safety, including the recommendation to integrate consideration of risks and benefits as the basis for taking action. The efficacy of this overall approach will best be determined by an annual status report and a five-year review of results from the surveillance, the adverse-event report monitoring system, and the effectiveness of command recommendations to allow or restrict the use of specific supplements. The designated oversight committee should decide on a timeline and specific criteria to validate this approach as well as to review the results.

Research should be conducted to identify the effectiveness of various methods of communication and outreach to educate service members, commanders, health care personnel, and physical training and fitness centers staff on the use of dietary supplements. Information should be obtained on the awareness of use and knowledge about supplements among military personnel, commanders, and military physicians.

IOM (Institute of Medicine). 2006. Dietary reference intakes research synthesis: Workshop summary. Washington, DC: The National Academies Press.

NRC (National Research Council). 2005. Application of toxicogenomics to cross-species extrapolation: A report of a workshop. Washington, DC: The National Academies Press.

NRC. 2007. Toxicity testing in the 21st century: A vision and a strategy. Washington, DC: The National Academies Press.

Wu, T., and B. Kayser. 2006. High altitude adaptation in Tibetans. High Alt Med Biol 7(3):193-208.