Special report. Frontlinis made possible by contributions to your pbs station from viewers like you. Thank you. And by the corporation for public broadcasting. Major support for frontliis provided by the john d. And catherine t. Macarthur foundation, committed to building a more just, verdant, and peaceful world. More information is available at macfound. Org. Additional support is provided by ford foundation, working with visionaries on the front lines of social change worldwide, at fordfoundation. Org. The park foundation, dedicated to heightening Public Awareness of critical issues. The john and Helen Glessner family trust, supporting trustworthy journalism that informs and inspires. And by the frontline journalism fund, with major support from jon and jo ann hagler. This is a product that was formulated for people who are under severe stress. So this is an herb that would be great for older individuals that are concerned about their memory. Narrator its estimated that half of all americans take a Health Supplement every day. That one is going to be amazing for supporting the. Encapsulates the nutrients in a nongmo. This is a very potent antioxidant. Narrator its a 30plus billion industry. I will guarantee you that this will change your reality within three to five days. Narrator companies range from big pharma to mom and pop. I started in my kitchen making them by hand back in the 80s. I would order the ingredients, i would order the capsules. And with a plate of 100 capsules, i would weigh it out and fill them up, and you have a bottle of 100 capsules of any particular vitamin you wanted. Narrator do you have a background in pharmacology, or medicine, or any expertise in this area . I did some college, but most of my time was spent in the medical libraries at stonybrook. Narrator so you sort of were selftaught, then, were you . Selftaught, correct, yes. Narrator Candice Tripp called her Vitamin Company purity first. She says she was helped by her then husband terence dulin, a chiropractor. And what was his academic background or expertise in this area . He was a chemist. He was a chemist in college and then he went on to chiropractic school. Narrator from modest beginnings, she said she grew the business into a half a Million Dollar a year enterprise, selling on the web, in stores, and through local alternative healthcare providers. Purity first is a great name, and i said, gee, how can you go wrong . Its what you would imagine that you would want in every single vitamin. Its absolutely pure. Narrator vinnie grosso was an early purity first customer. The vitamins became part of his daily quest for better health. I felt fine, and of course you know, im running every day, im feeling great, up until the october, november, december time frame of 2012 where i had some very unusual symptoms. Narrator it started with unexplained back pain that soon became debilitating. He then started hearing from other purity first customers, with troubling symptoms of their own. Im hearing stories, my daughter is an honor student and shes on the swim team, but shes been thrown out of school for being overly aggressive. Im talking to a woman who had lost her position in a choir, because her voice had changed. Im talking to another woman who said, ive got these incredible bleeding scales on my head, and i cant go to work. Narrator they were all takig the same vitamins recommended, they say by terrance dulin, the chiropractor, now a naturop, dulin declined to be interviewed and denies any responsibility. He declined to be interviewed. Terry had come to me in january and asked me if i thought anything was wrong. Because he said there was some blood tests coming back that were funky. At that point we had just had Hurricane Sandy come through and a lot of people were getting sick after they were in their basements cleaning up water. And thats why he had recommended people go see this other doctor. And they started going to see dr. Spaeth. We had an examination, and he said to me, what is this, that all of you who have come to me in the past month and a half have one commonality. Youve all taken purity first b50 vitamins. Narrator its estimated there are 85,000 Dietary Supplements for sale in the United States today. Right here i have our liposomal d. So this is our bacopa. This is an herb that would be great for older individuals that are concerned about their memory. Retains the essential nutrients like chromium. Narrator with so many pitches and promises you might assume some Government Agency has approved them before allowing them onto the market. The fda does not do any review of Dietary Supplements before they come onto the market, and i think that all consumers need to understand this. Narrator no testing, no obligation to provide any evidence a product is effective or even safe. The one thing manufacturers do have to show is that they follow good manufacturing practices. The fda conducts inspections for that, but its limited by resources, and by information. We actually dont know the total number of manufacturers that we need to be able to inspect, because there is no formal Registration System that is required of manufacturers that make Dietary Supplements, and so we do inspections of the ones we know about. Narrator the fda did know about a supplement manufacturer that used to operate here. In 2012, and again in the spring of 2013, mira Health Products was cited by fda inspectors for violating manufacturing codes. Among the products mira produced Candice Tripps purity first vitamins. I had a lot of faith in mira because he was more of a smaller scale manufacturer. He wasnt one of these Big Pharmaceutical Companies that just didnt really make you warm and fuzzy. Narrator what did you do to try to verify that this was a Reputable Company that would make the product that you wanted . Theyre supposed to test the product and give you an analysis at the end that what is in the capsule is what theyve tested, and the certificate