Dietary supplements: Reclaiming the roots of pharmacy

For many experts, the $30+ billion over-the-counter (OTC) dietary supplement market is a minefield studded with health hazards. Lifelong consumer health advocate, Drug Topics board member Frederick S. Mayer, RPh, MPH, president of Pharmacists Planning Services, Inc., says that herbal products, vitamins, minerals, and specialty items are a mystery of marketing claims, and their risks and benefits are poorly understood by health professionals and consumers. 

“Natural” does not equal “safe”

“We are learning every day about interactions between prescription drugs and dietary supplements,” said Mayer, citing the “four Gs” - ginkgo, ginseng, garlic, ginger - botanicals known to reduce blood platelets, with potential to be dangerous when accompanied by an anticoagulant such as Coumadin.

Also confounding is the vague labeling on bottles, especially for herbal products, Mayer said, asking, “Does that product come from the flower, the leaves, the roots, or the stems?” The source of an ingredient determines potency, which affects health benefit, serving size, and dosage.

Unfortunately, consumers have few roadmaps to navigate the mountain of advertising and product claims that surround the dietary supplement market. Lynn Lafferty, PharmD, ND, MH, MBA, associate professor of pharmacy, College of Medicine, NOVA Southeastern University, said that she sees people looking for health answers outside traditional medicine, but lacking expertise, they become easy prey to enticing but fraudulent promotional marketing.

“We’re seeing patients take their health decisions out of the hands of their physicians and pharmacists and put them into the hands of neighbors hosting ‘vitamin parties,’” said Lafferty.

Misleading messages

Kristi WolffFrom weight loss and improved virility to diabetes reversal and cancer cures, advertising claims keep the Federal Trade Commission (FTC) busy pursuing unfair and deceptive messages. Kristi Wolff, an attorney with the advertising and consumer protection group in the Washington, D.C. office of the legal practice of Kelley Drye & Warren, reports that the Food and Drug Administration (FDA) also monitors social media for health claims that cross the line.

 “The agency has issued warning letters explicitly referencing social media sites, such as blogs or Facebook, and have held companies responsible for "liking" consumer posts that go beyond the regulatory boundaries for dietary supplements and purport to treat disease,” said Wolffe. It is the agency's position that “the company's adoption of such statements renders the products unapproved new drugs,” she added.

The consuming public is caught in the middle, Wolff  said. “Consumers are presented with a staggering volume of health information in traditional and emerging technologies - basic web searches, Twitter, Facebook, and now mobile phone apps. It can be extremely difficult to determine what is reliable scientific information, what is quackery, what is independent, and what is advertising.”

Revisiting tradition

Mayer believes that the pharmacy profession needs to put more focus on pharmacognosy - the study of drugs from natural sources, which would facilitate for consumers some desperately needed counseling about supplements. Lafferty agrees that pharmacognosy expertise would leverage “a return to the traditional roots of the pharmacist.”

“We are the best equipped to recommend how these [supplement] products can work in a specific physiology because we understand it. For example, when filling a statin we might say, ‘This drug class is known to reduce an enzyme, CoQ10, which is important for heart function. A supplement may help you, would you like to hear more about that?’ and we would be helping those people.”

Tod CoopermanA visit to ConsumerLab.org would be the perfect first stop for pharmacists seeking to rediscover their “roots,” said Tod Cooperman, MD, company founder and president. Since 1999 his independent laboratory has been performing rigorous testing of vitamins, minerals, herbal products, and other items. Reports include scientifically valid reviews of product ingredients, their sources, purity, drug interactions, and more. They also provide nutrient recommendations classified by age, gender, and health status.

“We are the only comprehensive service to help consumers and the medical community understand the fine print of not just what’s in the bottle, but how it may affect other medicines people take.”  

Ultimately, Mayer cautions “caveat emptor” - let the buyer beware - but urges the profession to become educated in order to help patients and consumers make good choices. 

Barbara Hesselgraveis a healthcare writer in Baltimore, Md.