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.”

Before Vine’s die-hard fans said goodbye, they wanted to reminisce. The short-form-video app, which shut down in 2017, created lots of viral moments (“And they were roommates …”) and propelled a number of internet creators into the mainstream. It was unlike anything else on the internet at the time: You can still sometimes see the refrain “RIP Vine” thrown around on social media. But for the most part, everybody has moved on. Two of Vine’s biggest stars, Logan Paul and Shawn Mendes, are still plenty famous.

I immediately thought of Vine this morning, when the Supreme Court upheld a law that requires TikTok to be sold by its Chinese parent company or face a ban in the United States. After I saw the news I then checked TikTok. The app was a hotbed of nostalgia, with many users reposting their earliest videos from several years ago. The ruling is the latest twist in the ongoing saga over the app’s fate: For more than four years, TikTok has been plagued by questions about its ties to the Chinese government. Unless there’s a last-minute intervention—still possible!—the app could conceivably shut off on Sunday. (After the Supreme Court’s decision, Joe Biden’s administration announced that it would leave enforcement of the ban to Donald Trump.)

[Read: The internet is TikTok now]

It’s a lot of fanfare and suspense over an app that, well, just isn’t all that important. There’s no denying TikTok has had a significant impact on American culture. Its kitschy trends, given names like “coastal grandmother,” influence the stores Americans shop at and the products they buy. Why were Stanley cups suddenly everywhere last year? Blame TikTok. Artists are encouraged to create music that might spark a dance challenge on the app. This is part of what TikTok does well: Its algorithm serves users ultra-personalized content, increasing engagement.

But though Americans might be listening to music or shopping for clothing that was made with TikTok in mind, a majority of them are not scrolling the app itself. According to a Pew survey released last year, only a third of U.S. adults said they had ever used TikTok. YouTube touches far more Americans, with 83 percent of adults reporting that they use the platform. Although TikTok is often referred to as the Gen Z app, a larger share of 18-to-29-year-olds are on Snapchat and Instagram.

To some degree, TikTok users seem at peace with knowing they have other options. Few people have flocked to Capitol Hill to protest the ban. For the most part, celebrities are not speaking out about just how dire the stakes of a TikTok blackout could be. Online, people are expressing their dismay with sardonic humor: tearfully saying goodbye to the hypothetical “Chinese spy” that’s supposedly been observing their TikTok behavior all these years. Millions have downloaded another Chinese app, Xiaohongshu, whose name translates to “little red book” in English.

[Read: It’s just an app]

TikTok would be the first major social-media platform to face an outright ban in the U.S., but its demise would not be so unfamiliar. Even apart from Vine, Millennials and Gen X users spent their youth on platforms that also one day just disappeared, or became otherwise unrecognizable. Tumblr went through a number of changes that gutted the once-thriving blogging platform. Users eventually find new homes elsewhere: Facebook overtook MySpace, only to cede its cultural cache to Instagram, and TikTok itself absorbed Musical.ly. It’s all part of the larger cycle of migration that has always defined social media. The same will likely be true with TikTok. So many social platforms have already cribbed from the app and feature similar algorithmic feeds that keep you scrolling. As Hana Kiros wrote yesterday, “The app might get banned in the United States, but we’ll still be living in TikTok’s world.”

This isn’t to say a TikTok ban wouldn’t be felt. Influencers with big TikTok followings will have to fight for attention on other platforms that may have different audiences and mechanisms for success. Small-business owners, in particular, may materially suffer. Restaurants are one viral video away from waking up to a line down the street, a designer just one hashtag off from selling out their new product. The app’s boon for businesses has been abetted by TikTok Shop, through which users can directly buy items featured in the videos on their feed. Those who went all in on TikTok will surely take a hit as they attempt to set up elsewhere online, but in all likelihood, they will recover.

When I opened TikTok this morning, many of the videos that users were reposting in farewell to the app featured trends I barely remembered from the early pandemic: Morning routines soundtracked by Powfu’s 2020 song “Death Bed,” and exaggerated lip-syncing to anime. Those videos are a testament to how quickly the internet moves on. In a few years, TikTok’s most defining moments, like Vine’s catchphrases and Tumblr’s main characters, will largely have been forgotten.