is supposed to be certified, and this is what your product is. Narrator and did they give you those certificates . I believe yes, they did, they gave us those and there didnt seem to be a problem. Narrator but by 2013, there was a problem. Dr. Kenneth spaeth, who specializes in environmental health, is the man those purity first customers turned to, to investigate their symptoms. He arranged for the b50 vitamins to be tested. And the results were a shock the capsules were laced with two anabolic steroids. Joe kueler, Candice Tripps current husband, took it up with miras owner. I called mike and said pretty much what could have happened . And you know, he was making the male enhancement pills and he said, joe, he said, if they found any type of steroids in there, the only thing i could possibly think is maybe the mixer was not cleaned enough. Narrator by now purity first customers had started hiring lawyers, and sharing their stories. Change in the voice, change in the sexual organs, hair growth on a young lady with one of our clients basically developing mustache, beard. The female sexual organs taking on a male configuration. For the men who ingested these things, they developed whats called gynecomastia. You end up with male breasts. Narrator it would take the fda nearly six months to get the purity first vitamins off the market. A response dr. Spaeth calls glacial. He declined to be interviewed on camera, but he shared email exchanges with us detailing his efforts to get the fda to act. Spaeth says he suspected contamination, but his first inquiry went unanswered. When he emailed again asking if the lack of response was a lack of interest, he was referred to the fdas hotline for Adverse Reactions called medwatch. Spaeth had tried the line, been transferred and put on hold before being disconnected, twice. Five weeks later he was still frustrated. Will you tell me what your plans are . , he wrote. I have 20 very worried patients and little to offer them. Among the officials spaeth was writing to was daniel fabricant, then head of the fdas division of Dietary Supplements. We took that information. While it was helpful, it didnt make the whole case. We had to make the case at fda and we did, and removed the product successfully. Narrator one of his biggest complaints is the amount of time it took just to get somebody to call him back. He says one of the operators, she acted as if i was telling her that aliens put messages in my cheerios. Now, that doesnt suggest that youve got a particularly robust system in place, to allow people to report problems when they happen, right . Well, i can assure you the government worked very quickly. The agency is acting to remove the product, across the board, across the country. So its a bit more of a heavier scientific lift than just a doctor having an intuition or a feeling about something. We had to build evidence, court ready evidence, to take away somebodys product. Somebodys manufacturing operation. And thats exactly what we did and doing that in six months, the team at the fda worked diligently and worked quickly to do that, which was quite a successful accomplishment. Two women from the fda came in and they were speaking with us about how there seems to be a problem with one of our products. When we asked which product, they said, oh that didnt matter yet. Okay. Do you want us to stop selling the product . No, you dont have to stop selling the product. Nobody died, they said. Narrator nobody died. Those were their words. Their words were, nobody died, you dont have to pull the product. Narrator if there was any concern, at all, why didnt you just pull it from the market . I mean, why did you not do it yourself . Great question. Their response to me was, people call the fda all the time to report minor things. So dont worry about it. Narrator the fda strongly denies those things were said. Some vitamins manufactured here in long island are triggering some health concerns. The fda recently issued a recall after steroids were found. Narrator in the end, purity first withdrew the vitamins under pressure. Were in farmingdale in front of mira Health Products. Narrator mira was forced out of business by the fda. Nobody from the company would speak to us. 36 people are now suing the companies, and no one knows how many people in total may have been harmed. Spaeth had brought up that he was looking for. Narrator for vinnie grosso and his lawyer, it was a sobering look into a troubled world. I was very concerned and then i realized that this whole Industry Needs change. And how much danger were all in. Not just from purity first, likely, but from others that can put anything into these little bottles and put a seal and a label on it. Narrator in 2013, the Childrens Hospital of philadelphia had had enough. Worried about the number and quality of the supplements their patients were arriving with, hospital pharmacists decided to challenge manufacturers. Families are showing up literally with shopping bags full of Dietary Supplements. The regulatory issues in the United States are that you have to, if a patient brings a medication into a hospital, we have to as pharmacists verify that this is a quality product, it is what it says it is, its labeled appropriately, its being dosed appropriately and so on. We got fed up. We took a step back and we said, okay, were going to ask these companies to at least meet a labeling standard. They have to send us something called a certificate of analysis, which means theyve had their product analyzed by an independent party that says whats on the label whats in the bottle. 