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To the Editor: I applaud the critical scientific attention being given to the review of the therapeutic efficacy and safety of the saw palmetto plant extract Serenoa repens.¹ However, the article did not address the lack of quality and manufacturing standards of S repens and other phytotherapeutics. As health care professionals, we should assume a more proactive role in the review and selection of phytotherapeutics for our patients.

The current lack of universal definitions, practices, and standards within the supplement industry place the onus on the physician to judge product quality. As a practicing urologist, I consider 4 quality measures in selecting high-quality, reliable natural supplements:

1. The manufacturer tests raw ingredients for purity and potency prior to inclusion into a product.
   
2. The product is manufactured in a pharmaceutically licensed facility registered with the US Food and Drug Administration.
   
3. The product's ingredients meet the applicable United States Pharmacopoeia (USP. . . [Full Text of this Article]

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