Vitamania: Vitamins in American Culture (review)

Vitamania is a well-documented chronicle of America’s enthusiastic embrace of vitamin supplements, first marketed as tablets in the 1920s. Rima Apple begins with the promotional campaigns for cod liver oil in the 1910s and ends with an analysis of why 43 percent of American adults daily ingested vitamin supplements at a cost of more than one billion dollars in 1993. Her well-written social history of vitamin supplements illuminates the question of how Americans make their own interpretations of scientific findings when exposed to a cacophony of information in the form of advertisements, government pronouncements, physicians’ and pharmacists’ advice, and articles in the popular media.

Apple does not explain the technological development of vitamin preparations and food fortification or review the scientific research on vitamins. Nor does she try to determine whether vitamin supplements are necessary for optimal health. Instead Apple explores how Americans perceive the adequacy of their diet and the need to supplement it with vitamins. “In the face of fierce disagreement among scientists, . . . why has the American consumer’s love affair with vitamins continued unabated for nearly a century?” Apple asks (p. 1). Her book provides a useful overview of the history of drug regulation in the twentieth century, from the Food and Drug Act of 1906 to the rigorous clinical trials for new drugs required under the Kefauver-Harris Amendment of 1966.

Despite conflicting scientific interpretations of the efficacy of vitamin supplements (except in cases of gross vitamin deficiencies such as rickets and beriberi) and continuing opposition from the American Medical Association and the Food and Drug Administration (FDA), the percentage of Americans consuming vitamins has increased. Apple carefully lays out the arguments of the many sides in the controversy, including those of pharmacists, the vitamin industry, government regulators, members of Congress, organic farming advocates, the grocery industry, Ralph Nader watchdog groups, and consumers. She offers rich documentation from trade journals, court cases, internal memos from vitamin manufacturers, congressional hearings, the FDA archives, advertisements, the popular press, and popular books such as Linus Pauling’s Vitamin C and the Common Cold (1970).

Particularly gripping are Apple’s last four chapters on the FDA’s repeated attempts between 1940 and 1994 to regulate the vitamin industry in order to protect consumers from fraudulent claims by vitamin producers. In four major campaigns, the FDA tried to control the selling of vitamins by requiring manufacturers to prove their dietary claims for supplements. In 1973 the FDA proposed new rules that would have divided vitamin products into three categories based on potency, with higher-potency vitamins being classified as drugs, subject to strict clinical trials to prove efficacy. Fearing that the ultimate aim of the FDA was to take supplements off the market or make them available only by prescription, pharmaceutical companies and consumers mounted a fierce defense of the right to take vitamins of any potency in any combination. The volume of mail from consumers to the FDA and members of Congress reportedly was rivaled only by the number of letters received on the Vietnam War and Watergate. Apple shows that consumers resented the paternalism of the proposed FDA regulations and opposed government interference in their freedom of choice to take vitamins. In response to the objections, Congress passed two laws, one in 1976 and one in 1994, to prevent stricter FDA rules and to allow consumers free access to vitamin supplements.

Much of the book is an analysis of the aggressive advertising and industrial marketing strategies of vitamin manufacturers. Apple charts the history of how vitamin therapy was sold to middle-class Americans in advertisements that often posed as factual scientific information. For example, Miles Laboratories, the manufacturers of One-A-Day and Flintstones children’s vitamins, implanted the idea between 1945 and 1970 that even Americans with a well-balanced diet needed vitamins to correct insidious nutritional deficiencies that lurked subclinically. Miles characterized vitamins as “nutritional insurance.”

Apple concludes, however, that advertising...