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To dispense or not to dispense?
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They’re everywhere. Television, magazines, the Internet, even our professional publications. Nutritional supplements, a.k.a. nutraceuticals. Patients, led by aging baby boomers, covet them, as evidenced by an unprecedented growth in consumption. Manufacturers and retailers, vying for position, are providing an expanding array of products and innovative marketing strategies. As practitioners, we’re challenged with the task of putting all of this in proper perspective, the task of validating nutraceuticals in eye care, educating patients regarding formulations and dosages and deciding whether these products should be dispensed from our practices.
Supplements generally supported
The first issue is increasingly easy to justify. While it may take years of prospective studies for epidemiologists to give us unequivocal answers, conventional wisdom favors nutraceuticals. Whether attempting to abate maturation-related changes or mitigate pathology, nutraceuticals seem well founded. Ongoing research supports the role of vitamins A, C, B-complex, E and K, as well as zinc and lutein in promoting ocular health. In many respects, a well-balanced diet affords patients a reasonable – if not optimal – level of wellness. However, poor dietary habits or malabsorption prevent many from obtaining adequate essential nutrients. For these individuals – perhaps the majority – nutraceuticals are beneficial.
Of course, the questions are numerous. How much is enough? When should they be taken? Are gel-caps, tablets, powders or liquid formulations best? Are they safe? While nutraceuticals are incredibly safe, some can reach toxic levels in body tissue, interfere with other nutrient absorption, exacerbate anemia or alter blood clotting. Undoubtedly, good science, clinical research and a competitive marketplace will weed out the bad products. In the interim, a mandate of “supplementation in moderation” should prevail.
Delivery issue
Perhaps the greatest challenge for primary eye care providers involves the issue of nutraceutical delivery. On one hand, optometry is a “dispensing” profession, one in which professional services are intimately intertwined with the delivery of medical devices. Historically, we’ve provided refractions in conjunction with eyeglasses and contact lenses. In doing so we monitor product quality and visual outcomes while affording patients “one-office” convenience.
On the other hand, therapeutic drug privileges have taught us to be a “prescribing” profession. Indeed, every prescription validates the relationship we’ve developed with drug manufacturers and pharmacists — a relationship based on confidence that patients will receive the proper drug.
So, what’s the proper approach with nutraceuticals? Do we treat them as optical devices and dispense them as such or view them as drugs, to be prescribed but not dispensed? I suspect we’ve only seen the beginning of this debate. Personally, I’m not a nutraceutical dispenser, as I figure there’s much to be learned first. (Despite an OD degree and lab coat, I’m not an expert!) Much to be learned about patient education, establishing nutraceutical programs and identifying reputable companies providing good products. Should I elect to dispense somewhere along the way, it will be for one reason only. To better provide for my patients.