The Asterisk Economy

The global supplement market is worth ~$200 Billion and growing exponentially. ~59 million Americans say they use some type of non-prescription vitamin or supplement.

The average citizen can’t afford insulin, but they’re spending $60 a month on a laxative disguised as a “flat tummy gummy”.

We’re living in the Golden Age of Supplements. That aisle in CVS? That ad on your Instagram feed? That microinfluencer shilling mushroom powder or bloat pills? It’s all part of a booming $50 billion US industry that’s playing every one of us like a fool.

I’m not here today to say supplements are a sham.

Some work. Many don’t. I take a few myself.

But most Americans don’t realize that the supplement industry is regulated more like shampoo than like medicine.

Actually - it’s regulated significantly less intensely than your shampoo is. But that’s for another day’s discussion.

And unlike your prescription meds—which must be proven safe, effective, and FDA-approved before hitting the market—your probiotic powder can make just about any promise it wants without any proof or approval, as long as the wording is vague enough and there’s an asterisk on the label.

Let’s talk about how we got here…

When you get a prescription drug, it means that medication went through years of R&D, clinical trials, FDA review, and post-market surveillance. It had to prove safety and efficacy to get approved.

Believe it or not, supplements don’t need to do any of that.

In the US, dietary supplements are regulated under a 1994 law called the Dietary Supplement Health and Education Act (DSHEA). It was pushed through Congress with help from intense lobbying by supplement companies and celebrities like Mel Gibson (seriously, please watch the video below). DSHEA essentially declared that vitamins, herbs, and other “natural” substances could be sold without premarket approval from the FDA. Once passed, the FDA could only intervene after a product already on the market was found to be unsafe. It opened the floodgates.

Even earlier, in 1976, the Proxmire Amendments (named for Senator William Proxmire of Wisconsin) prohibited the FDA from regulating the potency of vitamins and minerals, effectively tying the agency’s hands behind its back. No matter how high the dose of a supplement, the FDA couldn’t call it a drug unless the manufacturer made an explicit disease claim.

The result? A parallel pharmaceutical universe was born. Anyone who wanted could sell a capsule of powder without approval from any sort of governing body to verify safety and effectiveness… as long as they didn’t make a strongly-worded claim. And once social media caught on, it became way too easy to find your target market.

Under DSHEA, supplement makers are allowed to make what are called structure/function claims. They can’t explicitly claim to cure or treat disease, but they can hint at it. A couple examples below:

These are statements that exist for the sole purpose of tricking you. The companies are legally required to include a disclaimer somewhere that says:

But you’d be forgiven for missing that asterisk—especially when it’s printed in size 6 font under a photo of someone doing yoga in provocative clothing. Or, as I’ll discuss below, shoved all the way at the bottom of a webpage.

The line between a claim and a cure is razor thin. You can’t say “this treats depression,” but you can say “supports emotional well-being.” You can’t say “reduces anxiety,” but you can say “helps promote calmness.”

It’s not illegal to lie. It’s just illegal to blatantly lie.

One of the most misleading terms in the supplement world is “clinically studied.”

It doesn’t mean effective. It doesn’t mean credible. It just means somebody looked into it once.

That can mean anything from:

It’s often used to lend scientific credibility to products that haven’t been clinically proven and don’t need to be. Because under DSHEA, there’s no requirement for that proof to exist in the first place.

“Clinically studied” sounds impressive. Especially when it’s being said by an actual doctor to sell you something that will change your life.

But if you really think about it, it doesn’t actually mean anything.

If you’re reading this, you clinically studied the bed you slept in last night!

Let me be clear: not all supplements are snake oil.

Creatine monohydrate is one of the most studied supplements in the world. Decades of peer-reviewed trials support its effectiveness for improving strength, muscle mass, and even cognitive function in some cases. I take it myself every day.

But even with something this well-regarded, there’s a catch: the bottle you buy on Amazon is on the honor system. The FDA doesn’t test it. No one verifies that what’s listed on the label matches what’s in the container. Unless a third-party like USP or NSF has tested it, you’re taking it on good faith.

A couple of recent studies found that nearly 30% of supplements tested didn’t contain what they claimed. Some were spiked with prescription drugs. Others had wildly inaccurate dosages. A few contained heavy metals or banned substances.

This is not a case of “trust but verify”. Nobody has your back here except for you. If you’re interested in investigating supplements you take, there are some independent third-party services that can give you peace of mind. I recommend Labdoor and ConsumerLab.

Kourtney Kardashian’s wellness brand, Lemme, recently launched a product called “Lemme GLP-1.” It claims to “support GLP-1 production”, “Fight visceral fat”, “Promote healthy weight management along with a healthy diet and exercise”, and “Promote reduced appetite, snacking, and cravings”. Notice the asterisk at the end of every single statement.

This is a masterclass in legal wordplay and it infuriates me that they are allowed to use that wordplay to prey on teenage girls through targeted ads on Instagram and TikTok:

The Lemme GLP-1 page links to a handful of studies with barely any participants, often using different doses than what’s in the gummy. And yet the sleek packaging, clean fonts, and pastel colors give it the appearance of something that’s been approved by doctors and blessed by science.

If you squint, it looks like medicine. That’s the point.

Meanwhile, consumer watchdogs like Truth in Advertising and The Center for Science in the Public Interest have questioned whether the product’s name and implied effects could be considered deceptive under FDA and FTC rules. In 2024, a New York City-based legal complaint alleged the branding could mislead consumers into thinking the product was equivalent to GLP-1 drugs.

I encourage you to take a look at the product page yourself, because it represents everything wrong with the supplement industry. It really is absolutely perfect. I might devote an entire newsletter to it soon.

For now, I will just point out how well these disclaimers are hidden all the way at the very bottom of the page - underneath even the reviews, Privacy Policy, and Terms of Service! You honestly have to give them credit for how shameless the greed is.

In the supplement world, the real regulator isn’t the government. It’s the algorithm.

Social media platforms are flooded with affiliate codes, detox routines, and before-and-after photos.

No regulators. No scientists. No ethics.

Just engagement.

We’ve entered an era where TikTok influencers sell “natural Ozempic,” mushroom coffee, and adrenal support capsules that conveniently ship in 3-packs for $99. Meanwhile, you still need to go through a doctor, insurance approval, and prior authorization to get insulin.

The medicalization of wellness—and the wellness-ification of medicine—has blurred every line.

To me, almost as awful as the supplement companies are the shameless influencers promoting this crap to their followers. God forbid something happens to someone who purchased a dangerous supplement using an influencer’s affiliate code because of their recommendation, I hope they are held equally responsible.

There needs to be some accountability. That’s the only way we’ll ever see change.

The supplement industry sells wellness, not medicine. It sells hope, not proof. And it’s allowed to thrive because the law lets it - so long as the words are twisted just right.

It doesn’t matter if the science is flimsy, the doses are meaningless, or the factory has never been inspected. If the packaging is millennial pink, the font is clean, the label says “clinically studied,” and a celeb says it changed their life, most people assume it works.

And once they believe it works, it might as well. Which is just fine, I guess, as long as there’s no physical harm done. That’s just capitalism. After all, this is America.

But you tell me:

Is tricking innocent people into emptying their wallets for fairy dust bad enough to change the system?

Or do we need to wait for something more catastrophic to happen?

At the very least, we need to make the public more aware that a bottle being on a pharmacy shelf does not mean the government has deemed it safe.

Be careful out there.

Stay vigilant.

Ride on.

Alec Wade Ginsberg, PharmD, RPh
4th-Gen Pharmacist | Owner & COO, C.O. Bigelow
Founder, Drugstore Cowboy