have shown that it canhave value.Women often take some formof the root instead of using hormone-replacement therapy. Still, in the U.S.the herbal product that you buy tomor-row may be different biologically fromthe same product purchased next month.I have a friend who, at the onset of men-opause, began to use a supplement that is composed principally of black cohosh.For several months, her symptoms dis-appeared. One day,however, she boughta new bottle, and within a week hersymptoms had returned so severely thatshe called her doctor from a car on theWest Side Highway.“I demanded a pre-scription for hormone-replacement ther-apy,” she told me, even though she con-siders it dangerous. Her doctor guessedcorrectly that she had just bought a

new bottle of the supplement, and ad-vised her to switch to a different prod-uct containing black cohosh—Remi-Femin—which is made, by Shaper &Brunner, in Germany, where it is regu-lated as a drug.

With herbal products made in theU.S., however, there is simply no way to know what you are getting in eachbottle. In 2002, researchers at the New

York Botanical Garden published a study in thejournal Economic Botany inwhich they reported onusing DNA-fingerprintingtechniques to identify sev-eral species of black cohosh.They found great variationin the herbal mixtures that

were turned into products for the mar-ketplace. It’s hard to make a botanicalproduct exactly the same way everytime. Without rules, there is almost noincentive to try.

Since the standards for making dietpills are set largely by the people

who sell them, I decided it would beuseful to see how Zantrex-3 was made.“You go look at the factory,”Dennis Gaytold me.“If you think we are a sleazy op-eration, remember: we could do it forhalf the price.” The next day, I drove toCornerstone Nutritional Labs, in Far-mington, about twenty minutes northof Salt Lake City on I-15. Cornerstone,an independent company that producesmost of the Zantrex-3 sold in the U.S.,pumped out 1.7 billion capsules, tab-lets, and pills last year, nearly two hun-dred thousand an hour for every hour of every day. I was greeted warmly byBrent Davis, Cornerstone’s director ofnutraceutical sales, who offered to showme around the plant.We slipped on dis-posable booties, gowns, and hairnets,and removed the metal from our pock-ets, so as not to contaminate the materi-als. Our first stop was the receiving areaat the plant’s loading dock,where dozensof fifty-kilogram drums of raw herbs—green tea,yerba maté,and pangea amongthem—were lined up and stacked nearlyto the ceiling, forty feet high. As soon asthe herbs arrive at the factory, they aresampled for color, consistency, density,and purity. The raw materials are thentaken to a weighing room, where theyare collected by men in moon suits and

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sampled again.Most of the machines sitin clean rooms adjacent to the factoryfloor, cordoned off by walls of double-paned glass.

After the herbs are collected, they aremixed in a blender. This is not as easy asit might appear; natural organic com-pounds are far harder to combine thansynthetically made drugs.A product likeVitamin E comes in tiny balls, and mostherbs come in flakes.The same herb canvary in consistency, in provenance, andeven, at times, in species. Some needwater; others are ruined by the slightestexposure to moisture. Some supple-ments require a minute amount of an in-gredient—less than a hundred and fiftymicrograms, for instance—to be mixedevenly into more than a hundred cubicfeet of powder. And each supplementmust be made in such a way that everycapsule in every bottle is identical inquality and strength. “It’s a hell of a jobto do,” said Michael Meade, the directorof operations for Basic Research, whowas also on the tour. “There’s a recipe,and once it’s worked out it’s fine. But ittakes time to get it right, and many com-panies fail. The idea that you just throwit all into the soup and wait is ridicu-lous.” He said that Cornerstone was un-usually rigorous in its testing, and thatBasic was pleased by the consistency ofthe results.

Like other manufacturers in the se-cretive and, for the most part, privatelyowned supplement industry, Corner-stone declines to talk about its revenuesor even name its clients. (Basic Research,too, reveals almost nothing about itsearnings, expenditures, plans, or goals.)But Zantrex-3 is obviously a big part ofCornerstone’s current business.The fac-tory’s largest blender, which was givenover completely to the production ofZantrex-3 when I was there, can turnfive thousand kilograms of raw powderinto the equivalent of fifteen million pillsa day. As soon as the newly homoge-nized herbal material leaves the blen-der, it is pressed by another machine into blue capsules, which are dumpedinto giant drums—thirty-five thou-sand capsules in each drum. They arethen collected in a hopper and fed intobottles.

