As one of the most trusted health care professionals with unique availability and accessibility to patients, pharmacists are in the forefront in guiding patients regarding the use, efficacy, and safety of dietary supplements. Studies show that pharmacists are frequently asked about dietary supplements and natural products.18
However, pharmacists lack vital knowledge related to dietary supplements and are not confident in patient counseling. Similarly, pharmacy students perceive their knowledge about the appropriate use of supplements as inadequate.21
During the last decade, awareness about the need for inclusion and integration of evidence-based training on dietary supplements in the health profession curricula has increased. Several national pharmacy professional organizations have acknowledged the need for training pharmacists about dietary supplements.24,25
The American Association of Colleges of Pharmacy has identified the need for curricular change to incorporate CAM courses in pharmacy curriculum.25
In 2005, a competency statement addressing whether pharmacists can provide sufficient information on the documented uses and safety profiles of dietary supplements was added to the North American Pharmacist Licensure Examination.26
Similarly, the Accreditation Council for Pharmacy Education Standards for Accreditation Guidelines, version 2, provided advice on incorporating classroom/lecture-based coursework on dietary supplements and evaluation of their efficacy, safety, and possible interactions with prescription drugs.27
In the United States, many pharmacy colleges and schools are incorporating CAM courses in the curricula that address mainly natural or herbal products.19
Bonafede and colleagues28
developed a 3-credit elective course on dietary supplements for third-year PharmD students comprised of discussions on dietary suplements based on a widespread therapeutic categories such as disease prevention, immune health, men’s and women’s health, weight loss, cardiovascular diseases, neuropsychiatric conditions, bone and joint health, and athletic performance. Atayee and colleagues27
designed and implemented a small-group self-guided active-learning CAM course and assessed changes in first-year PharmD students' attitudes and knowledge of CAM.
Although vitamins and minerals constitute the majority of dietary supplements consumed by Americans, it is unclear from published studies how and to what extent topics on vitamins and minerals are covered in US pharmacy school curricula. This paper is the first to describe an integrated approach to teaching the basic and clinical sciences pertaining to the use of vitamin and mineral supplements for human health and treatment of disease.
The major strength of the course is that it provided students with a strong background on the biochemical and physiological functions of vitamins and minerals in the body and their roles in disease states (module 1). Then the course progressed to clinical information (module 2) so that students would be able to integrate their knowledge with a thorough understanding of potential outcomes of using vitamins and minerals as dietary supplements. For example, in module 1, chemical and biochemical functions of selenium were discussed. In animal models, selenium appears to function as an antioxidant and its deficiency was found to be associated with an increased incidence of cancer. In module 2, students learned that the incidence of cancer or cancer deaths was found to be lower in patients with high blood levels of selenium or taking selenium supplements according to several human observational studies and randomized control trials. However, in the Nurses’ Health Study in 1982,30
over 60,000 participants observed for 3.5 years showed no reduction in the risk of cancer. Finally, students were introduced to 2 long-term studies, the SU.VI.MAX study31
in France and the Selenium and Vitamin E Cancer Prevention Trial (SELECT, 35,000 participants, seven years),12
in the United States and Canada. Both of these studies found the use of the supplements to be associated with an increased incidence of prostate cancer compared to a placebo group. Apart from the studies of selenium and cancer, students also learned that current evidence is insufficient to recommend selenium for the prevention of coronary artery disease, HIV, and arthritis. Another example is the discussion of physiological and pathophysiological roles of calcium, clinical manifestations of hypo- and hyper-calcemia, different calcium supplements and their formulations, uses, and finally the recent clinical studies relating calcium supplements and risk of cardiovascular events. Students also learned that randomized large-scale trials in the last two decades have shown that vitamin supplements are not only ineffective for the majority of population, but may be deleterious to health. Similarly, several other well-known clinical trials10,11,32-35
involving vitamins and minerals were discussed so that students learn evidence-based decision making on the use of a selected vitamin and mineral dietary supplement. Thus, the strengths of this course include the in-depth instruction on the basic science related to vitamins and minerals and then integration of that knowledge into clinical practice. This course is offered at a time when students make the transition from classroom-based courses to providing pharmaceutical care to patients in experiential courses. The course provides educational goals to increase the knowledge of next generation pharmacists, which will in turn benefit the profession of pharmacy and consumer health.
While the course outcomes were satisfactory in terms of students’ learning and acquiring knowledge, its effectiveness and applicability in direct patient care is not known. Additional research is needed to measure the lasting impact of this course in the practice setting. It would be interesting to gather data from students who took this course and are now practicing pharmacists. The goal of future research would be to capture translational data from this elective course to clinical practice.