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The use of complementary and alternative therapies in children has recently shown explosive growth, despite little scientific evidence of benefit, a need for better regulatory oversight, and continuing gaps in the knowledge and attitudes of pediatric health professionals.
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CLINICAL PHARMACOLOGY & THERAPEUTICS | VOLUME 87 NUMBER 2 | FEBRUARY 2010 155
perspectives
1Division of General Pediatrics, Department of Medicine, Children’s Hospital and Harvard University, Boston,
Massachusetts, USA; 2Department of Family Medicine, Boston University, Boston, Massachusetts, USA.
Correspondence: AD Woolf (alan.woolf@childrens.harvard.edu)
doi:10.1038/clpt.2009.224
Use of Complementary and
Alternative Therapies in Children
AD Woolf1 and P Gardiner2
The use of complementary and alternative therapies in children has
recently shown explosive growth, despite little scientific evidence of
benefit, a need for better regulatory oversight, and continuing gaps
in the knowledge and attitudes of pediatric health professionals.
Epidemiology
A dietary supplement is defined by the
National Center for Complementary
and Alternative Medicine (NCCAM) as
a product (other than tobacco) that is
intended for use by humans to supple-
ment the diet by increasing total dietary
intake and that bears or contains one
or more of the following ingredients:
a vitamin, a mineral, an herb or other
botanical, an amino acid, or a dietary
substance.1 Dietary supplements are in
the marketplace in unprecedented num-
bers, and consumers are likely to spend
increasing amounts on these products
in the future. Whereas there were about
4,000 supplements on the US market in
1994, the General Accountability Office
has estimated that upward of 75,000
such products were available in 2008 and
reported that US sales of dietary sup-
plements reached $27.7 billion in 2007,
with half of all Americans reporting use
of these products.2
In one study, as many as 70% of parents
said they give their children herbs and
dietary supplements to preserve their
good health as well as to treat minor
illnesses.3 Special populations, includ-
ing immigrants and ethnic minorities,
oen give traditional remedies contain-
ing herbal ingredients to their children.
Unfortunately, many such remedies,
including unregulated, imported prod-
ucts, may be of poor quality or may
contain undeclared drugs, chemicals,
metals, or other adulterants or contami-
nants, which can cause serious poisoning
in children. Use of dietary supplements
continues its high prevalence in adoles-
cence. Products that claim to enhance
sports performance or promote energy
or weight loss are especially popular.
It seems reasonable, therefore, to ask
whether health-care providers for infants,
children, and adolescents up to age 21
years should or should not endorse the
use of herbs and dietary supplements in
children, let alone provide guidance to
parents concerning the advisability and
safety of specific products.
Current policies
Parents assume that herbs and many die-
tary supplements are “natural” and there-
fore safe and effective. ey also assume
that they are regulated in the same way
that prescription medications are by the
US Food and Drug Administration (FDA).
Both are false assumptions. Parents most
frequently cite their children’s health-care
provider as a primary source of reliable
information on all matters concerning
their children’s health, including the advis-
ability of dietary supplement use. Yet they
oen treat their children’s ailments with
home remedies, herbal therapies, or over-
the-counter products without any input
from health professionals and do not dis-
cuss use of herbs and dietar y supplements
with their children’s doctors.3
Furthermore, health professionals are
largely uninformed about the evidence-
based medical uses of such products and
their safety. Although the majority of
schools for health professionals now offer
some coursework in complementary and
alternative medicine, the educational con-
tent does not necessarily provide detailed
information about herbs and dietary sup-
plements, address cultural competency in
communicating with parents about their
use of supplements, give instructions on
how to report adverse effects to the FDA,
or teach how to document such use rou-
tinely in the medical record.
Health-care institutions give evidence
of ambiguous policies when it comes
to herbs and dietary supplements. e
results of our recent survey of 109 US
children’s hospitals indicated that only
2% of hospital formularies included
herbs and only 38% included other die-
tary supplements.
4
Still, 84% of the same
childrens hospitals surveyed would allow
a hospitalized child to use a home supply
of dietary supplements. is suggests an
ambivalent approach to the therapeutic
value of such products. Allopathic health
professionals do not want to be the pur-
veyors of herbs and supplements, but
they acknowledge and support their use
by the lay public, oen without much
informed input into parental decision
making with respect to the potential risks
and benefits.
