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Getting a Dose of Reality

Americans are buying fewer vitamins, herbs and other health supplements, including the popular echinacea and St. John's wort. Questions about safety and effectiveness, as well as the advent of alternatives to pill-popping, are contributing to slowing sales.


The health supplement industry, which made the exotic echinacea plant a modern alternative to chicken soup, is scrambling to find a cure for its sales malaise.

Americans last year reduced purchases of vitamins, herbs and other health supplements for the first time since 1994, a sign that consumers have become skeptical of natural remedies marketed for maladies ranging from sniffles to depression.

The slowdown comes despite continued high prices for prescription drugs and dissatisfaction with managed medical care--factors that drove the self-care market during the last decade. But developments in science and the marketplace, along with recurrent questions about safety, have taken a toll on wellness products.

* Research on top-selling remedies has raised questions about whether they work. In two separate studies published last year, for example, scientists drew opposite conclusions about echinacea's purported cold-fighting ability. Sales of the strong-selling remedy dropped from 1999. "If experts can't agree, whom should [consumers] trust?" said nutritional-industry consultant Robert G. Donovan.

* Quality-control issues won't go away. Watchdog groups and, most recently, online testing service, have found that ingredient levels in supplements frequently fall short of amounts stated on product labels. Of 13 SAM-e products tested last year, for instance, five didn't contain the amount of S-adenosyl-methionine stated on the label. SAM-e is promoted as an antidepressant.

* Health-conscious consumers have more choices. Vitamin-fortified cereals and drinks, herbal teas and such anti-cholesterol butter substitutes as Benecol offer Americans ever-widening alternatives to pill-popping. "Consumers may be looking to foods first," said Phillip W. Harvey, an official with the Newport Beach-based National Nutritional Foods Assn., which represents mostly retail stores.

Beyond these issues is "mad-cow" disease, a concern up and down the nation's food chain. The Food and Drug Administration asked supplement makers on Jan. 29 to identify the source of bovine-derived products, including glandular extracts, collagen, glucosamine and chondroitin, which aren't covered by regulations that protect Americans from infected beef.

Trade groups representing the industry said they haven't been able to trace the source of every product and may not be able to do so. Supplement makers aren't required to maintain records on ingredient sourcing or meet federal manufacturing standards, as drug companies are.

"It is a multinational business," Harvey said. "It is very difficult to track."

Mad-cow disease, formally known as bovine spongiform encephalopathy, or BSE, and its human form, new-variant Creutzfeldt-Jakob disease, haven't been linked to dietary supplements. Industry officials consider the possibility of contracting the disease through supplements remote. But they worry that the faintest mention of the fatal, brain-wasting illness--detected in cattle in nine European countries--might cause consumers to swear off supplements.

"My paramount concern, if consumers freak out and overreact, is that we won't be able to manage that problem," said Loren D. Israelsen, executive director of the Utah Natural Products Alliance, whose members market mostly herbal products.

Questions about safety have plagued the supplement business. The FDA has received about 2,900 so-called adverse-event reports about herbal remedies, including ginkgo, ginseng, St. John's wort and ephedra, a stimulant that also has been linked to 70 deaths. On Wednesday, a jury awarded $13.3 million to an Alaska woman who suffered a stroke after taking a weight-loss product containing ephedra, which is the subject of a lengthy FDA investigation.

The industry consistently has maintained that ephedra, also known as ma huang, and other herbals are generally safe. It argues that the number of people who experience adverse reactions is small compared with the estimated 20% of American adults who regularly use them.

And loyal users of nutritional aids haven't been scared off. Rose Albano, a Los Angeles secretary, has been taking dietary supplements for close to 30 years and believes she is healthier for it. "I'm a big proponent of supplements because they get to the problem, unlike drugs that mask the problem," said Albano, 48.

But reports of serious side effects help explain why overall confidence in nutritional supplements is relatively low for substances intended to improve healthfulness. Prevention magazine reports that 14% of consumers consider herbal remedies "very safe." Only 30% of shoppers think herbal products' claims are "extremely credible," according to Natural Marketing Institute, a Philadelphia-based consulting firm.

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