With herbal product use growing by almost 400 percent in the 1990s, researchers
at Brigham and Women’s Hospital (BWH) decided to take a closer look at how
dietary supplements are marketed on the Internet -- an increasingly popular, but
poorly regulated way for consumers to access medical information. The survey,
outlined in the September 17, 2003 issue of the Journal of the American Medical
Association, found that more than half of all Internet marketers were in
apparent violation of federal law.
"A large number of sites make unauthorized health claims, a concern for
physicians because patients may be promised results that are unlikely to occur,"
said Charles Morris, MD, of BWH’s Division of Pharmacoepidemiology and
Pharmacoeconomics. "The majority of web sites selling supplements made
impermissible claims or omitted required Food and Drug Administration (FDA)
disclaimers and important clinical warnings."
Recent data has estimated that 91 million Americans, or approximately 49
percent of the adult population, have used an herbal product, and consumers
spent about $18 billion on herbal remedies in 2001. In addition, the Internet
has grown as a source of trusted health information for consumers. According to
a survey conducted by the Pew Foundation, 62 percent of individuals who used the
Internet in 2002 searched for health information, with more than half looking
into alternative and complementary therapies.
In their study, Dr. Morris and co-author Jerry Avorn, MD, analyzed 443 sites
that sold the eight best-selling herbs (ginkgo, St. John’s wort, echinacea,
ginseng, garlic, saw palmetto, kava kava and valerian root) on the most popular
search engines. Of the 338 sites that were involved in product sales, 81 percent
made one or more health claim and among these sites, 55 percent claimed to
treat, prevent, diagnose or cure specific diseases.
Manufacturers of herbal products are not required to submit their health
claims to the FDA in advance of marketing, a process required for makers of
prescription drugs. As a result, the agency must rely on surveillance of
Internet advertising after the sites are up and running. As the BWH research
indicates, this style of enforcement has apparently not prevented companies from
continuing to make unauthorized claims. The researchers concluded that in
addition to the government implementing more effective controls for herbal
marketers, clinicians need to discuss dietary supplements, their lack of strict
regulation and potential toxic side effects with their patients.