The use of herbal supplements has increased exponentially over the last ten years. Direct-to-consumer advertising, promotions on television, newspapers, mail-order catalogs, the internet, and even local retail stores have raised public awareness and interest in herbal supplements. A recent study by Kaufman et al.1 found that 14% of the population had taken at least one herbal/supplement in the preceding week. Furthermore, 16% of prescription drug users reported concurrent use of one or more herbal supplements. The concomitant use of prescription medications and herbal supplements increases the potential for drug/herb interactions that need to be evaluated by a healthcare professional.
The FDA does not regulate herbal supplements because they are considered dietary supplements under the 1994 Dietary Supplement and Health Education Act (DSHEA). Under this regulation, the herbal manufacturer may advertise how a product affects the structure or function of the human body but cannot claim effectiveness for prevention or treatment of disease. The manufacturer is also responsible for controlling product safety and quality. If a question of product safety arises however, the burden of proof lies with the FDA to prove that the product is unsafe.
Due to the limitations of federal regulation and lack of clinical information on herbal supplements, some healthcare professionals are wary of discussing herbal use with their patients. Leady et al.2 conducted a survey in a hospital setting and found that only 36% of patients were asked about their herbal supplement use by a healthcare professional. In addition, only 24% of patients had documentation in their medical record that someone inquired of their herbal use. This problem is compounded by the fact that patients may not volunteer information about what herbal supplements they are currently using. Conversely, physicians find lack of resources and lack of time the greatest barriers to discussing herbal supplements with their patients.
The language of the 2004 proposed JCAHO standards now includes herbal supplements, vitamins, neutraceuticals, and health supplements as over-the-counter medicines (http://www.jcaho.com/accredited+organizations/hospitals/standards/draft+standards/medication+use+standards.htm)
. The proposed standards state that the minimum amount of information that must be made available to physicians, pharmacists, nurses, or other clinical staff must include all current medications including herbal products. Each organization should also have a policy on whether to accept and/or how to handle orders for herbal supplements.
The following is a summary of the electronic resources that are accessible to all employees from the Massachusetts General Hospital. In addition, a variety of print resources are available at the MGH Treadwell Library.
1. Kaufman DW, Kelly JP, Rosenberg L, et al. Recent patterns of medication use in the ambulatory adult population of the United States: The Slone survey. JAMA 2002; 287(3): 337-44.
2. Leady MA, Wolsefer JS, Sweet BV. Survey of alternative supplement use within a hospital population. Hospital Pharmacy 2002; 37(12):1295-1300.
Quick tips references
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