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Keith Johnson, Deseret Morning News
Pharmanex has an emphasis on applying pharmaceutical standards to the supplement industry.

Five days before the 2005 Super Bowl, nobody knew if wide receiver Terrell Owens would play.

Six weeks before, the Philadelphia Eagles star broke his leg and severely sprained his ankle. If he played in the Super Bowl, his doctors warned, he could suffer a career-ending injury. Owens knew he would play. God had a plan for him, he said.

Plus, he'd been drinking noni juice.

"It's weird tasting, but it's supposed to make you heal," Owens said. "I don't know where the juice is from."

Soon the world was wondering the same thing. Before long, the phones at Provo-based Tahitian Noni International, the world's top maker of noni juice, were ringing off the hook.

"It was a totally unsolicited endorsement," recalls Shon Whitney, TNI's general manager of North American sales. "It was great."

True to his word, Owens played, catching the ball nine times for 122 yards. The press declared it a modern-day miracle.

As miraculous as Owens' recovery was, the story of the company that brought noni juice to the world is perhaps even better.

In the mid-1990s, Utah food scientist John Wadsworth traveled to Tahiti to find a fruit Polynesian healers had supposedly used for thousands of years.

After days of searching, Wadsworth stepped from his Jeep, tired and discouraged. Taking in a sunset, his eyes followed the rays of sun to a valley below and a lush grove of wild noni trees.

"As I was struck with this beauty," Wadsworth recalls on the company Web site, "a very powerful impression came to me, 'This fruit has been preserved from the world, and now is the time to take it to the world.' "

So Wadsworth took the fruit home, and by 1996 the first bottles of noni juice were ready for mass consumption. Rumors quickly spread that the sour, purple juice cured everything from AIDS to cancer. A dying man in Nevada ordered bottles by the caseload to bathe in. Others rubbed it on horses to cure festering wounds.

By 2001, TNI — or Morinda — was raking in the money, with annual sales topping $300 million.

The next year, an independent research marketing firm declared that "fewer than 10 private companies in the history of the world have been able to equal Tahitian Noni International's first six years of growth."

Today, TNI has 1.3 million distributors in 73 countries and an annual revenue of $550 million.

Dietary supplements — herbs, noni juice, multivitamins — were once the domain of hippies and fitness freaks, backpackers and chiropractors. Not anymore.

Now everyone from Terrell Owens to the next door neighbor uses them. In fact, one in five Americans takes some sort of supplement daily. A third have used herbs at least once to treat everything from colds to headaches, depression to diarrhea.

"It's become more mainstream. More medical professionals are embracing our products," says Rick Evans, a spokesman at industry giant Neways.

Supplements are big business in Utah, to the tune of $2.5 billion to $4 billion a year. That accounts for between 10 percent to 20 percent of the U.S. nutrition-supplement market.

It is also the state's third-largest industry, according to the Utah Natural Products Alliance, three times the size of the ski trade. All told, there are 130 dietary supplement companies in Utah, 30 percent to 40 percent of which are in Utah County.

"You have a natural health highway along I-15," says Loren Israelsen, executive director of the natural products alliance. "Clearly, the dominant area is Utah County."

In downtown Provo, Nu Skin towers over Center Street, its headquarters a 10-story building of blue-tinted glass. Nu Skin, which sells supplements under its Pharmanex brand, made more than $1 billion last year. It is one of Utah County's largest employers.

A stone's throw from I-15, near a Springville exit, Neways' corporate headquarters literally sparkle on sunny days. Neways, which also makes personal-care products, made about $625 million last year. It is Springville's second-largest employer.

And tucked away in the Riverwoods Business Park, not far from some of Provo's most expensive homes, is the opulent headquarters of Tahitian Noni International, which employs about 600.

These companies operate quietly. Most do little advertising, because their sales are done door-to-door through multilevel marketing. They give generously to their communities, pay millions in taxes, employ thousands of Utahns and support a dozen allied industries, from those who make vitamin bottles to truckers who haul cases of juice and pills.

And yet the industry goes largely unnoticed.

"There are a whale of a lot of people in Utah County who have never heard of Nature's Sunshine, even though it's the oldest and one of the largest supplement companies in the state," Evans says.

The supplement industry may be one of the state's best-kept secrets.

"We're an underappreciated and misunderstood part of Utah's economy," says Charles Allen, a Nu Skin vice president.

Misunderstood, Allen says, because as important as the industry is to the state, it is often stigmatized and shrouded in suspicion.

"People say we're not legitimate," Allen says. "It's absurd."

Some think herbs don't work. Others say supplements are overpriced. And some say the magic elixirs of the trade — noni juice and Xango juice, to name two — are nothing more than snake oil, that the men behind them are hucksters, duping the gullible and vulnerable.

"Truth be told, a lot of wool is being pulled over people's eyes," says Will McClatchey, a University of Hawaii scientist who has studied noni juice for 10 years.

There are also suspicions that multilevel marketing companies are actually illegal pyramid schemes. (See accompanying story.) While not all supplement makers in Utah are multilevel marketers, many are, especially in Utah County.

