Report: Dietary Supplements Send Thousands To The ER Annually

Dietary supplements can make you sick.

That’s the quick takeaway from a new report, published in The New England Journal of Medicine, that might make you think twice about the supplements.

Researchers at the Centers for Disease Control and Prevention conclude that about 23,000 emergency department visits each year in the United States can be attributed to “adverse events” due to dietary supplements. “Such visits commonly involve cardiovascular manifestations from weight-loss or energy products among young adults and swallowing problems, often associated with micronutrients, among older adults,” the study says.

Researchers analyzed data on dietary supplement-related emergency department visits over a 10-year period, from Jan. 1, 2004, through Dec. 31, 2013, from 63 hospitals. Of the more than 23,000 ER visits, researchers report that 2,154 patients were then hospitalized for further treatment. (The new analysis did not include patients who may have died en route to the hospital.)

The backdrop to all this is that supplement sales are dramatically on the rise:

The estimated number of supplement products increased from 4,000 in
1994 to more than 55,000 in 2012 (the most recent year for which data are publicly available), and approximately half of all adults in the United States report having used at least one dietary supplement in the past month. In 2007, out-of-pocket expenditures for herbal or complementary nutritional products reached $14.8 billion, one third of the out-of-pocket expenditures for prescription drugs.

I asked the study’s lead author, Dr. Andrew Geller with the CDC, what consumers should make of the study. Here’s what he said, via email:

People may not realize that dietary supplements can cause any adverse effects, but each year thousands of people are treated in emergency departments for symptoms attributed to dietary supplements.

Young adults taking products to lose weight or increase energy should keep in mind that some of these products can have effects on their heart, and they should not take these products in excess. If you have a heart condition, talk to your doctor before starting a weight loss or energy supplement.

Older adults should be mindful of possible choking or other swallowing problems from taking supplements. They should avoid taking several pills at once, avoid extra large pills or capsules, and swallow supplements with plenty of water or other fluid. Tell your physician you are having difficulty swallowing pills and ask him/her or your pharmacist for other options or if you can cut the supplement in half.

Patients should always tell their doctors if they are taking dietary supplements, and which ones.

All medicines and dietary supplements should be stored up, away and out of sight of young children.

Pieter Cohen — an internist at Cambridge Health Alliance and asistant professor at Harvard Medical School who studies dietary supplements and has been critical of the federal law governing them — said the new study may trigger some long-needed changes.

“This study is the most important research published since the passage of DSHEA [the Dietary Supplement Health and Education Act of 1994] and sends a clear message: Not only does the regulatory framework make no sense, it’s posing imminent threats to the public’s health,” Cohen says. “The publication of this new CDC study will hopefully be a watershed in regulating supplements in the U.S.”

He adds that the current regulations “are based on the premise that all supplement ingredients are safe.” But, he says, “with the new CDC study we learn that these products are anything but safe. In fact, the CDC found that supplements lead to tens of thousands of emergency room visits and thousands of hospitalizations each year.” Continue reading

CDC: Certain Antidepressants, But Not All, Taken During Pregnancy May Raise Birth Defect Risk

The debate over whether or not it’s safe to take antidepressants during pregnancy is heated, with extreme emotions — and conflicting research studies — on both sides.

But a broad new analysis led by researchers at the U.S. Centers for Disease Control and Prevention came to a fairly measured conclusion when comparing pregnant women who took SSRIs — a class of antidepressants — to women who did not take those medications during pregnancy.

The analysis suggests that certain serious birth defects occur 2 to 3.5 times more frequently among babies born to mothers taking the antidepressants Prozac or Paxil early in pregnancy. But the researchers also conclude that for pregnant women taking other SSRIs, such as Zoloft, the data “provide some reassuring evidence” that earlier studies linking the drug with specific birth defects could not be replicated.

The analysis of 17,952 mothers of infants with birth defects and 9,857 mothers of infants without birth defects was published in The BMJ.

“What our paper really adds, is that we can now offer women more options,” said Jennita Reefhuis, an epidemiologist with the CDC’s National Center on Birth Defects and Developmental Disabilities and the study’s lead author. Reefhuis said that since Zoloft (sertraline) was the most common SSRI taken among the women, “it was reassuring that we could not replicate the five earlier links with birth defects.”

In an interview, Reefhuis said: “The main message is that depression and other mental health conditions can be very serious and many women need to take medication to manage their symptoms. So women who are pregnant, or thinking of becoming pregnant, shouldn’t stop or start any antidepressants without speaking to a health care provider.”

