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Vitamin Vitae

Feeding Frenzy
Industry Lures Media

by Cara Miller

Yesterday, dietary supplements were "risky." Today, they are "natural miracle cures." And depending on which way the wind blows, they most likely will be "questionable" again tomorrow. In the last year, dietary supplements have gone from being a panacea of health problems to being a boil on the face of modern medicine. But regardless of whether the industry is championed or cursed, there is no question that it will be covered by members of the mainstream media.

Some industry experts believe it's because we, as an aging population, are continually seeking ways to improve our health. Others have speculated that it's simply a matter of commerce--headlines such as "Medicinal Herbs Have a Darker Side" sell newspapers. Overwhelmingly, however, the industry consensus seems to be that the controversial nature of the industry makes it an ideal subject for 30 second soundbytes. As Jim Hine, vice president of marketing for Weider Nutrition, explained, "The media love to hate this industry. They like the 'it could kill/cure you' sensationalism and they love the public's thirst for information about the products."

Vitamin Vitae

Whatever their perception of the industry and its products, the media has been forced to recognize and respond to the plethora of clinical studies that have emerged in mainstream medical journals such as the prestigious New England Journal of Medicine and the Journal of the American Medical Association.

Perhaps some of the most balanced coverage of the industry, media stories that respond to the publication of a clinical study generally cite the report, its authors, Reference Daily Intake levels, and experts within and outside of the industry. Reader's Digest's coverage of vitamin E, for example, included a synopsis of four of the most prominent studies on the multi-use supplement, as well as a sidebar on its safety. Published in the digest's August 1998 issue, "Why You Need Vitamin E" even suggested that consumers in perfect health who exercise regularly and eat a balanced diet can benefit from vitamin E supplements. Dr. Nancy Snyderman, a California cancer surgeon and medical correspondent for Good Morning America, lent further credence to the supplement and its benefits by adding, "I used to believe that if you ate a good diet, that was enough. But frankly you don't get enough of the nutrient (vitamin E)."

Folic acid is another supplement that finally found respect in the media. Following reports of its efficacy in preventing birth defects and a recommendation by the government increasing the Reference Daily Intake for men and women to 400 mcg, folic acid became the dietary darling of the supplement category. Reporters were quick to point out that most Americans receive an appropriate amount of B vitamins from fortified cereals, breads and grains, but they also disclosed that the amount of folate found in the majority of Americans' diets was not adequate to prevent birth defects or to help in the prevention of heart disease.

Even Jane Brody, health columnist for The New York Times, has expanded her writing repertoire to include a few positive pen strokes on the benefits of certain vitamins and minerals. Once one of the industry's biggest opponents, Brody since has discovered the beneficial action of glucosamine sulfate in abating her arthritis symptoms, and now frequently espouses on the benefits of the category as a whole (The New York Times--"The Arthritis is at Bay, Thank You," Jan. 13, 1998.)

Because basic nutritional needs are covered in every biology and nutrition class from age 10 on up, the media have a sense of familiarity and therefore, comfort, in covering and sometimes suggesting vitamin and mineral supplementation. Upon approaching the outskirts of the body's basic nutritional requirements, however, the media tread a little more lightly. Herbal therapy, for example, often is treated like milk with a day-old expiration date.

Real Medicine or Medicine Show--Herbal Alternatives Investigated

Redbook's May edition featured "Natural Cures You Can Really Trust, " a list of the 10 most popular herbs and their potential health benefits. Although the story offered a positive viewpoint on how herbs can be utilized for everything from nausea to insomnia, the story did not venture onto any limbs. Editorial content stuck close to herbs that can be found in such common grocery items as lotions and tea. Chamomile, for example, made the list, as did echinacea, ginger, feverfew, ginseng and peppermint. Lest the magazine overlook any recent trends, St. John's wort and kava also were mentioned.

Because the general overtones were positive, the story could be considered somewhat of a coup, but one particular line rang sour for those trying to change the media's perception: "...while some remedies are quite effective, others don't do much of anything. And a few natural treatments can cause serious trouble or even kill you." Yet another line, quoted from Varro Tyler, Ph.D., professor emeritus of pharmacognosy at Purdue University, seemed to imply that the efficacy of these herbs is surprising: "Modern studies are showing that many do work," he said.

