HERBAL MEDICINE UNDER SCRUTINY

Last week, five reports were added to the body of evidence that
indicates a need for tighter regulation of the herbal-medicine
industry (N Engl J Med 1998; 339: 785-91 ; 806-11 ; 847; 847-48 ; and
827-30 ).

Robert DiPoala (Robert Wood Johnson Medical School, New Brunswick, NJ,
USA) and colleagues showed that PC-SPES, a combination of eight herbs
used as a non-oestrogenic treatment for prostate cancer, has potent
oestrogenic activity. The use of this unregulated mixture could,
DiPoala said, "produce clinically significant adverse effects".

Nancy Slifman's group (Office of Special Nutritionals, Washington, DC,
USA) reported that a woman developed digitalis toxicity after taking a
contaminated herbal remedy; Richard Ko (California Department of
Health Services, Sacramento, CA, USA) said that 83 of 260 imported
Asian medicines contained undeclared pharmaceuticals or were
contaminated with heavy metals; Frank LoVecchio (Maricopa Medical
Center Phoenix, AZ, USA) discussed a man who had central-nervous-system
depression after taking a dietary supplement sold as a growth-hormone
stimulator; and Yitzhak Beigel (Rabin Medical Center, Petach Tikva,
Israel) et al described a patient who developed lead poisoning after
taking a herbal diabetes preparation.

Mohamed Farah (WHO Drug Monitoring Centre, Uppsala, Sweden) regards
herbal preparations as a lottery. "Classification of the original
plants used is often confused . . . Even if the plant is identified
correctly, the final composition of an extract varies according to
which part of the plant is used, where it was grown, what time of year
it is." Registration of herbal remedies may be tricky but "people have
a right to know what they are taking".

Checked-by: Rich O'Grady