90 of the Companies Never responded. And of the 10 that responded, of that 10 , often, they would send us certificates of analysis where what was on the label wasnt even close to what was in the bottle. And these were the ones who responded to us, which made us fearful of an industry that we couldnt trust. For example, this is an aqueous vitamin d drop. So we use vitamin d in premature infants. It says it should have 400 International Units per one ml of solution. However it tells us that the results are that its 213 of the labeled value. So its more than double what it says that it is. So if were dosing premature infants who need very tiny doses of this drug, were now potentially giving them double what they should get, and could really put them at risk for toxicity. Narrator in the end, only 35 supplements met the hospitals standards. I come away very worried and dismayed. Worried mostly about what the American Public is being exposed to. Because its essentially a complete unknown when you are buying a dietary supplement, unless you have some proof of what is in that product. It could be anything. Narrator at the new York Botanical gardens, you can find many of the herbs we buy in bottles in their natural state. This is black cohosh, commonly recommended to women to treat symptoms of menopause. In 2010, gynecologist david baker decided to check out what so many of his patients were taking. He bought dozens of brands of black cohosh supplements and started testing the dna. 30 had no black cohosh, and the samples that we found, we could identify the other plants as well, and they were from ornamental plants from china. Narrator baker and his colleagues published the results in an academic journal, but they didnt get much attention, so they kept on testing. Other supplements produced results that were no less disturbing. Upwards of 15 of supplements like saw palmetto are not saw palmetto. Supplements like devils claw 100 are not devils claw, or contaminated with some other problem. What i see in this is that there are those who take the easy way out, a fraudulent way, and want to put something in the bottle thats cheap and readily available, and buyer beware. Narrator with billions of dollars at stake, its no surprise that the supplement industry is a powerful force in washington. There are four separate lobby groups the largest, the Natural Products association, headed by daniel fabricant. A lot of products now, youll see private label. A lot of the contract manufacturers that make the private label are members as well. Narrator its the same daniel fabricant who until 2014 was in charge of regulating Dietary Supplements at the fda. He defends what critics have called a disturbing revolving door. Folks who understand an industry make for very effective regulators. I think it certainly works to the consumers benefit, which at the end of the day, i think fda, the industry are in the same business to make sure consumers have access to safe, healthy products. Do you accept that there is a problem with adulteration, though, in the Natural HealthFood Industry . There may be some supply chain issues we need to be mindful of, but again, i think there are federal authorities that cover that, that ensure that products are made to certain quality parameters as defined by law. And if firms dont, there are clear consequences. So i think thats the important thing, and americans have a high degree of confidence in the products because of that. Narrator but just months after leaving the fda, fabricant didnt sound so confident himself. In a presentation to a trade association conference, he shared some of the results of fda inspections. You talked about some of the findings. The companies were doing no testing, have no idea of what theyre buying or selling, companies that have no standards, inadequate records being kept, no specifications set. And this is a quotation the extreme of this observation is more common than expected, which i read to be, this is worse than we thought. Those are the companies we took action against, those are the companies we drove out of business. Im speaking from my experience when i was a regulator where we saw those problems, and they were extreme. We threw the book at people. And so i think thats good news for consumers. How Many Companies did you throw out of business . Quite a number. I think we processed over 25 injunctions during my time at the agency, so. In an industry that has 4,000 or more manufacturers, is that significant . I got my 25, you get yours. Im not a regulator, i dont think thats going to happen. It is significant. Its very significant. Narrator the fda division in charge of the supplement industry is tiny, just 25 employees. They target companies they consider the most risky, but agree the problem remains much bigger than that. Because of the targeting and because of traditionally the way this industry has developed over time, we do see a higher proportion of inspections that we do with Dietary Supplements, a higher proportion of them that have substantial problems than in other categories that we regulate. How much does that worry you . Of course its a concern, because ultimately this isnt about us and it isnt about the companies. Its about the consumers. Narrator to many, supplements may look like prescription drugs, but theres a big difference. Drug makers have to prove their products are safe and effective before putting them on the market. Those who make supplements dont, not unless theyre introducing a new ingredient thats never been marketed before. Its an absurd system. In the future, many years, well look back and well say, how could we have possibly done this . It took a hundred years of thoughtful regulatory advances to ensure that drugs now were talking about prescription drugs are both safe and effective. How could it be that the clock turned back to the world of 1920s, 1930s, when you can sell something without any evidence that its safe or effective . We are back at the turn of the century, when Snake Oil Salesman could hawk their potions with promises that couldnt be kept. Narrator in the early 1990s, the head of the fda was David Kessler. Hed arrived in office promising tougher regulations for supplements, in particular demanding Health Claims be backed by scientific evidence. The industry went bonkers. Everything