Dietary restrictions: implications on medication choice.

Some may take this ethical choice further and embrace a vegan (complete avoidance of animal products) lifestyle. In addition to this, Islam and Judaism follow strict dietary laws of Halal and Kosher respectively, both of which promote the avoidance of porcine products, and for Judaism, avoidance of shellfish too.3 It is an unavoidable fact that all medication will at some stage in its development have been tested on animal subjects, but inadvertent ingestion of animal products is something that can potentially be avoided. A survey of 500 urological patients4 revealed that 40% of these patients had a dietary restriction which required avoidance of animal products and up to 50% of this subgroup had inadvertently been prescribed gelatinecontaining medication. These proportions are far in excess of the figures in Table 1, based on estimates from the Office for National Statistics5 and the Vegetarian Society website.6 Although the number of people prepared to uphold their dietary principles even at great risk to their life and/or health may be small, very few prescribers pay consideration to the animal products contained in medication they prescribe. Pharmaceutical companies are beginning to pay heed to dietary choices within mainstream medicine. Some products are now being marketed by pharmaceutical representatives as vegetarian and some companies are sourcing halal gelatine. In contrast to food, which is often clearly labelled as ‘suitable for vegetarians’ excipients (nonactive substances in medication) can be difficult to identify as animal derived although it is a legal requirement for them to be listed on the packaging.7 Table 2 shows some examples of non-vegetarian excipients. Where alternatives to animal-derived ingredients are becoming increasingly available, and although the shelf life of such medications is likely to be shorter, we have already seen that a significant number of patients would choose non animal-derived medications if they are offered the choice.4 Doctors and other prescribers should be mindful of non-active ingredients in the medications they prescribe, especially when they are made aware of a patient’s ethical or moral principles. In order to identify animal ingredients in medications, doctors and patients can check product labelling and information or contact the manufacturer directly where uncertainty exists. However, manufacturers may not always be able to guarantee noncontamination during the manufacturing process or in some cases may be unable to identify the source of excipients. Prescribers have a duty to discuss medication options with patients and to respect their ethical and dietary beliefs. While we would not advise abstaining from life-sustaining treatment out of principle, by asking the right questions and putting pressure on manufacturers to provide clearer labelling of products regarding suitability for patients’ preferred dietary requirements, we can encourage a move towards ethical prescribing, fully informed choice, and improved patient compliance with medication.