I routinely recommend the use of dietary supplements as part of my treatment plans with my patients. Because of this my ears perked up when I heard a story on NPR a couple of weeks ago about the high number of people ending up in the ER due to adverse events related to dietary supplements. The story was about a study in the New England Journal of Medicine published on October 15th that found that an estimated 23000 emergency room visits each year were attributed to dietary supplements.
Now I am of the belief that it would be ideal to prevent any visit to the emergency room and so I was curious to look into the details of the study a little bit further. 23,000 sounds like a large number, but when you take into account that there are 136 million ER visits each year, this ends up being a very small percentage of total ER visits- .019% to be exact. To put this into perspective, 731,000 ER visits were associated with adverse events to the medical use of prescription drugs, 775,000 pediatric visits were for injuries associated with organized sports, 1.2 million visits were due to alcohol ingestion as the primary cause, and over 76,000 were for fire arm related injuries.
According to 2011 data 166 million Americans use dietary supplement and so there is only a .015% chance that someone taking a dietary supplement is going to end up in the ER because of an adverse event. As I said, I feel that any preventable ER visit is too many, but taking dietary supplements seems like a relatively low risk behavior and not worthy of devoting the media attention to it that it has received.
Looking at the study even more closely, 20% of the visits were due to accidental ingestion by children under the age of 4. While this is a serious issue, it has nothing to do with the supplements themselves but instead has more to do with the childproofing of the home. Of the close to 3000 visits that were attributed to those over the age of 65, over 60% were because of swallowing issues. Again this is a serious issue, but has less to do about the safety of the dietary supplements themselves.
This is not to say that there were no actual adverse events associated with supplements use. The products responsible for 42% of the total ER visits were supplements marketed for energy and weight loss. Many of these products contain stimulants and ingredients that are not really dietary supplements but instead should be classified as undeclared active pharmaceutical ingredients. While I agree that many of these supplements pose potential harm and should be taken off the market, the actual risk is still relatively low.