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Once Again, “Let the Buyer Beware”: New Data on an Old Subject

Robert E. Fisher, MD

08 Nov 2013 1:13 PM

We are all cognizant of the studies that show the high-percentage use of supplements and herbal remedies in our patient population. This issue frequently comes up in conversation in the clinic, and often, our patients may be reluctant to inform us of their supplement use.

As a clinician, I am not opposed to supplement use, and in fact, I will share educational information about a supplement with my patients as often as I can. I have found the information resource on the Memorial Sloan-Kettering Cancer Center website to be an encyclopedia of information on this subject (MSKCC.org/AboutHerbs). Patients respond very favorably to an informative discussion about the supplement they are taking and are often surprised at the depth of information available on this website.

However, an article published in the New York Times on 11/3/13, in the Science and Health Section, is eye opening for all of us, as it reveals the impurity and substitution of ingredients that may be occurring frequently within this industry.

The article cites a study done at the University of Guelph, in Ontario, involving 44 bottles of commonly used supplements from 12 different companies available throughout the United States and Canada. Using DNA barcoding, the researchers found that one-third of the bottles did not contain any of the supplement that the item was being sold as. Many of the bottles contained fillers in the tablets or capsules, not labeled on the ingredient panel of the label. These fillers included wheat, rice, soy, and nut products. For patients with food allergies, this mislabeling could lead to significant adverse effects. The researchers found that only two of the 12 companies’ products entirely contained the labeled substance in the bottle. Whereas, two of the same 12 companies’ contents contained none of the labeled substance. The remaining eight companies’ products all contained various portions of unlabelled fillers, with many bottles containing very little of the labeled substance, at all.

The message for us as clinicians is clear: This is an unregulated industry, with no quality control or FDA scrutiny as we and the public have come to expect in the United States’ pharmaceutical industry. Please read this New York Times article. At least I feel better informed for my discussion with the patient in the office, as the situation arises. I think that I will offer the patient a copy of the article for their full reading of this finding. As mentioned at the beginning of this post, I am not opposed to the use of supplements, but feel that we as clinicians owe our patients knowledge that there is strong likelihood that what’s on the label, isn’t in the bottle! Caveat Emptor!

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Robert E. Fisher, MD