The Dietary Supplement Health and Education Act led to a flood of poor-quality dietary supplements. The Food and Drug Administration's (FDA's) jurisdiction is limited to removing products proven unsafe, rather than prospectively assessing them for quality manufacturing. With so many products available, there is very little FDA oversight until reports of patient harm occur. Microbial and heavy metal contamination, adulteration with synthetic drugs (including drugs banned from the United States), substituting herbs, and fraudulently specifying ingredients on the label have all occurred. Clinicians should collectively advocate for legislative change, only recommend products tested by outside laboratories for quality, and educate consumers about the risks of using unverified products.
Keywords: FDA; adulteration; contamination; dietary supplements; herbs; patient safety.