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As COVID cases exceed 28 million in the United States, many pandemic-weary people are trying dietary supplements, a market valued at $48 billion in 2019, which grew to $52 billion in 2020, and is projected to reach $58 billion this year.
Demand from consumers has grown in the backdrop of the pandemic as people search for new methods to elude COVID-19. But evidence supporting these efforts is scarce.
The US Food and Drug Administration (FDA) is not authorized to review dietary supplement products for safety and effectiveness before they are marketed. They do not come with a prescription or warnings about side effects, yet many supplements contain active ingredients that can have strong biological effects, which can make them unsafe, even life threatening, in some situations.
Early in the pandemic, regulators started receiving complaints about illegitimate products. In response, the FDA launched Operation Quack Hack, and by June had identified 700 fraudulent and unproven medical products.
Warning letters issued by the FDA to companies selling products that claim to prevent, treat, mitigate, diagnose, or cure COVID-19 are available online. Recent letters issued include ones related to a so-called COVID-Aid tincture, a supposed corona destroyer tea, and a purported bioshield peptide.
It’s not the first time scammers have taken advantage of a crisis situation to sell their wares. The FDA issued 10 warning letters in 2013 to companies selling fraudulent products to combat influenza, and in 2014, regulators sent letters to companies selling fraudulent Ebola protection.
An FDA public service video warns the public to “be suspicious of any product claiming it’s a quick fix.” A claim of a miracle cure or secret ingredient “is likely a sham.”
Regulators have also flagged the registration of thousands of high-risk domain names that could become a source of misleading claims.
And the #immunebooster hashtag has already started to trend online.
The problem with this is the hashtag typically serves commercial interests, according to research published in BMJ Open by a Canadian team.
In nearly every post, “commercial endeavors are highlighted implicitly and explicitly,” warned Timothy Caulfield, research director of the Health Law Institute at the University of Alberta in Edmonton.
The hashtag has become a euphemism for strength and protection from viruses like COVID-19, and on Instagram last spring, the user-generated tag that enables content sharing jumped by 46%.
This helped supplement makers market unproven therapies and products, Caulfield said.
Immune Busted
Biomedical jargon and authoritative signaling can be used to give credibility to scientifically unsound ideas, Caulfield pointed out, and crowning misleading messaging with a “health halo” is an insidious trend that shouldn’t be ignored in the midst of a public health crisis.
An immune system on overdrive can become an autoimmune disease, an anaphylactic reaction, or a cytokine storm, problems that don’t fit the health hashtag, Caulfield said.
And misinformation or pseudoscience, whether it is about boosting the immune system or anything else, has no place in discussions of public health, he added. Caulfield is part of the COVID-19 Resources Canada network of 7000 science advocates helping to stop the spread of deceptive information.
Their #ScienceUpFirst Anti-Misinformation campaign was launched at the end of January to develop and share reliable health information with the public.
Throughout the COVID-19 pandemic, there has been a marked rise in misleading information and conspiracy theories, Caulfield pointed out. The World Health Organization has classified this as a global infodemic.
Caulfield said he worries about how misinformation has exacerbated the pandemic. And if people are buying into the idea that vitamins, herbs, or enzymes are fortifying them against the virus, they can become more complacent and decline a vaccine.
Vitamins vs Vaccines
A study of Google searches for “boost immunity,” published in Frontiers in Medicine, showed that vaccines placed 27 on a list of 37 approaches to improve health. That put vaccines behind hygiene, ginger, and citrus fruits on predominantly commercial websites promoting biased information.
Since the start of the pandemic, more than 514,000 people have died from COVID-19 in the United States. This has led to an uptick in studies evaluating the benefit of alternative health practices, such as dietary supplements.
There is not enough evidence to support a recommendation for vitamin D supplementation — a popular, well-tried option — according to a review reported by Medscape Medical News in December 2020.
Results from a randomized controlled trial on the efficacy of two more popular options, zinc and vitamin C, for patients with mild COVID-19 were published February 12 in JAMA Network Open. The idea of testing supplements for efficacy was “a no-brainer,” said investigator Milind Y. Desai, MD, from the Cleveland Clinic. “If it works, it’s a cheap way to help people. If not, we put this hoopla to rest.”
His team explored whether adding zinc and 8000 mg of vitamin C would improve symptoms. “We chose patients on the less-sick spectrum — at the base of the pyramid — because if we could have an impact there, we could get people back to work sooner.”
But the trial ended early because the results clearly showed there was no benefit.
“As a doctor, we take an oath to do no harm,” Desai said. “But medications are meant to make us feel better or live longer.” The burden of proof for taking anything should never be “it doesn’t hurt,” he noted. “People are saying, ‘it’s not harmful, so I might as well take it’.” This is a very low, potentially dangerous bar, he said.
Walter Willett, MD, from the Harvard T.H. Chan School of Public Health in Boston, agrees, but said that “many Americans are a metabolic mess.” In the United States, 70% of the population is overweight or obese, he explained, and less than 5% meet dietary guidelines. So many people were at a significant health disadvantage at the outset of the pandemic.
A list of healthy habits, including exercise, smoking cessation, drinking in moderation, sleeping well, maintaining a healthy weight, and getting vaccinated, has been published by Harvard Heath Publishing.
Most people shouldn’t be taking large amounts of expensive supplements, Willett said. Herbs and supplements should be used as an approach to get out of a vitamin-deficient state. “You can do that with a multivitamin, and it shouldn’t cost more than about $30 a year. It’s plausible that for some people, additional nutrient intake might be beneficial, but we have no direct evidence for that at this time,” he explained.
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