Vitamin Vitae

Feeding Frenzy
Industry Lures Media

by Cara Miller

Yesterday, dietary supplements were "risky." Today, they are "naturalmiracle cures." And depending on which way the wind blows, they most likely will be"questionable" again tomorrow. In the last year, dietary supplements have gonefrom 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 thatit will be covered by members of the mainstream media.

Some industry experts believe it's because we, as an aging population, are continuallyseeking ways to improve our health. Others have speculated that it's simply a matter ofcommerce--headlines such as "Medicinal Herbs Have a Darker Side" sellnewspapers. Overwhelmingly, however, the industry consensus seems to be that thecontroversial 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 medialove to hate this industry. They like the 'it could kill/cure you' sensationalism and theylove the public's thirst for information about the products."

Vitamin Vitae

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

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

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

Even Jane Brody, health columnist for The New York Times, has expanded herwriting repertoire to include a few positive pen strokes on the benefits of certainvitamins and minerals. Once one of the industry's biggest opponents, Brody since hasdiscovered 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 YorkTimes--"The Arthritis is at Bay, Thank You," Jan. 13, 1998.)

Because basic nutritional needs are covered in every biology and nutrition class fromage 10 on up, the media have a sense of familiarity and therefore, comfort, in coveringand sometimes suggesting vitamin and mineral supplementation. Upon approaching theoutskirts of the body's basic nutritional requirements, however, the media tread a littlemore lightly. Herbal therapy, for example, often is treated like milk with a day-oldexpiration 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 thestory offered a positive viewpoint on how herbs can be utilized for everything from nauseato insomnia, the story did not venture onto any limbs. Editorial content stuck close toherbs that can be found in such common grocery items as lotions and tea. Chamomile, forexample, made the list, as did echinacea, ginger, feverfew, ginseng and peppermint. Lestthe 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 ofa coup, but one particular line rang sour for those trying to change the media'sperception: "...while some remedies are quite effective, others don't do much ofanything. 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 atPurdue 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 becauseof increased media exposure. They've said it themselves: "Popularity of Herbs Sproutsfrom Publicity" (USA Today, July 13). As Mark Blumenthal, founder of theAmerican Botanical Council, put it, "There's a media feeding frenzy going on inherbal medicine right now." And as of late, that media frenzy has alighted on kavaand St. John's wort.

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

Little more than a month later, ABC's 20/20 aired a similar piece. Broadcast onJune 22, the "Kava Craze" segment featured interviews with Chris Kilham, notedherbal researcher and consultant; Harold Bloomfield, M.D., author of Healing Anxietywith Herbs; Dr. Steven Hyman, director of the National Institute of Mental Health; andNatalie 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 andeffective, 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 July17, Dateline NBC ran an innocuous piece on the benefits of 5-HTP in reducingstress, inducing sleep and helping in weight loss. This multi-use supplement was endorsedby a model, an office worker and a housewife. Even the Maury Povich show indulgedin an episode on natural remedies, which featured bottles of Scottsdale, Ariz.-basedTriMedica's 5-HTP and an anecdotal endorsement by a priest. By late August, however, thesupplement had become potentially toxic," according to the media.

Following the publication of a "Letter to the Editor" in the Sept. 1 issue ofNature Medicine magazine, which suggested the discovery of a potentially harmfulcontaminant 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 insiderspredicted that reporter Stone Phillips would be whistling a new tune set to music usuallyreserved for dramatic film moments.

In a preemptive strike, the National Nutritional Foods Association released a statementsaying that the letter contained "more speculation than fact." ExecutiveDirector Michael Ford also raised questions about the conclusions reached by theresearchers and their impartiality. According to Ford, the researcher's bias was evidentin its aggressive verbal treatment of the Dietary Supplement Health and Education Act of1994 (DSHEA), as well as in the source from which the commercial preparations wereobtained--Dateline NBC. "Clearly, all involved had a vested interest in anegative outcome in testing 5-HTP." Because the story had yet to air at HSRpress time, the impact of the NNFA's words is not yet known.

Sports Supplements-The Media's Bitter Pill

Sales of sports supplements are similarly affected by television news broadcasts ornewspaper reports that focus on the "hottest" trends in protein, pills orpowders. 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 forless than 10 percent of the multibillion dollar dietary supplement industry, yet theendorsement of a few well-known athletes and celebrities has catapulted them to anear-celebrity status.

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

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

Yet many of the initial news reports called the testosterone-boosting supplement acompound, 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, andandrostenedione and "roid rage," a condition of increased aggression usuallyexperienced with steroid use. "If you put a male at two or three times the normaltestosterone level for a long time, (and he has a) personality which is maladjusted, thiscan potentially set him off," said Karlis Ullis, a Santa Monica sports medicinedoctor, who is writing a book on androstenedione for Simon & Schuster. Ullis'credibility may be strained, however, when you compare his opening quote thatandrostenedione can cause a temporary "spike" in testosterone levels, toa later quote that "One of the potential problems is that tissue levels oftestosterone can build for a long time."--a quote delivered in response tomanufacturers who say androstenedione is safe because it elevates testosterone levels foronly a few hours.

