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

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. "10 Scientific Principles for Integrating and Evaluating the Available Data." 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

AMOUNT OF INFORMATION NEEDED TO DRAW A CONCLUSION

GUIDING PRINCIPLE: In the absence of scientific studies designed specifically to test the safety of a dietary supplement, concern for public safety may be raised by the presence of even a few reports of possible safety concerns when viewed together and constituting the weight of available evidence.

Even if there are only one or two convincing reports of safety concerns about a dietary supplement, from either in vitro, animal, or human data, it may not be necessary to gather much additional information to raise concern about the implications for public health. However, in other cases, it may be necessary to assemble several data reports and reach a conclusion about risk based on the totality of available evidence, overall consistency, and biological plausibility of the evidence (a “weight of evidence” approach). In the absence of data on the safety of a specific ingredient, convincing information about safety of chemically or functionally related substances may be used to judge concern.

INTEGRATING INFORMATION

GUIDING PRINCIPLE: Integration of data across different categories of information and types of study design can enhance biological plausibility and identify consistencies, leading to conclusions regarding levels of concern for an adverse event that may be associated with use of a dietary supplement ingredient.

Individual pieces of information from any one of the categories of information (human, in vitro, animal, or related substances data) may sometimes be sufficiently compelling to both exceed a threshold level of concern and to justify focused evaluation or action. In many circumstances, however, data will need to be collated within the same category or across several categories to determine the appropriate level of concern. That is, even if concern raised by one category of data—for example, human data—does not meet a threshold for action, the body of evidence available across several categories may raise the level of concern. In integrating observations across categories of data, consistency and evidence of biological plausibility should raise the level of concern. In other words, available evidence from

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255
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)