Selling misleading fertility hope

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0:30No bouncing between tabs. And best of all, no spreadsheets. Stop managing software and start managing your business with one unified system. Try for free today at odoo.com. That's O-D-O-O dot com. Hello, Greg Jenner here. I'm the host of You're Dead to Me, the BBC comedy show that takes history seriously. Every episode, I pair up a top historian with a fantastic comedian. And we have a lovely, funny, fascinating chat about a different subject from world history. And in this new series, we're beginning with an epic voyage through the story of Homer, the Iliad and the Odyssey. And that's with Kyle Smith-Bino joining us.

1:08And then we'll be learning about Francis Galton and the racist, discredited pseudoscience of eugenics with Desiree Birch. We'll meet many medieval saints in their bone boxes with Rachel Parrott. So if that sounds like your sort of thing, listen to You're Dead to Me wherever you get your podcasts. Thank you. Bye.

1:30Chances are you've been targeted by ads and influencer posts nudging you towards a tea, gummy or capsule you didn't even know you needed. If you have poor sleep, you need magnesium glycate. Does your immune system need a multivitamin? I bought some apple cider vinegar gummies off TikTok shop. The world of supplements is vast and growing. And in this episode of BBC Trending, I'll be taking a closer look at one small but booming corner of it, the fertility supplement industry. If I think about 15 years or so ago, people really didn't ask about supplements beyond folic acid. I'm Kayleen Devlin from BBC Verify and earlier this year my online feed was dominated by ads for various fertility related supplements.

2:12The claims were compelling, though there was a question mark around how much evidence actually supported them. They don't have to provide that evidence to anybody, they just have to promise FDA that they actually have that evidence. In this programme you'll hear about one company which is particularly active in marketing its products on social media and claims they are backed by science and built on faith.

2:33Kayleen Devlin:I felt really called by God to be able to help other women with their bodies. And we'll hear a personal account, expert opinions, and find out how a loosely regulated market is being further exploited online.

2:49At one point, I started to notice a pattern. Every time I went online, the algorithm them seemed increasingly fixated on my biological clock. I'm convinced that these two products are going to be the thing that finally helps me get pregnant. So for backstory, we... I had been researching egg freezing at the time, and I wasn't far out from undergoing the procedure. I remember scrolling through Instagram, and I was pushed an ad for a fertility supplement from a company called Pinkstalk and I remember in bold letters the ad read, name a product that has helped thousands of women get pregnant. I wasn't trying to get pregnant but I was about to undergo an expensive procedure that offered hope but no guarantees.

3:40After spending so much already I found myself wondering could a supplement just maybe give me a slightly better a shot. If I think about 15 years or so ago, people really didn't ask about supplements beyond folic acid. I mean, it just wasn't a topic of conversation, but that was pre-Instagram. Dr. Tim Child is an Associate Professor of Reproductive Medicine at the University of Oxford and sits on the UK's fertility regulator, the Human Fertilisation Embryology Authority, or HFEA. This year, the regulator reported that nearly three quarters of fertility patients surveyed in the UK had used some form of add-on, extra products or treatments not backed by strong evidence.

4:22The most common was extra medications and supplements. All women who are wanting to conceive or trying to conceive should be taking folic acid, 400 micrograms daily, and certainly during the winter months, maybe all year, some vitamin D on top. But in terms of going further than that, other non-routinely advised supplements could include things like coenzyme q10 and dhea there's other ones such as melatonin different antioxidants omega-3 the issue is that because these are food supplements they've not really been studied and if there are any studies there they tend to be very poor quality it's difficult to pin down the exact value of the global supplement industry but one research firm grandview research estimates it's worth hundreds of billions of dollars, with fertility supplements alone exceeding two billion.

