By Justin Yamashita, MSc. Benchtop, site, CRO: three levels of basic and clinical research, explained without spin.

From Open Label Media, the team of one behind Root to Rx, comes a quiz to find out your type of skepticism, plus four free interactive games for discussions about claims made online and telling what’s true.

All four play in your browser in about two minutes at openlabelmedia.com, and I’d love to see your results on social media.

Last issue you filled out a conmed log, every prescription, supplement, and powder you take, and brought it to your doctor (or you could send it to them today). This issue is about a different list. The one read at you, fast and quiet, at the end of every drug commercial. In Issue 013 we took that commercial apart. This time we read its list backwards.

If you watched the World Cup this summer from the United States, you sat through it. A smiling couple, a golden sunset, a dog, and then a voice speed-reads a list of side effects like an auctioneer. Nausea, dizziness, and a few things you can’t pronounce. If you watched from almost anywhere else on earth, you didn’t see that, because those ads barely exist outside the United States and New Zealand.

Myth: That scary list means the drug is dangerous, and they’re only reading it to cover themselves.

It’s not a confession. It’s a receipt, and you can read it backwards. Before that treatment (lotion, cream, pill, inhaler, spray, drop, etc.) could be advertised it spent years in trials, and a chain of people watched every step. At the clinic, at doctor (Primary or Sub Investigator) running the study logged every headache and every hospital visit, whether or not the drug seemed to be related. A traveling Clinical Research Associate (CRA)/monitor checked those notes against the real charts. A data manager cleaned and questioned every number. A safety doctor, the medical monitor, decided which events were serious enough to act on. Drug-safety scientists, the pharmacovigilance team, hunted for patterns and reported the dangerous ones to regulators while the study was still running. An independent review board could have stopped the whole thing at any point. Only then did medical writers assemble the results, and a rule called fair balance requires the ad to say those risks out loud, not just the benefits.

What couldn’t be explained got left in, reported as it was seen after months, years of doctors assessing relatedness. So that long list is the stuff they actually found and could not be ruled out. It’s the sound of a system that looked, even if it’s often comical at how long the list is to the average listener and parodied constantly.

It is the reason causality can be assessed. When a medical safety team can see when the patient was also taking other drugs, they can check the timing. Did the reaction start before the study drug, or after? Did it fade when a different medication stopped? Those overlaps are what let them assign relatedness instead of guessing. No conmed log, no timeline. No timeline, no honest answer about what caused what, and your doctor and pharmacist can do the same analysis.

The supplements there broadcast zero side effects, and the ads on Facebook similarly often have nothing listed as side effects. Not because there are none, but because no one was ever required to look. It’s on the same shelf as pharmaceuticals that went through millions of dollars of testing. One product reads you every risk it could find even the ones likely not related but just couldn’t definitively be ruled out. The other was never made to find a single side effect. Notice which one feels safer to you and sit with why that is.

All that watching isn’t free. The project managers, the clinical trial managers and their monitors, the data management team, the data analytics teams, pharmacovigilance, medical monitors, the inspectors, that safety net is funded, by sponsors (pharmaceutical companies, biotech companies, and by the public by way of government funding). And when you starve it, you don’t get fewer problems. You get more of them slipping through, unseen. You cannot rebuild trust in a field by cutting the people who keep it honest. Whether it’s cutting funding to basic research upstream of clinical trials that’s often government funded, sponsors trying to keep monitoring costs as low as possible, or the public misunderstanding parts of what contributes to the cost of drugs, there are aspects that are protecting the field’s reputation for safety, while asking for its resources to be trimmed.

Run the toolkit on both sides of that pharmacy aisle or when a supplement ad flashes on your feed. The next time an ad scares you with a list, remember the list is the receipt, and ask what the thing with no list ever had to prove. And keep your own list, the conmed (Medication and Supplement) log from last issue, because your doctor can only protect you from what they know you take.

Q5, Am I applying the same standards to all claims? The standard you hold the drug to, prove it works and tell me the risks, is the standard to hold the supplement to.

Q6, Am I seeing the full picture, or only part of the evidence? A list of risks is more of the picture, not less of it.

Q4, Who funded this, and do they have a stake in the answer? Ask it of the drug company. Then ask it of the wellness brand.

Next time we meet the supplement that wants to be a drug, the herb sold as a natural version of a prescription, and what that label quietly leaves out.

If you’d like to read more detail about this, head to our homepage and find The Informed.

New here? Start with three foundation issues: 003b, the Skeptic's Toolkit. 001, why we distrust. 004, how a drug is actually made.

·        FDA, Basics of Drug Ads (the fair-balance requirement: product-claim ads must state the drug’s major risks alongside its benefits). https://www.fda.gov/drugs/prescription-drug-advertising/basics-drug-ads

·        FDA, Prescription Drug Advertising: Questions and Answers (the “brief summary” and the broadcast “major statement” that make ads read the risks out loud). https://www.fda.gov/drugs/prescription-drug-advertising/prescription-drug-advertising-questions-and-answers

·        FDA, The FDA’s Drug Review Process (a drug spends years in trials before approval; a few hundred to a few thousand patients cannot reveal every effect). https://www.fda.gov/drugs/information-consumers-and-patients-drugs/fdas-drug-review-process-ensuring-drugs-are-safe-and-effective

·        FDA, Postmarketing Surveillance Programs (rare effects a trial is too small to catch are tracked after approval). https://www.fda.gov/drugs/surveillance-post-drug-approval-activities/postmarketing-surveillance-programs

·        FDA, Information for Consumers on Using Dietary Supplements (under DSHEA 1994, supplements are not FDA-approved for safety or effectiveness before they are sold). https://www.fda.gov/food/dietary-supplements/information-consumers-using-dietary-supplements

·        Direct-to-consumer prescription drug advertising is permitted in only two countries, the United States and New Zealand. Wisconsin Watch (2025): https://wisconsinwatch.org/2025/05/prescription-drug-direct-advertising-us-new-zealand-pharmacy/ | The Conversation (2024): https://theconversation.com/most-high-income-countries-ban-direct-advertising-of-prescription-drugs-why-does-nz-still-allow-it-231688

·        Report a problem with a dietary supplement (FDA): https://www.fda.gov/food/dietary-supplements/how-report-problem-dietary-supplements

·        Report a serious problem with any medicine or supplement (FDA MedWatch): https://www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program/reporting-serious-problems-fda

·        See reported side effects in the FDA Adverse Event Reporting System (FAERS): https://www.fda.gov/drugs/drug-approvals-and-databases/fda-adverse-event-reporting-system-faers-database