In a Massachusetts cellar in 1873, Lydia Pinkham first brewed the elixir that would make her famous. The dirt-brown liquid, made from herbs including black cohosh and pleurisy root, contained somewhere between 18 and 22 percent alcohol—meant as a preservative, of course. Within a couple of years, Pinkham was selling her tonic at $1 a bottle to treat “women’s weaknesses.” Got the blues? How about inflammation, falling of the womb, or painful menstruation? Lydia E. Pinkham’s Vegetable Compound was the solution. Pinkham’s matronly smile, printed on labels and advertisements, became as well known as Mona Lisa’s.

Lydia E. Pinkham’s Vegetable Compound was one of thousands of popular and lucrative patent medicines—health concoctions dreamed up by chemists, housewives, and entrepreneurs—that took the United States by storm in the 19th and early 20th centuries. These products promised to treat virtually any ailment and didn’t have to reveal their recipes. Many contained alcohol, cocaine, morphine, or other active ingredients that ranged from dubious to dangerous. Dr. Guild’s Green Mountain Asthmatic Compound was available in cigarette form and included the poisonous plant belladonna. Early versions of Wampole’s Vaginal Cones, sold as a vaginal antiseptic and deodorizer, contained picric acid, a toxic compound used as an explosive during World War I. Patent-medicine advertisements were unavoidable; by the 1870s, 25 percent of all advertising was for patent medicines.

After the Pure Food and Drug Act was passed in 1906, the newly created Food and Drug Administration cracked down on miracle elixirs. But one American industry is still keeping the spirit of patent medicine alive: dietary supplements. In the U.S., vitamins, botanicals, and other supplements are minimally regulated. Some can improve people’s health or address specific conditions, but many, like the medicines of old, contain untested or dangerous ingredients. Nevertheless, three-quarters of Americans take at least one. Some take far more. Robert F. Kennedy Jr., the longtime conspiracy theorist and anti-vaccine activist who’s awaiting Senate confirmation to run the Department of Health and Human Services, has said he takes a “fistful” of vitamins each day. Kennedy has in recent years championed dietary supplements and decried their “suppression” by the FDA—an agency he would oversee as health secretary. Now he’s poised to bring America’s ever-growing supplement enthusiasm to the White House and supercharge the patent-medicine revival.  

The newly created FDA eventually required all pharmaceutical drugs—substances intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease—to be demonstrably safe and effective before they could be sold. But dietary supplements, as we call them now, were never subject to that degree of scrutiny. Vitamins were sold with little interference until the “megadosing” trend of the late 1970s and ’80s, which began after the chemist Linus Pauling started claiming that large amounts of vitamin C could stave off cancer and other diseases. The FDA announced its intention to regulate vitamins, but the public (and the supplement industry) revolted. Mel Gibson starred in a television ad in which he was arrested at home for having a bottle of Vitamin C, and more than 2.5 million people participated in a “Save Our Supplements” letter-writing campaign. Congress stepped in, passing the 1994 Dietary Supplement Health and Education Act, which officially exempted dietary supplements from the regulations that medications are subject to.

Since then, the FDA has generally not been responsible for any premarket review of dietary supplements, and manufacturers have not usually had to reveal their ingredients. “It’s basically an honor system where manufacturers need to declare that their products are safe,” says S. Bryn Austin, a social epidemiologist and behavioral scientist at the Harvard T. H. Chan School of Public Health. The agency will get involved only if something goes wrong after the supplement starts being sold. As long as they disclose that the FDA hasn’t evaluated their claims, and that those claims don’t involve disease, supplement makers can say that their product will do anything to the structure or function of the body. You can say that a supplement improves cognition, for example, but not that it treats ADHD. These claims don’t have to be supported with any evidence in humans, animals, or petri dishes.

In 1994, the dietary-supplement industry was valued at $4 billion. By 2020, it had ballooned to $40 billion. Patent-medicine creators once toured their products in traveling medicine shows and made trading cards that people collected, exchanged, and pasted into scrapbooks; today, supplement companies sponsor popular podcasts, Instagram stories are overrun with supplement ads, and influencers make millions selling their own branded supplements. The combination of modern wellness culture with lax regulations has left Americans with 19th-century-like problems: Pieter Cohen, an associate professor of medicine at Cambridge Health Alliance, has found a methamphetamine analogue in a workout supplement, and omberacetam, a Russian drug for traumatic brain injuries and mood disorders, in a product marketed to help with memory.

