The compliance paradox: what we need to know about "real-world" dietary supplement use in the United States.

Current research on dietary supplements (primarily survey-based prevalence studies and clinical trials of safety and efficacy) is inadequate for understanding how consumers use supplements in the real world. Analyzing interview data from formative research with dietary supplement users (N=60), we observed skepticism in the way our informants interpret scientific information about supplements, trust in referrals from those they feel are like them, and experimentation with products in order to tailor them to their bodies and needs. We stress the need for qualitative research focusing on patterns of supplement use in context (rather than as isolated supplements in fixed doses), the network effect of supplement use, and the way information about supplements is translated and transmitted. Furthermore, we urge clinicians to pay careful attention not only to whether patients are taking dietary supplements, but also how supplements are being used alone and in combination with other supplements, pharmaceuticals, and over-the-counter (OTC) medications.