Cornerstone’s computer system mon-itors every gram as it passes down theline, and supervisors keep the floors spot-

less. Once the bottles are filled, they arecapped and a tamper-proof seal is meltedon. Labels are applied by the same ma-chine. Finally, one of the brochures ad-vertising Zantrex-3’s “amazing power”is fastened by hand to the neck of everybottle on the assembly line. From there,the bottles are packed into boxes thatare loaded into cartons,which are shrink-wrapped and ready to ship. If Basic Re-search were willing to cut a (totally legal)corner or two, there is no doubt that it could produce those pills for far lessmoney.

When I left Cornerstone, I drove toa nearby Wal-Mart,which,along

with such stores as Circuit City and BedBath & Beyond, anchors a mall in a sub-urb of Salt Lake City called Murray.Wal-Mart is the biggest of what Gayrefers to as the “big boxes,” the giantchains that can insure a product’s successsimply by stocking it. By summer, allfour thousand Wal-Mart stores willcarry Zantrex-3; many of them will fea-ture displays with the tango-dancingcouple that I had noticed on the subwayin New York.

The Murray Wal-Mart has an ex-tensive section devoted to supplements ofall kinds: bottles, packets, and cartonspromising the usual array of unprovedbenefits,and promoting the health of theeyes, the skeletal system,the urinary tract,the brain. A tiny asterisk appeared onevery product—including Zantrex-3—that suggested a connection between itscontents and better health: “This state-ment has not been evaluated by the Foodand Drug Administration. This productis not intended to diagnose, treat, cure orprevent any disease.” If a product whoselabel promotes it as contributing to “well-ness” is not intended to cure, treat, diag-nose,or even prevent any health problem,what, one has to wonder, is it supposed to do? But there they all are, dozens ofbrands: Stacker 3, with chitosan, andStarch Away,which “blocks calories from

bread, pasta, pastries and other foods”(“Dieting has never been easier,” the bot-tle says). Zantrex was for sale, along withZN-3, a new product that advertises it-self on the label as being like Zantrex. Ithas the same ingredients and costs half asmuch,but, since only the names of ingre-dients are listed, not the amounts, whatcomes in each capsule is anybody’s guess.

As I walked out of the store, I heardan announcement on the loudspeaker:“Welcome, shoppers. Right now at theMcDonald’s inside this Wal-Mart youcan get two cheeseburgers for only onedollar. This offer is for a limited timeonly. Also at this McDonald’s we acceptMasterCard and Visa.”

Dennis Gay is a fifty-seven-year-old,pear-shaped man who has been

waging an unsuccessful war on his weightfor years. The first time I met with him,he was dressed in shades of green: olivepants,pale,pine-colored shirt, and lodentie.He had a short,neatly trimmed gray-ing beard. At that meeting, Gay was ac-companied by a man who was described as a “consultant” but who obviouslyplayed a significant role in the company,because he did most of the talking.(Nearly every time I asked Gay a ques-tion, he deferred to his colleague.) Theman spoke fast, and had a New York ac-cent. He didn’t give me his name, al-though I asked him for it three times.

I wondered whether Basic Researchbelieved that new laws requiring moreregulation and stricter standards wouldbe bad for the industry.“They are simplynot needed,” the man who wouldn’t iden-tify himself blurted out.“The F.D.A.hasthe authority to act today if it wants toremove something from the market. Butit always prefers to use the media.” Hewent on to say that although he assumedthat ephedra would be banned there werereally no significant problems with theherb, which Basic Research continues tosell, and which its salespeople told me onthe telephone was the “best way by far to lose that weight fast.” He said thatZantrex-3 increased “metabolism with-out increasing the heart rate or bloodpressure”—which, as it happens, is al-most never the case.