Last year, Kennedy accused the FDA of suppressing vitamins and other alternative health products that fall into the dietary-supplement category. But “there is no truth about the FDA being at war on supplements over the last several decades,” Cohen told me. “In fact, they have taken an extremely passive, inactive approach.” Experts have repeatedly argued that the FDA needs more authority to investigate and act on supplements, not less. And yet, Kennedy continues to champion the industry. He told the podcaster Lex Fridman that he takes so many vitamins, “I couldn’t even remember them all.” Kennedy has vocally opposed additives in food and conflicts of interest in the pharmaceutical industry, but has failed to mention the dangerous additives in dietary supplements and the profits to be made in the supplement market. (Neither Kennedy nor a representative from the MAHA PAC responded to a request for comment.)

In an already permissive environment, Kennedy’s confirmation could signal to supplement manufacturers that anything goes, Cohen said. If the little regulation that the FDA is responsible for now—surveilling supplements after they’re on the market—lapses, more adulterated and mislabeled supplements could line store shelves. And Americans might well pour even more of our money into the industry, egged on by the wellness influencer charged with protecting our health and loudly warning that most of our food and drug supply is harmful. Kennedy might even try to get in on the supplement rush himself. Yesterday, The Washington Post reported that, according to documents filed to the U.S. Patent and Trademark Office, Kennedy applied to trademark MAHA last year, which would allow him to sell, among other things, MAHA-branded supplements and vitamins. (He transferred ownership of the application to an LLC in December. Kennedy’s team did not respond to the Post.)

A truly unleashed supplement industry would have plenty of tools at its disposal with which to seduce customers. Austin studies dietary supplements that make claims related to weight loss, muscle building, “cleansing,” and detoxing, many of which are marketed to not just adults, but teenagers too. “Those types of products, in particular, play on people’s insecurities,” she told me. They also purport to ease common forms of bodily or mental distress that can’t be quickly addressed by traditional medical care. Reducing stress is hard, but ordering the latest cortisol-reducing gummy on TikTok Shop is easy. Your doctor can’t force vegetables into your diet, but a monthly subscription of powdered greens can.

Judy Z. Segal, a professor emerita at the University of British Columbia who has analyzed patent-medicine trading cards from the 19th and 20th centuries, told me that supplement-marketing strategies “have not changed that much since the patent-medicine era.” Patent medicines appealed to ambient, relatable complaints; one ad for Burdock’s Blood Bitters asserted that there were “thousands of females in America who suffer untold miseries from chronic diseases common to their sex.” And the makers of patent medicine, like many modern supplement companies, used friendly spokespeople and customer testimonials while positioning their products as preventive care; according to one ad for Hartshorn’s Sarsaparilla, “The first deviation from perfect health should receive attention.”

In 1905, the muckraker Samuel Hopkins Adams lamented that “gullible America” was so eager to “swallow huge quantities of alcohol, an appalling amount of opiates and narcotics, a wide assortment of varied drugs ranging from powerful and dangerous heart depressants to insidious liver stimulants; and, far in excess of all other ingredients, undiluted fraud.” Compounds and elixirs go by different names now—nootropics, detoxes, adaptogens—but if Adams walked down any supplement aisle or browsed Amazon, he’d still find plenty of cure-alls. He could even pick up a bottle of Lydia E. Pinkham’s Herbal Supplement, which is sold as an aid for menstruation and menopause. Pinkham’s face smiles at buyers from the label, though its advertised benefits are now accompanied by a tiny disclaimer: “This statement has not been evaluated by the FDA.”

British and Irish Lions duo Josh Adams and Liam Williams return for Wales' Six Nations opener against France, along with Dafydd Jenkins.

So much political news over the past four years has been astonishing: Joe Biden’s disintegration on a debate stage, Donald Trump’s return to power, the possible U.S. annexation of Canada. But New York Mayor Eric Adams’s MAGA turn, by contrast, seems completely predictable.

Since the election, Adams has lunched with Trump and his son at the Trump International Golf Club in Florida. On Monday, he accepted “on behalf of New York City” what his spokesperson described as a last-minute invitation to the inauguration. And Tuesday, he sat down with the house media organ of MAGA, Tucker Carlson, for an interview.

“People often say ‘You don’t sound like a Democrat,’ and ‘You seem to have left the party,’” Adams told Carlson. “No, the party left me.”