Perhaps that's why herbal extracts are the category's fastest-growing segment, experiencing a double-digit expansion each of the last four years. Or perhaps it's because of increased media exposure. They've said it themselves: "Popularity of Herbs Sprouts from Publicity" (USA Today, July 13). As Mark Blumenthal, founder of the American Botanical Council, put it, "There's a media feeding frenzy going on in herbal medicine right now." And as of late, that media frenzy has alighted on kava and St. John's wort.

First reported in the Wall Street Journal, the beneficial effects of kava in combatting today's stressful lifestyle soon were broadcast on everything from the nightly news to Dateline NBC. Although the Dateline story, which aired May 19, covered both safety and marketing issues related to kava, it offered only a limited perspective of three people. Elliott Balbert, president of Natrol, represented the dietary supplement manufacturers and Harvard Psychiatrist Michael Smith presented a medical opinion. Dateline reporters also interviewed a man who went into a sedated state after pairing kava with Zanax.

Little more than a month later, ABC's 20/20 aired a similar piece. Broadcast on June 22, the "Kava Craze" segment featured interviews with Chris Kilham, noted herbal researcher and consultant; Harold Bloomfield, M.D., author of Healing Anxiety with Herbs; Dr. Steven Hyman, director of the National Institute of Mental Health; and Natalie Koether, president of Pure World.

During the report, Hyman countered Kilham's endorsement of the supplement as the "answer to stress," by saying that until there is knowledge that it's safe and effective, he would advise using something else.

Derived from griffonia seed, 5-HTP is another dietary supplement that went from a "triple threat" panacea to just a threat within the span of two months. On July 17, Dateline NBC ran an innocuous piece on the benefits of 5-HTP in reducing stress, inducing sleep and helping in weight loss. This multi-use supplement was endorsed by a model, an office worker and a housewife. Even the Maury Povich show indulged in an episode on natural remedies, which featured bottles of Scottsdale, Ariz.-based TriMedica's 5-HTP and an anecdotal endorsement by a priest. By late August, however, the supplement had become potentially toxic," according to the media.

Following the publication of a "Letter to the Editor" in the Sept. 1 issue of Nature Medicine magazine, which suggested the discovery of a potentially harmful contaminant in products containing 5-HTP, Dateline producers started crafting a new story, one that focused solely on the dangers of 5-HTP. At HSR press time, the segment, which was originally set to air Aug. 31, had not been broadcast, but industry insiders predicted that reporter Stone Phillips would be whistling a new tune set to music usually reserved for dramatic film moments.

In a preemptive strike, the National Nutritional Foods Association released a statement saying that the letter contained "more speculation than fact." Executive Director Michael Ford also raised questions about the conclusions reached by the researchers and their impartiality. According to Ford, the researcher's bias was evident in its aggressive verbal treatment of the Dietary Supplement Health and Education Act of 1994 (DSHEA), as well as in the source from which the commercial preparations were obtained--Dateline NBC. "Clearly, all involved had a vested interest in a negative outcome in testing 5-HTP." Because the story had yet to air at HSR press time, the impact of the NNFA's words is not yet known.

Breaking News

Los Angeles Times Questions St. John's Wort

On Aug. 31, the Los Angeles Times reported that independent laboratory testing of St. John's wort products commissioned by the paper revealed that consumers may not be getting their money's worth. According to the newspaper, many of the brands tested by Flora Research of San Juan Capistrano, Calif., were found to contain lower hypericin concentrations than what was claimed on the label.

The first industry response heralded from the American Herbal Pharmacopia (AHP), which criticized the newspaper for the limited number of companies included in the review and for its use of a validation method that differs from that used by industry manufacturers.

According to the AHP, had the newspaper utilized the same testing method as that used by industry manufacturers, the products would have fared an average 17.5 percent closer to claimed potency. However, even with this variation, several brands tested well below label claims. Look for a complete analysis of this controversy in the November issue of HSR.

Sports Supplements-The Media's Bitter Pill

Sales of sports supplements are similarly affected by television news broadcasts or newspaper reports that focus on the "hottest" trends in protein, pills or powders. But unlike vitamins and herbs, which are backed by decades of clinical studies, most sports supplements are still in the infancy stages of clinical development, and, therefore, draw the brunt of media skepticism. Sports nutrition supplements account for less than 10 percent of the multibillion dollar dietary supplement industry, yet the endorsement of a few well-known athletes and celebrities has catapulted them to a near-celebrity status.

