Context Passage of the Dietary Supplement Health and Education Act in 1994 restricted
the Food and Drug Administration's control over dietary supplements, leading
to enormous growth in their promotion. The Internet is often used by consumers
as a source of information on such therapies.
Objective To assess the information presented and indications claimed on the Internet
for the 8 best-selling herbal products.
Data Sources We searched the Internet using the 5 most commonly used search engines.
For each, we entered the names of the 8 most widely used herbal supplements
(ginkgo biloba, St John's wort, echinacea, ginseng, garlic, saw palmetto,
kava kava, and valerian root). We analyzed the health content of all Web sites
listed on the first page of the search results.
Study Selection We analyzed all accessible, English-language Web sites that pertained
to oral herbal supplements. A total of 522 Web sites were identified; of these,
443 sites met inclusion criteria for the analysis.
Data Extraction The nature of the Web site (retail or nonretail), whether it was a sponsored
link, and all references, indications, claims, and disclaimers were recorded.
Two reviewers independently categorized medical claims as disease or nondisease according to Food and
Drug Administration criteria.
Data Synthesis Among 443 Web sites, 338 (76%) were retail sites either selling product
or directly linked to a vendor. A total of 273 (81%) of the 338 retail Web
sites made 1 or more health claims; of these, 149 (55%) claimed to treat,
prevent, diagnose, or cure specific diseases. More than half (153/292; 52%)
of sites with a health claim omitted the standard federal disclaimer. Nonretail
sites were more likely than retail sites to include literature references,
although only 52 (12%) of the 443 Web sites provided referenced information
without a link to a distributor or vendor.
Conclusions Consumers may be misled by vendors' claims that herbal products can
treat, prevent, diagnose, or cure specific diseases, despite regulations prohibiting
such statements. Physicians should be aware of this widespread and easily
accessible information. More effective regulation is required to put this
class of therapeutics on the same evidence-based footing as other medicinal