Since the United States Dietary Supplement Health and Education (DSHEA) Act was passed in 1994, there has been an immense increase in the use of these products by American consumers. Eisenberg reported that 42.1% percent of Americans were regularly using alternative forms of health care, with 17% using herbs and dietary supplements (HDS; 1). This is a special topic for educational activities because American physicians, pharmacists, nurses and public health educators have had little training on HDS topics in pharmacology and toxicology courses.
Additionally, the FDA’s Center for Food Safety & Nutrition, which was assigned regulatory authority for HDS under DSHEA, has specified labeling requirements for HDS products. Both the FDA’s action to withdraw ephedra-containing HDS due to cardiovascular risks and kava-related liver toxicity from cases in Europe, has called attention to these hazards (2,3). Other stages of implementation of DSHEA are in progress, such as Good Manufacturing Practices (GMP), involving plant inspections, product testing for active ingredient consistency, and adulteration testing. With an increase in usage there has been an increase in the reporting of the prevalence and incidence of toxicity. Toxic Exposure Surveillance System (TESS) data reported an increased in exposures of 344% from 1990 to 1997; a time period when consumer consumption increased 138% (4,5). As such, poison centers and those in the medical toxicology community are increasingly being asked to consult on HDS cases and questions.
The HDS interest group of the North America Congress of Clinical Toxicology (NACCT), now officially known as the American Academy of Clinical Toxicology (AACT) HDS Special Interest Group, presented the first HDS Symposium on this topic at the Orlando NACCT Conference in September 2005, which attracted a standing room only audience for papers by Drs. Haller, Ko and Woolf, which follow. An even more defining approach will occur in the San Francisco NACCT Conference in 2006, with informatics, toxicogenomics of herbal-drug interactions and case discussions.
REFERENCES
- Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990–1997; results of a follow-up national survey. JAMA 1998; 280: 1569–1575, [INFOTRIEVE]
- 2. Food and Drug Administration, HHS. Final rule declaring dietary supplements containing ephedrine alkaloids adulterated because they present an unreasonable risk. Washington, DC: Fed Regist. U.S. Government Printing Office; 69(28):6787–854, [email protected] (11 February 2004).
- 3. CDC. Hepatic toxicity possibly associated with kava-containing products—United States, Germany, and Switzerland, 1999–2002. MMWR 2002; 51:1065–1067
- Smolinske SC. Herbal product contamination and toxicity. J Pharmacy Practice 2005; 18: 188–208, [CROSSREF]