The Integrator Blog
Home
Share |
about
Contact Me, Experience, Mission, Sabbatical in Central America, plus
Editorial Advisory Board
Columnists
Michael Levin
Taylor Walsh
background resources in PDF
Insurance, Integrative Clinics, Industry Summit Reports, News Files '99-'04
some organization links
Professions, Academia, Research, Policy
some CAM/IM publication links
Electronic, Peer-Reviewed, Blogs, More
Bradly Jacobs, MD, MPH, Revolution Health Blog
supported conference
Institute for Health & Productivity Management - Integrative/Complementary Healthcare
AAAOM Analysis: Neither Practiitioners Nor Educational Institutions Exempt from FDA's cGMPs PDF Print E-mail
Written by John Weeks   

AAAOM Analysis: Neither Practitioners Nor Educational Institutions Exempt from FDA's cGMPs

Summary:  Recent Integrator columns have explored the meaning of the FDA's current Good Manufacturing Practices for dietary supplements. But what impact will these cGMPs have on the actions of individual practitioners who prepare products for their patients? Might they influence educational programs and institutions where instruction in herbal preparations, for instance, may be part of the clinical practicum? The American Association of Acupuncture and Oriental Medicine (AAAOM) recently sent its members advance notice of the AAAOM's analysis of these issues. Their answers are yes, and yes, with caveats. Here are the AAAOM's key points.
Send your comments to
for inclusion in a future Your Comments forum.

cGMP, FDA, AAAOM, acupuncture, herbs, botanical medicines, regulation As a complementary or integrative practitioner, or as a leader of an educational program involved with natural health products, how is one to view the
US Food and Drug Administration's recently issued current Good Manufacturing Practices on dietary supplements? Is this a document that only influences one's trade show exhibitors? Or might the regulations touch closer to home.

The American Association of Acupuncture and Oriental Medicine (AAAOM) made a useful contribution to efforts to understand the reach of the cGMPs via an electronic notice to their members. The AAAOM's short answer: Neither practitioners nor educators are necessarily exempt. The FDA has considerable "discretion" in applying the regulations.

Here are the "Key Points" the AAAOM sent to their members, together with an opportunity to comment.
The cGMP can be viewed by clicking here and entering the docket number "96N-0417" in the search field.

________________________________________

For Practitioners & Educational Institutions:
AAAOM "Key Points" on the FDA's cGMPs

  • A practitioner whose only involvement with dietary supplements is that the practitioner purchases herbal formulas which are packaged and labeled as dietary supplements and resells these products to the practitioner’s patients for consumption in a course of treatment is exempt from the Final Rule.

The Final Rule says in §111.1(a) that the Final Rule only applies to you "…if you manufacture, package, label or hold a dietary supplement." In the example above, the practitioner is not manufacturing, packaging or labeling dietary supplements. The practitioner's only connection with the Final Rule is holding dietary supplements pending sale to patients. The Final Rule then goes on to say in §111.1(b) that the "requirements pertaining to holding do not apply to you if you are holding those dietary supplements at a retail establishment for the sole purpose of direct sale to consumers." The preamble to the Final Rule explains that "retail establishment" includes not just an herb shop and a health food store, but also includes an individual, such as the practitioner in our example. Consequently, the practitioner in the example above is exempt from the Final Rule.

 

There are limitations on the retail establishment exemption, but they should not be a problem for most practitioners. To be eligible for the exemption the practitioner cannot store the dietary supplements in a warehouse or other storage facility or sell directly from a warehouse.

 

  • A practitioner who maintains an herbal pharmacy and prepares herbal formulas for patients based on their individual needs is not exempt from the Final Rule.

According to the Final Rule, a practitioner who prepares herbal formulas may be engaged in manufacturing, as defined by the FDA, and consequently subject to the Final Rule, if what the practitioner is manufacturing is a dietary supplement.

 

   
 
While declining to exempt
herbalists from the Final Rule,
FDA did say that it might
exercise its enforcement
discretion in favor of "herbalists,
acupuncturists, naturopaths
and related health care
providers" under certain
circumstances.
 
While declining to exempt herbalists from the Final Rule, FDA did say in the preamble to the Rule that it might exercise its enforcement discretion in favor of "herbalists, acupuncturists, naturopaths and related health care providers" under certain circumstances. FDA explained that a "one-on-one consultation by a practitioner adequately trained in their profession may not necessitate the same type of controls as we are establishing in this final rule for manufacturing activities on a larger scale.” FDA concluded: "We believe that it would be appropriate to consider the exercise of our enforcement discretion, on a case-by-case basis, to determine whether to apply the requirements of the final rule to such persons."

