The public health impact of herbs and nutritional supplements

Dietary supplement use has increased exponentially in recent years despite the lack of regulatory oversight and in the face of growing safety concerns. This article provides an overview of the public health implications and safety concerns associated with dietary supplement use, especially by cancer patients. Botanical research is actively pursued at the Memorial Sloan-Kettering Cancer Center (MSKCC) Integrative Medicine department. Work of the MSKCC Center for the Study of Botanical Immunomodulators is described, and guidelines for cancer patients' use of dietary supplements outlined. Herbs and other botanicals are complex, physiologically active agents, but little is known about most of the popular, widely available dietary supplements. Herb-drug interactions, a major concern, are exacerbated in the cancer setting. Biologically active agents may interfere with chemotherapy and other prescription medications. They may exert anticoagulant activity at rather inconvenient effective dosage, safety, and benefits of these complex agents is sorely needed. Oncology professionals and other health care providers should educate themselves and their patients about these issues. Probably the largest, continuously updated free information resource is MSKCC's AboutHerbs website (www.mskcc.org/AboutHerbs).