"Utah has a reputation for schemes and scams. I'm not sure why or even if it's accurate," says John Petersen, a Nu Skin spokesman. "When a Nu Skin distributor comes knocking on your door, people can be a bit hesitant and may wonder if we're one of those schemes. It's hard to get away from that stigma."

It doesn't help matters that some of Utah's largest supplement makers have had a run-in or two with the law, mostly for making false claims.

Other headlines have been equally embarrassing. Neways' founders, who no longer run the company, were convicted earlier this year of tax evasion. And in a recent Forbes article, allegations surfaced that a paid speaker for Tahitian Noni International had given up his medical license after several women accused him of sexual misconduct.

Jon Taylor, a former Nu Skin distributor, calls the industry "the dark underbelly of the state."

Stephen Barratt, a retired Pennsylvania psychiatrist who has written extensively on supplements and multilevel marketing, calls the industry "a total scam."

Whether those charges are fair is open to debate. What is certain is that the industry is under fire.

Earlier this year, the Institute of Medicine released a 327-page report urging Congress to require supplement makers to prove their products are safe. That report came after the FDA's decision to ban ephedra, an herbal stimulant that has been linked to anywhere from 20 to 150 deaths.

To consumer advocates, ephedra — an herbal cousin to a chemical used to make meth — is proof enough the law governing the supplement industry is not working.

That law, the Dietary Supplement Health and Education Act of 1994 (DSHEA), was sponsored by Sen. Orrin Hatch, R-Utah, who has received hundreds of thousands of dollars in campaign contributions from the industry since 1994.

Under the law, supplements are not subject to FDA approval, and the companies behind them do not have to report adverse side effects.

The net result of DSHEA, critics say, is an industry that is almost entirely unregulated.

There are, for example, no established quality-control standards, meaning that what's on the label isn't always in the pill.

"You have companies who put a little bit of, say, echinacea in a tablet, and the rest is fairy dust," says Pharmanex president Joe Chang. "And so someone takes that pill and thinks echinacea doesn't work. It hurts the whole industry."

Now everyone from Sen. Ted Kennedy, D-Mass., to the publishers of Consumer Reports magazine want the law strengthened.

Supplements, they say, should be held to the same research and quality control standards as drugs.

"That would have a fairly dramatic impact on the industry. But it's highly unlikely that DSHEA would be yanked. It's a worst-case scenario," says Grant Ferrier, an editor at the leading trade magazine Nutrition Business Journal.

Clinical studies on a single drug average $130 million. While drug companies can recoup those costs, supplement manufacturers can't.

"You can't patent products that grow on trees," says Israelsen, from the natural-product alliance. "Why would one company spend millions of dollars in research and development, only to have a host of imitators pop up as soon as they release their product?"

"If you impose a drug-like standard, there won't be any dietary supplements. The industry would shut down."

And that would spell disaster for Utah's economy.

On a quiet side street next to Nu Skin's headquarters, there's a squat, nondescript building. Inside, the walls are decorated with watercolor paintings of herbs. Scientists in white lab coats peer into microscopes. Jars containing herbal roots line the shelves.

This is the Pharmanex lab. There are two others like it in China. Across the street at company headquarters, nine stories up, is the office of Pharmanex president Joe Chang.

Today, Chang is seated in front of several glass shelves stocked with Pharmanex products — LifePak, the best-selling multivitamin; CordyMax, the stamina booster; and BioGinkgo, which helps improve memory.

When he is asked a question, he nods before it is over and answers with a knowing smile. He's heard them all. He knows what the critics say. There are so many misconceptions, he says.

"Unfortunately it's one of the challenges of the industry," he says. "We suffer from the negative publicity."

What most people don't understand, he says, is that herbs have been used for centuries, and that they have long been a part of Utah's economy.

The pilgrims carried them on the Mayflower, the Mormon pioneers chased away ulcers with cayenne pepper and the American Indians treated headaches with the bark from willow trees.

Even pharmaceutical companies like Parke-Davis and Merck relied on herbs in the early 1900s to make their pills.

Then came World War II and the rise of synthetic drugs.

Before long, doctors had stopped prescribing herbs, pharmacies dropped them, and health insurers wouldn't reimburse those who bought them.

In the mid- to late-1960s, herbs made a comeback, thanks largely to three Utah County companies — Nature's Way, Nature's Sunshine and Nature's Herbs. Those three start-ups would eventually spawn an entire industry.

"Utahns have a natural sympathy for herbs. It's a Mormon cultural tradition. The pioneers used them, and the (LDS scriptures) make reference to them," the UNPA's Israelsen says.

Utah's dry climate also proved ideal for growing and storing herbs. Its location was perfect for distribution. And its pristine mountains and streams looked great on brochures and catalogs for companies hawking "all natural" products.

As the demand for herbs and other supplements increased, the government, which viewed supplements as a drug, stepped up efforts to ensure safety. The emerging supplement industry cried foul, claiming the FDA was forcing their products from the shelves.

"The FDA was inconsistent and predatory. They were going after products they didn't like, not because they were unsafe, but because they didn't like the claims they were making," Israelsen says.