 

The FDA is retaining its right to enforce the requirements, while also saying it will consider not enforcing the requirements against these practitioners. While we would prefer that qualified practitioners were fully exempt in these situations, we understand that without any clear guidance distinguishing small from large scale manufacturers, it would be difficult to grant such an exemption.

 

  • The FDA states that "Many products that are manufactured by practitioners would not necessarily be considered to be dietary supplements (e.g. certain products used by Traditional Asian medicine practitioners).” These products would not be subject to the Final Rules.

To the extent that these formulas are not dietary supplements, the Final Rule does not apply to them. Yet, current law does not delineate which herbal products are considered to be dietary supplements are which are not in this category. The AAAOM plans to do further work in this area.

 

  • The Final Rule does not take effect until June 2010 for persons employing fewer than 20 employees.

This category should include most practitioners, so there is time to discuss and plan for any action needed.

 

  • Academic institutions are not exempt from the Final Rule.

While declining to exempt academic institutions, FDA did say it is not its policy to inspect academic institutions providing training for therapeutic disciplines that use dietary supplements in their practice. In addition FDA would consider using its enforcement discretion in situations where dietary supplements are dispensed after one- on – one consultation which includes a practitioner with adequate training. FDA intends to issue further guidance in this area.

Comment: A note of thanks to the AAAOM for this work. The tone of the FDA's caveats cited here suggests a rather understanding FDA. Yet, it is clear also that if the FDA goes adversarial, it has a grounds to harass. For those who view the FDA through fear-tinted lenses, the agency's "discretion" may be the better part, not of valor, but of of paranoia.

 

Send your comments to
for inclusion in a future Your Comments forum.


< Prev   Next >
Search
Advertisement
Advertisement
Sponsors
Integrative Practitioner
The Westreich Foundation
voluntary contributions
Support the work!
Archive
All Integrator Round-ups
Integrator Top 10 Lists 2006-2015
Issues #140-#142 Oct-Dec 2015
Issues #137-#139 July-Sept 2015
Issues #134-#136 April-June 2015
Issues #131-#133 Jan-March 2015
Issues #127-#130 Sept-Dec 2014
Issues #123-#126 May-Aug 2014
Issues#119-#122 Jan-April 2014
Issues #116-#118 - Oct-Dec 2013
Issues #113-#115 July-Sept 2013
Issues #110-#112 April-June 2013
Issues #108-#109 Jan-March 2013
Issue #105-#107 Oct-Dec 2012
Issues #102-#104 - July-Sept 2012
Issues #99-#101 - April-June 2012
Issues #96-#98-Jan-March 2012
Issues #94-#95 Nov-Dec 2011
Issues #92-#93 Sept-Oct 2011
Issues #90 and #91 - July-Aug 2011
Issues #88 and #89 - May-June 2011
Issues #86 and #87 - March-April 2011
Issues #84 and #85 - Jan-Feb 2011
Issues #82 and #83 - Nov-Dec 2010
Issues #80 & #81 - Sept Oct 2010
Issues #78 & #79 - July August 2010
Issues #76 & #77 - May June 2010
Issues #74 & #75 - March-April 2010
Issues #73 & #73 - Jan-Feb 2010
Issues #69, #70 & #71 - Nov-Dec 2009
Issues #67 and #68 - Sept-Oct 2009
Issues #65 and #66 - July-August 2009
Issues #63-#64 - May-June 2009
Issues #60-#62 - March-April 2009
Issues #57-#59 - Jan-Feb 2009
Issues #55-#56 - Nov-Dec 2008
Issues #51-#54 - Sept-Oct 2008
Issues #47-#50 - July-August 2008
Issues #46 & -#47 - May-June 2008
Issues #43-#45 Mar-April 2008
Issues #41 & #42 - Feb 2008
Issues #39 & #40 - Dec-Jan '08
Issues #37 & #38 - Nov 2007
Issues #35 & #36 - Oct 2007
Issues #33 & #34 - Sept 2007
Issues #30-#32 - July-Aug 2007
Issues #28 & #29 - June 2007
Issues #26 and #27 - May 2007
Issue #25 - April 2007
Issues # 23 & #24 - March 2007
Issues #21 and #22 - Feb 2007
Issues #19 and & 20 - Jan 2007
Issues #17 and #18 - Dec 2006
Issues #15 and #16 - Nov 2006
Issues #13 and #14 - Oct 2006
Issues #11 and #12- Sept 2006
Issues #9 and #10 - Aug 2006
Issues #7 and #8 - July 2006
Issues #5 and #6 - June 2006
Issues #3 and #4 - May 2006
Issues #1 and #2 - April 2006
All Articles by Subject: 2006
All Articles by Subject: Jan-June 2007
IAYT-Sponsored Series on the Future of Yoga Therapy