02/06/2015 05:02 pm ET Updated Apr 08, 2015

Nannies, Ninnies, Nutrients and Nonsense

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When the New York Times reported recently that a lot of alleged nutrient supplements are devoid of nutrients and supplements, the scrum was immediately predictable. That much more so because we have seen a recent backlash against our over-hyped reliance on supplements as silver bullets.

Supplements are not silver bullets, not even when they contain exactly what they claim. So some degree of pushback against the fatuous notion that some dose of some nutrient can fix all that ails us, and that everything natural (or claiming to be) is intrinsically virtuous, wise, and salubrious -- was warranted.

On the other hand, our cultural inertia seems to be entirely Newtonian: for every action, an equal and opposite reaction. That suggests that the answer to excessive enthusiasm for supplements is comparably excessive repudiation. That proves to be exactly true. I have developed the case previously that calls for abandoning all supplements were clearly the product of deep bias, preconceived notions, and either willful distortion of, or wanton disregard for, the relevant scientific evidence. I have developed the case previously, so won't belabor that matter here.

This column could be another about nutrient supplements, and probably interesting as such. There are important tales to tell on that topic.

I have studied nutrient supplements, and published the results. I have reviewed the published studies of others, and written about them. I have been in the privileged position of choosing relationships with select nutrient supplement makers over the years, serving as a science adviser to some of the best. I have been to factories where supplements are bottled, and seen examples of just the claimed ingredients being put into capsules in just the claimed amounts with meticulous care and exacting quality control.

So let's acknowledge that while the New York Times is right to expose a large, neglected puddle of sullied bathwater, there is a baby in there, too. Let's acknowledge that for today, and move on. This column is not about supplements.

It's about the bigger societal issue the pile-on over supplements illuminates. It's about the prevailing nonsense regarding nannies, and ninnies, with nothing in between. Nonsense it is.

I am rather centrist in many of my views, and perhaps more so as youthful idealism succumbs to tiring miles in the real world. A quote famously, and apparently falsely attributed to Winston Churchill reads: "If you're not Liberal when you're 25, you have no heart. If you're not Conservative when you're 35, you have no brain." OK, Churchill didn't say it -- but somebody obviously did. In any event, I have some understanding of the tendency.

Be that as it may, I -- as a public health physician -- continue to lean left. But speaking for myself, and everyone I know who leans much further left than I: none of us wants the government deciding what we can have for breakfast. The so-called standard bearers of the "nanny state" do not, in fact, want to be nannied by the state. Really.

Correspondingly, I'm pretty sure none of my right-leaning friends (and yes, I am proud to say, I do have right-leaning friends! We are, after all, still members of the same species) wants to have to secure notarized documents to verify that a zinc lozenge contains any discernible trace of actual zinc, or is reliably free of narcotics, steroids, or radioactive waste. I don't think even those to the right of my most rightward friends want to be personally responsible for verifying that a fish oil capsule contains anything remotely like oil once coursing through a fish.

But we act, in our dysfunctional dispersion to the poles of opposition, as if those are our only choices: nannies, who want everything stipulated by the state; and ninnies who think all will be well in a state of utterly unregulated mayhem.

True, it would be lovely if all businesses could be relied upon to place honor ahead of profit and do the right thing for the right reasons all the time. But the psychologists and others espousing game theory could quickly tell you why all who enter into that fantasy -- should abandon hope at the door.

In a world -- and it clearly isn't this one -- where every business does the honorable thing, there would be enormous potential profit for the first corner-cutting, exploitative innovator to come along (think of the move, The Invention of Lying). Then, when everyone started losing out to those profitable predations, the choice would be clear: be beaten by 'em, or join 'em. Welcome to Wall Street. Or biology, for that matter.

So even if people are intrinsically good, a system that rewards people for being bad will corrupt the practices of those people. Regulation, obviously, is the remedy.

The objective of regulation -- of nutrient supplements, or anything else -- should be to establish the bounds of allowable practice within which competition can thrive. If within those bounds are practices that legally derive profit from deception and exploitation, there is a good case for too little regulation. If those bounds close in on even honorable businesses and attenuate opportunity for seller and buyer alike, there is a comparably good case for too much.

Obviously, then, the answer is somewhere in between. And that's what this column is about.

No one leans so far to the right that they think we should each be personally responsible -- presumably in state-of-the-art basement laboratories -- for verifying the ingredients claimed on the label of a supplement vial. No one leans so far left that they think the government should tell us whether or not we can shop for supplements in the first place. Or have a basement.

The fracas over supplements shines a light on the specious contention that we have to choose between being nannies, or being ninnies. The flagrant reality is that some regulation is needed to avoid egregious and predatory dysfunction in a world of competition; and too much regulation is an intrusive nuisance, or worse, for all of us alike.

If the saga of supplements can help us take a few steps out of opposing corners toward common cause on common ground near the middle -- then maybe there was something genuinely useful in gingko biloba supplements containing no gingko biloba, after all.


David L. Katz, MD, MPH, FACPM, FACP leans left, but not so far that he falls over and hurts himself.

Director, Yale University Prevention Research Center; Griffin Hospital

President, American College of Lifestyle Medicine

Editor-in-Chief, Childhood Obesity

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Author: Disease Proof