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Alisa Sano, MPH

Alisa Sano is a public health auditor.

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Latest articles

Conditions and diseases

How to diagnose supplement toxicity in 4 clinical steps

Only 33 percent of patients who use herbs or supplements disclose their use to health care providers, often viewing them as natural and therefore harmless. Targeted history-taking is the ultimate line of defense for ruling in or out herbal/dietary supplement-induced…

Only 33 percent of patients who use herbs or supplements disclose their use to health care providers, often viewing them as natural and therefore harmless. Targeted history-taking is the ultimate line of defense for ruling in or out herbal/dietary supplement-induced liver injury (HILI) and broader supplement toxicity, including herb-drug interactions.

Clinicians must look beyond standard prescription lists and systematically audit everything a patient ingests. Asking a few high-yield questions …

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How to diagnose supplement toxicity in 4 clinical steps

Conditions and diseases

Supplement country-of-origin labels hide the real source

We previously discussed the certificate of analysis myth and economically motivated adulteration in the dietary supplement industry. This article focuses on the basics of how the supply chain of dietary ingredients works and why it is critical for clinicians always…

We previously discussed the certificate of analysis myth and economically motivated adulteration in the dietary supplement industry. This article focuses on the basics of how the supply chain of dietary ingredients works and why it is critical for clinicians always to consider the possibility of supplement-induced adverse side effects such as herb-induced liver injury (HILI).

The surging interest in dietary supplements over the past few decades reflects a positive shift …

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Supplement country-of-origin labels hide the real source

Drugs and prescribing

How supplement fraud slips past a certificate of analysis

In our first article, we discussed the international regulatory clash between U.S. supplement mandates (21 CFR 111) and foreign food/supplement laws. This gap can lead to inadequate dietary ingredient identity verification. "We review a Certificate of Analysis (CoA) for 100…

In our first article, we discussed the international regulatory clash between U.S. supplement mandates (21 CFR 111) and foreign food/supplement laws. This gap can lead to inadequate dietary ingredient identity verification.

“We review a Certificate of Analysis (CoA) for 100 percent of our globally sourced ingredients.” This is a frequently offered defense by supplements’ brand owners when challenged on international supply chain vulnerabilities. To a physician, this defense sounds like an …

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How supplement fraud slips past a certificate of analysis

Drugs and prescribing

Why a supplement supply chain hides behind its label

"I bought this premium multivitamin online," Patient A tells you during a routine history-taking at the annual checkup. "It's a prominent Japanese brand. Since people over there have such long life expectancies, this has to be safer and purer than…

“I bought this premium multivitamin online,” Patient A tells you during a routine history-taking at the annual checkup. “It’s a prominent Japanese brand. Since people over there have such long life expectancies, this has to be safer and purer than a domestic brand, right?”

As a health care provider, you would find it easy to agree. Countries universally recognized for longevity and high-quality standards enjoy an organic, built-in reputation for wellness …

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Why a supplement supply chain hides behind its label

Drugs and prescribing

GMP vs. non-GMP: the hidden truth about your supplements

Suppose you are looking for multivitamin supplements. You pick up two containers of multivitamins and wonder which one you should get. At first glance, they have similar labels, but then you notice that one has a comment indicating that the…

Suppose you are looking for multivitamin supplements. You pick up two containers of multivitamins and wonder which one you should get. At first glance, they have similar labels, but then you notice that one has a comment indicating that the supplement was manufactured in a registered GMP-compliant facility, and the other does not.

Then you ask yourself the following questions: How much of what ingredients are included in proprietary blends? Where …

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GMP vs. non-GMP: the hidden truth about your supplements

Conditions and diseases

The curious cases of the Tenerife plane crash and medical errors: What we see through the Swiss cheese model

"Even a room with flammable gas will not explode unless someone strikes a match." – Dr. Bob Wachter Case 1: On March 27, 1977, two 747s collided on the runway at Tenerife in the Canary Islands, killing 583 people. On…

“Even a room with flammable gas will not explode unless someone strikes a match.”
– Dr. Bob Wachter

Case 1:

On March 27, 1977, two 747s collided on the runway at Tenerife in the Canary Islands, killing 583 people. On a foggy morning, the KLM 747 was waiting for clearance to take off. Captain Van Zanten was a well-known pilot with excellent safety records. The KLM crew spotted a Pan Am 747 taxiing …

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The curious cases of the Tenerife plane crash and medical errors: What we see through the Swiss cheese model

Conditions and diseases

Don’t lie about medical errors. Apologize.

Time of death: unknown. It was around 6 p.m. on April 21, 2013. My mom saw my grandfather dying slowly in the hospital bed. She had pressed the nurse call button frantically over the last 20 minutes. She rushed to…

Time of death: unknown.

It was around 6 p.m. on April 21, 2013.

My mom saw my grandfather dying slowly in the hospital bed.

She had pressed the nurse call button frantically over the last 20 minutes.

She rushed to the nurse station only to find out nobody was there.

She went back to my grandfather and spent the last three minutes with him.

She was the one who saw my grandfather’s bpm (beats per minute) …

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Don’t lie about medical errors. Apologize.

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