Benefits vs. danger
As parents look for environmentally
safe, nonpharmaceutical remedies for
their children, the marketing of products
intended for children has expanded, and
there is a danger in parents being misled
by unsubstantiated marketing claims.
Unfortunately, there are few clinical
studies supporting the use of herbs and
dietary supplements for the treatment of
common childhood conditions. Although
more pediatric studies are planned, there
are many research and ethical barriers to
building this evidence base, thus lead-
ing to a dearth of randomized control-
led trials to give credence to claims of
herbal and dietary supplement efficacy
for children. Such proof of efficacy and
safety is especially needed in infants and
young children, whose small size, sensi-
tive and developing organs, and imma-
ture immune and detoxification systems
make them more vulnerable than adults
156 VOLUME 87 NUMBER 2 | FEBRUARY 2010 | www.nature.com/cpt
perspectives
inform themselves broadly regarding
the safety and effectiveness of
herbs and dietary supplements
before giving advice to families or
recommending specific products
for use in pediatric patients. ey
also should be educated in the
recognition and reporting of
adverse effects from such products.
Additionally, governmental
agencies should issue appropriate
guidance specific to the use of
dietary supplements by children and
adolescents to the public and health
professionals alike.
3. Governmental agencies should
assign a higher priority than is
currently evident to the scientific
study of herbs and dietary
supplements in the context of
their efficacy and safety for use by
children and adolescents.
4. As a corollary to the above
recommendation, new and existing
pediatric clinical pharmacology
units must be developed and
supported to include within their
research goals the pursuit of
prospective, controlled clinical trials
of dietary supplements in children.
5. Health-care institutions should
adopt best-practices guidance
manufacturers’ telephone numbers on
labels and the mandating of manufacturer
reporting to the FDA of serious adverse
events involving its products, have come
to fruition. In 2008, in accordance with
another ASCPT recommendation, the
FDA released a new good manufactur-
ing practices regulatory guidance, which
should improve the quality of domesti-
cally produced dietary supplements.
Yet the ASCPT white paper did not
specifically address the needs of children
and adolescents. Children rely on adults to
make informed decisions regarding their
health and well-being, and parents and
other caregivers have a duty to seek out
the best treatments for them. We endorse
the ASCPT recommendations but believe
that there are six critically important initi-
atives necessary to safeguard the interests
of children:
1. Congress should empower the
FDA with needed expanded
regulatory oversight and funding
so as to monitor adequately the
manufacture, labeling, safety, health
benefits claims, and postmarketing
testing and monitoring of herbs and
dietary supplements intended for
children.
2. Health professionals both in training
and in clinical practice should
to allergic reactions and adverse effects
from a chemical or xenobiotic in a plant
or supplement. More research is also
needed into additive risks from mixtures
of dietary supplements or their interac-
tions with drugs when both are taken
together by children. Moreover, the use-
fulness of such products must be weighed
against the known clinical value and risk
of more conventional therapies.
e National Institutes of Health (NIH)
has incurred tremendous expenditures
on research investigating the medical
value of complementary and alternative
medicine, but relatively few studies have
been completed in children. e NCCAM
(part of the NIH) has spent more than
$1 billion on research from fiscal year
1999 to 2009 (see Figure 1), but as yet
its website provides no functionality for
informing the public as to which specific
dietary supplements have been proven
safe and effective for use in children.
1
e
NCCAM laments the continuing lack of
rigorous scientific studies investigating
the use and safety of dietary supplements
in children. In fiscal year 2008, the NIH
spent $298 million on complementary
and alternative medicine research, but
only $1.4 million (or less than 0.5% of
the total) was expended by the National
Institute of Child Health and Human
Development.5 us, there is evidence
of a lack of commitment to investigating
both the efficac y and the safety of dietary
supplements in children, even though an
uncontrolled experiment is going on daily
via the easy accessibility and widespread
uninformed use of such products.
There is a “buyer beware” mentality
regarding the contents and quality of
many dietary supplements. Some prod-
ucts still bear claims of health benefits
that are not scientifically proven in chil-
dren. Other problems include undeclared
ingredients, inadequate warnings, a lack
of child-resistant packaging, and absent
pediatric dosing guidance.
Measured approach
In 2005, the American Society for Clini-
cal Pharmacology and Therapeutics
(ASCPT) published a position statement
on herbs and dietary supplements that
contained important recommendations.
