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Not only has the prevalence of use of natural medicine increased, but the pattern of use has also changed. Self-directed herbal use increased by 10% between 1997 and 2002.3 Of concern, researchers estimated that 18% of patients who took prescription medications in 1997 also used herbal products or high-dose multivitamins. As a result, an estimated 15 million adults were at risk for dietary supplement drug interactions. Studies have also found that less than 40% of users of CAM disclose use to their physician.4 This is despite the frequent reports in the lay and medical literature about the potential adverse effects and herbal-drug interactions associated with use. Perhaps many users are not aware that dietary supplements are marketed without documentation of safety and efficacy.