The Children's Hospital of Philadelphia is now rejecting the use of most dietary supplements, in what it describes as a break from other hospitals. CHOP recently took just about all dietary supplements off its Formulary, or list of approved medicines, for patients admitted to the hospital.
If families wish to use them anyway, they must sign a waiver form.
"What's happened to us over past few years is just a growing level of frustration," said Dr. Paul Offit, chief of infectious diseases at CHOP and chair the board which approved the new policy. Offit said supplements aren't necessarily what they claim to be because they're not regulated in the same way that the Food and Drug Administration regulates pharmaceuticals, raising red flags for patient safety and health.
"The problem has been that we can't even get from most companies that certificate of analysis, that shows the product was independently tested and what's on the label is in the bottle," said Offit, citing a recent problem in Hawaii, where a fat-burning supplement was linked to liver failure.
Dietary supplements are generally defined as vitamins, minerals, herbs and extracts that may come in the form of tablets, capsules or powders. For patients with medical conditions who take supplements because their diet lacks enough of a nutrient, the hospital is developing a list of about three dozen exceptions which are U.S. Pharmacopeia verified.
"They have to have a certain standard regarding safety efficacy manufacturing. If not, we strongly encourage the parent not to give this to their child," Offit said. Along with the waiver, the hospital is also giving families additional information about supplements.
Possible unintended consequences
The hospital may have good reason to create the policy, but Dr. John Neely, a professor of pediatrics and oncology at Penn State's College of Medicine and director of Penn State Milton S. Hershey Medical Center's integrative medicine out-patient program, worries it might backfire.
"What I find is patients are acutely aware if physicians are really opposed to herbal medicines and supplements," said Neely. "When I start to negatively ask patients about them, people just don't divulge, they are so afraid physicians will be angry with them."
Neely says that situation could result in unintended drug interactions. It's also of special concern with patients from cultures that gravitate toward alternative remedies, like the Amish.
"I think it would be really good if we had the time to sit down with someone with expertise in herbal medicine, to explain how they work," said Neely. "More often than not when I do that, patients understand the ramifications."
For Michelle Niesley, president of the Pennsylvania Association of Naturopathic Physicians, recognizing which supplements are certified and reputable is important, though she hopes CHOP’s policy doesn’t “restrict a patient’s access to optimal wellness.” Niesley, also a clinical trials manager at Cancer Treatment Centers of America, says allopathic doctors traditionally don’t train or specialize in dietary supplements, but others do and can be of assistance.
Other doctors, like Alexis Lieberman, a private practice pediatrician in Philadelphia, don’t make much of the new policy.
“I think that’s totally reasonable,” said Lieberman, who has also referred some patients to alternative medicine specialists. “CHOP wants folks to know that just because it says it’s natural, doesn’t mean that it is. If it sounds too good to be true, it probably is.”
Offit, with CHOP, meanwhile, says the intent is to improve dialogue with families, and have a better way of tracking all of what patients are taking and how that’s affecting them.
“I think frankly for the first time we can understand the level of usage in our hospital,” said Offit. “What often happens is a patient will come in, we’ll ask the parent are they taking medication. The patient will say no, not considering these dietary supplements to be medicines, to be drugs, which frankly they are because they can have a physiological effect.”