6
Some of these, such as the inclusion of
140
120
100
80
60
40
20
01999 2001 2003 200520072009
$US (millions)
Fiscal year
Figure 1 National Center for Complementary and Alternative Medicine funding, fiscal years 1999–2009.
From ref. 5.
CLINICAL PHARMACOLOGY & THERAPEUTICS | VOLUME 87 NUMBER 2 | FEBRUARY 2010 157
perspectives
with respect to policies and
procedures regarding the use of
herbs and dietary supplements for
hospitalized children, under more
precise stipulations promulgated by
oversight agencies such as the Joint
Commission.
6. New research and public policy
initiatives should be supported to
expand poisoning prevention to
include inadvertent exposure of
infants and children to herbs and
dietary supplements and exposure to
toxic contaminants and adulterants
in some ethnic remedies and dietary
supplements. New scientific inquiry
and public policy are also needed
to address the specific use of herbs
and dietary supplements for goals
of weight loss and enhancement of
sports performance, as well as their
intentional abuse by adolescents.
is is a critical area within a myriad
of children’s health interests that has b een
neglected while the commercial market-
ing of herbs and dietary supplements
intended for children has experienced
explosive, exponential growth. It is time
to get serious about remediating the gaps
in this area of children’s health care.
CONFLICT OF INTEREST
The authors declared no conflict of interest.
© 2010 ASCPT
1. National Center for Complementary and
Alternative Medicine <http://nccam.nih.gov/
health/supplements/wiseuse.htm>.
2. US Government Accountability Office (GAO).
Dietary supplements—FDA should take further
actions to improve oversight and consumer
understanding. GAO publication 09-250,
January 2009.
3. Wilson, K., Dowson, C. & Mangin, D. Prevalence of
complementary medicine use in Christchurch,
New Zealand: children attending general
practice versus paediatric outpatients. NZ Med. J.
120, U2464, 2007.
4. Gardiner, P., Phillips, R., Kemper, K., Legedza, A.,
Henlon, S. & Woolf, A.D. Dietary supplements:
inpatient policies in U.S. children’s hospitals.
Pediatrics 121, e775–e781, 2008.
5. National Center for Complementary and
Alternative Medicine. Complementary and
Alternative Medicine Funding by NIH Institute/
Center <http://nccam.nih.gov/about/budget/
institute-center.htm>, 16 February 2009.
6. Morrow, J.D. et al. American Society for Clinical
Pharmacology and Therapeutics position
statement on dietary supplement safety and
regulation. Clin. Pharmacol. Ther. 77, 113–122,
2005.
Assessing the Safety and
Comparative Effectiveness of
Follow-On Biologics (Biosimilars)
in the United States
S Hennessy1, CE Leonard1 and R Platt2
As Congress begins drafting legislation concerning the US Food and
Drug Administration (FDA) regulation of biosimilars, it is critical to keep
in mind that these agents may differ from their innovator compounds.
Therefore, it is of the utmost importance to be able to differentiate
among innovators and biosimilars in administrative data in order to
facilitate the conduct of population-based safety and comparative
effectiveness studies. This Commentary proposes methods that would
allow these agents to be distinguished in such data.
1University of Pennsylvania Center for Education and Research on Therapeutics and Center for Clinical
Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania,
USA; 2HMO Research Network Center for Education and Research on Therapeutics and Department
of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston,
Massachusetts, USA. Correspondence: S Hennessy (hennessy@upenn.edu)
doi:10.1038/clpt.2009.249
e patents for several biologic products
manufactured using recombinant DNA
technology are nearing expiration. Forth-
coming generic biologics (also known as
follow-on biologics or biosimilars) will
be manufactured using biotechnology
or derived from natural sources with the
intent of being highly similar to one or
more already-approved innovator prod-
ucts. is has led Congress to begin work
on legislation under which the Food and
Drug Administration (FDA) could approve
follow-on biologics via an expedited
approval process that would rely in part
on scientific knowledge about the inno-
vator products safety and efficacy.1 e
rationale for encouraging the develop-
ment of follow-on biologics is the same
as that for encouraging generic small-
molecule drugs: to reduce costs by foster-
ing price competition. Indeed, availability
of biosimilars is expected to result in sav-
ings of $9–12 billion to the US Medicare
program over the next decade.2
Because several factors, including the
larger size and higher degree of molecu-
lar complexity of biologic products com-
pared with small-molecule drugs, the
regulatory model of approving essentially
exact copies of the same drug generally
may not apply to biologics. In particular,
the potential exists for real differences in
the active molecules and therefore in the
safety and effectiveness of different ver-
sions of the same biologic. is potential
is not merely hypothetical. For example,
changes to the manufacturing process of
one version of epoetin alfa were associ-
ated with an increased risk of the hema-
tologic abnormality known as pure red
cell aplasia.3 Other differences in safety
or effectiveness could well emerge as
use of biosimilars becomes widespread.
