What You Need to Know About the Supplements You re NOT ...

[Pages:48]Safety of Dietary Supplements

What You Need to Know About the Supplements You're NOT prescribing

Pieter A. Cohen, MD Associate Professor of Medicine,

Harvard Medical School Cambridge Health Alliance

Disclosures

?NSF International ? research collaboration ?Consumer Union ? research support ?Defendant in civil suit brought by a supplement company regarding BMPEA.

I recommend many supplements (e.g., many vitamins & minerals; occasionally probiotics & omega-3 fish oil). I don't recommend botanical supplements to my patients, but I also do not spend significant time discouraging use of many of the botanical supplements that my patients use on their own.

Acknowledgements

?Bastiaan Venhuis, PhD, RIVM, Netherlands ?John Travis, NSF International ?Ihklas Khan, PhD, Univ of Mississippi ?Bharathi Avula, PhD, Univ of Mississippi ?Roy Gerona, PhD, UCSF ?Yan-Hong Wang, PhD, Univ of Mississippi ?Jim Neal-Kababick, Flora Research ?John Swann, US FDA ?My many students & residents

Rainbow diet pills

The Return of Rainbow Diet Pills. Am J Public Health. 2012;102(9):1676-1686

Goals

Understand the regulatory framework under which dietary supplements are sold

Help develop a more nuanced approach to counseling your patients in respect to dietary supplements that your patients use on their own & understand why it's important to do so

Learn what to do when you suspect your patient has been harmed by a supplement

Learn about free speech protection under antiSLAPP statutes

We usually don't know who's using supplement...

Patient don't tell us:

~70% of patients didn't tell their physician*

We don't ask:

~75% of physicians didn't know**

*Arch Intern Med 2006;166:1968. **Br J Clin Pharm 2007;64:373

How do I know if what my patient is

Food

using is a supplement? Supplements

OTC med

What are dietary supplements?

?Vitamins & minerals ?Botanicals ?Amino acids ?Probiotics ?Glandular extracts

We use them frequently (calcium, iron, vitamin D, folic acid, MVI, B12, etc.).

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