Case Study #1: Mark McGwire--As this St. Louis slugger closed in on the record for the most home runs in a season, (as of HSR press time, he had 57 home runs), media reports of his use of a testosterone-boosting dietary supplement seemed more pervasive than his athletic prowess. The media flurry began Aug. 22 when Associated Press sportswriter Steve Wilstein disclosed McGwire's use of androstenedione after seeing it on top of his locker. Since then, a cavalcade of news reports have appeared in newspapers and on television broadcasts nationwide. Some called it a "drug," others called it a glorified "anabolic steroid" culled from the murky waters of the dietary supplement industry. Either way, media members were quick to suggest that, at best, androstenedione is a product with "unproven value."

"Androstenedione is not an anabolic steroid and it does not work like an anabolic steroid," explained the NNFA's Ford. "It does not have a pharmacological action. The body isn't responding to an exogenous substance like a steroid. Androstenedione stimulates production of the body's own testosterone."

Yet many of the initial news reports called the testosterone-boosting supplement a compound, a pill or "the secret to legal steroid use."

One particular report by Marian Jones, which appeared on the Fox News Web site, even implies a relationship between use of androstenedione and infertility, and androstenedione and "roid rage," a condition of increased aggression usually experienced with steroid use. "If you put a male at two or three times the normal testosterone level for a long time, (and he has a) personality which is maladjusted, this can potentially set him off," said Karlis Ullis, a Santa Monica sports medicine doctor, who is writing a book on androstenedione for Simon & Schuster. Ullis' credibility may be strained, however, when you compare his opening quote that androstenedione can cause a temporary "spike" in testosterone levels, to a later quote that "One of the potential problems is that tissue levels of testosterone can build for a long time."--a quote delivered in response to manufacturers who say androstenedione is safe because it elevates testosterone levels for only a few hours.

It is also interesting to note that reporters at the Philadelphia Inquirer utilized the same sources as Jones and as the Minneapolis-St. Paul Star Tribune. The only industry representative consulted in crafting their stories was Dr. Scott Connelly, founder of MET-Rx Engineered Nutrition and co-developer of androstenedione. Dr. Charles Yesalis of Penn State University, who studies hormones, was also a popular source. Members of the NNFA or the Council for Responsible Nutrition, however, were curiously absent from the majority of news reports on androstenedione.

Case Study #2: Creatine--More studies have been conducted on the safety and efficacy of creatine than any other sports nutrition supplement currently on the market, yet in the wake of the death of three college wrestlers (none of which were caused by use of creatine), it remains one of the most closely scrutinized supplements in the industry. As Jim Hine, vice president of marketing for Weider Nutrition International, explained, "The FDA, in an effort to be seen to be doing their job, created a poorly founded flap over creatine in connection with some college wrestlers' deaths," he said. "Meanwhile, the press, looking for a safety, rather than an appropriateness story (on the basis of the FDA scare tactics) played the story bigger than they might have."

While interest seemed to abate once it was proven creatine was vindicated in the wrestlers' death, it recently surged again when McGwire, who reportedly uses creatine in addition to androstenedione, began his home run barrage. In an effort to put a new face on an old story, media members attempted a "hero worship" approach, suggesting that young children may try androstenedione as a means of emulating McGwire and his record. Based on the lack of availability of long-term studies on creatine, media members questioned the safety of its use by those whose bodies had yet to fully mature. Everyone from the International Center for Sports Nutrition to local Little League coaches was consulted for an opinion on the potential long-term effects of this muscle-building supplement.

Yet for all of creatine's reported "potential side effects" the media only can point to anecdotal reports of cramping and gastrointestinal discomfort, not documented clinical adverse effects. Even Laurel Eu, an FDA spokesman, said that there haven't been many complaints about creatine. To make up for any shortcomings on the controversial side of the issue, journalists inevitably invoke a familiar misconception: that the dietary supplement industry is largely unregulated and that the Food and Drug Administration (FDA) has no power to remove unsafe products from the market--a statement sure to raise consumer's (and industry members') hackles.