However, it will be possible to identify
such differences only if data are retained
to distinguish among multiple versions of
a given biologic. Complicating the ability
to make this distinction is the fact that, as
of this writing, it remains to be decided
whether follow-on products will share the
same nonproprietary (i.e., generic) name
as the innovator product.
... And some traditional practices like harmful traditional health practices were found to be killing practices for children. These practices are violating the children's health rights and hindering the country from achieving millennium development goal (MDG 4) [6]. ...
... This might be due to in Ethiopia also most of the people are religious and religious therapies are given priority. However, the study was in contrary in most cases with the study conducted in Eastern-Harargie district of Oromya region, Ethiopia, where uvulectomy, tonsillectomy, cauterization, milk tooth extraction, spiritual healing and herbal medicine were the most commonly used therapies [6]. The difference could be from the study population; in this study, participants were parents having under eighteen years old children and in previous study participants were parents having under five years old children. ...
Article
Background: Traditional medicine is the ancient and culture bound medical practice which existed in human societies before the application of modern science to health. Around 80% of Ethiopians relies on traditional medicines. Although some traditional medical practices in children are useful and contributing positively and need to be strengthen, some are harmful from the perspective of health. In Ethiopia, studies conducted so far are very limited and focused on adults. As a result, this study was conducted to assess the prevalence and factors associated with parental traditional medicine practice for children. Objective: The aim of this study was to assess prevalence and factors associated with parental traditional medicine use for children in Motta Town. Methods: Community based cross-sectional study design was used. Data was collected using structured interviewer administered questionnaire. The study was conducted among 381 households selected using systematic random sampling method. Both descriptive and inferential statistics were used to present the data. Odds ratio, binary and multiple logistic regression were used to assess the association between dependent and independent variables. Result: It was found that 88.2% of parents had used either forms of traditional medicine for their children. The top therapies used were herbs (66.9%), religious therapies (52.8%), massage (22.8%), bone settler (21.8%) and traditional birth attendants (13.1%). Female parents, low educational level, accessibility of traditional medicine, low price and perceived effectiveness were significantly associated with parental traditional medicine use for children. Conclusion and recommendation: There was high parental traditional medicine practice for children in this study. Female parents, low educational status, easily accessibility, cheap in price and perceived effectiveness were significant predictors. The integration of traditional medicine as part of modern medicine and controlling mechanism should be strengthen. Community education and further research on its efficacy and safety should also be done.
... According to the National Center for Complementary and Alternative Medicine (NCCAM), "complementary" generally refers to using a nonmainstream approach together with conventional medicine, while "alternative" refers to using a nonmainstream approach in place of conventional medicine [4]. There is very little scientific proof of their benefits; however, the rising administration of CAMs to children is noteworthy [5,6]. The use of CAMs by children is reported to vary between 0.8 and 68% worldwide [6][7][8][9][10][11][12]. ...
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The aim of this study was to determine the complementary and alternative approaches used by parents of children with epilepsy on epilepsy management. This descriptive study included a total of 304 parents of children with epilepsy aged between 0 and 18years evaluated at the Pediatric Neurology Clinic of Akdeniz University Hospital in Turkey between January and May 2013. Data were collected by using a questionnaire developed by the researchers. It was determined that all the parents use complementary and alternative approaches for their children with epilepsy, and the most common approaches are praying (99.3%); keeping their children away from the effects of smoking (79.8%); feeding their children with walnuts (79.6%), butter (59.2%), and bone marrow (58.6%); providing their children with good quality sleep (58.6%); and enabling their children to play games (51%). The approaches commonly applied during seizures include praying (96.2%), comforting their children in their arms and showing affection (55.6%), waiting for seizures to finish at home (45.7%), and laying children on their side (41.1%). Of parents, 98% stated that alternative approaches enable them to control their child's seizures, 100% said that alternative approaches have no adverse effect, and 98.4% stated that they will continue to use these approaches. The children's approaches to cope with epilepsy included looking after pets (72.7%), listening to music (70.1%), watching television (64.5%), playing games (55.3%), praying (51%), and spending time with friends (48.7%). Most of the approaches used by parents and children with epilepsy for the management of illness are determined to consist of complementary approaches that may contribute to management of epilepsy. Knowing the approaches of parents and children with epilepsy that could adversely affect disease management is important for educating parents and children to avoid these potentially harmful interventions.
