Dietary supplements are steeped in controversy

Herbal supplements and other complementary therapies are surrounded by clinical and ethical issues, some involving urologists. In this exclusive interview, Mark A. Moyad, MD, MPH, discusses the current controversies and reviews data on commonly used supplements. Dr. Moyad is the Phil F. Jenkins Director of Preventive and Alternative Medicine, Michigan Urology Center, Ann Arbor, and editor-in-chief of the journal Seminars in Preventive and Alternative Medicine. He was interviewed by UT Editorial Consultant Philip M. Hanno, MD, MPH, professor of urology at the University of Pennsylvania, Philadelphia.

Q: Tell us how you became interested in complementary medicine, and describe your position at the University of Michigan.

I realized that this was a fascinating area that no one was touching. I also wanted to do some type of cancer research because my family has been affected by it. The fact that natural compounds can do such good and such harm was intriguing. I knew that there was no formal program in medicine for studying natural compounds, although such programs existed in public health. I began to see a huge need in this area.

To be honest, there's no way that you and I would be here had it not been for several patients who donated a large sum of money to set up an endowment that came when I was in medical school. An endowment within urology was established so I could pursue the study of complementary medicine in terms of clinical and basic science research and set up a consulting practice within urology at the University of Michigan.

I now have the best of both worlds. I can pursue what I want to pursue and stay within the area of complementary and alternative medicine, but at the same time, I can do this within the specialty that I love the most. I really believe I am a part of the perfect and best possible occupational marriage by working in urology at Michigan because the bi-directional learning is limitless and, in the end, the patients are really the winners because they receive good, comprehensive care. I hope it has set up a paradigm for other specialties to follow in the future.

Q: What makes herbal and complementary medicine preparations different from drugs, apart from their lack of scientific efficacy and side effect data?

A: First and foremost, herbal and dietary supplement preparations shouldn't be treated differently than drugs are. The credibility of alternative medicine and dietary supplements is not enhanced unless they are held to the same standards as drugs. The data have to be evidenced based.