Americans' Views On The Use And Regulation Of Dietary Supplements - Brief Article

Nutrition Research Newsletter, April, 2001

One of the most striking changes in American's health behaviors in the 1990s was the widespread and growing use of dietary supplements for health reasons. Since 1994, dietary supplement sales have grown by nearly 80%, from $8.8 billion to an estimated $15.7 billion for 2000. The sharp rise in the use of these supplements has raised concerns in the medical community and the media about the potentially serious health risks of the mostly untested and unregulated products. Various reports from poison control centers and practicing physicians have indicated examples of individuals being harmed by taking these supplements. The issues has been raised that as these products are increasing advertised in the media and sold in drug stores and supermarkets, the public may be given a false sense of security about their safety. In the Nutrition Labeling and Education Act of 1990, Congress gave the FDA the authority to require manufacturers of dietary supplements to provide evidence that their products were safe, prior to sale. After the 1994 legislation was enacted, the burden of proof concerning the safety of dietary supplements shifted, and the FDA now has to prove that a supplement is unsafe. Also, as a result of the legislation, manufacturers have been able to make general health claims about products as long as they do not contain references to preventing or curing specific diseases.

The present article summarizes public opinion survey data on the dietary supplement issue, using national opinion survey data. In the surveys, regular users of supplements were defined as respondents who reported that they used products, such as echinacea, ginseng, over-the-counter hormones, or amino acids. Other categories were classified as sometimes users and nonusers. A review of the findings of these surveys showed that approximately half (48%) of all American adults surveyed reported taking some type of nonprescription vitamin, dietary, or mineral supplements regularly. One in six reported regularly using dietary supplements like echinacea, ginseng, amino acids, or over-the-counter hormones. American respondents with higher levels of education reported greater use than those with less education. Regular users were more likely to be white and older than 45 years. Uninsured American respondents were significantly more likely than those with insurance to use dietary supplements, and one of six parents reported giving dietary supplements to their children.

The survey found that a substantial percentage of the Americans surveyed held positive views of the health benefits derived from taking dietary supplements. Overall, 85% of regular users reported that dietary supplements are good for people's health and well-being. More than 70% of those who reported taking supplements regularly said that they had shared this information with their regular physician. Many regular users were skeptical of their physician's knowledge and/or attitudes toward supplements. Nearly half (49%) of regular users believed that physicians are prejudiced against supplement use and 44% believed that their own physician knows only a little or not much at all about these products.

Only 37% of the respondents believed that dietary supplements are adequately tested. However, regular users were more likely than nonusers to believe that there is adequate testing of these products. The majority of regular users (53%) believed that people are "rarely or never" harmed by taking dietary supplements. In contrast, 51% of nonusers reported that people are "often or sometimes" harmed by these supplements. Slightly more than half of the respondents were aware that supplements are not regulated by the government. One-third of the respondents believed that supplements are currently regulated, and 12% reported that they did not know.

The findings show that 81% of respondents support giving the FDA the authority to allow new supplements to be sold only if the safety of the supplements has been tested by the FDA, and that 80% of respondents supported giving the FDA the authority to remove dietary supplements from the market if they are proved unsafe.

R. Blendon, C. DesRoches, J. Benson, M. Brodie, D. Airman. Americans' Views on the Use and Regulation of Dietary Supplements. Arch Intern Med 161:805-810 (March 2001) [Correspondence: Robert J. Blendon, ScD, Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Ave., Boston, MA, 02115. E-mail: cdesroch@hsph.harvard.edu].