Why do we trust some pills and not others?  The answer often eludes me.  Patient “A” is quick to remind me that he does not want to take any medications.  His chart reveals that he is taking a multivitamin, Echinacea, Benadryl, saw palmetto, and Sam-E.  Aren’t they pills?   

According to the dictionary, a medication is defined as, “a drug used to treat an illness.”  My patient is treating his depression with Sam-E and his prostate with saw palmetto, despite the fact that he does not want to take “a medication.”  He is treating his poor dietary habits with multivitamins.  He is taking Echinacea on a daily basis to ward off colds and isn’t aware of the fact that Echinacea is a ragweed, something he is highly allergic to.  He is taking Benadryl to treat the side effects of his Echinacea.  For a man who does not want to take any medications, he is heavily medicated with over the counter garbage.

Why do we trust some pills and not others?  The F.D.A. regulates prescription medications.  The government requires strict adherence to F.D.A. standards requiring certification of a host of factors.  First and foremost, a prescription medication must be proven to be effective and safe.  Secondly, studies must be done to identify potential side effects, contraindications, and interactions with other medications.  Third and foremost, all company literature or advertisements about a medication must show a fair balance of information:  if you mention a positive, you must mention a negative.

Over the counter nutraceuticals are not regulated.  As long as they make no claim of treating any disease, they can say anything they want about themselves.  They are not required to show effectiveness, side effects, drug interactions nor contraindications because, officially, they don’t treat anything!  According to one internet site, Sam-e “promotes a healthy mood” a “revitalized mood”.  The site goes on to state, “These statements have not been evaluated by the Food and Drug Administration.” With regard to side effects, the site states, “Generally speaking, SAM-e supplements have been shown to be very safe, with no known side effects.”  What does “generally speaking” mean?  What are the possible side effects?  The site dodges this question.

The unknowing public is caught in the middle.  On the one hand, the doctor tells his patient to take a medication for his depression that comes with a three page list of possible side effects; and, on the other, the internet tells him that Sam-e will “promote a healthy mood” and “generally speaking” is very safe.  It’s no wonder the public doesn’t want to take medication but is willing to take lots of unproven, under studied, non-regulated pills and potions.

Why do people claim that their over-the-counter pills work so well?  Many neutriceuticals actually are medications with active ingredients.  Many simply deliver a placebo effect.  I like placebos; they are safe and, in some studies, show effects, both positive and negative, in a large percentage of people.  I worry about neutriceuticals that have active ingredients.  How will they react with my medications?  What are the unknown possible side effects that I should be monitoring?  How are they processed by the body?  What do I do if my patient overdoses on neutriceuticals?  Will my patient admit to taking them?

In the case of my patient on Echinacea, he is actually making himself sick.  He is allergic to the product he is taking and doesn’t know it!  In addition, Echinacea, when taken on a daily basis, may damage the immune system.  Many studies have found that Echinacea is ineffective at preventing or treating the common cold, yet it is marketed heavily (http://nccam.nih.gov/health/echinacea/) for the treatment of a variety of symptoms. 

Why do we trust some pills and not others?  The answer is easy; it is all in the marketing!  Snake oil salesmen have been successful throughout history.  Be skeptical of products that make fantastic claims.  Look for the following disclaimer, “These statements have not been evaluated by the Food and Drug Administration.”  Essentially, the merchandiser is telling you that his product is unproven and not approved to prevent or treat any disease state.  While I am not a fan of government intervention, someone has to independently assure the effectiveness, safety, and quality of anything you ingest.  That assurance cannot come from the company that is selling it to you.  The F.D.A. needs to step in and regulate the neutriceutical industry the same as pharmaceutical industry. Comparing apples to apples would certainly make deciding what is best for you a lot easier.  Forcing the neutriceutical companies to perform under the same standards as the pharmaceutical companies would result in the elimination of false claims and the unmasking of the snake oil salesmen who prey on the unsuspecting. 

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