... The use of complementary and alternative medicine (CAM) in children has recently shown explosive growth, despite little scientific evidence of benefit, a need for better regulatory oversight, and continuing gaps in the knowledge and attitudes of pediatric health professionals. 1 The use of CAM is considerably higher in certain children with special health care needs. 2 Approximately more than 50% of children with chronic, recurrent, and incurable conditions use CAM, almost always in conjunction with mainstream care. 3 on its use for children with epilepsy in Turkey. ...
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We aimed to determine the prevalence, pattern of use, parental sources of information and adverse effects of complementary and alternative medicine (CAM) in children with epilepsy. Parents of children with epilepsy (n=305; mean age: 8.3±4.3 years) were interviewed with structured open and close-ended questionnaire. Patients were divided in two groups, CAM and non-CAM and compared using statistical tests. The use of CAM was detected in 22.6% of the patients (n=69). Prayer was the most commonly used therapy in 91.3% of children (n=63). Gender (p=0.032, [OR]: 0.5, 95%CI: 0.287-0.945) and resistance to antiepileptic drugs (p=0.005, [OR]: 3.4, 95%CI: 1.459-8.148) were found to be associated with CAM use. Parental use of CAMs to treat their children with epilepsy is not common in the Eastern Blacksea Region of Turkey. The research findings have demonstrated that patients' parents trust in their doctors. However, male sex and the presence of resistance of anti epileptics are potentially CAM predictors.
... Natural antidepressants are widely perceived to exhibit more favorable side effect profiles than conventional antidepressants, 18,25,26,38,142 and the publications examined for this review tend to support this view. However, claims 143 that these alternative products are completely benign and devoid of side effects are not supportable. ...
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A boxed-warning in antidepressant labeling now informs prescribers of the potential for treatment-emergent suicidality to occur. Consequently, alternative "natural" antidepressant therapies widely viewed to be devoid of this risk, such as St. John's wort (SJW) and s-adenosyl methionine (SAM-e), may experience a resurgence in popularity and expansion of use beyond mild forms of depressive illness. The purpose of this article is to critically assess whether the clinical evidence supports the use of SJW and SAM-e as alternatives to conventional antidepressants in the treatment of major depressive disorder (MDD). In addition, this article evaluates whether the behavioral adverse event profiles of SJW and SAM-e suggest an increased risk for suicidality, like their conventional counterparts. A comprehensive literature review was performed (Jan 1975-July 2010) to identify all English language reports of placebo-controlled studies of SJW and SAM-e conducted for psychiatric indications. MDD studies were categorized as "positive" or "negative" based on statistical superiority to placebo on prospectively-defined, primary, clinician-rated efficacy parameters (e.g., change in Hamilton Depression scores [HAM-D] or Montgomery-Asberg Depression Rating Scale [MADRS] total). Treatment effect size (Cohen's d) was also calculated in each case to assess the clinical relevance of the findings. Behavioral-related adverse events were summarized by treatment. Ten of 14 (71%) SJW studies in mild-to-moderate MDD were positive. The mean and median effect sizes for HAM-D change in those studies were 0.64 and 0.48, respectively, indicative of a moderately-large treatment effect. In the few studies that included patients with severe symptoms, however, or which evaluated long-term maintenance of effect, SJW did not differentiate from placebo. The majority of SAM-e studies in MDD were also positive (8/14, 57%); however, most were methodologically flawed to some extent. Based on the magnitude of the treatment-effect size in a number of positive studies, SJW appears to be useful for the short-term treatment of mild-to-moderate depressive illness in adults. Existing data do not support the use of SJW in more severely depressed individuals. The SAM-e clinical data also are strongly suggestive of antidepressant efficacy; however, until more rigorously generated data become available it is not possible to reach a more definitive conclusion. There are no long-term treatment data that convincingly demonstrate long-term maintenance of effect for either product. The reviewed studies did not reveal evidence of treatment-emergent suicidality, suggesting that this risk for either product is low. However, the studies examined were not prospectively designed to detect such events and therefore were likely unable to reliably assess this risk.
