Question 2 - November 2014
The supplemental article provided, published in the The American Journal of Medicine in 2008, actually looked at the interactions between dietary supplements and prescription medications to identify potentially dangerous interactions. The researchers' conclusions were pretty straight-forward: the actual potential for harm was low despite a fair number of “potential” interactions between prescriptions and supplement. Zero patients out of nearly 1800 were seriously harmed from an interaction. What is your reaction? Does this change the way you feel about the first article’s findings and conclusions?
posted by Brady Jiter @ 9:09 AM
14 comments
14 Comments:
It is surprising that the potential for harm was low, however, I think it's still important to be cautious with them. Just because it hasn't really harmed those 1800 patients, doesn't mean that it still can't or that other people outside of the study hasn't been harm. I think that studies are very limited and 1800 is a lot of people but it still doesn't cover absolutely everyone. It may also be a good idea to look at long term effects. I don't know how long this study was but having just a snapshot doesn't really show the whole story. I think it may also depend on the types of medications they're looking at too. I guess I would just need more info to really have an opinion.
I agree with Tina and find this statistic to be surprising. This research was done in 2008 and I believe that there are a lot more products and medications on the market. The population, medications, and supplements tested would have to be listed and researched individually. I find this study to be hard to get accurate results with so many different types out there. Long term effects would also need to be evaluated. The credibility as well may be an issue. I don't know if it's possible to completely account for all the variables and side effects in this study.
No. It is the job of the healthcare system to provide the best care possible to patients. When medication is prescribed, doctors have a certain expectation for what that medication will be able to do for the patient. While none of the participants in this study were significantly harmed, there may have been a chance that their treatment was less effective than it could have been. Interfering with a doctor's recommendation does not allow them to do their job to the best of their ability, and in turn undermines the health field. In general, supplements may not be truly harmful, but there is also little need for them in many cases. Patients should understand that supplements may have possible interactions with their treatment, and should feel comfortable letting their healthcare provider know exactly what they are taking.
Tina & Haley, great point about long-term effects. There could certainly be interactions that don't present themselves initially and don't get accounted for. Susan, that's a good insight that patients' treatments might have been less than optimal due to supplementation interactions - I didn't even think about that.
This actually doesn’t surprise me and I think this is exactly the reason people don’t disclose the fact that they’re taking a supplement-because the perception of supplements are that they’re safe! Even if zero patients were “seriously” harmed, some patients may have had other side effects and in my opinion, because there isn’t usually a real need for supplements in most cases, the risk doesn’t outweigh the benefits. It’s also important to pay attention to the new products that are constantly being added to the market because who knows what side effects or interactions those may present either short-term or long-term.
The supplemental article doesn't change the way I feel about the first article's results because of what Haley pointed out. This article was in 2008. Six years may not seem like a long time, but in the supplement world (which is growing exponentially) that is an aeon. There are just so many new products coming onto the market that even if this article was published in 2013, I don't know if it'd be valid now 6 weeks away from 2015. Also, like Tina said, 1800 participants is a rather small sample size to extrapolate to the general population. In my mind, even if there is one negative interaction in any population group or demographic, that is too much. This study accounts for the 1800 at hand, but not for the other 150 million Americans using supplements. With the ever changing industry, and the fact that each individual's condition is so unique, I just don't know if any research (even the most current) could account for all of the possible interactions or harms that supplements could potentially cause.
Now, the argument could also be made that everything we do (driving a car, walking down the street, turning on our stove, plucking our eyebrows) carries a risk for something bad to happen and that's just life. I think that's a valid point, but I also think that all of those above examples at least have of benefit to help outweigh the risk. With many of these supplements (there are some exceptions, such as having an vitamin supplement prescribed by an MD to help with a deficiency), there isn't really any benefit, perceived or otherwise, and it's all a risk. This is especially the case when considering possible contamination, potential for an overdose etc.