exploded. Ive taken on some of the hardest regulatory issues. I did tobacco. Tobacco looked easy compared to Dietary Supplements. What happened was the dietary supplement industry recognized that the standard that we set significant scientific agreement would require it, before it could make a claim, to have a scientific basis. They just couldnt make any claim. And they saw, literally, billions of dollars at stake. And they unleashed a lobbying campaign that was second to none. Narrator the campaign was as dramatic as it was effective. Freeze whoa, hey guys, its only vitamins narrator complete with hollywood stars. Vitamin c. You know, like in oranges . Congress received more letters regarding this than they ever received regarding the vietnam war. Narrator dan hurley has written what many consider the definitive account of the industrys battle with the regulator. We hear people claiming that fda. Narrator while David Kessler was trying to convince congress, behind the scenes, another kessler was at work. Jerry kessler ran a large dietary supplement company, was a very strongwilled character, the fda is going to limit potencies of vitamins, which is what theyve said. The fda is going to take herbs and make them drugs. And he called together every leading manufacturer to come out to his ranch in california, which used to belong to ray kroc of mcdonalds, okay . So, jerry basically stands up before the group and says, this is either the end of our industry or a new beginning, and we have to defend our interests. Narrator Jerry Kessler would turn out to be a very effective lobbyist, joining forces with powerful political friends. Today, we honor the wishes of 100 Million People consumers of Dietary Supplements. Narrator friends like senator orrin hatch of utah. The senator declined to be interviewed. His state is seen as the Global Center for dietary supplement manufacturing. His son has lobbied for the industry, and hatch himself has owned shares in at least one supplement company. Hes never hidden the fact hes a believer. We know that the American People are not a bunch of kooks or a bunch of dummies, and what the people want is the right to use products which have helped them for centuries. Narrator the campaign worked. Jerry kessler said, forget this law thats going to actually regulate. We need a law that says you cant regulate these products. And he named it the dietary supplement, health, and education act. He came up with the name of it, Jerry Kessler did, a manufacturer. Narrator the one concession the fda did get was an agreement that manufacturers would not make unproven Health Claims. And so, for example, they cant say their products cure arthritis or prevent heart disease, but they can say they support things like bone density, promote cardiovascular health. What congress did is basically said, industry, you go make the claims, and if fda has a problem with it, fda has to prove its false or misleading. So the horse is out of the barn. Fda then has to go seize the product, go into court, and it has the burden. 784, a bill to amend the federal food, drug, and cosmetic act to establish standards with respect to Dietary Supplements. Narrator problems with the legislation would become apparent even before it passed. The fda was getting complaints about popular new weight loss supplements containing an ingredient called ephedra. Manufacturers fought the fda for more than a decade. Yesterday, 23yearold Steve Bechler became the first baseball player ever to die. Narrator it wasnt until a Young Major League pitcher died after taking ephedra that sales were halted. A new stimulant called ephedra. Narrator by then, more than 160 deaths had been linked to the supplement. It almost takes a sacrificial lamb to die of liver injury or some other injury before the food and Drug Administration can take any action. Hi, im dr. Bonkovsky, thanks for being here. Narrator dr. Herbert bonkovsky is an investigator with a Liver Injury Network funded by the National Institutes of health. Let me get a listen of your lungs. Narrator hes concerned about the harm supplements are causing. Just lie down. This has been sort of the Fastest Growing kind of liver injury that were observing in the druginduced Liver Injury Network. The frequency with which we see this has roughly tripled in the last ten years. About 7 of all the cases that weve enrolled into this network over the years were due to these. In the last couple of years, its been around 20 . Its incredibly hard to quantify the current problem, how much harm are supplements doing. Just yesterday, i was talking to a patient who suffered a bleeding stroke into his brain after taking just one workout supplement. And the reason why we dont know is that theres no effective system to detect harm from supplements. Narrator take what happened in hawaii in the summer of 2013. There was an outbreak of liver Problems Health officials would link to a diet and workout supplement. We didnt know if it was something in the hawaiian population or some sort of contaminant or what exactly the problem was. Narrator the states only transplant center was overrun. An initial cluster of seven patients grew to more than two dozen, two of them sick enough to need new livers. It was difficult, it was stressful because people were calling up, and they were continually referring new patients, and i dont have enough organs to give, i dont know how i could put all these patients on a transplant list and possibly save all of them. Sad news tonight from the family of a mali woman. The mother of seven who fell ill after taking diet pills has died. 32 cases of liver damage. The product is oxyelite pro. The dietary supplement oxyelite pro. Narrator just two months before the outbreak, the makers of oxyelite pro had been pressured to pull an earlier formulation from the market following years of complaints. The new version included a compound called aegeline. Now, aegeline is a normal component of the bael tree, and