Academic journal article American Journal of Pharmaceutical Education

An Evidence-Based Elective on Dietary Supplements

Academic journal article American Journal of Pharmaceutical Education

An Evidence-Based Elective on Dietary Supplements

Article excerpt

INTRODUCTION

Dietary supplements are commonly used and account for substantial healthcare expense. As of 2004, nearly 50% of the US population used a vitamin or mineral supplement and 14% used an herbal supplement consistently for at least 1 year. (1) In 1998, 12% of the US population used herbal medicine and only 15% of that use was guided by a practitioner. (2) This common use of dietary supplements is reflected through the dollars spent annually by the US consumer. In 2005, more than $4 billion was spent on dietary supplements. Over 50% of these products were purchased at a drug store or supermarket. Specialty stores (eg, GNC, Vitamin Shoppe, Vitamin World) and natural food stores accounted for 12% and 9% of purchases, respectively, according to the Council for Responsible Nutrition (CRN). (3) Seventy percent of patients who use complementary and alternative medicine, of which dietary supplement are a component, do not report this to their primary care physician. More than 1 in 3 Americans use a dietary supplement without consulting their doctor and this inarguably poses a risk to patient health. With millions of Americans passing through retail pharmacies to spend billions on dietary supplements, pharmacists can play a key role in addressing this issue.

The extensive use of dietary supplements highlights the importance of additional evidence-based training on dietary supplements for pharmacy students. The magnitude of dietary supplement use in the United States is not paralleled by course content in pharmacy education. As of 2003, only 15 out of 64 colleges/schools of pharmacy offered an elective in natural products and 20 offered an elective in natural products and complementary and alternative medicine. (4) By 2005, 7 colleges and schools of pharmacy offered a course exclusively covering herbal supplements, 57 offered courses in which at least one third of the content covered herbal supplements, and 13 did not offer any instruction on herbal supplements. (4-7) Of concern, pharmacists and pharmacy students list the Internet, lay people, media, and product labels as their primary sources of information on herbal supplements. (5,8,9) We created an elective course in dietary supplements at the Albany College of Pharmacy and Health Sciences in response to informal student feedback indicating an interest in this area and the lack of any courses covering dietary supplements. In addition to covering current knowledge of dietary supplements, courses should prepare pharmacy students to assess the validity of emerging information. The importance of this is accented by the ongoing work of the National Center for Complementary and Alternative Medicine (NCCAM). As of March 2008, NCCAM had nearly 50 dietary supplements clinical trials that were either recruiting or not yet recruiting patients. (10) While this is only a snapshot from one National Institutes of Health (NIH) center, it represents a significant amount of new information regarding the use of supplements. Future pharmacists need to be able to assess and incorporate this information prospectively.

DESIGN

The course, An Evidence-Based Approach to Dietary Supplements, was offered to third-year doctor of pharmacy (PharmD) students as a 3-credit elective. Course objectives were discussed with students and provided in the course syllabus. Goals were for students to be able to: (1) describe the federal regulatory process for the production and sale of dietary supplements in the United States; (2) discuss the potential problems and concerns with regulation of dietary supplements; (3) compare and contrast the advantages of available dietary supplement resources and references; (4) describe the body of scientific evidence supporting the safety and efficacy of individual dietary supplements reviewed during the course in terms of quantity, quality, and consistency; (5) identify knowledge gaps in the scientific evidence for dietary supplements; and (6) given a patient scenario involving the current or desired use of a dietary supplement, develop an evidence-based recommendation for the patient. …

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