5:18Pinkstalk, the company whose supplement I was advertised, sells a range of products for both women and men, from fertility teas to gummies and capsules, which are described on their website as scientifically backed and guided by faith. They are just one of many companies selling supplements to aid fertility, But I'm focusing on them because they're particularly active in marketing themselves on social media and building a community there. And while they claim to be backed by science, some of their ads question modern medicine in favor of so-called natural but unproven alternatives.

5:54Kayleen Devlin:I'm the founder and CEO here at Pink Stork and in honor of our new documentary coming out, partnering with Meg Ryan. The company recently announced that their CEO would be featuring on Empowered, a documentary strand hosted by the actress Meg Ryan. Empowered, who create what appears to be branded content, say on their website that they are dedicated to inspiring and educating audiences on important topics. We emailed them about Pinkstalk's segment, but haven't yet received a response. So growing up, I was actually told that I wasn't even going to be able to have kids. This is Pinkstalk's founder, Amy Upchurch, speaking on the Marketing Millennials podcast.

6:32She now has six children. She's publicly spoken about her experience with severe morning sickness and a life-threatening blood infection during her first pregnancy, which she says doctors said gave both her and her unborn child just 24 hours to live.

6:48Kayleen Devlin:The pregnancies had really wracked my body. Long story short, I ended up working with my doctors and we came up with this protocol. And it sounds so simple, but I was really just watching the vitamins and minerals that I was putting into my body and really focusing on my gut. And without any kind of thought of ever starting a company, I felt really called by God to be able to help other women with their bodies. Amy's story is compelling, but personal experiences alone do not provide scientific proof that a product is going to be effective for everyone. And that's where experts like Dr. Tim Child urge caution.

7:29So there are lots of claims that are made by the manufacturers of these supplements that really can't be backed up by the science or by the studies. If it was a drug, you'd have to have, you know, a thousand women taking that and a thousand women taking a placebo. Now for supplements, nearly always those trials just haven't been done, or if they have been done, And they've been done in animals, not in humans. Or if they have been done in humans, they nearly always are very underpowered. So when you see supposed evidence, which is anecdotally, someone's saying, well, I took it and it worked. Maybe it did, but maybe if they had had a ham sandwich the same day, you know, you just don't know.

8:07Some of Pinkstalk's company's products include ingredients that are backed by solid evidence, like folate, which helps reduce the risk of neural tube defects, and vitamin D, which has been associated with improved pregnancy outcomes in some cases. But those sit alongside other products containing ingredients with little or no scientific backing. Chaste tree berry, for example, is a key herb in the company's fertility tea, which is advertised on their Instagram page with the description, why are we so quick to turn to synthetic hormones and invasive treatments when nature already offers potent remedies for fertility.

8:47But experts told us that there's no reliable evidence that the ingredients in the tea improve fertility or increase the chances of conception. In both the UK and the US, supplement companies aren't required to prove safety or effectiveness before selling their products. Clinical trials aren't mandatory and many launch without the US Food and Drug Administration, or FDA, ever knowing they exist. The FDA oversees safety and labelling, where the Food Trade Commission regulates advertising. But both typically act only after a problem arises, such as safety concerns or misleading claims. There's also no legal requirement for companies to list potential side effects.

9:30Kayleen Devlin:I was getting a little bit desperate and a little bit like, well, what can I do to help this process along before we were able to see a doctor about any possible fertility issues. Samantha Berkowitz and her husband had been trying to conceive for eight months when she bought Pink Storks fertility gummies, but she stopped taking them after experiencing what she says were unusual side effects. I had seen a bunch of reviews that were very positive, and so I read the directions. I took them only for three days because I was starting to have some stomach issues and just not feeling right. So I stopped after the third day and I ended up having a 12-day long period, which is unusual for me.