Similar to Brady, I really liked how Tina & Haley brought up the long term effects of dietary supplements which many studies don't account for. One thing we can do for our patients is provide them with the information that they need to disclose any interaction or side effect that they thought was caused by a supplement. Many people may not know this, but the FDA does have a reporting system in place for adverse reactions associated with supplement use. The link is provided here: http://www.fda.gov/Food/DietarySupplements/ReportAdverseEvent/
Going through my thesis research, many of the authors of supplement related research studies (especially those articles pertaining to safety and/or efficacy) discussed the fact that while this reporting portal exists, many people have NO idea that they have any ability to conveniently report any problems (such as a drug-supplement interaction) directly to the FDA. As RDs, (future RDs, at least), I think it's our job to provide customers with this information not only for their benefit, but also to make the most of the options that are available for overall consumer safety. How is the FDA supposed to do anything about dangerous supplements if nobody ever reports that they've experienced an adverse reaction?
I also really, really, like what Susan said about the possibility of some of these products not causing an adverse event per se, but possibly antagonizing or decreasing the effect of other medications . For example, per the FDA's website (http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm096386.htm#supplements), taking Ginkgo Biloba can reduce the effectiveness of seizure medications, while St. Johns wort can decrease blood levels of cholesterol lowering medications. I didn't even know either of those interactions until just now, but that's why it's so important for us all to stay abreast with things like supplement interactions. Great point Susan!!
Seems to be a common theme so far that there are just too many supplements out there and too many potential unrecognized impacts to feel overly comfortable with the findings of this study. And I agree that there are countless new supplements that have entered the market since 2008 that could change the results of the study if it were done again today. I’ll be interested to see what the others think when they chime in.
The results of this article are very surprising to me. I would like to know who decided what “seriously harmed” by an interaction entails. The supplemental article stated hospitalization and/or serious bleeding were considered serious adverse effects of interactions. However, something such as vomiting or diarrhea that leads to dehydration could be considered a “seriously harmful” interaction. If left untreated, dehydration could be damaging.
This does not really change the way I feel about the first article’s conclusions. I think clients and patients still need to disclose their supplement usage even though they may not be “seriously harmed” by supplement interactions. I think it is important for the public to know that supplements can still be harmful, even though the likelihood of fatal interactions may be low.
I'm not surprised, I figured it would be low, however, I don't feel like that makes it less important. I feel like since being in clinicals, our role is fairly small when you look at the big picture. But I think that's almost what makes it even more important, physicians don't seem to care about these things unless they are a huge problem. Even if drug supplement interactions aren't life threatening, figuring out their side effects and deciphering if this is the cause of a persons decreased appetite (hypothetically), could increase their quality of life.
Great point Haley, we all know that a lot of supplements and drugs hit the market every year. The potential for harm is still lurking. Does this make anyone else want to push for FDA involvement?
No, it doesn't change how I feel. We should prevent every adverse event we can, especially if the cost is only asking the right questions. I also agree with what Susan said about the possibility of supplements changing the effects of other medications. People would be unlikely to realize that their medications were not working as they should be. In addition, how many adverse reactions do they have that are never attributed to the supplement? For example, someone may be taking a supplement but also has multiple risk factors for heart disease, and has a heart attack. Even if the supplement is disclosed, how do you know whether the cause is the supplement or one of the risk factors?
Susan made a good point about what patients take can decrease the effectiveness of the doctor prescribed order. Jessica made a great point that the physician is not necessarily concerned about the little things like we need to be, and that's why we're here. Even though some side effects aren't life threatening, they should still be a concern and treated so that the patient can feel better faster.
Arthur brought up a really important point about the reporting portal. More people need to be informed that there is a resource for documenting complaints and supplement side effects. There have been so many cases of unreported negative effects caused by poor supplements. The reporting portal could make companies more accountable for their products.
Jessica has a good point about pushing the FDA for involvement in monitoring new supplements. It's really frustrating to me that supplement manufacturers don't have to show that supplements have been tested before putting them on the market. Many consumers believe the FDA regulates supplements just like they do drugs, and assume that if supplements are on the market, they must be safe.
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