Thread by @scott_mintzer

I saw this news the other day, courtesy of @MDaware, and it has not received nearly as much attention as it deserves — for a few reasons.

So, a thread on the important and overlooked topic of medicinal “supplements”. 1/16

nbcnews.com/health/health-…

CVS announced that it will obtain independent testing of all vitamins & supplements it sells to ensure that they actually comply with their labels.

This is huge news, & I applaud the company for doing so.

But let’s take a step back & consider why this is needed at all. 2/16

In the 90s, a new Federal law took supplements & other “natural” products away from FDA oversight.

The agency doesn’t monitor these products for safety, study them for effectiveness, or check the factories that make them. They only get involved if some major danger arises. 3/16

Physicians largely shun these things because there is typically little or no evidence that they actually work for the condition in question.

Lacking safety study makes any assessment of risk vs. benefit even more impossible.

But… it’s actually far worse than even that. 4/16

Any FDA-approved drug must contain EXACTLY what it says it does. If it’s a 100 mg lamotrigine pill, every pill has 95-105 mg of lamotrigine in it. They can only be off by a few percent on average, and that’s for the generic.
(The brand name tolerances are even tighter.) 5/16

Pills also contain extra stuff like binders, resins, flavorings, & coloring agents that make the active ingredient into a palatable, stable pill. All those ingredients also have to be FDA-approved.

And the factories are inspected to ensure they are compliant. 6/16

But the FDA doesn’t monitor supplements. And that means that you have no idea that it even contains what it says it does.

It may say that it’s a 5 mg melatonin pill, but it might have 3 mg, or 8 mg. Or it might have none at all. Really. That actually happens. 7/16

And it’s even worse than THAT. Many of these supplements contain ingredients that have been BANNED BY THE FDA FOR HUMAN CONSUMPTION.

Those might be dyes, or flavorings. Or sometimes they are actual drugs.

Yes, you read that correctly. 8/16

A study recently published in JAMA Open found that some supplements contained drugs barred for use in the US.

So, for example, that supplement promising to help you lose weight? Might contain a weight loss drug that the FDA banned years ago. 9/16

jamanetwork.com/journals/jaman…

Of course, many — possibly most — supplement manufacturers are decent. And most supplements probably aren’t harmful.

But it doesn’t change the fact that there is simply no oversight of these things. They are the Wild West of therapeutics. 10/16

I’ll put it as bluntly as I can:

WHEN YOU TAKE A SUPPLEMENT, YOU HAVE ABSOLUTELY NO IDEA WHAT YOU ARE PUTTING INTO YOUR BODY.

None. Whatsoever. Sorry. It’s true. 11/16

Into this arena, CVS’ move is bold and welcome. In fact, I will tell all my patients that if they want to use these things (which they mostly shouldn’t), they ought to buy them only at CVS.

But, consider the implications of this. 12/16

People flock to the shelves of retail pharmacies, assuming that all this anodyne-appearing stuff on the shelves must be safe — and accurately labeled! — because this is America, and we watch over the populace and regulate things to ensure safety... 13/16

...when in point of fact this has been so completely forsaken that we now have to rely on a private company to do it for themselves.

And how do we know they are doing it right? Who’s overseeing THEM? Where is our recourse?? 14/16

The only reasonable conclusion one can come to is that that law from the 90’s taking supplements out of FDA purview is — and I want to choose my words carefully here —

AMONG THE DUMBEST FREAKING LAWS THE U.S. CONGRESS HAS EVER PASSED.

15/16

So while I truly applaud CVS for taking this step, and will advise patients and others accordingly, all of us should be demanding that this policy be undone so that we don’t have to rely on the vagaries of the marketplace to vouchsafe for the products on pharmacy shelves. /16x