The Dietary Supplement Health And Education Act: are we healthier and better informed after 27 years?

• Published in: The lancet oncology Vol. 22; no. 7; pp. 915 - 916
• Main Authors: Sissung, Tristan M, Cordes, Lisa M, Figg, William D
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 01.07.2021; Elsevier Limited
• Subjects: Alternative medicine; Bans; Biological activity; Cancer; Consumers; Dietary minerals; Dietary supplements; Enforcement; FDA approval; Hematology, Oncology, and Palliative Medicine; Immune system; Manufacturers; Manufacturing; Morbidity; Mortality; Nutrient content; Polypharmacy; Prescription drugs; Prostate; Selenium; Structure-function relationships; United States > US
• ISSN: 1470-2045; 1474-5488; 1474-5488
• DOI: 10.1016/S1470-2045(21)00084-X

Drug interactions are already far more likely in the setting of cancer due to polypharmacy, comorbidity, and compromised organ function. Since patients with cancer use more supplements than others, and since 50% of patients with cancer do not mention complementary and alternative medicine use to their physicians, are patients with cancer made even more vulnerable to morbidity and mortality due to the DSHEA? The intent of the Act was to provide consumers with scientifically robust information to make informed decisions; however, this standard of proof has no bearing on the strength of consumers' beliefs about the advertised benefit. [...]the costly and time-consuming process of obtaining FDA approval for qualified health claims is of little interest to most companies, which can simply opt for DSHEA-sanctioned structure or function, nutrient, or wellbeing claims. According to a Dietary Supplement Label Database (DSLD) query of “cancer” or “immune support”, claims fall into six categories: other ingredient-related or constituent-related claim or use (n=1337 for cancer and n=1848 for immune support), structure or function claims and related dietary supplement claims (n=1151 and n=1827), nutrient content claims (n=427 and n=732), qualified health claims (n=96 and n=10), and health claims (n=7 and n=6). Yet, there are ten systematic reviews on this subject, and the most recent one concludes “well-designed and well-conducted RCTs have shown no beneficial effect of selenium supplements in reducing cancer risk (high certainty of evidence)”. [...]dubious claims extend to both ends of the spectrum of scientific evidence: some are presented without discernible justification, and others make claims in spite of highly credible scientific evidence to the contrary.