Dear Editor: In Temple's review, “The Marketing of Dietary Supplements in North America: The Emperor is (Almost) Naked”1 and Cooper's response,2 both authors profoundly miss the Emperor altogether. Yes, Dietary Supplement Health Education Act legislation is ambiguous in its regulation of which claims can appear on supplement labels (allowing “structure and function” claims, while barring most “health and disease” claims). Yes, the supplement industry often exploits this by marketing products with names and claims that consumers easily decode. And yes, while the US Food and Drug Administration lacks resources for adequate enforcement, they do have the authority to remove dangerous products from the market. What both authors miss, however, is that a key concern is not only whether people are using dietary supplements perhaps marketed in misleading ways, but how consumers use them. The Institute of Medicine committee for the study of Complementary and Alternative Medicine (CAM) in the United States identifies the lack of data on how people use CAM products, including dietary supplements, as “a major oversight in current CAM research.”3, p. 61 In a set of articles examining the disconnect between official discourse regulating the US supplement market and supplement users' actual practices,4,5 we present data in which US supplement users report motivations for use that go far beyond the “general wellness” or “structure and function” claims on supplement labels. In light of high frequency of “off-label” supplement use, attention to how people actually use these products becomes more important than ever. In fact, the ambiguity of supplement labeling may present a particular dilemma for consumers in determining how to use these products. If a supplement label provides guidance for “general wellness,” do the same instructions apply if one is using the product for illness management? If supplement users cannot rely on labels to provide relevant information about dosage, frequency, and duration of use, where do consumers turn? How do they make these determinations? In this formative research, our participants reported skepticism toward “formal” sources of information (from manufacturers, media, and scientific reports), especially when information challenged their personal experience with a product. These supplement users voiced trust in referrals from networks of friends, family, and others they view as like themselves in relevant ways (i.e., high-performance athletes in the same sport). Importantly, our participants also described a climate of experimentation that leads to the privileging of embodied knowledge and personal experience with supplements over external information. While we support calls by Temple and Cooper for better testing of the safety and efficacy of dietary supplements, we also call for increased research on “real world” use of dietary supplements that cannot be captured in current, clinical trial paradigms: how supplement users experiment with products and determine the dosage, frequency, and duration of use, and how embodied knowledge, personal experience, and lay recommendations are transmitted through social networks, the Internet, and other informal channels. In short, we urge researchers and clinicians to pay careful attention not only to whether patients are using dietary supplements, but how they do so, alone and in combination with other products.
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Jan 1, 2013
Waris Qidwai + 4
Open Access
