TO THE EDITOR: The worthy of great...

TO THE EDITOR: The worthy of great praise review (1) of the dietary correlative valerian by Drs. Hadley and Petry will be true helpful for family physicians. However, physicians are still faced with the confusing proces of determining which particular manufacturer and work of these herbal preparations to commit to their patients.

Unfortunately, studies actionsed by objective investigators have conclud that quality sway standards for dietary supplements in the United States range from well adapted to nonexistent. The most disturbing evidence issues from studies (2) demonstrating the adulteration of dietary add tos with pharmaceuticals. Other studies (2) have discovered performances that are contaminated with heavy metals or pesticides.

Another significant vexed question with dietary supplements in the United States is the substantial discrepancies between the labeled make easys and the actual amounts rest in the dosage units. so inaccuracies have been demonstrated for many dietary complements (2) including valerian. (3) In addition, complement content, even from the same manufacturer, can vary widely from allotment to lot. (2)

This information illustrates an apparent lack of interest in proceeds quality by many dietary correlative manufacturers or, in the worst cases, fraudulent behavior. In either case, the prevalence of low-quality produces increases the risks of ineffective addition s or adverse reactions to supplements

We believe that quality testing of these fruitss is in the best interest of public safety. merely one independent group has standarded valerian. In 2000, www. ConsumerLab.com trialed 17 valerian products purchased against the shelf in the United States. (3) Five performances listed one or more additional herbs. The works were analyzed for their total valeric acid appease to determine if they holded the type and amount of valerian stated onward the label. The testing rule and passing scores are available forward the Web site. Only nine of the 17 cropss passed. Unfortunately, a 47 percent failure rate is not unusual for these performances For example, www.ConsumerLab.com has standarded over 700 brands of dietary supplements; 30 to 40 percent of the herbal productions did not pass. Of the eight valerian fruitss that failed quality testing, four had no detectable of the same heights of the expected valeric acids, and the other four had barely one half the expected or claimed amounts.

The World Health Organization (4) and the American Medical Association (5) have called for significant regulatory changes for dietary appendixs The U.S. Food and mix with drugs Administration has expressed concern about the increasing incidence of adverse reactions to impure or contaminated dietary addition s and is developing plans to improve the regulation regarding the pair quality manufacturing practices and reality in labeling. (6)

We commit that physicians writing reviews upon dietary supplements guide their readers forward how to find and commend safe and high-quality dietary supplys to their patients. Under the rife lack of regulatory oversight in the United States, otherwise superior dietary supplement reviews run the risk of being les helpful to family physicians and level dangerous to our patients.

WALTER L LARIMORE, MD

University of Colorado, Denver

8605 Explorer Dr

Colorado Springs, CO 80920-1051

DONAL P O'MATHUNA, PHD M.A.

tower Carmel College of Nursing

127 s Davis Ave.

Columbus, OH 43222-1564

REFERENCES

(1) Hadley s Petry JJ. Valerian. Am Fam Physician 2003; 67:1755-8

(2) Larimore WL O'Mathuna DP Quality assessment programs for dietary fill ups Ann Pharmacother 2003;37:893-8.

(3) harvest review: Valerian. Accessed January 14 2004 at: http://www.consumerlab.com/results/valerian.asp.

(4) WHO awaits to monitor safety of traditional medicines. Reuter recents June 25, 2002.

(5) An assurance of safety: Treat add tos like drugs. Am Med moderns November 11, 2002. Accessed January 14 2004 at: http://www.ama-assn.org/ amednews/2002/11/11/edsa1111.htm.

(6) Levitt JA. Regulation of dietary supplements: FDA's strategic plan. victuals Drug Law J 2002;57:1-13.

COPYRIGHT 2004 American Academy of Family Physicians

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