This is a man who less than four years ago described himself as “the future of the Democratic Party.” Finding a reason for the abrupt shift isn’t all that hard, and it doesn’t involve any changes in the Democratic Party. It involves the multiple felony charges against Adams, and the pardon power that Trump has now regained. Trump said before his inauguration that he would consider pardoning Adams.

[Michael Powell: How it all went wrong for Eric Adams]

The mayor was charged in September, in an indictment that alleged florid corruption, including bribery, campaign-finance violations, and elaborately constructed travel itineraries through Istanbul (the New York City of Turkey, if you will). Adams has denied any wrongdoing, in the emphatic way only he can. So many top officials in his administration have been raided, indicted, or forced to step down that New York magazine could barely fit them all on a cover; by the time the issue hit stands, it was already out of date. Things are so bad that polls suggest he could lose reelection to Andrew Cuomo, the former New York governor with his own long record of alleged misconduct, though he, too, has denied wrongdoing.

Adams is not the first Democratic politician to discover a strange new respect for Donald Trump. Rod Blagojevich followed the well-trod path from the Illinois governor’s mansion to prison, then pioneered the playbook Adams appears to be employing, culminating in a 2020 pardon.

“My fellow Democrats have not been very kind to him,” the former governor said of Trump afterward. “In fact, they’ve been very unkind to him.” He even coined a useful term: “If you’re asking me what my party affiliation is, I’m a Trumpocrat.”

Other politicians have turned Trumpocrat, or at least Trumpocrat-curious. When former Senator Bob Menendez, a New Jersey Democrat, was indicted for corruption, he echoed Trump in claiming that shadowy forces were out to get him because of his politics. Never mind that Menendez was indicted by the Biden Justice Department. He’d previously been charged by the Obama Justice Department, but he beat that rap; this time he was convicted, despite his best efforts to blame his wife. Representative Henry Cuellar, a Texas Democrat indicted for bribery last year, has also gone out of his way to signal openness to working with Trump. (Cuellar denies wrongdoing.) Trump appears receptive; after the indictment, he claimed on Truth Social that Cuellar was being punished for being tough on the border.

But Adams and Trump share more than felony charges and a love of New York City nightlife. Seldom have two politicians seemed so destined for alliance. Both men are masters of personality politics—naturally charismatic but also perversely watchable because of the likelihood that they’re going to blunder and cause a huge blowup. They’re also big-picture thinkers, able to tap into emotionally freighted topics—especially crime—with grand gestures, but less skilled and less interested in minutiae, leaving that to lieutenants.

Not coincidentally, both have also been Democrats and Republicans at different times in their careers. Conforming to a platform is less important to them than rallying voters around a feeling. Moreover, they are both nakedly transactional—in Adams’s case, according to federal prosecutors, to a criminal degree; in Trump’s case, his attempt to exchange aid to Ukraine for an investigation into Hunter Biden was enough to get him impeached. They share a sense that they are perpetually being persecuted by the establishment, even as one is the mayor of the nation’s largest city and the other is starting his second term as president.

[Michael Powell: The low comedy of Eric Adams’s indictment]

The possible benefits for Adams—a pardon—of cultivating Trump are clear enough. What does Trump get out of it? One can imagine a few possibilities. The first is that Trump is a New York real-estate developer, and it’s never a bad idea to be on the right side of city hall. He surely noticed that, according to prosecutors, the bribes paid to Adams helped get quick inspection approval for a building in Manhattan. Trump also remains obsessed with the idea of success and belonging in New York, even as he lives elsewhere—another thing he might share with Adams.

Politically, Trump has been working to make inroads with Black voters in blue cities and states, and Black voters open to a more conservative vision happen to be Adams’s core constituency. By embracing Adams, just as he did Cuellar, Trump is also hoping to bolster his claims of being a target of political prosecution: He contends that their indictments show how the “deep state” goes after its enemies. This doesn’t make much sense—Adams and Cuellar are both Democrats indicted by federal prosecutors in a Democratic presidential administration—but coherence has never been all that important to Trump.

Of course, all of this might be overthinking the situation. The attraction between Trump and Adams may be as simple as the two men seeing a lot of themselves in the other—game recognizing game.

Former Sinn Fein president Gerry Adams is in line for "a pay day from the taxpayer" under plans to repeal the Legacy Act, a report backed by several peers has stated.

Leon Adams was found unconscious near Grangetown train station in the early hours of 14 February 2002.