Letters to the Editor - Oct. 9, 2000

U.S. Pharmacopeia is setting standards for dietary supplements - "When adults stop being violent, children will no longer feel the need to learn violence" - Not all doctors play by CME rules

U.S. Pharmacopeia is setting standards for dietary supplements

Regarding "Herbal hype" (Article, Aug. 21): This article raises concern over a lack of quality "standards governing concentrations of key ingredients, which can vary widely, 'which doesn't allow the ph ysician to prescribe the product in an analytical fashion.' "

I would like to bring to your attention the U.S. Pharmacopeia's efforts during the past 10 years to develop and establish public standards for dietary supplements.

Before the enactment of the Dietary and Nutritional Supplement Health and Education Act in 1994, the 1990 USP Convention delegates adopted a resolution that encouraged the elected body of scientific experts to establish public standards for vitamin-min eral combination products. This was fueled by concerns at the convention over the poor quality of calcium and vitamin supplements marketed at the time in the United States.

Between 1990 and 1995, public standards for over 1,000 multivitamin-mineral supplement products were established through a unique class monograph system. The standards established included tests of identity, potency, microbial limits and disintegration -dissolution test requirements.

Since 1995, the USP Committee of Revision, again following a 1995 USP Convention resolution encouraging the USP to establish public standards for botanicals used as dietary supplements, has directed considerable efforts toward developing public standar ds for botanicals. Because of the complexities associated with botanicals, standards development in the botanical area is progressing slowly.

USP is currently developing standards for 20 botanicals that account for about 90% of the botanicals market. The standards being developed for each botanical include standards for identity, purity and strength, as well as testing requirements for toxic contaminants such as pesticide residues, heavy metal, etc. When adopted by manufacturers, these standards would ensure product quality and purity. For example, USP recently published a monograph on saw palmetto that can be accessed through our Web site (http://www.usp.org/).

--Roger L. Williams, MD Executive vice president and CEO, U.S. Pharmacopeia Rockville, Md.

"When adults stop being violent, children will no longer feel the need to learn violence"

Regarding "Tune out media violence" (Editorial, Sept. 4): I find it a little puzzling that so much attention is being given to the effect of media violence on violence committed by children. I think it is an accepted principl e of biology that children of all mammalian species play in ways which will give them mastery over adult activities.

Millions of children are exposed daily, personally, to real acts of violence in the form of punitive child-rearing practices, as well as witnessing spousal abuse. They learn early that the threat of being overpowered is the ultimate mode of maintaining order in all social activities, at first by one's parents, and eventually by the police.

The very foundation of the country in which we live is based on the violent expropriation of the land from its native inhabitants. For hundreds of years the land was worked by people violently removed from their homes and brutally enslaved. Their desce ndants still constitute the highest percentage of victims of hate crimes and life-threatening discrimination. In many Third World countries, an economic order very little different from slavery persists to this day, maintained by state violence.

Violence and fear of violence are a daily fact of life for most women. Politicians have created drug laws that have greatly increased the burden of violence among citizens, between citizens and the criminal justice system, and even in other nations.

In this setting, of course children might assume that mastery of violence is one of the most important goals of childhood. Of course they will turn to violent games and TV shows to study and practice how to become competent adults. When adults stop bei ng violent, children will no longer feel the need to learn violence.

--Lorraine Bonner, MD Oakland, Calif.

Not all doctors play by CME rules

Regarding "CME sleuths" (Article, Aug. 14): This article was excellent. Protection and enforcement of CME standards is laudable. But the physicians themselves damage the credibility of continuing medic al education requirements by not-so-ethical means.

I refer to the practice of arriving 30-40 minutes late to a one-hour CME session, signing in and either leaving immediately or early in order to get CME credits.

When I asked one member who signed in and left, why he would do this, the response was, "I need the points."

--Edward W. St. Mary, MD Miami