My beef with herbal concoctions is not that they cannot work (like homeopathy or therapeutic touch) but that they are not properly regulated. Herbs contain chemicals that can have a pharmacological action in the body, can alter metabolism, have toxicity, and can interact with other drugs. In other words – they are drugs. They are simply not purified and quantified, and most countries do not require testing for herbs similar to pharmaceuticals. So they are unreliable drugs.

But another dirty little secret of the supplement industry is the occasional use of actual known drugs in supplement preparations to give it a real and quantifiable effect. The most common example of this are diet supplements, which commonly contain stimulants. I recently surveyed all the diet supplement products at my local grocery store and almost all of them had some form of caffeine as a major ingredient. It used to be common for such products to contain ephedra (another stimulant) – until it was banned by the FDA for causing cardiac deaths.

Last week Canadian news agencies reported about the death of trucker Michael Berggren, who fell asleep at the wheel. Routine blood screening turned up estazolam – a strong and addictive sedative in the benzodiazempine class of drugs (the same class as valium). Estazolam is not commonly sold in the US or Canada so this presented a bit of a mystery. It turns out that Berggren was likely getting the drug, unknowingly, in an herbal supplement he was taking called Eden Herbal Formulations Serenity II Pills.

It turns out that Health Canada has already pulled three herbal products for containing this same drug. Several products, mostly sleep aids, that were ultimately coming from manufacturers in China were found to contain estazolam, and were mostly being sold through acupuncturists or other purveyors of Traditional Chinese Medicine (TCM).

It turns out that the tradition is China is to put real known pharmaceuticals in their herbal remedies. When American investigators went to China to look into the claims of acupuncture anesthesia what they found is that they were putting morphine in the IV fluid. I guess it’s always a good idea to hedge your bets. This fact was not being hidden – it was openly admitted. It just didn’t occur to anyone that the acupuncture might be superfluous.

Prior to the FDA there was a tradition of putting known drugs into patent and herbal medicine in the US as well. The preferred drug for patent medicines was alcohol. The marketing strategy was clear – put some cheap and (hopefully) harmless ingredients in a bottle, along with some alcohol. It doesn’t really matter what else is in there. Then make up some health claims that will sell to a broad customer base. And include some alcohol so that people will feel a positive effect when they take the product.

The softdrink, Coke, actually once did contain cocaine.  This may seem strange now, but originally soft drinks were not sold as everyday beverages but as health tonics. That is why some drinks have survived with names like Coke, Ginger Ale, and Root Beer – they were herbal products. They were sold and consumed for their presumed health benefits, and like the herbal supplements of today sometimes contained real drugs – you know, something to give it a little kick. Soft drinks did not come to be consumed as beverages until after home refrigerators became common, and the grocery stores started selling 6-packs that could easily fit into those refrigerators.

Coke is now considering marketing Coke with herbal supplements – returning full circle to their roots as a purveyor of health tonics.

The common thread in all of this is deception in advertising. Herbs are consumer friendly, can have the label “natural” placed on them – which is marketing gold, and are generally not regulated or poorly regulated. Drugs, on the other hand, are tightly regulated and have a more complex image with the public. By surreptitiously putting some known drugs into an herbal remedy – you get the best of both worlds. That herbal sleep aid from China actually works because there is a powerful sedative in there.

The danger, of course, is that the consumer does not know what they are getting. They may become addicted, or may have dangerous interactions with prescription drugs. There is still an ongoing investigation as to whether or not Berggren’s death was caused or contributed to by the estazolam he did not know was in his supplement.

I am all for researching and marketing herbal drugs and even true nutritional supplements. I simply favor the honesty and transparency that we expect from science and other sectors of health care. Rather it seems that the patent-medicine hucksters of old have found a way to come back. They have had their revenge against the FDA and government regulators. We have come full circle – it’s 1900 again.