Raw animal tissues and dietary supplements

Medicines Information and the Regulation of the Promotion of Pharmaceuticals

Many factors contribute to the inappropriate use of medicines, including not only a lack of information but also inaccurate and misleading promotional information. This review examines how the promotion of pharmaceuticals directly affects the prescribing and use of medicines. We define promotion broadly as all actions taken directly by pharmaceutical companies with the aim of enhancing product sales. We look in greater detail at promotion techniques aimed at prescribers, such as sales representatives, pharmaceutical advertisements in medical journals and use of key opinion leaders, along with the quality of information provided and the effects thereof. We also discuss promotion to the public, through direct-to-consumer advertising, and its effects. Finally, we consider initiatives to regulate promotion that come from industry, government and nongovernmental organizations.

Variant Creutzfeldt‐Jakob Disease and the Acquired and Transmissible Spongiform Encephalopathies

In 1995 a fatal epidemic of spongiform encephalopathy appeared in Great Britain. The new epidemic condition was clinically and pathologically similar to Creutzfeldt-Jakob disease (CJD), a rare sporadic encephalopathy, and was called "variant CJD" (vCJD). The vCJD epidemic was detected by active epidemiologic surveillance, which had been set up in response to a British epizootic of another new disease called "bovine spongiform encephalopathy" (BSE). Widespread cattle exposure to the BSE agent (a prion) had presumably been occurring in Britain since about 1982, when changes in the rendering process allowed infected material to contaminate cattle feed. Concern that the bovine disease might transmit to humans via beef consumption led to the active surveillance program. Tragically, BSE transmission to humans appears to have led to over 100 cases of vCJD. Millions of affected cattle were eventually slaughtered throughout Europe. Cattle are now routinely tested for BSE at 24-30 months of age, and affected herds are destroyed. These measures have exponentially reduced the BSE epizootic. Britain and other European countries that received contaminated beef or cattle feed nevertheless remain concerned about the combination of nearly universal past human exposure in Britain, variable exposure elsewhere, an unknown incubation period, vCJD case totals that continue to mount, and worst-case predictions that extend to many thousands of eventual human cases.

Use of dietary supplements and natural remedies increased dramatically during the 1990s

OBJECTIVES

To estimate the prevalence and trends in dietary supplement and natural remedy use in Sweden during the 1980s and 1990s.

DESIGN

Three nationally representative, cross-sectional surveys conducted in 1980-81, 1988-89 and 1996-97 were used for analysis. In face-to-face interviews participants reported consumption of dietary supplements and natural remedies during the previous 2 weeks.

SETTING

Sweden.

SUBJECTS

The samples consisted totally of 38 594 adults aged 16-84 years (14 642 in the 1980-81 survey, 12 391 in the 1988-89 survey and 11 561 in the 1996-97 survey). Main outcome measures. Changes in prevalence of dietary supplement and natural remedy users between 1980 and 1997.

RESULTS

The 70% increase in the prevalence of dietary supplement users amongst both men and women [odds ratio (OR), 1.7; 95% confidence interval (CI), 1.6-1.9, OR, 1.7; 95% CI, 1.5-1.8, respectively] occurred mainly between 1988-89 and 1996-97. The increase in the prevalence of natural remedy users was even more dramatic - more than threefold in men (OR, 3.3; 95% CI, 2.9-4.0) and almost threefold in women (OR, 2.6; 95% CI, 2.3-2.9) - and the systematic increase started already in the 1980s. The increase was observed in all age groups and in all socio-economic groups, except for farmers. In 1996-97 the prevalence of dietary supplement users was 22% amongst men and 33% amongst women, and of natural remedies 7 and 14%, respectively.

CONCLUSIONS

During the last two decades, the use of dietary supplements and natural remedies amongst the adult Swedish population has dramatically increased.