10:18Kayleen Devlin:My periods are usually about five to six days and it was very, very heavy, very clotty. That cycle ended up being, I want to say it was close to like 40 days long for me, which is very unusual. Of course, it's not possible to say with any confidence whether supplements caused Samantha's body to react the way it did. I spoke to her about other possible causes and she mentioned she later discovered she had fibroids which can lead to really painful and heavy periods. She still thought the supplements had made things worse but she didn't consult a doctor at the time. Just as we have to be careful with health claims about the benefits of supplements if they're not based on robust data, we can't draw conclusions from a single anecdote and we don't have any other evidence to suggest that Pinkstalk's products cause side effects to others.

11:09Samantha claims she emailed Pinkstalk about the issue and they responded saying that her reaction was unusual. We contacted the company about this and asked whether their products had been clinically tested for side effects. They haven't responded to these claims, but I have as a result of this received marketing emails advertising their products. This is the documentary from the BBC World Service.

11:38Hello, Greg Jenner here. I'm the host of You're Dead to Me, the BBC comedy show that takes history seriously. Every episode, I pair up a top historian with a fantastic comedian, and we have a lovely, funny, fascinating chat about a different subject from world history. And in this new series, we're beginning with an epic voyage through the story of Homer, the Iliad, and the Odyssey. And that's with Kyle Smith-Bino joining us. And then we'll be learning about Francis Galton and the racist, discredited pseudoscience of eugenics with Desiree Birch. We'll meet many medieval saints in their bone boxes with Rachel Parrott.

12:12So if that sounds like your sort of thing, listen to You're Dead to Me wherever you get your podcasts. Thank you. Bye.

12:22I'm Kayleen Devlin and for BBC Trending, I'm investigating how dubious fertility supplements are being promoted online. I mean, it's actually bandit country at the moment with all of this kind of stuff. And fertility is lucrative. That's Melanie Brown, a UK-based fertility nutritionist. She's worked in this field for over two decades. And while she does recommend supplements to some clients, she's also realistic about the limits of the evidence behind some of them. Because there are so many variables with nutritional supplements, you know. what works for one person because they've got an inadequate diet so they may have some improvement then you get somebody who's got a really good diet and there isn't any improvement you can find a paper that supports any hypothesis and you have to be very meticulous.

13:13So how do you balance recommending certain supplements with the fact that the clinical evidence out there is not hugely robust? Well, again, depending on the person. So say I've got somebody who's had multiple failed IVFs, okay? They are absolutely desperate. They are hemorrhaging money. And it's egg quality. You know, they've been told by their clinic, you need to go for egg donation. This is not working. But they want to keep going. There are things out there that are very novel, you know, they've been researched on animals. I guess I just, I look at the research such as it is, okay, and then if it's not doing any harm, and it may do some good, I give it to them.

14:06Melanie's reflection touches on something deeper. When evidence is limited, but not entirely absent, is it better to offer some hope or none at all? For those I interviewed, the line is crossed when hope becomes false when products are sold with claims unsupported by robust evidence, especially if that delays more effective treatment. There's about 90 ,000 supplements out there. This is Jensen Jose, a member of the Regulatory Council with Center for Science in the Public Interest, a US-based watchdog group. In 2019, his team investigated 39 fertility supplements, including pink stalks. They found no solid evidence that any of them increased a woman's chances of conceiving and flagged them to the FDA.

14:48They don't have to provide that evidence to anybody. They just have to promise FDA that they actually have that evidence. Three of the companies his organisation investigated eventually did receive FDA warning letters. Pinkstalk was not one of them. We weren't sure why, so I reached out to the FDA to ask how they determine who gets warned. They told me that they take a risk-based approach, focusing on the highest potential threats to public health. In the US, it's unlawful for supplement companies to claim their products can treat infertility. Doing so would make them unapproved drugs. But they can use what are called structure function claims, like supports fertility, as long as they're not misleading and come with a disclaimer stating that the product isn't FDA approved.

