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Consumers and physicians should talk openly about supplements, not in the limited conversation JAMA suggests

CRN's Steve Mister
JAMA's latest Patient Page takes a close-minded approach to herbal medications and creates a missed opportunity for dialogue and patient trust.

More than one in five American adults uses herbal supplements every year, with the most popular products being green tea, cranberry, garlic, ginseng, echinacea and ginkgo. We agree that patients should let their physicians and other healthcare practitioners know about the herbal supplements they use and how much they are taking, just as they should let them know about their prescription drugs, over-the-counter medications, and even significant changes in diet. Unfortunately, the latest JAMA Patient Page is likely to discourage herbal supplement users from doing so because it discounts the growing consumer interest in integrative and traditional medicine.

Research shows that supplement users engage in a constellation of healthy practices and are higher educated than non-supplement users. We believe that supplement users want to play an active role in identifying ways to stay healthy and live longer, and they are looking for doctors to be partners, sharing their knowledge but being open to a patient’s interest in a healthcare paradigm that goes beyond an over-reliance on pharmaceuticals as the only means to stay healthy.

The Patient Page is flat-out wrong to suggest that only one herb is supported by scientific evidence—a quick search of PubMed for any particular popular herb will produce dozens of scientific studies linking these products to research on various health conditions. Granted, this research may not be focused solely on randomized clinical trials (RCTs) as drug research would, but RCTs are necessary for drugs because they are used to treat disease and can have serious side effects. In contrast, herbs have been used safely for thousands of years by different cultures globally and are primarily used today as dietary supplements to maintain health and for mild health conditions.

Further, from a practical standpoint, consumers may be more interested in their own experience of benefits rather than the results of clinical trials. Many patients would prefer to take products that may offer some benefit, rather than take nothing while waiting for the perfect clinical trial. It is important that these patients communicate openly with their doctors about their choices. 

By focusing on alarmist tactics, cherry-picking the science and spreading misinformation, rather than embracing the patient’s desire to focus on a health-based lifestyle that goes beyond prescription medications, physicians could be losing an important opportunity to ensure that their patients are open about what they’re taking.

The authors may not like the way supplements are regulated, but it is inaccurate to state they are not regulated by the U.S. Food and Drug Administration (FDA). Supplements are subject to extensive manufacturing and labeling requirements, and FDA has enforcement tools to be sure they are followed. Further, even with highly regulated pharmaceuticals, pre-market testing doesn’t prove safety, and as we are all aware, sometimes these drugs are later recalled for safety issues.   

The reason this is all so important is because doctors and other healthcare practitioners do need to know what their patients are putting into their bodies. Some supplements can reduce the effectiveness of prescription drugs, just as there are prescription drugs that result in nutrient depletions. In fact, there are even some interactions resulting between foods and prescription medications. So the JAMA Patient Page on herbal medications is, in theory, a necessary educational tool that raises some important discussion points for doctors and patients. Unfortunately, its close-minded approach creates a missed opportunity for dialogue and patient trust.

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