A massive letter-writing campaign followed, culminating in the passage of the now-controversial DSHEA, which re-defined supplements as a class of food. At the time, an estimated 130 million Americans were using supplements on a daily basis.

Under the law, supplement makers couldn't claim their products cured or prevented disease — but they could say they helped people feel better.

"Before that you had a sort of ad-hoc, patchwork approach to regulation. After DSHEA we knew how we were able to make claims, what we could and couldn't say," says Rich Hartvisgen, Nu Skin's vice president of global regulatory affairs.

A year after the law passed, Chang and others from the pharmaceutical industry helped start Pharmanex. The idea was to use the same standards of research and quality control to make supplements.

Today, Pharmanex is at the forefront of scientific research in the supplement community.

For each new product Pharmanex spends 18 to 24 months and $1 million in research and development, Chang says.

If a product doesn't work, they scrap it. "You can't pay lip service to science," Chang says. "You need the scientists, you need the labs. On a business level it gives us a different feature. We're not just another supplement company out there putting pills in bottles with pretty little labels."

Chang recognizes that his industry is not without scoundrels and scams, and that even his parent company has had a few scrapes with the law — but that is the past.

Pharmanex, with its emphasis on science, is the future.

"I'm sure there are still some scams and schemes out there, but the industry has changed," said Nu Skin's Petersen. "We've been around 20 years and we've shown there's a legitimate way to do this."

Life is good at Tahitian Noni International.

You can tell that before you step inside corporate headquarters.

Go upstairs, past the call center, where hundreds of college students are working, speaking more than a dozen languages to distributors across the world, to people who believe they have found the elixir of life.

Cross the hall, to the founders' offices. The carpet is thicker here, the color of a rich cream. The offices are huge — the size of your living room. Check out the fireplace, the fine leather furniture, the view.

The founders have built a park behind their offices, 25 acres big, 251 varieties of flowers, exotic trees, a circulating trout stream and a rock garden.

From a Lindon warehouse to this, in less than 10 years.

An impressive success story, to be sure.

But if supplement makers were required to meet the same research standards as drug companies, noni juice may have never reached the market. After 10 years of research, scientists are still trying to find a medicinal value in the juice.

So should supplements be held to the same standards as drugs?

Chang, at Pharmanex, doesn't think so. "Drugs have to go through testing because they are synthetically made. These are brand-new molecules," he said. "Foods have been around forever."

In the 10 years since Hatch's law passed, the FDA has only recalled one supplement — ephedra. And a Utah federal judge in April struck down the ban on dietary supplements that contain ephedra.

"To me, that's a testament to the general safety of nutritional supplements," says Nu Skin's Hartvisgen.

To Hartvisgen, ephedra is proof the law is working. Grant Ferrier, the editor at Nutrition Business Journal, says the stimulant has only been linked definitively to 20 or 30 deaths — not 150, as many contend — over a 10 year period.

"Even in the most exaggerated case, that's nothing compared to the 100,000 people who died last year from taking pharmaceutical drugs."

According to the 1998 book "Bitter Pills," by investigative journalist Stephen Fried, "more people die each year from adverse reactions to prescription and over-the-counter medications than succumb to all illicit drug use."

"Illicit drugs kill anywhere from 5,000 to 10,000 Americans a year," Fried writes. "The estimates for U.S. deaths from legal drugs have ranged from 45,000 to over 200,000 per year."

Put another way, more people die each year from drug reactions than are killed in automobile accidents.

"You could have 100,000 FDA inspectors and still have problems. There will never be a perfect system," Israelsen says. "Could something like ephedra happen again? Of course it could, to the same degree it could happen with any class of food or drug."

It is unlikely DSHEA will be drastically changed, at least not without a fight.

Hatch has vigorously defended the law he helped write, and he has been well paid for his support. His son is also a paid lobbyist for the industry.

Rep. Chris Cannon, R-Utah, who calls Utah County home, has also counted supplement makers among his top campaign contributors. Two weeks ago, Cannon stopped by Neways' headquarters to announce legislation that would aid the industry.

At the event, Cannon mentioned he knew people who can't get by without supplements, and said his brother once worked in a Utah County factory, putting together vitamin capsules.

It's big business in Utah, he said, one of vital importance that has touched thousands of families, even his. His support is unwavering.

There are two changes to DSHEA most within the industry would support. The first isn't really a change. From the beginning, DSHEA has asked the FDA to implement quality-control standards, or Good Manufacturing Practices, for the industry as a whole.

"We're 100 percent behind that," the UNPA's Israelsen says. "We're baffled why the FDA can't get that done."

The second is adverse-reporting legislation, which would require supplement makers to report adverse side-effects to the FDA.

"We think it would be a good thing. We have nothing to hide," says Neways' Evans. "If our products had problems, we'd be hearing from our distributors, and we're not."

"The reason herbs have stood the test of time is because they work. The industry gets criticized from time to time, we think unfairly. Every industry has its detractors. But we've been around for 20 years, and we're not about to fold anytime soon."

In the end, Evans and Israelsen say they are giving Americans exactly what they want.

Just ask Terrell Owens.

E-mail: [email protected]