Kessler called the system “a joke.”

Of a few other intense moments in the discussion, one that stood out began when a clinical psychologist in the audience asked about dietary supplements: “I'm not so concerned that those supplements don't really hurt anybody medically—and they probably do. I'm more concerned with the lack of regulation, where a legitimate medical patient is taking supplements when they could be taking real medicine. What's that cost? And will the FDA ever regulate this industry?”

“We tried,” Kessler said flatly. His tenure is better remembered for reigning in the tobacco industry in the 1990s, some decades after the product was proven to be among the leading preventable causes of death in the country. “We have some authority,” he added. “But the difference is, we have to chase after any bad actor.”

Products now sold in the rapidly expanding industry of “dietary supplements” include not just vitamin and mineral formulas, but those derived from herbs, glands, amino acids, and enzymes of all sorts, in any combination and amount, sold as tablets, capsules, gel caps, powders, or liquids. The global market for these products was $82 billion as of 2013, with the U.S. accounting for more than a quarter of that. Sales increased by $6 billion between 2007 and 2012. According to a document by McKinsey titled “Cashing in on the Booming Market for Dietary Supplements,” growth “is expected to remain strong through 2017, between five and six percent a year.”

Much of this growth is attributed to the fact that these products can go to market without any safety, purity, or quality testing by the FDA.

While it costs millions of dollars to develop and substantiate a pharmaceutical product, selling supplements requires no such investment. And new products are easily sold as supplements: The only common feature among them, as defined by the FDA, is that these are edible things “not intended to treat, diagnose, prevent, or cure diseases.”

That is why people take them, though.

This expansive category was set forth in the Dietary Supplements Health and Education Act of 1994, known as DSHEA, which passed on Kessler’s watch. Backed by Senator Orrin Hatch and enormous investment from the supplement industry, the law allows any of these products to go directly to market and carry unfounded claims about what the product does. The burden is on the FDA to prove that the product is unsafe, if it later proves to be harming people, and then take the producer to court.

“When there's a problem, FDA does take action, and usually it's when there is a contaminant,” explained Margaret Hamburg, who served as FDA commissioner from 2009 to 2015. She noted that while companies are required to report any known “severe” adverse effects of their products, “it's very hard to even know what's going on.”