Regulating the "Unregulated" Perception

Phrased in a variety of ways, the statement usually reads something like this:

  • Associated Press, Sept. 1--"In 1994, Congress passed a law prohibiting the FDA from regulating dietary supplements unless they are marketed as drugs," or,
  • Los Angeles Times, July 29--"Since passage in 1994 of the Dietary Supplements Health and Education Act (DSHEA), the FDA no longer evaluates their (dietary supplements') safety," or
  • Fox News, Aug. 26--"This industry remains largely unregulated under DSHEA, which classifies any 'natural' supplement--one derived from animal or plant extracts, rather than synthetic chemicals--as a food, not a drug. Although supplement makers are precluded from saying their products prevent or cure disease, the 1994 law allows them to advertise their products freely and to make a variety of other boasts."

Reporters who read DSHEA, however, will find that it clearly details the FDA's enforcement powers, as well as labeling and potency standards (see DSHEA side bar). Those who read their own archives also will find reports on a recent action by the FDA to redefine "structure/function" claims on dietary supplements. Any industry that is "unregulated" surely would not be subject to a proposed rule such as this.

But even if the FDA did not have any power of retribution (a wide-spread misconception), the majority of companies within the industry would continue to self-regulate in an effort to produce the most consistent, efficacious and safe products.

"We regret that the media continues to portray us as 'snake oil salesmen,'" said Elliott Balbert, president of Natrol. "When, in fact, many of the leading companies have poured millions of dollars into their state-of-the-art manufacturing facilities to ensure their products' quality and safety."

DSHEA's Definition of "Regulated"

Reporters interested in learning more about the Food and Drug Administration's role in regulating the industry need look no further than the Dietary Supplement Health and Education Act of 1994 (DSHEA). DSHEA clearly details the FDA's enforcement powers, as well as labeling and potency standards.

Under DSHEA, FDA has the power to:

  • Require dietary supplements to meet strict manufacturing requirements (Good Manufacturing Practices), including potency, cleanliness and stability (Section 402(g)).
  • Seize dietary supplements that pose an "unreasonable or significant risk of illness or injury" (Section 402 (f)).
  • Refer for criminal action any company that sells a dietary supplement that is toxic or unsanitary (Section 402(a)).
  • Obtain an injunction against the sale of a dietary supplement that has false or unsubstantiated claims (Section 403(a), (r6)).
  • Sue any company making a claim that a product cures or treats a disease (section 201(g)).
  • Stop the sale of an entire class of dietary supplements if they pose an imminent public health hazard (Section 402(f)).

In attempting to explain the media's promulgation of this misconception, some industry members offer a plea of ignorance. "I don't think the media truly understand our industry," said Andrew Fischman, director of marketing for Bodyonics. "And if they don't understand it, how can they report responsibly?"

Others such as the NNFA's Ford feel the media is simply responding to effective public relations efforts by the FDA. "It's really tough to get the attention of the media unless you are either innately skilled like Michael Jacobson or have a platform like a David Kessler."

But as Weider's Hine pointed out, this perception is not only a seemingly bad reflection on the industry, but on the FDA as well. "The fact that the prescription drug market is 'tightly regulated' did not intercept Fen-Phen or the six prescription drugs the FDA asked be withdrawn since May of this year," he said.

Still, both the media and the FDA's attention on the industry have had a paradoxical effect. Rather than create a disdain for the industry, it seems to have created a sales boom that "is not showing any signs of abating," according to the Chicago Tribune. In fact, the industry consenus is that the media has had an overwhelmingly positive impact on the industry. Whether because of these reports or in spite of them, sales of each of these products have continued to soar. Androstenedione is the perfect example. Less than two months ago, no one had ever heard of this multi-syllable supplement. Today, consumers are asking for it by name.

As Hine put it, "The media exposure on various flap issues generally has increased sales. Not only has it sparked consumer interest, resulting in increased sales, but it also puts more information out in the mainstream from which the general consumer can pick and choose. The more the consumer understands, the better for everyone."

The Public Relations Machine
Public relations is an inexact science at best...

When Dateline NBC broadcasts a story on creatine, the camera pan of an assembly line racking up bottles of Weider Nutrition's creatine bottles is no coincidence. That three-second spot was probably the result of 40 hours worth of telephone calls, e-mails, faxes and mass mailings of creatine-encased boxes by a public relations expert.