The issue, she added, isn’t clear cut, but highly dependent on each individual woman and a very personal calculation of risks versus benefits. “We are trying to find the nuance here,” Reefhuis said. “It is really important that women get treated during pregnancy. Their illness doesn’t stop the moment they get pregnant. Women need options.”

It’s also important to retain perspective when evaluating risk, Reefhuis said, noting that in every pregnancy there is already a 3 percent risk of a birth defect. Continue reading

CDC: Risks Loom As Many Women Of Child-Bearing Age Are Prescribed Painkillers

Source: CDC

Source: CDC

The U.S. Centers For Disease Control and Prevention reports that many women of child-bearing age (notably, women on Medicaid) are taking opioid pain medications and that these drugs taken during pregnancy can increase the risk of birth defects.

According to the agency’s latest Morbidity and Mortality Weekly Report:

During 2008–2012, more than one fourth of privately insured and more than one third of Medicaid enrolled reproductive-aged women (15–44 years) filled a prescription for an opioid from an outpatient pharmacy each year. Prescription rates were consistently higher among Medicaid-enrolled compared with privately insured women.

The most frequently prescribed opioids, says the CDC, were hydrocodone, codeine and oxycodone.

The report details why early exposure is particularly risky:

“The development of birth defects often results from exposures during the first few weeks of pregnancy, which is a critical period for organ formation. Given that many pregnancies are not recognized until well after the first few weeks and half of all U.S. pregnancies are unplanned, all women who might become pregnant are at risk.”

Continue reading

In Tough Flu Year, CDC Touts Prompt Tamiflu Prescriptions

(Photo via

(Photo via

Note: We’ve also posted a follow-up to this news story: Quick, Take Tamiflu? Maybe Not A Slamdunk If You’re Young and Healthy.

Flu seasons are never good, but this year’s is shaping up as a notably nasty one. It’s dominated by a strain of virus — known as H3N2 — that tends to cause more severe symptoms and is a poor match for this year’s vaccine. And we’re still right in the middle of it.

So today, CDC director Dr. Tom Frieden issued this new, Tamiflu-touting message to reporters and the public: “Anti-viral flu medications are greatly under-utilized. But if you get the flu, and if you get medicines early, they could keep you out of the hospital; they could keep you from having to go into the intensive care unit; and they might even save your life.”

If I or one of the members of my family got flu or a flu-like illness, I would get them or me treated with Tamiflu as quickly as possible.

– CDC director Dr. Tom Frieden

That message is especially important, he says, for people at high risk for complications of flu, including elders over 65, pregnant women, very young children and people with underlying health issues such as asthma or diabetes. The anti-virals work best if taken within the first 48 hours of flu onset.

In case you’re now feeling an urge to run out and stock up on Tamiflu, well, first of all, you can’t. Tamiflu and its ilk are available only by prescription.

And second, you shouldn’t. It would make you a bad citizen. Frieden reports that though manufacturers have a big enough supply overall, there are spot shortages of Tamiflu around the country, and it may already take some calling around to find a pharmacy with a supply. Stockpiling could deprive patients who need the drug more than you do.

Dr. Alfred DeMaria, medical director for the Bureau of Infectious Disease at the Massachusetts Department of Public Health, says a local pediatrician recently told him about prescribing an antiviral drug for a Cystic Fibrosis patient at high risk for flu complications. The family had to go to several pharmacies before they could fill the prescription.

“Why was that? The pharmacies have just-in-time inventory for expected sales,” Dr. DeMaria says, “and if those expected sales go up because people say, ‘Oh, it’s going to be a bad flu season; they’re recommending Tamiflu; I’m going to get some and keep it just in case,'” then supplies run short.

The new CDC recommendations encouraging health care staffers to write more antiviral prescriptions may surprise those familiar with less-than-exciting reports on how effective the drugs can be. In general, if taken early, they appear to cut the flu’s duration by 20 percent, from an average of five days to four. Continue reading

CDC: Autism Rate Up To 1 in 68 Kids, But Still No Why

A new CDC analysis of autism prevalence shows a nearly 30 percent jump in cases between 2008 and 2010: that means 1 out of every 68 eight-year-olds in the U.S. is diagnosed with the disorder.

But health officials still don’t agree on what’s driving the increase. Debate continues to rage over whether the increase in cases is due to changing definitions and greater awareness of autism spectrum disorders, or if it’s due to some environmental or other factor.