15:33But while those laws exist on paper, enforcing them across the sprawling, fast-changing world of social media is another matter. People want, they want to be part of the community and the supplement companies are creating that community. Pinkstalk openly taps into this sense of community in multiple ways. One is through a private Facebook group with thousands of members in which people share their wellness journey and offer advice. Another is through its brand ambassador initiative, where selected individuals with a public social media presence can apply to earn commission. One video on TikTok I saw promoting Pinkstalk included in the description that the company's myoinocetil product works for PCOS, infertility and irregular periods.

16:18This is a disease-related claim and experts tell me there's insufficient evidence to support what's being said. The video included a commission paid label, which means the creator would get a cut of any product sold through the link in her video. It doesn't mean Pinkstalk is paying directly for the content, but the Pinkstalk account did leave a comment on the video saying, thank you for being such an amazing piece of our community. And I also came across this stranger sounding TikTok post, also labelled commission paid and commented on by Pinkstalk.

16:51Kayleen Devlin:I had been trying to conceive for months and every time the test was negative. But then I tried the Pinkstalk 40 to one in Naughtyville blend and Bama pregnant in the first month. It's from an account that has an AI-generated profile picture and posted multiple videos implying that one of Pinkstalk's products had prompted conception after months of failed attempts. Let's say they say, we've been trying for months and months and months and we've been having trouble conceiving, then that's the definition of infertility. They're really trying to hug that line. And that's the problem. It's an artificial legal line.

17:25The legal part is real, but people don't think that way. You know, they'll hear that, they'll read it and say, oh, this will be good for my infertility. We emailed a list of all the social media claims we found from ads, paid partnerships or paid commissions to Pinkstalk and requested every bit of scientific evidence to back them up. We haven't yet received a response. However, their website includes a disclaimer on every page saying these statements have not been evaluated by the FDA. this product is not intended to diagnose, treat, cure or prevent any disease and advising customers to consult a physician before using any dietary supplements.

18:03Since 2020, the FDA has issued over 260 warning letters relating to dietary supplements. Yet in an already under-regulated market, the problem goes beyond just some manufacturers selling these products. During our research, we found over 800 ads on Meta's platforms promoting what appeared to be counterfeit pink stalk products. They were posted by a network of accounts using AI-generated profile pictures and claiming to be based in Vietnam. Clicking through led to a website called Coral Swans, registered earlier this year. Meta removed links to the site after we flagged it and said they had disabled the account behind the ads.

18:42But many of the profiles remain active, with some promoting other wellness products. We don't know what these products we found contain, or if they'd even arrive when ordered. But the volume alone raises concerns about how effective current safeguards are, and how easily misleading, even dangerous products might reach consumers online. I think that that's the most common scenario, is the false hope. But harm is a real problem. Dr Peter Curran, an associate professor of medicine at Harvard, says he does recommend supplements to some patients, but stresses that understanding side effects and ensuring safety is critical.

19:19There's a bunch of different ways that supplements can create problems. So sometimes supplements are made without proper manufacturing guardrails in place, and that could create a situation where someone could get a toxic amount. There are other situations where manufacturers are placing ingredients into supplements that haven't been well tested and might have adverse health effects. And then there's other situations where the ingredients aren't even listed on the label. Here's Jensen Hosey again. Everyone knows it's a problem. Arguably, that's one of the reasons why FDA was created, was because you had snake oil salesmen literally coming and selling fake cures.

20:00So they created drugs. Now put the internet on top of that. A lot of the trade associations we talk to, they'll say, please don't paint us in the picture with all these bad actors. We don't operate that way. And that may be true. But the problem is the system that has been created that allows these dietary supplements to flourish also allows bad actors to flourish. That's it from BBC Trending this week. This episode was presented by me, Kayleen Devlin. It was mixed by Annie Gardner and the editor was Flora Carmichael.

20:35The B.B.C.

20:58and then we'll be learning about Francis Galton and the racist, discredited pseudoscience of eugenics with Desiree Birch. We'll meet many medieval saints in their bone boxes with Rachel Parrott. So if that sounds like your sort of thing, listen to You're Dead to Me wherever you get your podcasts. Thank you. Bye.