With the recent proliferation of media attention on the dietary supplement industry, suppliers, manufacturers and industry associations across the country are fast learning the value of public relations. By definition, the job of a public relations expert is to garner free publicity. But in attempting to gain free "air time," or "space," the expert has to offer the media something in return--a timely, newsworthy story or angle. The challenge is pitching the right angle to the right outlet. A newspaper reporter, for example, may just want the results of a clinical study, while a broadcast reporter may want to talk to someone who participated in the study. Likewise, The New York Times is going to want a, shorter, harder news angle than Reader's Digest.

Without the right news hook, explained Jay Wright, senior public relations counsel for Integrated Marketing Group, "the story means nothing and will be lost in the sea of news releases reporters receive every day." A news hook can be anything from a large herb harvest to a local angle on a national news story. The secret, experts say, is knowing the audience.

Because of time constraints, television reporters don't have the luxury of providing in-depth analysis. Compelling visuals, therefore, become critical in the ability to convey four pages worth of a story in the span of 60 seconds. Both public relations experts and television news broadcasters agree that video news releases (VNRs) are, therefore, invaluable when competing for air time. Often, a local television station does not have the resources to send a cameraman on a feature assignment. The role of the public relations expert, then, is to produce the segment themselves. Experts suggest approaching VNRs like Dateline NBC or 20/20 would produce a news story: write a news script and outline the visuals as if it were a news story rather than a commercial. Once the video is produced, it is then made available to news reporters across the country via satellite. While a VNR may not be utilized in a Dateline NBC segment, it can be an ideal launching point from which a producer may decide to send out his own camera crew.

Keeping abreast of media editorial calendars and deadlines is another critical element in garnering press. If the feature story for Good Housekeeping's June issue is on stress, for example, public relations representatives should be talking to the editor about kava kava in March. In general, mainstream media publications work three months in advance, while industry publications work two months out. But because breaking news can often preempt a previously scheduled segment in newspapers and television news magazine, predicting which stories will air on what day proves more challenging.

In order to stay in the loop, Sheldon Baker of Sheldon Baker Public Relations, often calls reporters just to say 'hello.' "Not every phone call has to involve pitching a story," he explained. "It is okay to call just to introduce yourself or offer an informative session. We also recommend that our clients allocate time and money for a personal visit with a reporter or producer. Often, if the chemistry is there, they will give you more air time. That isn't to say that a good relationship is necessary to getting a story published. A story that is meaty will sell itself."

Take new research, for example. William Seroy, president of InterHealth Nutraceuticals stated that the company's release of 10 new clinical studies within the last 18 months has resulted in a number of media announcements both in print and broadcast. "Health sells," he said. "People want to know about dietary supplements and how they can maintain good health. As long as consumers are interested and want to learn more, the media will be more than eager to provide them the information they are asking for, and take advantage of the increased circulation this interest generates."

Once the publication or broadcast date of a story is established, public relations experts try to get a sense of whether the story is going to be negative, positive or neutral to decide if they even want their client to be included. As Andrew Fischman, marketing director for Bodyonics, stated, regardless of what you do know about a publication's news angle, "you never really know if it is going to be positive or negative until the story appears."

That isn't to say that negative publicity cannot be helpful. As Wright stated, "Sometimes in this industry, any publicity is good publicity." The Mark McGwire/androstenedione brouhaha, for example, caused retail sales of the testosterone-boosting supplement to skyrocket.

The secret is being prepared. As Jim Hine, vice president of marketing for Weider Nutrition, stated, "Sometimes we know of a story in advance, but more often it is because we are prepared, have offered ourselves as a resource and respond honestly and intelligently. We make this effort because we think one of the biggest problems or challenges this industry has is consumer education--anything that gets product information in clear, clean English before the audience is good for the industry and good for Weider."

Sometimes, however, despite every good intention and every valiant effort, a story ends up on the cutting room floor. "Public relations is an inexact science at best," said Suzanne Shelton, president of the Shelton Group. "You can pitch a story and schedule the interviews, but you just don't know until it goes out over the airwaves. But the effort is worth it. Editorial coverage carries a third-party endorsement value that you just can't buy."

Due to the overwhelming media response to the dietary supplement industry, HSR:Health Supplement Retailer will debut a new column next month dedicated to cataloging the most recent media reports. Each month, MediaWatch will bring you a condensed version of newspaper and television broadcast reports nationwide, as well as information on how to obtain copies of the story.

Please help keep us informed by faxing any newspaper or magazine clipping in which your company has been featured to (602) 990-0819.

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