its been used as a natural product by naturopathic healers for centuries, usually fairly safely. But they didnt use bael tree extract. They bought aegeline from a chinese drug company that made aegeline at least, the company claimed it was aegeline and within a few months, they began to observe patients with liver failure. Mostly in hawaii, but not entirely. Narrator Cynthia Novida is a chief petty officer with the u. S. Navy based in san diego. She turned to oxyelite pro to help pass fitness tests. It helped keep my weight down, it helped, you know, just give me that extra push during a workout, and i was liking it and i would take it. Narrator but only halfway through the first bottle, cynthias eyes started turning yellow. Her doctor had bad news. Thats when he told me that, your liver is shot, pretty much. Youll possibly need a liver transplant. Narrator she would get a transplant. The fda has linked oxyelite to more than 70 cases of liver dam. The company declined to be inted and denies any responsibility. Doctors in hawaii still remember how slow the fda was to act. They say they followed all the directions on the agencys medwatch website. Theyd phoned several times. But it wasnt until they approached the state Health Authorities that the fda finally called them back. They told one of our liver doctors that, you know, they thought she was a prankster because she had sent in her private email address and, you know, kept bugging them, and, you know, they didnt think we were real. They werent taking you seriously. No. It would be nice if there was a system that, you know, we could use and get some consistent results. But the fda says they do have a system. Thats what medwatch is. Right, but i dont know if theyre overwhelmed, but the way it stands is theres. You know, were not getting a response as quick as we probably should be. In hawaii, there were reports of a cluster of people who developed severe liver problems. The doctor in the case we have spoken with raises troubling questions. Repeatedly, she says she and her colleagues tried to contact medwatch, tried to report, and tried to get advice from the fda as to what to do. And repeatedly, she says, they heard nothing back. Had you heard this before . No. I cant deal with hearsay and speculation, and im not going to speculate. What i can tell you is when the documents did come into the fda that alerted us to the problem in hawaii, we were able to remove the product within a month. By that point, there were 56 cases of liver damage that had been reported, and this is for a company that only six months earlier had had another formulation removed. There werent 56 cases reported until sometime after we had the product removed. We had the product removed with effectively about 20 cases. Narrator Cynthia Novida is one of more than 100 people who are now suing the makers of oxyelite pro. A 23year veteran with the navy, she had hoped to get her 25year service pin. Thats not likely to happen now. I have to be able to travel, and i cant do that now. I cant go on a ship because they dont carry the meds that i need continuously. Narrator her doctors tell her the price of that one pill is that shell have to take 19 pills every day for the rest of her life. The makers of oxyelite pro declined to be interviewed and have rejected all the claims against them. The allegations against usp labs and its operators. Narrator but on november 2015, the department of justice launched a criminal case against the company and arrested four of its executives. Its federal partners will be vigilant when it comes to the health and safety of the American Public. Its a great, big beautiful day. Omega3 is essential for good health. Narrator the promises are endless. The minerals your kids need narrator but even if what you buy in those bottles is real, critics contend theres a bigger problem many supplements simply dont work. Whats worse, they could be doing you harm. Now, supplements, i get this question all the time. I only take four pills. Narrator our screens blare advice on how to get health from a pill. Today, id like to talk to you a little bit about supplementation. Narrator reputations and fortunes are built on dispensing that advice. Everyone should be taking a multivitamin, multimineral product. Narrator but amid all the hype, whats often lost is the science. When people walk into the dietary supplement or vitamin store, they think that everything is just perfectly safe. Narrator in addition to being a pediatrician, paul offit is a bestselling author whose book do you believe in magic . Questions our supplement habit. So ive got vitamins for children and vitamins for adults. The problem is that when you look on the back, you find that a number of these vitamins are contained in amounts that are much greater than the recommended daily allowance. Narrator offit believes we simply take too many. I think multivitamins dont hurt, which is to say, vitamins at or around the recommended daily allowance for each of those vitamins. You need vitamins to live. The question is, do you get enough in food . And i think the answer to that question is yes. But now there are studies done showing that if you take a megavitamin, you actually can hurt yourself. You actually can increase your risk of cancer, increase your risk of heart disease. I think few people know the risks theyre taking. And how do you know whats too much . Heres how you know whats too much you shouldnt bypass the satiety level. Your stomach is only so big for a reason. Narrator he illustrates the point with 1,000 milligrams of vitamin c. Thats one of these pills. To get the same amount of the vitamin from a food source, youd have to eat between seven and eight entire cantaloupes. You know, youre not meant to eat eight cantaloupes. Its a dangerous thing to do, to go against what nature intends. Narrator its even worse with vitamin e, he says. This capsule has 1,000 International Units. You can also find vitamin e in