Friday, September 12, 2008

Gluten in Medication Seminar: Follow-Up

I liked today's online seminar on Gluten in Medication. It was refreshing to get the medical overview from Dr. Daniel Leffler of Boston as well as the perspectives of pharmacists Priti N. Patel and Gerry McAvoy.

In Vanessa Maltin's remarks, she described the difficulty she recently faced when trying to get answers about gluten in medications. After weeks, she still hadn't gotten clear answers.

I think Vanessa's experience is common and symptomatic of bad practices permeating the marketing and regulation of over-the-counter and prescription medications. The regulation of those items is the responsibility of the FDA, but (as pointed out at the seminar) the FDA has not enforced rules about identifying sources of botanical ingredients—even though such rules have been in place since 1975. 1975! On top of that, the rules are not even as helpful as those governing food labeling. That's sad, considering that whereas people should be eating food to stay healthy, people should be taking medications to improve or at least stabilize their endangered health. They might not be well enough to interrogate manufacturers about gluten content, and their conditions might not afford them the time it might take to properly vet medications regarding their safety in terms of gluten.

The institutions represented at the seminar—the National Foundation for Celiac Awareness (NFCA), the American Society of Health-System Pharmacists (ASHP), the St. Johns University College of Pharmacy (STUCP), and the Celiac Center at Beth Israel Deaconess Medical Center (CCBIDMC)—all seem to be onboard when it comes to reforming the system, including the FDA, which needs to be strengthened to be better able to uphold its own standards.

One piece of information offered at the seminar was that the FDA has built a database currently listing ingredients of more than 4000 medications. Out of those medications included in this Daily Med database, 1320 contain starch, which seems to be the main "warning flag" for those on the lookout for gluten. Of those, only three have wheat identified as a source for the starch—but 66% of the starch sources are not identified at all. So we just don't know about those.

It's possible that the danger from gluten in medications is relatively minor, but at present we just don't know enough because of the poor practices in the industry that keep the content of the products a mystery, even in defiance of long-existing regulations. Those regulations interfere with the ability of medical professionals to prescribe and dispense drugs knowing that they will do no harm. And the situation is worse when it comes to supplements, according to Patel and just about everyone else who knows how the industry works, because supplements are governed by even fewer regulations.

Three online sources of information offered at the seminar are Gluten and Medications,, and the NFCA site. I know that Clan Thompson also maintains lists of over-the-counter and prescription drugs. Between those resources and the FDA database, there might be some unnecessary duplication of effort that might be rechanneled into the creation of more accurate and comprehensive listings that would be freely accessible to the public, especially with adequate funding. A similar list could be established for food.

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