Karen Weintraub reports for USA Today:

…virtually every grade in every elementary school has at least one child with autism – a seemingly astonishing rise for a condition that was nearly unheard of a generation ago.

What’s still unknown is the driver of that increase. Many experts believe the rise is largely due to better awareness and diagnosis rather than a true increase in the number of children with the condition.

(Jesse Costa/WBUR)

(Jesse Costa/WBUR)

“We don’t know the extent those factors explain in terms of the increase, but we clearly know they do play a role,” said Coleen Boyle, director of the National Center on Birth Defects and Developmental Disabilities at the CDC. “Our system tells us what’s going on. It (only) gives us clues as to the why.”

The aging of parents is also known to be a factor; the chances of autism increase with the age of parents at conception.

“But that’s not the whole story is it?” said Robert Ring, chief science officer for Autism Speaks, a research and advocacy group. Whether something in the environment could be causing the uptick remains “the million-dollar question,” Ring said.

Despite their concern, experts said they were not surprised by the increase, because other data had suggested the numbers would continue to climb. In New Jersey, for instance, autism rates were 50% higher than in the rest of the nation in 2000, and they remained that much higher in 2010 – suggesting the national rates will continue to rise to catch up, said Walter Zahorodny, a psychologist who directs the New Jersey Autism Study. “To me it seems like autism prevalence can only get higher,” Continue reading

Study Finds Fivefold Increase In Alzheimer’s Deaths: Why It Matters

JAQ'S PhotoStorage/flickr

JAQ’S PhotoStorage/flickr

By Nell Lake
Guest contributor

Consider a hypothetical 70-year-old woman; she could be your mother, your sister, your wife. Call her Margaret. She’s becoming ever-more forgetful; one day she gets lost on her way home from the grocery store. A neurologist diagnoses Alzheimer’s.

Over the next five years, Margaret’s thinking continues to decline. She speaks less, confuses words, falls often. She needs a wheelchair, becomes incontinent. No longer able to manage her care, you move her to a nursing home. A year later, the disease has spread to the part of Margaret’s brain that controls swallowing; she has difficulty eating. Because of this she “aspirates” her food — bits of it enter her lungs, and Margaret develops pneumonia. Within weeks, her lungs stop working, and Margaret dies.

Margaret’s story is a difficult one, but common. It also illustrates a conundrum: Did Margaret die of pneumonia, or Alzheimer’s?

On some level, the answer doesn’t matter much: death is death. But as a matter of public health, the answer is deeply important: funding for medical research, new treatments and ultimately, someday, a cure, tends to flow toward the most widespread and deadly diseases. That’s why a new study out this week is getting so much attention; should its findings become widely accepted, they could substantially increase the pace and effectiveness of Alzheimer’s research in the U.S.

Massive Underreporting

The study, published Wednesday in the journal Neurology, confirmed what clinicians and researchers have long assumed: Alzheimer’s deaths have been greatly underreported.

The research found that 500,000 people die each year from Alzheimer’s — more than five times the number most recently reported by the CDC. That makes Alzheimer’s the third leading cause of death in the United States, after heart disease and cancer. Currently the CDC ranks Alzheimer’s sixth as a cause of mortality, with 84,000 deaths reported on death certificates.

The new report’s fuller accounting of Alzheimer’s deaths reinforces a basic but frequently overlooked fact: The illness is entirely fatal. A progressive brain disease that gradually impairs memory, reasoning and personality, Alzheimer’s eventually damages all brain functions, so that even walking, eating and breathing become impossible. Alzheimer’s kills because the brain is no longer able to keep the body alive. Continue reading

New Home Birth Data: Numbers Rise A Bit, Controversy Remains Unchanged

A new CDC analysis of trends in out-of-hospital births from 1990-2012 found that home births are on the rise — but only a tiny bit.

The federal agency reports that 1.36 percent of U.S. births occurred outside a hospital in 2012, up
from 1.26 percent in 2011. Those new numbers mark the highest level of non-hospital births since 1975, according to the CDC.

In terms of actual births, that means 53,635 births in the U.S. took place out of a hospital in 2012, including 35,184 home births and 15,577 birthing center births, the CDC says.

(Source: CDC)

(Source: CDC)

Here are some more findings from the CDC news release:

• In 2012, 1 in 49 births to non-Hispanic white women were out-of-hospital births;

•The percentage of out-of-hospital births was generally higher in the northwestern United States and lower in the southeastern United States;

•Out-of-hospital births generally had a lower risk profile than hospital births.