After the interview, I learned that theman’s name was Mitchell K.Friedlander,and that he had made false claims aboutdiet pills, and in the nineteen-eighties

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was prohibited by the U.S.Postal Servicefrom selling them through the mail.

When I spoke to Gay a second time,Friedlander was not there. I said it washard to ignore the fact that his mosttrusted adviser—Gay described him tome as a “marketing genius”—had beenfound to have made false claims aboutdiet pills. Gay told me that he had hireda private investigator to “check Mitchout” and that he was comfortable withthe report.“Mitch is valuable,”Gay said.“He doesn’t desire to become a part ofthe company, and I don’t think we wanthim to be.” I asked if working with aman with Friedlander’s past botheredhim, since he was trying to establishBasic Research as one of the more repu-table companies in an extremely irregu-lar business.

“Remember the old days when thebanks hired safecrackers to protect them?”Gay said. “Is this that different? Whatare the standards in this industry? Tellme what they are, because I really wish I knew, so that I could abide by them.We try to do better, but there are no clear rules. None.” He went on, “Wewould welcome standards as long as they don’t take the choice away from thepublic. I wouldn’t welcome the standardsthat exist on the drug side. Because thenyou have no choice. And the Ameri-can consumer is not stupid. He deservesto make his own mind up about what he does.”

This is Gay’s bottom line, and that ofthe industry as well. “I have to get intomy lecture,” he said, and walked over toa whiteboard in the office. “Let’s say I’vegot ninety-nine people that have a fatalform of cancer.The way the F.D.A. reg-ulates drugs now, a study would typi-cally look like this.” He drew three bigcircles and wrote the number thirty-three in each of them. “A third will getnothing, and they are going to die.Thenanother thirty-three we are going to givea placebo. The last third get the activeingredient they are testing as a new drug.

“Let’s assume the first thirty-threedie. What about placebo? Well, moststudies show that placebo survival rate isthirty-six per cent. That suggests thateleven of the people on placebo will sur-vive at least long enough to be signifi-cant. And now let’s say that of the thirdwho receive the active ingredient elevensurvive. Based on today’s regulations,

that drug would not be approved. It’s nobetter than placebo. And it would betossed in the trash. But this is what Iwant to ask: What about these twenty-two people here?” Gay drew a big lineunder the eleven placebo and elevendrug recipients who, in his reckoning,would have lived. “What the govern-ment of the United States says is thatthose twenty-two people don’t have thebenefit of a placebo or of the active in-gredient. So you have zero people sur-viving out of ninety-nine when youcould have had twenty-two surviving.”Gay looked mournful. “All I am sayingis that I want to have the right to appealto those twenty-two people. I want togive them a chance to live.”

There is a demonstrable placebo ef-fect in most clinical studies, althoughthe idea that placebo could save eveneleven patients with fatal cancer is ludi-crous. But Gay and Basic make theirmoney by selling the dream of wellness,not the reality. If their products could re-ally swell breasts, banish wrinkles, anderase fat, Basic would probably becomethe most successful company in Ameri-

can history. After all, is Zantrex-3 anydifferent from Lydia Pinkham’s miracu-lous concoctions?

This year,Congress will consider a billthat would modify the 1994 law so thatthousands of unregulated botanical sub-stances would be treated more like drugsthan like foods. Supplement manufac-turers—and their customers—are prepar-ing to fight any such change with everyresource they can muster. The bill hasbeen advertised as an assault on the FirstAmendment. The alarm has soundedacross the Internet, and congressionaloffices have been besieged with protests.Walk into any health-food store andyou’ll see leaflets warning that the gov-ernment is about to deny you the right to choose your own fate.

Gay went back to his chair and sat si-lently for a moment.“We put disclaimersin our ads, and we give people the resultsof the studies and a money-back guar-antee,” he said. “What more could youwant? Don’t prevent people from usingtheir own judgment.Let them try it. If itdoesn’t work, they can return it. That’swhat’s fair. That’s what’s American.” ♦

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“In the store it was kitschy—in my apartment it was tacky.”

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