It is also interesting to note that reporters at the Philadelphia Inquirerutilized the same sources as Jones and as the Minneapolis-St. Paul Star Tribune.The only industry representative consulted in crafting their stories was Dr. ScottConnelly, 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 curiouslyabsent from the majority of news reports on androstenedione.

Case Study #2: Creatine--More studies have been conducted on the safety andefficacy 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 useof 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 foundedflap over creatine in connection with some college wrestlers' deaths," he said."Meanwhile, the press, looking for a safety, rather than an appropriateness story (onthe 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 thewrestlers' death, it recently surged again when McGwire, who reportedly uses creatine inaddition to androstenedione, began his home run barrage. In an effort to put a new face onan old story, media members attempted a "hero worship" approach, suggesting thatyoung 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 membersquestioned the safety of its use by those whose bodies had yet to fully mature. Everyonefrom the International Center for Sports Nutrition to local Little League coaches wasconsulted for an opinion on the potential long-term effects of this muscle-buildingsupplement.

Yet for all of creatine's reported "potential side effects" the media onlycan point to anecdotal reports of cramping and gastrointestinal discomfort, not documentedclinical adverse effects. Even Laurel Eu, an FDA spokesman, said that there haven't beenmany complaints about creatine. To make up for any shortcomings on the controversial sideof the issue, journalists inevitably invoke a familiar misconception: that the dietarysupplement 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 raiseconsumer's (and industry members') hackles.

Regulating the "Unregulated" Perception

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

Reporters who read DSHEA, however, will find that it clearly details the FDA'senforcement powers, as well as labeling and potency standards (see DSHEA side bar). Thosewho read their own archives also will find reports on a recent action by the FDA toredefine "structure/function" claims on dietary supplements. Any industry thatis "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-spreadmisconception), the majority of companies within the industry would continue toself-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 leadingcompanies have poured millions of dollars into their state-of-the-art manufacturingfacilities to ensure their products' quality and safety."

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

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

But as Weider's Hine pointed out, this perception is not only a seemingly badreflection on the industry, but on the FDA as well. "The fact that the prescriptiondrug market is 'tightly regulated' did not intercept Fen-Phen or the six prescriptiondrugs 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 paradoxicaleffect. Rather than create a disdain for the industry, it seems to have created a salesboom that "is not showing any signs of abating," according to the ChicagoTribune. In fact, the industry consenus is that the media has had an overwhelminglypositive 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 perfectexample. Less than two months ago, no one had ever heard of this multi-syllablesupplement. Today, consumers are asking for it by name.

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

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

When DatelineNBC broadcasts a story on creatine, the camera pan of an assembly line racking upbottles of Weider Nutrition's creatine bottles is no coincidence. That three-second spotwas probably the result of 40 hours worth of telephone calls, e-mails, faxes and massmailings 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 learningthe value of public relations. By definition, the job of a public relations expert is togarner 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 abroadcast 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'sDigest.

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

Because of time constraints, television reporters don't have the luxury of providingin-depth analysis. Compelling visuals, therefore, become critical in the ability to conveyfour pages worth of a story in the span of 60 seconds. Both public relations experts andtelevision news broadcasters agree that video news releases (VNRs) are, therefore,invaluable when competing for air time. Often, a local television station does not havethe resources to send a cameraman on a feature assignment. The role of the publicrelations expert, then, is to produce the segment themselves. Experts suggest approachingVNRs like Dateline NBC or 20/20 would produce a news story: write a newsscript and outline the visuals as if it were a news story rather than a commercial. Oncethe video is produced, it is then made available to news reporters across the country viasatellite. While a VNR may not be utilized in a Dateline NBC segment, it can be anideal 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 elementin garnering press. If the feature story for Good Housekeeping's June issue is onstress, for example, public relations representatives should be talking to the editorabout kava kava in March. In general, mainstream media publications work three months inadvance, while industry publications work two months out. But because breaking news canoften 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, oftencalls reporters just to say 'hello.' "Not every phone call has to involve pitching astory," he explained. "It is okay to call just to introduce yourself or offer aninformative session. We also recommend that our clients allocate time and money for apersonal visit with a reporter or producer. Often, if the chemistry is there, they willgive you more air time. That isn't to say that a good relationship is necessary to gettinga story published. A story that is meaty will sell itself."

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

Once the publication or broadcast date of a story is established, public relationsexperts try to get a sense of whether the story is going to be negative, positive orneutral 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 apublication's news angle, "you never really know if it is going to be positive ornegative 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 MarkMcGwire/androstenedione brouhaha, for example, caused retail sales of thetestosterone-boosting supplement to skyrocket.

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

Sometimes, however, despite every good intention and every valiant effort, a story endsup 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 andschedule the interviews, but you just don't know until it goes out over the airwaves. Butthe effort is worth it. Editorial coverage carries a third-party endorsement value thatyou just can't buy."