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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

harm, and (2) a set of science-based principles that serve as guidelines for evaluating risk to human health.

For the Framework to be useful, FDA must have adequate resources for implementation. To be credible, it must be scientifically based and include guidelines for obtaining and integrating the totality of the information from many areas of science. The Framework should allow FDA to react to information, as well as to proactively gather information. It needs to be efficient and provide a system for updating information as new information becomes available. In providing a scientific infrastructure for the evaluation of the safety of dietary supplement ingredients, the framework must facilitate decision-making regarding a dietary supplement’s potential to cause harm when uncertainty exists. Adequate staff with appropriate expertise must be available within FDA to administer the process and evaluate the information.

The Framework described here characterizes the nature of the scientific evidence that FDA is likely to encounter and describes a process for organizing this evidence to assess where a dietary supplement ingredient lies on a spectrum of concern2 (see Figure 3-1). As the level of concern increases, so does the potential for a “significant or unreasonable risk,” the standard warranting regulation under the Food, Drug, and Cosmetic Act (FDCA), as amended by DSHEA.

I. THE PROCESS

The process comprises three major components:

  • Signal detection,

  • Initial review of the signal, and

  • Integrative evaluation.

Signal Detection

According to the DSHEA, it is assumed that dietary supplements are generally safe; given the large number of dietary supplement ingredients, it is unlikely that FDA will have the resources or the need to evaluate each ingredient uniformly to determine if it presents an unreasonable risk of illness or injury. Thus, at least initially, it is assumed that some “signal” will indicate that an ingredient’s safety may need to be reviewed. When a signal is detected, it is up to FDA to decide the next step once the credibility of the

2  

The use of the term “concern” denotes a need for further investigation and inquiry by FDA based on a relative level of interest arising from initial information.

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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)