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Dietary Supplements: A Framework for Evaluating Safety (2005)
Institute of Medicine (IOM)

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. "3 The Framework." Dietary Supplements: A Framework for Evaluating Safety. Washington, DC: The National Academies Press, 2005.

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Dietary Supplements: A Framework for Evaluating Safety

TABLE 3-1 Relative Spectrum of Concern for Individual Spontaneous Adverse Event Reports

Increasing Concern

Describes a serious adverse event with less information than would justify moderate or strong concern, and/or with prominent confounding factors (e.g., multiple concomitant substances and/or conditions)

Describes a serious adverse event with some, but not all, characteristics associated with strong concern

Describes a well-documented serious adverse event with plasma levels (if available) at a relevant range and demonstrates dechallenge and rechallenge (if possible), temporality, and strong attribution

TABLE 3-2 Relative Spectrum of Concern for Case Series of Spontaneous Adverse Event Reports

Increasing Concern

Describes a series of serious adverse events, with less information than would justify moderate or strong concern, and/or prominent confounding factors (e.g., multiple concomitant substances and/or conditions)

Describes a series of serious adverse events, with some, but not all, characteristics associated with strong concern

Describes a series of well-documented cases demonstrating consistent serious adverse events and clinical findings, and dechallenge (if possible), temporality, and strong attribution

TABLE 3-3 Relative Spectrum of Concern Raised by Historical Evidence of Toxicity

Increasing Concern

Traditional cautions (contraindications) exist regarding use in certain populations or circumstances

Traditional cautions (contraindications) exist regarding use in certain populations or circumstances that, if ignored, might be associated with a serious adverse effect (e.g., do not use during pregnancy)

There is clear evidence that traditional use causes conditions considered to be serious adverse events (e.g., hallucination, lethal poisoning)

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104
Front Matter (R1-R20)
Executive Summary (1-18)
1 Introduction and Background (19-42)
2 Approaches Used by Others and Existing Safety Frameworks (43-84)
3 The Framework (85-125)
4 Categories of Scientific Evidence--Human Information and Data (126-155)
5 Categories of Scientific Evidence--Animal Data (156-174)
6 Categories of Scientific Evidence--Information About Related Substances (175-216)
7 Categories of Scientific Evidence--In Vitro Data (217-234)
8 Interactions (235-246)
9 Vulnerable Groups and Prevalance of Use (247-252)
10 Scientific Principles for Integrating and Evaluating the Available Data (253-268)
11 Applying the Framework: Case Studies Using the Prototype Safety Monographs (269-291)
12 Factors Influencing Use of the Safety Framework (292-296)
13 Findings and Recommendations (297-306)
Appendix A: Existing Frameworks or Systems for Evaluating the Safety of Other Substances (307-315)
Appendix B: Scope of Work and Comments to Initial July 2002 Framework (316-321)
Appendix C: Plant Family Information (322-355)
Appendix D: Chaparral: Prototype Monograph Summary (356-362)
Appendix E: Glucosamine: Prototype Monograph Summary (363-366)
Appendix F: Melatonin: Prototype Monograph Summary (367-371)
Appendix G: Chromium Picolinate: Prototype Monograph Summary (372-375)
Appendix H: Saw Palmetto: Prototype Monograph Summary (376-379)
Appendix I: Shark Cartilage: Prototype Monograph Summary (380-384)
Appendix J: Prototype Focused Monograph: Review of Liver-Related Risks for Chaparral (385-449)
Appendix K: Protoype Focused Monograph: Review of Anti-Androgenic Risks of Saw Palmetto Ingestion by Women (450-477)
Appendix L: Acknowledgements (478-480)
Appendix M: Biographical Sketches of Commitee Members (481-488)
Index (489-506)