almonds, but to get the same 1,000 units, youd have to eat a lot of almonds 1,670, to be precise. Scientific studies have shown that much vitamin e can be dangerous. If you take large quantities of vitamin e as a supplement, you clearly and definitively increase your risk of prostate cancer, and in a better world, a regulated world, were vitamin e a regulated product, it should have a blackbox warning on it that says just that. Vitamins e and c are antioxidants, and for years, weve been told to take them because antioxidants are the mortal enemy of free radicals cells linked to cancer and other diseases. If you look at people, for example, who eat diets rich in fruits, rich in vegetables, that contain antioxidants, they do seem to live longer and have lesser rates of cancer and heart disease. So the thinking was great. Okay, now weve figured out a way to make ourselves healthier. Now lets doubledown and take even larger quantities of antioxidants, and thats where we crossed the line. And now study after study shows that in fact, its true. You can take too much in the way of antioxidants. Narrator in response to the studies, in 2013, one of the worlds most important scientific journals published an editorial. Enough is enough argued, the case is closed. Supplementing the diet of wellnourished adults with most supplements has no clear benefit and might even be harmful. Dr. Eliseo guallar was the lead author. This may be some of the best wellstudied compound in the history of mankind in terms of Clinical Trials. There are well over a couple hundred thousand people that have participated in Clinical Trials. So the conclusions that we have for antioxidant vitamins i think are very strong. Narrator vitamin d is not an antioxidant, but its one of the topselling vitamins in america, pushed hard with information thats often confusing. If i had to pick one vitamin to push to everybody to think about and get in their lives, its vitamin d. Narrator its true, we do all need some vitamin d. The institute of medicine recommends adults get 600 International Units a day. But look at the doses some others are suggesting. Ive recommended 5,000 ius daily. Around 5,000 ius tends to be perfect. Narrator on one website, i answered just three questions my age, my height, and my weight and i was told i needed 10,000 International Units a day, 16 times the ioms recommendation. When i hear that various groups are recommending 10,000 ius a day or even 5,000 ius a day routinely, i really want to say, show me the data, show me the evidence. Narrator evidence is what dr. Joann manson is accumulating here. Shes collected blood samples from over 25,000 people. The vital trial is, to our knowledge, the largest randomized Clinical Trial of vitamin d supplementation in the world. Narrator manson is comparing disease rates between those who take vitamin d supplements and those who dont. Final results wont be known until 2017, but already, she has concerns. Many people are taking too much vitamin d. The institute of medicine also recommended avoiding getting above 4,000 ius daily because that could be associated with adverse events. Calcium in the urine, which can be associated with kidney stones, high blood calcium, calcium in the arteries, vascular calcification, as well as soft tissue calcification. And there are now studies that show a ushaped curve that those who have high as well as low blood levels of vitamin d have higher risk of cardiovascular disease, as well as allcause mortality. So we cant assume that more is necessarily better. Narrator the third most widely used supplement in america is fish oil the omega3s contained in the oil are believed by many to be essential for good health. Dha omega3 in particular is extremely important. Narrator it also helps prevent disease, according to the man who heads one of the Largest Fish Oil trade associations. Theres certainly ample evidence that it helps things like reducing blood pressure, reducing your risk of coronary death. Narrator but the Science Behind fish oil is a little more complicated than that. So these are two capsules. This is a fdaapproved product. Narrator dr. Preston mason is a Harvard University researcher. Here, hes comparing prescriptionquality fish oil to the oil found in overthecounter supplements. And give it a smell. It smells a little bit fishy, but not bad. Right. Youre gonna have always some smell. Narrator one of the issues with fish oil is its delicate. Its extracted as a byproduct from oily fish like anchovies. As the fish get crushed, the oil is exposed to oxygen, and it doesnt take much oxygen to turn the oil rancid. This is a common supplement for fish oil. See what that smells like. Oh. What . That doesnt smell good. That smells like its going bad. Yeah, right. Its a very strong fishy smell. Narrator if it was simply an odor issue, that would be one thing, but oxidized oil contains oxidized lipids, one of the Building Blocks of cells. Weve long known that lipids, when oxidized, can be harmful. So an oxidized lipid triggers inflammatory responses within our body, particularly in our cells, and if we ingest oxidized lipid, we can trigger these inflammatory changes that can lead to things like cardiovascular disease. Narrator recently, mason published his own study of fish oil supplements. Lts were consistent with other studies, showing high levels of oxidation. One in new zealand found 83 of fish oils tested failed to meet the industrys own standard. It was shocking to see such a high proportion of products that had high oxidation levels. And so we went and actually bought 47 products from the new Zealand Market and had them tested at multiple labs, and we did not see that same effect. Well, ws the percentage that you discovered that were not in compliance . It was around 20 . Would you agree that 20 is still problematic, from the consumers point of view . Well, if its truly 20 , then yeah, we would like to see those 20 improved. Narrator but improving the quality