Supplements: Tell Your Doctor
It always surprises me that so many people are taking herbal and homeopathic supplements but don't think of them as medicines. Perhaps it is the type of people I see in a cosmetic surgery practice; a 2005 study in the journal
Plastic and Reconstructive Surgery found that more than half of cosmetic surgery patients were taking at least one of the ten most common supplements, compared to less than one in four in the general public. Because they don't think about supplements in the same way as they do pharmaceuticals, they often neglect to tell their doctor that they are taking them. The problem for plastic surgeons is that many of these substances interfere with blood clotting (for example, ginko biloba), which can cause problems with surgery, or react with anesthetic medications. Practitioners in other specialties worry about drug interactions as well.
Otherwise sensible people often don't give a second thought to stocking up on pills from the health food store while neglecting to fill their prescriptions or take their medication as directed. Noncompliance is one of the most significant problems in medical care across a variety of specialties, particularly for conditions like high blood pressure that don't have any overt symptoms. What people assume, often erroneously, is that supplements must be safe because they are natural. Many of these are marketed as anti-aging nostrums, and the reasoning is that they can't hurt but might help, so why not? Physicians on the other hand are perceived to be biased in favor of drugs, and so patients decide to hold back information about their supplement use.
This can have deadly consequences. The stimulant ephedra (ma huang) was responsible for several deaths among prominent athletes before being banned, and those are just the ones we know about. Clearly some of these substances are powerful, and even riskier when they are being taken in combination with drugs or other supplements. What many people are unaware of is that there is almost no regulatory oversight of supplements. Prior to 1994, the FDA disallowed health claims for herbal supplements, but the passage of a law called the Dietary Supplement and Health Education Act reclassified them as foods, resulting in looser regulations. So while prescription drugs have to undergo extensive (and expensive) testing to document safety and effectiveness, herbals have no pre-marketing requirements at all. The FDA can only intervene when it becomes clear that they are harmful.
This is starting to change. Since the passage of the original law, the FDA has published guidance on reporting requirements for adverse events, and Good Manufacturing Requirements for dietary supplements. They asked the Government Accounting Office (GAO) for suggestions on improving safety with supplement use. They issued a set of recommendations in January. As these are implemented, we can expect some tightening of the claims being made and how these products are marketed, but without another act of congress, the FDA lacks the authority to do very much. So in the meantime the best policy is a skeptical mind and open communication about what you are using with your health care provider.