Participant responses to survey questions related to the safety and government regulation of herbal products and dietary supplements indicated a wide gap between perception and reality (
Table 3). Of 267 participants, the majority (176 [66%]) believed that these products “pose no risk to the general population.” In addition, a large number of participants (160 [60%]) were under the misimpression that the FDA “regulates herbal products,” and an overwhelming majority (187 [70%]) incorrectly believed that the FDA routinely tests these products. Although few participants (72 [27%]) knew that the purity of these products is questionable, nearly half (120 [45%]) knew that product contents were not standardized among manufacturers.
Participants' responses to queries concerning their attitudes toward herbal products and dietary supplements also demonstrate a disparity between perceptions and reality. The vast majority of survey respondents (243 [91%]) expressed their belief that older Americans are often the targets of “medical quackery.” Yet, most participants (208 [78%]) also indicated that they believe herbal products and dietary supplements have health benefits, and about half (137 [51%]) believe that Medicare, Medicaid, or private insurance should pay for these therapies. A minority of participants (55 [21%]) incorrectly believe that “dietary supplements provide all the nutritional benefits of real food.” Nearly half (121 [45%]) of respondents said they would take an herb or supplement “if my doctor tells me to,” whereas only 75 (28%) said they would take it on their own “if I think it will help me.”
A number of drug or disease interactions involving herbal products and dietary supplements have been documented in the literature.
15,18-20 Potential interactions were apparent in 12 individuals participating in the present survey. For example, though garlic has been cited as an aggravating factor for gastroesophageal reflux disease (GERD),
43 1 participant with GERD was taking concomitant garlic and cimetidine. In addition, though there may be an increased risk of bleeding when taking garlic with aspirin,
44-47 we found that 2 survey respondents were taking both substances concurrently. One survey participant reported taking estrogren in addition to ginseng, which has been touted to have estrogen-like effects.
48-50 Similarly, patients have been advised against combining oral diabetic agents and ginseng, as ginseng may reduce blood glucose levels,
51 but 1 respondent reported taking both agents simultaneously. Five participants receiving aspirin or other nonsteroidal anti-inflammatory drugs were also taking
Gingko biloba, which has known antiplatelet and anticoagulant properties.
18,20 One participant with an anxiety disorder was taking ginseng, which has been reported to exacerbate this condition.
18,20 Participants taking St John's wort also reported taking paroxetine hydrochloride, digoxin, or estrogen—all of which have been shown to potentially interact with the herbal antidepressant.
18,20