Continue reading

The Good News, Bad News Story On Measles

Back of female with measles/ Wellcome Library, London. Wellcome Images/flickr

Back of female with measles/ Wellcome Library, London. Wellcome Images/flickr

By Alexandra Morris
CommonHealth Intern

Lately, when you hear about measles in the news, the reports tend to be grim: outbreaks in 2011 and 2013 in the U.S., parents who are choosing not to vaccinate their children for religious or philosophical reasons. But a new report from the CDC this week paints a bigger – and far more heartening – picture: from 2000 to 2012, 13.8 million deaths were prevented through measles immunizations globally. In other words, a population roughly the size of New England is still alive thanks to the measles vaccine.

Deaths from measles have dropped 78% since 2000. “These figures represent historic lows for estimated measles deaths globally,” said James Goodson, a co-author of the CDC report published in this week’s Morbidity and Mortality Weekly Report.

Since 2000, the Measles and Rubella Initiative – a partnership between various agencies including the CDC and the World Health Organization – has provided over a billion doses of measles vaccinations worldwide.

Measles was eliminated in the U.S. in 2000, but there have been a couple of recent spikes in cases. Just last year, there were three times as many measles infections in the U.S. than in previous years. In raw numbers, that translates to 189 cases, according to the CDC. While that doesn’t seem like a lot, such a highly contagious disease can spread rapidly, especially among people who haven’t been vaccinated.

Countries around the world are also aiming to eliminate measles by 2020 or earlier. Europe, for example, set a goal of measles elimination by 2015. But it doesn’t look like they’re on track to meet that goal, said Goodson. That may be due in part to parents’ fears about the possibility of vaccine side effects.

In 1998, a British medical journal issued a report suggesting the measles vaccine was linked to autism cases, which led to a sharp decline in vaccinations. Although the report was discredited, and later retracted by the journal, parent and anti-vaccine groups continue to fight against routine immunizations.

Misinformation is a major threat to vaccine efforts, say public health officials. Continue reading

CDC: Millions Acquire Antibiotic-Resistant Infections, Thousands Die Annually

The CDC reports today that more than two million people a year in the U.S. get infections that are resistant to antibiotics and at least 23,000 people die as a result.

In a new report called Antibiotic Resistance Threats in the United States, 2013, the public health agency ranks the antibiotic-resistant germs most threatening to human health. Here’s more from the CDC website:

The threats are ranked in categories: urgent, serious, and concerning.
Threats were assessed according to seven factors associated with resistant infections: health impact, economic impact, how common the infection is, a 10-year projection of how common it could become, how easily it spreads, availability of effective antibiotics, and barriers to prevention. Infections classified as urgent threats include carbapenem-resistant Enterobacteriaceae (CRE), drug-resistant gonorrhea, and Clostridium difficile, a serious diarrheal infection usually associated with antibiotic use. C. difficile causes about 250,000 hospitalizations and at least 14,000 deaths every year in the United States.

“Antibiotic resistance is rising for many different pathogens that are threats to health,” said CDC Director Tom Frieden, M.D., M.P.H. “If we don’t act now, our medicine cabinet will be empty and we won’t have the antibiotics we need to save lives.”

In addition to the toll on human life, antibiotic-resistant infections add considerable and avoidable costs to the already overburdened U.S. health care system. Studies have estimated that, in the United States, antibiotic resistance adds $20 billion in excess direct health care costs, with additional costs to society for lost productivity as high as $35 billion a year. The use of antibiotics is the single most important factor leading to antibiotic resistance. Up to 50 percent of all the antibiotics prescribed for people are not needed or are not prescribed appropriately. Continue reading

Despite Mounting Evidence, High School Girls Keep Tanning


You’re surely aware of all of the information out there clearly explaining why tanning salons are absolutely, unquestionably not a good idea?

Evidently, young America has yet to get the memo.

As a new report from JAMA Internal Medicine found:

Among non-Hispanic white female high school students, 29.3% engaged in indoor tanning and 16.7% engaged in frequent indoor tanning during the previous 12 months. The prevalence of indoor tanning and frequent indoor tanning increased with age.

These numbers  — about 1/3 of high schoolers tanning within the past year — are surprisingly static. A study done by the CDC in 2010 also found about a third of young white women reported indoor tanning.

What’s going amiss? I talked to Emily Colson, a high school senior in South Carolina whose experience closely mirrors the study’s findings. She first started using tanning beds as a freshman, relying on them for occasions with high expectations, like prom and the first week of summer. “I don’t like being pale or being pasty – I think I look a lot better when I’m tanner,” she said. Continue reading