wont address the other issue with fish oil the growing questions about whether it prevents disease. Two years ago, epidemiologist dr. Andrew grey compiled all the best studies on fish oil as reported in the worlds most prestigious scientific journals. I think for cardiovascular disease, one has to say there is no compelling evidence that taking fish oils protects against a first heart attack or a second heart attack. And so people who are advised to do that or are doing it are wasting their time and their money. Narrator but the Fish Oil Industry continues to insist there is a benefit, particularly for preventing heart attacks. We asked their spokesman to send us his best evidence, which included some of the same studies grey had cited, and didnt seem to support his case. This one says it doesnt appear to reduce sudden cardiac death. The next one, insufficient evidence. Jama 2012 overall, omega3 supplementation was not associated with a lowerrisk of allcause mortality. Another journal, the evidence is not clearcut, and any benefits are almost certainly not as great as previously believed. So, that doesnt seem to be suggesting theres an overwhelming amount of evidence. Yeah, well, i think what youre looking at are the abstracts. But the conclusions are the conclusions. But again, those pers are looking at very large areas of cardiovascular disease, and i think its hard to argue that omega3s arent important for how your heart functions. Narrator many researchers agree if you get them from eating actual fish. The problem is, science still hasnt proven its true for supplements. We would think that something thats natural, thats essential to normal cell function and body function, would have clinical benefits, it just has to be proven. But in the meantime, theres certainly been a lot of promotion suggesting a benefit in everything from alzheimers disease to cardiovascular disease. But we still need the strong Clinical Trial to validate those hypotheses. Narrator the same can be said about virtually every product the supplement industry sells. We wanted to discuss the issues with some of the industrys most prominent advocates. So many questions, so many concerns. Narrator dr. Mehmet oz. Dr. Joseph mercola. And dr. Andrew weill all declined to be interviewed. Narrator while the debate continues over whether supplements actually work, in rural guelph, ontario, there is a botanist who may have found an answer to that other troublesome question whats actually in the pills and potions that we take . Dr. Steven newmaster is part of a worldwide effort to collect and catalogue natures wide array of dna. He believes in the power of nature to heal. I buy and use natural Health Products. I believe in them. Ive used them all my life. Ive used them with my family. We have that anecdotal evidence that you have some ailment and you take whatever the remedy is and its dealt with. Narrator so its an irony that Guelph University was responsible for one of the latest studies documenting problems with supplement quality. In 2012, newmaster and his team randomly selected 44 herbal products off the shelves in canada and the u. S. And started comparing them to the plant dna in their databank. And we looked at the results, and i was fairly astounded. I was like, wow. Narrator 60 of the products contained ingredients not listed on their labels. Even more astonishingly, one in three proved to be outright fakes. If i put my consumer hat on, that pissed me off, because i go in to buy a product that i believe in, that i care about and i pay a lot of money for, and its not even the bottle . Are you kidding me . Narrator unlike similar studies in the past, this one got noticed front page of the Health Section in the new york times, an article that was read by, among others, new yorks attorney general. Last december, my office purchased a variety of store brand herbal supplements from stores in different parts of new york state. Narrator Eric Schneiderman ordered up his own tests of herbal supplements, which produced even worse results. Only 21 of the products we tested in fact had dna evidence that they contained the product listed on the label. We found the results to be shocking. We purchased products from four major chains walmart, walgreens, target, and gnc. We found asparagus dna, houseplant dna, rice, and other things, but not the product that was on the labels. And it seemed that there was just a massive fraud going on. Narrator the attorney general demanded the company stop selling the products. At first, the industry questioned the methodology, but then gnc, the largest of the supplement retailers, agreed to use dna barcoding to authenticate its products. The industry spokesman, however, still isnt convinced daniel fabricant. Were working with the Attorney Generals Office so they understand more about the industry and we understand more of their concerns. I think that its important that we Work Together do you accept the findings that theyve published . Well, i havent been able to review the findings. No, because they say because its an active investigation, but what they have told you, do you accept them . Without seeing the science, im a scientist first and foremost, i cant really comment on data i havent seen. So is that a yes or a no . Thats a no. You say you havent seen the actual study from the attorney general so you cant actually comment, but you have seen the study from Guelph University that was published in 2013. I have seen that. And what do you make of that . Theyre fairly similar findings. I think theyre the same challenges, though, the accreditation of the lab. Theres no mention of reference materials. Reference materials are critical when youre doing dna analysis. Not knowing how you establish the baseline, what are you comparing . Narrator newmasters comparison was to that library of dna he and International Scientists have been collecting. Weve done this now thousands, actually tens of thousands of times for