Sarah Erush was cooking one evening when her phone rang. Putting down her spatula as she answered, she recognized the voice of the on-call pharmacist at work, the Children’s Hospital of Philadelphia. The pharmacist told Sarah they just admitted a 12-year-old named Jessica with suspected pancreatitis, whose mother brought her in because of severe stomach pains.
Jessica’s mother, Nancy, explained that she had tried everything she could think of to help Jessica recover from a presumed chronic viral infection. She brought in a bag filled with more than 40 types of dietary supplements, including some recommended by a homeopathic physician. Looking at these bottles of treatments from unknown origins, the pharmacist knew she needed Sarah’s help to determine what to do next. She had already spent two hours trying to identify the mysterious pills and herbal supplements with little success and sounded anxious and frustrated. And Sarah knew why.
“It’s an issue that is coming up more and more often,” reflected Sarah. As the pharmacy clinical manager and pharmacy residency program director at Children’s Hospital, Sarah sees cases like these far too often. Families enter the hospital with an array of products they’ve purchased online or with unknown dietary supplements friends have recommended. They are taking these products as part of their daily regimen hoping for treatment. Yet they don’t realize that many of these products are not tested for quality or safety – and can sometimes cause serious harm. The U.S. Food and Drug Administration estimates that approximately 50,000 adverse reactions to dietary supplements occur every year. That’s more than 130 cases a day.
Common misconceptions about the nature of dietary supplements compound the problem. “Many people assume that dietary supplements are safe simply because they appear to be natural products,” said Sarah. “But that is not necessarily the case. Here at Children’s Hospital, we try to stress that they are taking these supplements to achieve a desired effect. And that too much of anything can be harmful.”
Another misconception is that these products actually are medications, so people assume they undergo a high level of evaluation for safety and quality. For Sarah, this confusion comes as little surprise. “They are in a bottle on a shelf in the pharmacy just like all those other over-the-counter medications,” she said. But they don’t undergo the same kind of rigorous review that medications receive.
It can take time for patients and their families to grasp the unintended effects supplements might cause. Sarah worked with Jessica’s doctor for two days before convincing Nancy to wean her daughter off the large quantity of supplements and pills. It wasn’t until Jessica’s system was clear of the unknown substances that her pancreatitis started to resolve and she began to feel better.
Jessica’s case was the tipping point for Sarah. She worked with colleagues to put two new systems in place to help protect patients. First, she helped make sure that the hospital only provides patients with dietary supplements that have been verified by a trusted third party, such as USP, an independent scientific organization with a long and respected history of setting quality standards for pharmaceuticals.
Sarah also worked with the hospital’s chief of the division of infectious diseases on a hospital policy to help educate patients’ families about dietary supplements. Sarah and her staff meet with these families to discuss the risks of using products that haven't been evaluated for safety or quality, and may have wide variations in dosage levels. Dosage levels are particularly important to Sarah because children are at higher risk if they inadvertently receive too much of an active ingredient.
Sarah says she prefers relying on USP to provide that independent verification because they conduct both qualitative and quantitative analysis when verifying dietary supplements, which means they not only verify that the active ingredient is what the label claims it is, but that it’s present in the quantity the label states.
Healthcare professionals know patients and caregivers like Nancy scour the internet or their local pharmacies for drugs and supplements that might provide relief or make their loved ones feel better. But stories like Nancy and Jessica's illustrate the risks to patients. Sarah believes that educating patients, practitioners and consumers is the best way to ensure everyone understands the risks associated with dietary supplements and can look for products that have been tested for quality.
Sarah Erush served as the Pharmacy Clinical Manager at Children’s Hospital of Philadelphia until December 2018. The names of the characters and certain identifying details have been altered in this story to protect those involved.