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Herbal Supplement Web Sites Mislead
Sept. 16, 2003 -- When it comes to regulation, herbal supplements get a lot of slack. But on the Internet, they've run off with the leash.
If you surf the Internet for information on herbal supplements, you'll get a lot of misleading information, a study in the Sept. 17 issue of the Journal of the American Medical Association shows. Three fourths of these web sites sell herbal supplements. More than four out of five of these retail sites make specific health claims.
All that isn't too surprising. After all, herbal supplement makers are exempt from rules that force drug makers to prove their products are safe -- and that they really work. But they are forbidden to claim that the supplements cure, treat, prevent, or diagnose specific diseases. And many of the retail web sites do just that, find Charles A. Morris, MD, and Jerry Avorn, MD, of Brigham and Women's Hospital and Harvard Medical School in Boston.
"These products should be thought of as drugs," Morris tells WebMD. "If, like drugs, they are marketed with disease indications -- and they are -- they need to be regulated."
Regulation: The Solution or the Problem?
This isn't the first time the medical community has called for regulation of herbal supplements. Last year, Donald M. Marcus, MD, of Baylor College of Medicine, Houston, co-authored a New England Journal of Medicine article calling for tighter regulation of herbal supplements.
"The basic issue is that people are not getting reasonable information," Marcus tells WebMD. "People have been sold on the idea that herbs are gentle and safe. But herbal supplements are crude drugs. If they have a potential for benefit, they also have a potential for adverse effects."
The supplement industry agrees that safety is a concern. But even existing regulations make it hard for reputable supplement manufacturers to provide quality information, argues Annette Dickinson, PhD. Dickinson is president of the Council for Responsible Nutrition, a trade association of dietary supplement manufacturers. She's also the industry representative on the FDA's Center for Food Safety and Applied Nutrition.
Dickinson says the rules forbidding firms from talking about how their products might be used to treat specific diseases have an unintended consequence. Forbidding firms from discussing specific diseases makes it hard to give accurate information to consumers, she says.
"The trend is for consumers to take control of their own health," Dickinson tells WebMD. "People want to be given more information about the health effects of foods -- which includes supplements. They want information that empowers them to make those choices and make those decisions without a company having to go through a $500 million new-drug approval process with the FDA."
Marcus says a 1994 law -- the Dietary Supplement and Health Education Act or DSHEA -- defined all kinds of supplements as food products and effectively ended FDA regulation of these products. That, he says, means nobody has to prove that supplements are effective -- or even that they are safe.
"There's very little quality evidence about herbal medicines," Marcus says. "Along with not knowing whether they work, we don't know much about their safety. If you look at prescription drugs, even though preapproval trials are done in several thousand people, some still have to be removed from the market because their side effects become known only on extensive follow-up. But the follow-up on herbs is very fragmentary. A lot of people prescribe herbs for themselves. If they have an adverse effect, they may not ascribe it to the herb because they know herbs are harmless"
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