products, and the process works, and it works really well. Narrator today, 14 states attorneys general have come together to demand change, not only from the industry, but from the fda and lawmakers. We think that theres responsibility in congress and theres responsibility at the agency level, and were just going to keep pressing until we can get them to take action. Narrator since that interview, federal prosecutors and regulators announced theyve taken action against over 100 companies. We see a number of serious issues with Dietary Supplements and products falsely marketed as Dietary Supplements. Narrator there are now signs that at least some in the industry are adopting new technology to ensure accurate labeling. We have implemented the use of dna Barcode Technology here in our products. I think it is a gamechanger, and its new, and with newness comes, you know, early adopters. Narrator natures way is among those leading the way. The manufacturer is one of several who have now partnered with the canadian scientists in a renewed effort to put quality first. We made contact with him and started a relationship, which included testing many of our herbal dietary ingredients for identity. Right now, testing is done offsite at the university of guelph, and dr. Newmaster is working on some technology that could possibly be implemented in a commercial manner. Take some of the sample and simply put it into. Narrator newmaster believes the partnership is just the beginning. And load it into the machine, press go. Narrator he has refined his Barcoding Technology further, making it cheaper and easier to use. You can Start Testing further back in the supply chain. What about that batch that came in, and its a huge vat, and its powder . The dna is excellent in that, its easy, its cheap. It could be tested at where its being transported by the suppliers doing trading and buying. It could be tested at the producer, the farmer, it could be tested all the way along. And i think thats an appropriate way to solve the problem. Narrator but that still leaves the question of what, if any, of this stuff actually works. Using the herb combined with a standardized extract. Its a joint supplement that contains perna. Narrator the industry is quick to criticize studies that challenge their products, but it hasnt produced large, peerreviewed studies of its own, with Clinical Trials where supplements are tested against placebos. The crazy thing about the dietary supplement world is there are none of those studies, and the studies that are done say the stuff doesnt work. There is new science out there all the time. Consumers are going to continue to take supplements because they derive a benefit. Over half the country every day takes a supplement safely and effectively. We love the notion of the magic pill. Its something that makes it all better. Its just too seductive. But it is a pill just like any other pill, the only difference is its an unregulated pill and you dont know whats in it. Shooting continued across paris. Narrator a wave of terror attacks in europe. These individuals were on the radar. Narrator frontline and propublireporter Sebastian Rotella unravel the breakdowns in intelligence. How could known terrorists travel through europe so easily . Narrator and why europe remains so vulnerable. Theres every reason to expect that well see isis lash out while its under pressure to maintain its relevance. Narrator terror in europe. Go to pbs. Org frontline for more about many widely used supplements. I think few people know the risks theyre taking. Over half the country every day takes a supplement safely. Learn more of what states and regulators are doing to keep up with the industry. There was just a massive fraud going on. Then connect to the Frontline Community on facebook and twitter. Visit us on youtube for even more original frontline reporting. And sign up for our newsletter at pbs. Org frontline. Frontlinis made possible by contributions to your pbs station from viewers like you. Thank you. And by the corporation for public broadcasting. Major support for frontliis provided by the john d. And catherine t. Macarthur foundation, committed to building a more just, verdant, and peaceful world. More information is available at macfound. Org. Additional support is provided by ford foundation, working with visionaries on the front lines of social change worldwide, at fordfoundation. Org. The park foundation, dedicated to heightening Public Awareness of critical issues. The john and Helen Glessner family trust, supporting trustworthy journalism that informs and inspires. And by the frontline journalism fund, with major support from jon and jo ann hagler. Captioned by Media Access Group at wgbh access. Wgbh. Org for more on this and other frontline programs, visit our website at pbs. Org frontline. Frontlines supplements and safety is available on dvd. To order, visit shoppbs. Org or call 1800playpbs. Frontline is also available for download on itunes. Youre watching pbs youve said youd favor middleclass tax cuts. The front line is just up here. Thats where the river. She took me out to those wetlands. I think were off to a great start. Female announcer coming up, simon schama explores the paradox of israel, a safe haven and a land of conflict. Schama it was not just what the nazis did to the jews, but what everyone else failed to do that made the moral case for israel. So you have this really rather innocent image of the hallutz, the pioneering house, and then you had the military reality around it. Schama, voiceover today in israel, the distance between dream and reality can be measured in hundreds of miles of barbed wire and concrete. Theres not going to be peace if jews cant live anywhere, especially in their homeland. Schama the bible is many things, but a blueprint for peace in this land it is surely not. If we know one thing for sure about the jewish tradition, its that the chapter is written, but the book is not finished