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Less Is More
July 2014

Approach to Overuse of Herbal and Dietary Supplements: A Teachable Moment

Author Affiliations
  • 1University of California, San Francisco
JAMA Intern Med. 2014;174(7):1033-1034. doi:10.1001/jamainternmed.2014.1879

Herbal and dietary supplement use is prevalent. Medication reconciliation should include a careful review of herbal and dietary supplements, including medical and nonmedical harms and benefits. The use of shared decision-making is recommended to integrate these findings into a patient-centered treatment plan.

A man in his 80s was seen in the geriatrics clinic to establish care and for evaluation of cognitive decline. He had a medical history of benign prostatic hyperplasia and a longstanding interest in dietary supplements. He was previously treated by an antiaging physician, from whom he was transferring care. The patient’s medications included more than 50 supplements that had been recommended to him by this physician. He also reported purchasing additional dietary products to improve his health. Collectively, these supplements were marketed to treat memory impairment, sexual performance, urinary symptoms, digestive health, or aging. They comprised multiple vitamins, minerals, amino acids, caffeine stimulants, hormones, and proprietary formulas. His invoice for the supplements provided by his antiaging physician totaled almost $9000 per quarterly shipment. His other dietary products cost him an additional several hundred dollars per month.