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Background: Little is known about the characteristics of US children who are dietary supplement users. Objective: We described the prevalence and predictors of and reasons for giving children dietary supplements. Design: The study included children <18 y of age who participated in the Complementary and Alternative Medicine supplement of the National Health Interview Survey of 2007 whose proxies provided complete information on child dietary supplement use. Results: A total of 37% of subjects used dietary supplements, 31% of subjects used multivitamin mineral (MVM) products exclusively, 4% of subjects used single vitamins or minerals solely or in combination with MVMs, and 2% of subjects used nonvitamin, nonmineral products either solely or in combination with other supplements. Users were more likely than nonusers to be Asian, white, or non-Hispanic; belong to families with higher parental education and income levels; reside in areas other than the South; be in good, very good, or excellent health; have private health insurance; and have a usual place at which they received conventional medical care. Children (3%) with the most disease burden and health care were more likely to use supplements than were healthier children. Supplements were given for the prevention or treatment of many illnesses and conditions. Neither the caregiver's reasons nor specific supplements used were consistently associated with particular conditions. Conclusions: The 37% of US children who used any type of dietary supplements differed from nonusers in family socioeconomic status and many other health-related characteristics. Users were given supplements to prevent or treat many illnesses and conditions for which there is only limited evidence of their efficacy.
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There is little information about the use of complementary and alternative medicines (CAM) in New Zealand children who attend a general practitioner for intercurrent illness compared to children attending secondary care with a chronic condition where CAM use is high. This study aims to establish whether there are differences in prevalence and non-disclosure rates, information sources, and potential predictors of CAM use in these two populations of children. A study-devised CAM-use questionnaire was administered to 50 participants recruited from general practice surgeries and 50 from a paediatric diabetes clinic. Prevalence of lifetime CAM-use was high (70%) with no significant difference between the two populations sampled. Not disclosing CAM-use to a doctor was common (77%), with the majority unintentional (87%). Parental-use was predictive of child CAM-use (OR 4.73). CAM-use amongst New Zealand children is higher, and disclosure rates lower, when compared to overseas populations of children. This suggests that there is greater potential for New Zealand children to be at risk of adverse events directly and through interaction with prescribed medicines. Contrary to expectations, CAM-use behaviours and disclosure rates are comparable between GP and outpatient populations--suggesting that all prescribers need to explicitly ask parents about CAM-use with their children, particularly those that report CAM-use themselves.
Article
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Variations in hospital policies and practices regarding the use of vitamins, minerals, herbs, and other dietary supplements could compromise patient safety and quality of care. We undertook this study to describe pediatric hospital policies regarding dietary supplements. We administered a cross-sectional survey of a sample of National Association of Children Hospitals and Related Institutions members. Pharmacy personnel were asked about the following: written policies addressing dietary supplements; how such policies are made; and responsibilities for storage, administration, documentation, and checking for potential interactions. We created a 10-point hospital policy and practices quality score to assess the quality of each policy. Of the 186 eligible National Association of Children Hospitals and Related Institutions hospitals, 109 responded (59%). Forty-four percent reported having written policies on vitamins and minerals, herbs, and other dietary supplements. Few hospitals had herbs (2%) or other dietary supplements (38%) on formulary. However, most (81%) allowed patients to use their home supply of dietary supplements under defined circumstances, and 64% allowed staff to make recommendations about dietary supplement use. In 70% of hospitals, nurses stored and administered the home supply of dietary supplements. Less than half (46%) required documentation of a check for drug or dietary supplements interactions. One third (32%) had surgical preoperative recommendations regarding dietary supplements. Only 11% of 109 hospitals satisfied the 10 criteria necessary for a perfect hospital policy and practices quality score indicative of quality practices regarding patient use of dietary supplements. Even among those hospitals that have written policies about dietary supplements, there is a wide range in policy quality, which may compromise the safety of patients.
Complementary and Alternative Medicine Funding by NIH Institute
  • National Center
  • Alternative Complementary
  • Medicine
National Center for Complementary and Alternative Medicine. Complementary and Alternative Medicine Funding by NIH Institute/ Center <http://nccam.nih.gov/about/budget/ institute-center.htm>, 16 February 2009.