Blog | Wednesday, December 16, 2015

More ammunition

I have never been a fan of dietary supplements. In fact, I have spent many hours trying to talk my patients out of taking nearly all of them. My reasons for doing so are based on both my conservative approach to medical therapies in general, and on my skepticism about these products in particular. A recent article in the New England Journal of Medicine gave me more ammunition to oppose their use.

Here's what I mean by a “conservative approach” to medical therapies. I believe that there should be a good reason, backed by good evidence, to take any medication, prescribed or over the counter (OTC). Since every medication (or supplement, herb, vitamin, mineral, etc.) carries some risk of adverse side effects, and costs some money, I have never ascribed to the “It can't hurt” school of thought. “Why not?” has never seemed to me a compelling reason to recommend or prescribe anything. There is a profound lack of reliable evidence supporting the use of the vast majority of OTC supplements that patients take.

This is of course compounded in the common scenario where people are taking multiple prescribed medications or OTC products, in which there is also a real risk of unanticipated interactions among compounds.

My skepticism about their use is based on a very practical consideration. I just don't trust that in the world of dietary and nutritional supplements that the label on the bottle reflects the composition of the pills in it. Even though I am convinced that some herbal remedies have genuine therapeutic value, I have no confidence—based on the absence of meaningful regulatory oversight—that consumers can know what they are getting.

Believe me, I am not saying that conventional pharmaceutical companies are run by a bunch of saints, but I do believe that their products have been subjected to way more scrutiny in terms of safety, efficacy, and manufacture.

Here's the new reason I don't believe in these products. According to the work of a group of investigators at the CDC and FDA, there are an estimated 23,000 visits to Emergency Departments in the U.S. prompted by adverse events related to dietary supplements. The events range from diet-pill induced tachycardia to swallowing difficulty and choking episodes associated with micronutrients. I know that the numbers are not that large in absolute terms, but they underscore my earlier point: why would you accept any risk in the absence of any evidence of anticipated benefit?

Makes no sense to me. What do you think?

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital. He then held a number of senior positions at Mount Sinai Medical Center prior to joining North Shore-LIJ. He is married with two daughters and enjoys cars, reading biographies and histories, and following his favorite baseball team, the New York Yankees, when not practicing medicine. This post originally appeared at his blog, Ausculation.