Once limited mainly to vitamins and minerals, the supplements industry has experienced explosive growth. Among the hottest items have been herbal remedies and botanical products such as gingko biloba, touted for failing memory, Echinacea, claimed to improve immune system response, ginseng, sold for centuries to improve male sexual performance, in part because its root resembles the male sex organ.

The third area of rapid growth is hormones-such as melatonin and DHEA-and the amino acids, such as l-tryptophan, the chemically similar 5 HTL, and L-carnitine. All these drug products are legally exempt from the rigorous testing and independent safety review mandated for new prescription and over-the-counter drugs.

A Cure for Everything

Not only has the array of products expanded, so have the claims that these products will fight disease or improve health. In a visit to a large Washington area store I located products touted to combat cancer, depression, anxiety, the common cold, impotence, obesity, menopause, fatigue, digestive problems, high blood pressure, prostate problems and heart disease. Since these also rank among the main complaints that trigger doctors' office visits, it shows the emergence of a major "alternative" to mainstream medicine. The products on sale ranged from harmless-and surely ineffective--tonics to chemical agents so powerful they have been banned in most advanced countries and many states.

A Media Blitz That Worked

So intense has been the media blitz that most Americans are familiar with dietary supplements and one-half the public uses them. It less understood that dietary supplements are generally without the safeguards provided for a large array of consumer products-prescription drugs, over-the-counter drugs, even hair dryers and kitchen appliances.

Under a clear and permissive law, the dietary supplement industry has boomed, nearly doubling in size in five years time. Sales last year reached $13 billion, according to the Nutrition Business Journal. This is a substantial fraction of total spending for prescription drugs-approximately $85 billion--further proof that a popular alternative to mainstream medicine has arrived.

The Drug Companies Move In

Also, the major drug companies have now moved into the market in force: pharmaceutical giants Bayer, American Home Products, Johnson and Johnson and Boeheringer-Ingelheim all sell supplements. The most rapid growth is in botanicals such as Echinacea (the best seller), gingko biloba, ginseng, garlic and St. John's Wort. With sales of more than $200 million each, they in the same league with many prescription drugs, but without patent protection there are no billion-dollar blockbusters among the dietary supplements.

While dietary supplements have been profitable, effectively promoted and popular, it is not clear what consumers are getting for their hard-earned $13 billion. What's actually in the bottle is anybody's guess